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08/11/2011 - hepatopulmonary syndrome, Everest and the Warburg effect

posted Sep 20, 2011, 7:58 AM by Chief Resident   [ updated Sep 20, 2011, 5:25 PM by Purnema Madahar ]
As we are approaching the middle of the month, it's time for some reflection. In order to give you all useful feedback, we are planning some reconnaissance: 

1. We will join you for work rounds as silent observers.
2. We will review some of your notes in the charts.
3. We will ask you to record your work hours for a week.

Although this might feel a little intrusive, it will hopefully allow us to give you specific tips and guidance, which should help you improve and ultimately enjoy your work more.

Please return the favor and give us feedback on how things are going, what we should be doing differently, what has been difficult or frustrating. You're always welcome in my office, so please don't be shy.

A little heads-up for those of you who are thinking about the boards: the Department is in the process of obtaining a group-license on MKSAP for the PGY3s. If you're about to purchase MKSAP yourself, hold off for now or check with me. More details to come soon.

Some of the pearls Vic Schuster taught us in Chief of Service:

1. In the hepatopulmonary syndrome, hypoxemia is caused by pre-capillary and capillary vasodilatation, which causes a V/Q mismatch due to increased blood flow exceeding the speed of diffusion of oxygen. Read more in the attached NEJM paper he sent along.

2. Well acclimatized individuals can sustain a PaO2 as low as 20 mm Hg, as demonstrated by some adventurous researchers who took their blood gas syringes up Mount Everest - read their story in the attached paper and get inspired to do research, the exciting way!

3. Why do we find high LDH in tumors? Because it features in aerobic glycolysis aka the Warburg effect, explained in the attached paper, '...converting all of the glucose to CO2 via oxidative phosphorylation in the mitochondria to maximize ATP production runs counter to the needs of a proliferating cell. Some glucose must be diverted to macromolecular precursors such as acetyl-CoA for fatty acids, glycolytic intermediates for nonessential amino acids, and ribose for nucleotides.....'