Our youngest patients' pain--from disbelief to belief?

Though human pain has existed since the dawn of time, formal medical pain relief in the form of anesthesia and analgesia has been available only since the mid-nineteenth century. Even after these measures became available, they were used very selectively for the first 100 years of their existence. The youngest patients, especially, were denied pain relief, probably because they could not complain about their pain as articulately and as effectively as adult patients could. A desperate need existed for health care professionals to recognize and appreciate the fact that their youngest patients could suffer immensely and to adequately address the issue. This article reviews the evolution of knowledge and attitudes regarding young patients' pain and addresses why and how this process occurred. The evolution of knowledge was traced by reviewing the literature found in MEDLINE, CINAHL, and LEXIS-NEXIS searches and through hand searches of articles that were frequently cited. Physiologic, pharmacologic, ethical, and psychologic aspects of young patients' pain are addressed. A unique phenomenon arose from the data reviewed. The process of belief and changes in practice were encouraged not only by advances in science, but also by consumer demand. Advances in the past decade in the management of young patients' pain were profound, but are still not complete. Understanding the evolution surrounding pain recognition in young patients provides a stepping stone that can facilitate further improvements in the management of pain in young patients.     

Cerebrovascular and metabolic perturbations in delayed heavy charged particle radiation injury

Focal heavy charged particle irradiation of the rabbit brain created defined lesions which were observable by nuclear magnetic resonance (NMR) and positron emission tomography (PET) imaging techniques. The lesions appeared approximately 9-11 months after left partial hemibrain irradiation with 30 Gy (230 MeV/u helium ions), and were restricted to the white matter tracts and deep perithalamic and thalamic regions. 82Rubidium PET and Gadolinium DTPA enhanced NMR imaging were used to detect blood-brain barrier perturbations. 18Fluordeoxyglucose PET studies demonstrated widespread decreases in cerebral glucose uptake in the cortex and thalamus of the irradiated hemisphere. NMR and PET imaging results correlated well with histological findings. Rabbits irradiated with 15 Gy did not demonstrate any abnormalities in the brain with sequential NMR scans through 14 months post-irradiation.     

Familial long thoracic nerve palsy: a manifestation of brachial plexus neuropathy

Long thoracic nerve palsy causes weakness of the serratus anterior muscle and winging of the scapula. It is usually traumatic in origin. Isolated long thoracic nerve palsy has not been recognized as the major manifestation of familial brachial plexus neuropathy, but I have studied the syndrome in four members of three generations of one family. One individual suffered an episode of facial paresis. The inheritance pattern was autosomal dominant.     

The development of a research human milk bank.

Although there are well-established clinical human milk banks in the United States, there are no milk banks specifically intended to foster research on human milk. The authors' goal was to establish a milk bank with a core data set to support exploratory and hypothesis-driven studies on human milk. Donations to the Cincinnati Children's Research Human Milk Bank are accepted within the context of ongoing, hypothesis-driven research or on an ad hoc basis. Donors must give informed consent, and scientists wishing to use the samples must have Institutional review board approval for their use. Development of more research human milk banks can potentially provide resources for multidisciplinary collaboration and advance the study of human milk and lactation.     

What do you do for a living? Toward a more succinct definition of health services research

This commentary discusses the need for, and the advantages of, a more concise, revised definition of the field of health services research. It argues for a definition that includes not only the topics on which health services research focuses but also the goals of health services research. A number of condensed definitions are provided for consideration.     

Uveal melanoma radiation. 125I brachytherapy versus helium ion irradiation

The optimum radiation therapy for uveal melanoma is uncertain. Both helium ion irradiation and 125I brachytherapy have been used to treat this neoplasm. This investigation analyzed the control and complication rates of uveal melanomas treated with helium ions of 125I plaques. In both a retrospective and a prospective dynamically balanced study, the control rates appeared to be similar. There were more posterior segment complications after 125I plaques and more anterior segment complications, including neovascular glaucoma, after helium ion irradiation. The follow-up period is too short to draw definitive conclusions on the radiation complications. Overall, approximately 89% of eyes were retained and less than 4% of treated eyes were removed because of failure to control the tumor.