Irwin K. Rosenberg

Renal vasoconstriction in association with acute pancreatitis

Abstract Renal failure is a common complication of pancreatitis. To better understand this association, renal function was evaluated in eleven patients in the acute phase of alcoholic pancreatitis and again during convalescence in seven patients. Parameters measured included glomerular filtration rate, effective renal plasma flow, true renal plasma flow, renal vascular resistance, osmolar clearance, amylase clearance, renal oxygen consumption, cardiac output, and peripheral resistance. Average glomerular filtration rate, effective renal plasma flow, and true renal plasma flow were decreased in the acute phase. Osmolar clearance, amylase clearance, mean arterial blood pressure, renal vascular resistance, and total peripheral resistance rose in the acute phase. Cardiac index and extracellular fluid space remained normal. All parameters returned toward normal with convalescence. The combination of systemic hypertension, increased total peripheral resistance and renal vascular resistance, and normal extracellular fluid space suggests a release of a vasopressor during the acute phase of pancreatitis. The therapeutic implications of these findings including the role of vasodilator infusion are discussed.

Effects of traumatic hypovolemic shock on renal function

Abstract Renal and systemic hemodynamic evaluations were made in 16 patients within 12- to 72-hr after injury in an effort to determine the effects of severe traumatic hypovolemic shock on renal function. Eleven patients were again studied in the convalescent period. All patients had stable vital signs at time of renal evaluation and no patient received vasopressors or diuretics within 24 hr of study. The early postresuscitative period was associated with a significant reduction in effective renal plasma flow, true renal plasma flow, true renal blood flow, renal oxygen consumption, and the percentage of renal blood flow compared to the total cardiac output; renal vascular resistance, osmolar clearance, and sodium clearance were increased at this time. The glomerular filtration rate, extracellular fluid space, cardiac output, and total peripheral resistance remained normal. All abnormal renal parameters returned to normal with convalescence except in those patients who developed nonoliguric renal failure which was associated with a persistant decrease in glomerular filtration rate and effective renal plasma flow during convalescence. The clinical significance of these findings including the roles of loop diuretics and vasodilators are discussed.

Defining a core curriculum in surgery

One of the greatest challenges to teaching arises from the current rapid expansion of knowledge. From the minutest portion of the atom to the farthest reaches of the universe, man is today discovering, classifying, and recording new information at a phenomenal rate -essentially doubling our fund of knowledge every ten years. At this rate, there could conceivably be 1,OOO times as much to know by the turn of the century, even as there is now estimated to be I 0 0 times as much to know today as there was in 1900 (Byown, Lewis, and Harcleroad, 1969, p. 15).

Surgery: An integral part of core curriculum☆☆☆

Abstract The surgical clerkship is under attack from several quarters and has been reduced or eliminated in many schools. Exposure to the diagnosis and management of routine surgical disease is thus impaired, and training in the care of acutely ill or traumatized patients is virtually eliminated. A well-balanced “core” curriculum demands such exposure, and these objectives are being fulfilled by a structured 11-week surgical rotation at Wayne State University. Instruction in elective surgery assumes three forms: (1) morning tutorials, where each of five groups of seven junior clerks meets daily with a staff member for a 1-hour, predefined, case-oriented tutorial; (2) ward rounds, where each division meets with its staff member two times weekly for a student-oriented round based on student presentation of an interesting case; and (3) specialty sessions, where all students meet weekly with the surgical specialties for an introduction to basic concepts and clinical management. Instruction in care of the acutely ill is provided in a 3 1 2 -week rotation on the Emergency Service at Detroit General Hospital. The students participate in (a) patient management problems twice weekly, directed toward emergency situations; (b) night duty every third night, on a 1:1 basis with a surgical resident, resuscitating injured patients; (c) daily tutorials designed to cover various specialty-oriented emergencies; and (d) instruction in orthopedic and neurosurgical emergencies. Student critiques provide guidance on deficiences in logistic support. Cognitive behavioral objectives are evaluated by multiple-choice, multidiscipline midterm and final examinations; behavioral objectives in the affective domain are evaluated by detailed rating scales of eight traits considered important in a physician. Ceaseless curriculum revision is invaluable in establishing an organized surgical course which provides a broad exposure to all areas of surgical management. Our aim is to produce a curriculum under constant revision of objectives and methods based upon evaluation of student performance. Such a dynamic curriculum is requisite to medical school education and must not be allowed to vanish from the scene.