Reduction of pain response in premature infants using intraoral sucrose.

The potential of sucrose to reduce the pain response in a group of healthy premature infants was investigated. Fifteen infants of 32-34 weeks postmenstrual age were tested in a blind crossover manner on two separate occasions no more than two days apart. Either 1 ml of 25% sucrose solution or sterile water was syringed into the baby's mouth 2 minutes before routine heel lancing. Response to the painful stimuli was measured by duration of cry and by facial expression (pain score). There was a significant reduction in the duration of first cry, the percentage of time spent crying in the 5 minutes after heel prick, and the pain score in the sucrose treated group. It is concluded that sucrose has analgesic effects in healthy premature infants.

Effect of non-sucrose sweet tasting solution on neonatal heel prick responses.

A substance commercially described as 'sugar free,' used as a sweetener for paracetamol suspension, was evaluated on measures of neonatal pain. Sixty infants were randomly allocated to receive one of four solutions before heel stab blood sampling: sterile water (placebo); 25 or 50% sucrose (weight/volume); and the commercial sweet-tasting solution. There was a significant reduction in crying time and pain score 3 minutes after the painful stimulus in all groups compared with the controls. It is concluded that this sweet-tasting solution has analgesic effects as potent as those of concentrated sucrose solutions.

Noninvasive cardiac output monitoring during exercise before and after coronary artery bypass surgery.

A computerized continuous wave Doppler instrument was used to monitor changes in cardiac output and stroke volume during supine symptom limited graded bicycle exercise in 30 subjects. Eight patients were studied before and after coronary artery bypass graft (CABG) and were found to have patent grafts (group 1). Six patients were symptomatic after CABG and had at least one graft occluded (group 2). Sixteen age matched asymptomatic subjects served as controls (group 3). In group 1 patients before CABG, the duration of exercise was 5 +/- 2 mins (mean +/- standard deviation), the double product was 162 +/- 25, the percentage change in cardiac output with exercise was 33 +/- 7 and the percentage change in stroke volume was 1 +/- 5. Following CABG in group 1 patients, the duration of exercise increased to 9 +/- 2 mins, the double product to 186 +/- 16, the percentage change in cardiac output to 74 +/- 14 and the stroke volume to 13 +/- 12% (P less than 0.05). These results were not significantly different from those obtained in the group 3 patients (controls) in whom the duration of exercise was 10 +/- 3 mins, double product 211 +/- 24, percentage change in cardiac output 95 +/- 30 and the percentage change in stroke volume was 13 +/- 5.(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary steroids in the measurement of aging and of atherosclerosis.

Several studies conducted by the authors' group have shown that urinary steroid measurements are a valuable aid in differentiating the normal aging process, the pronounced aging associated with increased risk to coronary heart disease, and the deviations associated with myocardial infarction. Data are presented on 428 men in the age range of 30-70 years. The study design most effective in elucidating aging and disease patterns involves selection of subjects from a wide age range. Data on persons identified as clinically normal can be used to describe physiologic aging. Once this is determined, data on persons with disease can be used to identify abnormalities of aging associated with the clinical conditions studied. This approach offers a potential method for differentiating between aging effects and disease effects. The foregoing findings led to the development of an Index of Aging in males, based on combined serum lipid and urinary steroid values. This Index may be a means of differentiating between normal aging and the deviations seen in atherosclerosis and myocardial infarction. Current studies are directed toward extending these observations.

Relevance today and tomorrow in medical education. A forum with a purpose.

Students of today question the relevance of much of their formal education. In medical schools the concern is particularly with the relevance of the educational experience to the professional commitment in modern society. To engender discussion of the subject, California Medicine in its January issue printed eight essays by authors known to have keen interest in the subject. Readers in California and elsewhere are invited to take part in a continuation of the forum in succeeding issues. The following are contributions selected from those received to date. Others will be published in the months ahead. At an appropriate time the material will be collated and, if feasible, the distillate will be prepared in the form of a statement. If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California, 94102. Keep your essays short, please.

Rheumatic fever; summary of a rheumatic fever workshop on various aspects of the disease.

While rheumatic fever is becoming an uncommon disease in all parts of the United States, it still exists in all areas including Southern California. The disease is sufficiently common in Los Angeles County to warrant organized programs of control aimed particularly at careful follow-up, accurate case reporting, secondary prophylaxis and primary prevention.In April of 1965 a Rheumatic Fever Workshop, in which local, national and state experts in rheumatic fever participated, reviewed the status of the rheumatic fever programs in Los Angeles County. Guidelines for future organization for the control of rheumatic fever were developed and presented.