Renal and hemodynamic effects of diltiazem after elective major vascular surgery--a potential renoprotective agent?

A postoperative study was done of the effects of an infusion of diltiazem (DTZ), 1 microgram.kg-1.min-1 after a bolus dose of 0.28 mg.kg-1 on renal function and hemodynamics in 10 patients who were operated with insertion of an abdominal aortic graft. Urine flow, glomerular filtration rate (GFR) by inulin clearance, and renal plasma flow (RPF) by PAH clearance and fractional excretion of electrolytes and osmols were measured for three periods of 20 min during infusion of DTZ, in the morning after surgery. Systemic hemodynamic studies were conducted and serum levels of catecholamines were measured. GFR increased during the initial period of DTZ infusion. There were no significant changes during the study period in any of the other parameters, compared to baseline, except for a decrease in heart rate from 84 to 77 beats per minute. The absence of a sustained increase in GFR and a natriuretic and diuretic effect may possibly be ascribed to a preexisting nonconstricted status of the renal vasculature. The authors conclude that the dose of DTZ used in this study can be safely used for further investigations to elucidate the effects of peroperative infusion of DTZ on renal function in connection with major vascular surgery.

Saponin-induced release of cell-surface-anchored Thy-1 by serum glycosylphosphatidylinositol-specific phospholipase D.

A glycosylphosphatidylinositol-specific phospholipase D (GPI-PLD) was purified from human serum and used for studies on the release of GPI-anchored Thy-1 glycoprotein from mouse T lymphoma cells Y191. Previous studies have shown that whereas GPI-PLD is highly active against detergent-solubilized GPI-anchored proteins, it is normally unable to release GPI-containing proteins anchored in a lipid bilayer. Confirming these findings, the addition of GPI-PLD to intact Y191 cells did not result in cleavage of Thy-1. However, pretreatment of cells with saponin, a cholesterol-sequestering agent, rendered Thy-1 susceptible to hydrolysis. Very little solubilization of GPI-containing Thy-1 occurred under these conditions. From experiments with reconstituted liposomes it was inferred that the effect of saponin on cells was to aid in the presentation of Thy-1 to GPI-PLD. Furthermore, it was concluded that cholesterol-saponin complexes formed in the membrane were not alone responsible for the effect. Rather, additional molecules in the plasma membrane are possibly involved in the presentation of Thy-1 on saponin-treated cells. This finding may have implications for a physiological role of circulating GPI-PLD in the regulation of GPI-anchored proteins on cells.

Calcitonin gene-related peptide attenuates experimental ischemic renal failure in a rat model of reversible renal ischemic insult.

Calcitonin gene-related peptide (CGRP) has been shown to decrease vascular resistance and increase renal blood flow. To study the effects of CGRP in acute renal failure (ARF) of moderate degree, we used a rat model of bilateral temporary renal artery occlusion (RAO) inducing ARF with spontaneous recovery within 1 week, resembling a clinical situation. Three groups were studied: CGRP 10 (CGRP10) and 25 (CGRP25) pmol.kg-1.min-1 and vehicle alone (control), respectively, infused from 10 min before until 2 h after declamping. Serum urea levels reached a peak after 24 h at 13.0 +/- 1.3, 8.1 +/- 1.1, and 8.5 +/- 1.0 mmol.L-1 in the control, CGRP10, and CGRP25 group, respectively. They were significantly lower postischemia in the two CGRP-treated groups than in the control group. Mean arterial pressure (MAP) decreased to 90%, 80%, and 60% of baseline MAP in the control, CGRP10, and CGRP25 group, respectively. Histologically there was no significant difference between the three groups. Our data indicate that CGRP preserves renal function in experimental ARF despite reductions in MAP. We conclude that further investigations of the renal effects of CGRP are needed in order to clarify whether CGRP might be used clinically to maintain or improve renal function in ARF.

Support services for pediatric trainees. A survey of training program directors.

We conducted a survey of pediatric training program directors (75% response rate) regarding program support services for house staff, directors' attitudes about stress in training, and program plans to ameliorate such stress. Support services included explicit measures to alleviate stress, policies that may minimize stress, evaluation of house staff performance, feedback regarding career concerns, and benefits (eg, medical insurance and child care). Most programs offered services to reduce stress from training, but few offered preventive services. Support policies were reported to be inadequate, especially in the areas of coverage for leaves of absence. Maternity leave represented most leaves of absences, as 10% of the female house staff and 11% of the male house staff members became parents. Program directors' terms were short, and only 30% perceived these roles to be their primary roles. Male directors believed that female house officers had a harder time adjusting to their programs. We suggest changes and present a simple way for program directors to evaluate their support services.

Child psychiatrists' characteristics, communication, and competence as described by pediatricians in a national survey.

A nationwide survey of pediatricians was undertaken to evaluate pediatricians' attitudes and utilization patterns regarding child psychiatrists. The response of 1,089 pediatricians (69% of those surveyed) to open-ended questions in the survey are described. A wide variety of strongly-held beliefs concerning child psychiatrists' usefulness as collaborators and consultants in training and in clinical practice are identified. The implications of these findings for both medical specialties are discussed.

Pediatricians and mental health professionals. Patterns of collaboration and utilization.

We surveyed 1,089 fellows of the American Academy of Pediatrics regarding (1) their experiences with child psychiatrists during training, (2) their current utilization preferences and practice with psychiatrists and other mental health professionals, and (3) differences in responses between pediatricians who completed ambulatory pediatric and related training and other pediatricians with respect to the aforementioned questions. Of those pediatricians who had contact with psychiatrists during training, more than 68% remembered the psychiatrist as being helpful. There was a strong preference on the part of all respondents for referral to a "behaviorally oriented pediatrician" for selected psychosocial problems. The pediatricians trained in ambulatory pediatrics believed they were more competent to treat the psychosocial problems of their patients than did other pediatricians and indicated more collaborative activities with psychiatrists than did other pediatricians.

Clinical social work in a medical setting.

This paper, using case vignette and discussion, will elaborate on two specific functions of the clinical social worker practicing in a medical setting. The first, helping patient, family and staff to acknowledge the psychological impact of physical illness; the second is helping a family to accept that there may be no organic etiology for a symptom, and that the symptom may be psychogenic in origin. Barriers to performing these functions are discussed as well as reasons why the social worker is in an ideal position to integrate medical and psychological information into a coherent and practical treatment plan.

[Experimental study on the effect of 11-deoxyprostaglandin E1 on hormonal balance in animals]. / Eksperimental'noe issledovanie vliianiia 11-dezoksiprostaglandina El na gormonal'nyi balans zhivotnykh.

The effects of prostaglandin F2 alpha and (+/-) 11-deoxyprostaglandin E1 (DPGE) on the levels of progesterone and estradiol in the blood plasma or serum of experimental animals were studied and compared. It was found for the first time that the synthetic analog of natural PGE1, DPGE, is capable to substantially reduce the progesterone level in the blood (rats and cows) and to induce the luteolysis of yellow bodies in the cow ovaries. It was demonstrated that DPGE promotes the resolution of both cyclic and persistent yellow bodies. The pattern of the drug action on rat blood steroid hormones depends on the time of pregnancy and is most pronounced in the last trimester of pregnancy.

Consultation-liaison training for child psychiatrists: results of a survey.

As a first step toward improving the quality of training for child psychiatrists in the increasingly important area of consultation-liaison work, a survey of current educational experiences in child psychiatry programs was carried out. Sixty-four programs (61% of those sampled) responded to a questionnaire and request for information. The consultation-liaison field remains minimally emphasized, as three-fourths of the programs devote less than 11% of the fellowship training time experiences to this area. Variations in the rotations are summarized, and five reasons for the low priority of consultation-liaison training are proposed.

Psychiatric and social work collaboration in pediatric chronic illness hospital.

Recently pediatric literature has noted that pediatric facilities often function as mental health facilities for their patients. There is little acknowledgment of the role of the pediatric social worker in such care. This paper reviews one year of child psychiatry consultations in a pediatric chronic illness hospital, with particular attention paid to quality of social work, pediatric and psychiatric collaboration. In the study year, 72 psychiatric consultations were requested for medical patients, the majority of which were requested by the social worker assigned to the medical service. Organizational and theoretical issues of the psychiatric consultation-liaison and social work service are discussed as well as disposition of consultations. From the data presented, close collaboration between pediatricians, social workers and child psychiatrists can be efficient, effective and offer a high level of continuity for mental health care of children with chronic illness.

Marital stress and medical training: an experience with a support group for medical house staff wives.

This paper reports on a support group for medical house staff wives. This informal group revealed prevailing feelings of depression, anger, frustation, and impotence in coping with their spouses' training period. All participants agreed that the group had been a positive experience, allowing them to express anger in a safe place, and not to their husbands. They also stated that the group validated the fact that their concerns were in fact real and shared by many women. Although it is unclear what the responsibility of a training program is to wives of physicians in training; this group demonstrated that not only were physicians stressed, but their wives were as well. Further study of the impact of the training experience on both physician and spouse would be helpful in determining appropriate methods of intervention to reduce feelings of stress and depression for both physician and spouse during the training period.