We evaluated the impact of a 15-hospital, rural, multi-state intensive care unit (ICU) telemedicine program. Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) scores, raw mortality rates, and actual-to-predicted length of stay (LOS) ratios and mortality ratios were used. Surveys evaluated program impact in smaller facilities and satisfaction of the physicians staffing the remote center. Smaller facilities' staff reported improvements in the quality of critical care services and reduced transfers. In regional hospitals, acuity scores increased (retention of sicker patients) while raw mortality was the same or lower. Length of stay ratios were reduced in these hospitals. In the tertiary hospital, actual-to-predicted ICU and hospital mortality and LOS ratios decreased.

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(1) Early food restriction provided the greatest metabolic and renal benefits; (2) glomerular injury correlated with hyperphagia-induced hyperfiltration and hypertriglyceridemia and both were prevented by food restriction; (3) hypercholesterolemia was due to an increase in LDL and/or VLDL cholesterol; and (4) leptin does not directly contribute to glomerular injury in the obese Zucker rat.

SUMMARY Accumulating evidence suggests that hypertension hi blacks is manifested hi part by impaired renal excretion of salt. Consequently, this study was performed to determine if hypertensive and normotensive black subjects differ hi their ability to generate known natriuretic substances. Fourteen normotensive and 11 hypertensive blacks were maintained on constant metabolic diets containing either 40 or 180 mmol of salt per day for 14 days each. During the last 4 days of each salt intake period, urine was collected for measurement of sodium, dopamine, and norepinephrine. On the last day of each 14-day dietary period, blood pressures were measured, blood was collected for measurement of plasma atrial natriuretic factor (ANF) and aldosterone, and urine was collected over 2 hours for measurement of prostaglandin E 2 (PGE 2 ). Both the normotensive and the hypertensive groups manifested salt sensitivity; then-mean arterial pressure rose by 7 ± 0.2 and 6 ± 0.2%, respectively, when salt intake was increased from 40 to 180 mmoJ/day. The hypertensive group exhibited decreased (p < 0.05) dopamme excretion as compared with the normotensive group for both dietary salt intakes. Plasma ANF levels increased (p < 0.05) in the hypertensive group, but not in the normotensive group, with increasing dietary salt. Plasma aldosterone and urinary norepinephrine and PGE 2 were comparable in the two groups for both dietary salt Intakes. These data suggest that salt sensitivity is not unique to hypertensive blacks but occurs hi normotensive blacks as well. Decreased renal production of dopamme may be a pathogenic factor hi the development and maintenance of hypertension in blacks. compared with hypertension in whites, is characterized by a higher incidence of salt sensitivity '-4 in spite of the apparent lack of differences in sodium and salt intakes between the two populations. 5 The mechanisms involved in the relatively high incidence of salt-sensitive hypertension in blacks are poorly understood. However, an impaired natriuretic response to a salt load in hypertensive blacks could result from a reduced ability to generate natriuretic substances such as dopamine (DA), prostaglandin E? (PGE2), and atrial natriuretic factor (ANF).There is a considerable body of evidence suggesting a relationship between renal production of DA and the ability of the kidney to excrete a salt load. 6 -21 Enhanced dietary salt intake or infusion of saline results in an increase in urinary DA excretion and a decrease in norepinephrine excretion. 13 -22 That the dietary salt or saline-mediated natriuresis is causally linked to renal DA excretion is supported by the observation that administration of carbidopa, the peripheral inhibitor of the enzyme dopa decarboxylase, prevents the increases in urinary sodium in response to dietary salt 23 and saline infusion. 14 -15 However, there is evidence that salt loading does not appropriately increase urinary DA excretion in hypertensive patients, 24 -M suggesting that decreased renal DA production in response to...