局部封闭治疗瘢痕疙瘩38例疗效观察

瘢痕疙瘩，是皮肤科常见的良性肿瘤之一，一般分为表浅性瘢痕、增殖性瘢痕、萎缩性瘢痕。瘢痕疙瘩不但防碍美观，而且伴有疼痛，特别是萎缩性瘢痕具有很大收缩性，可牵拉临近组织、器官，而造成严重的局部活动功能障碍甚至畸形。目前治疗方法较多，本院于2003年4月至2006年4月用得宝松局部封闭治疗38例瘢痕疙瘩，取得较好疗效，现报道如下。     

瘢痕的药物治疗进展

伴随创伤修复而产生的增生性瘢痕和瘢痕疙瘩，一直是临床治疗的棘手问题。近年来用于瘢痕治疗的药物和治疗方法主要有传统中药、肾上腺皮质激素、抗肿瘤药物、钙离子通道阻滞药、前列腺素E2、糜蛋白酶、玻璃酸、聚硅酮、细胞因子和基因疗法等。创伤的修复是一个极其复杂的生物学过程，影响瘢痕产生、发展的因素很多，且瘢痕的形成机制尚未完全清楚，对治疗瘢痕药物的研究主要集中在生化和细胞水平，对分子机制和基因水平的研究还不够深入。     

胸部瘢痕疙瘩综合治疗的临床体会

目的：探讨胸部瘢痕疙瘩治疗的有效方法。方法：对本院27例，共30处胸部瘢痕疙瘩采用手术切除，术后结合X线放疗，疤痕贴、美宝疤痕平软膏、药物注射等综合治疗方法。结果：创面一期愈合19例，共22处，随访6个月～2年，仅4例共5处复发。结论：胸部瘢痕疙瘩的综合治疗是有效方法。     

干扰素和康宁克通组合治疗瘢痕疙瘩120例

瘢痕疙瘩是整形外科的棘手问题,特别是对瘢痕体质的患者和某些张力较大的功能部位生有瘢痕疙瘩的患者,若采用手术治疗,则瘢痕常有复发。山东省威海市文登中心医院自2010年以来采用干扰素和康宁克通组合治疗瘢痕疙瘩120例共188个瘢痕疙瘩,现将临床资料和方法介绍如下。     

手术切除加曲安奈德局部封闭治疗瘢痕疙瘩

瘢痕疙瘩是皮肤上的一种纤维组织肿瘤，临床治疗方法较多，但复发率较高。2003年5月至2005年7月采用手术切除加曲安奈德局部封闭治疗瘢痕疙瘩19例，取得较好疗效，现报告如下。     

瘢痕疙瘩治疗的临床探讨

目的对瘢痕疙瘩的治疗进行临床探讨。方法采用联合疗法治疗瘢痕疙瘩。结果患者通过联合疗法治疗瘢痕疙瘩较单一治疗临床疗效好，治愈率提高，复发率有所降低。结论目前联合疗法是最有效和最安全的治疗瘢痕疙瘩的方法。     

巨大型瘢痕疙瘩治疗1例报告与文献复习

目的探讨罕见、巨大型瘢痕疙瘩非外科手术治疗方法。方法典型病例治疗分析及文献复习。结果4年半随访,瘢痕组织变平,痛痒消退。结论非外科手术治疗罕见、巨大型瘢痕疙瘩有明显效果。     

瘢痕疙瘩的治疗进展

瘢痕疙瘩虽然历史久远，但在治疗方面仍然是整形外科的难题之一。由于难以控制其复发，到目前为止国内外还没有一种非常满意的治疗方法。瘢痕疙瘩是人类所特有的，加之目前尚不能制作满意的生物模型，使其实验研究工作进展缓慢。就目前所知理论，有效的治疗方法是去除病变，并通过抑制成纤维细胞的增殖及其胶原的合成、分泌或沉积来预防其复发。其治疗方法有手术、药物注射、放射治疗、激光、硅凝胶、加压及冷冻等多种，单一的治疗方法疗效均不理想，目前较统一的主张是多种方法联合应用，进行综合治疗才能取得较好的疗效。现就近年来有关瘢痕疙瘩治疗的研究进展综述如下。     

瘢痕疙瘩的临床治疗研究进展

瘢痕疙瘩（keloid）是皮肤损伤愈合过程中,胶原合成代谢功能失去正常的约束控制,持续处于亢进状态,以致胶原纤维过度增生的结果,它表现为隆出正常皮肤,形状不一,色红质硬的良性肿块。本文意在总结瘢痕疙瘩的临床治疗方法,探讨瘢痕疙瘩的研究进展。     

瘢痕疙瘩的综合治疗研究

目的探讨瘢痕疙瘩的综合治疗方法和临床效果评价。方法自2002年3月至2007年9月对82例98处瘢痕疙瘩采用综合方法进行治疗,手术切除＋电子射线放射治疗60例72处瘢痕,注射曲安奈得注射液＋局部贴敷硅凝胶膜治疗22例26处瘢痕,根据刘文阁法判断临床疗效,进行效果评价。结果手术切除＋电子射线放射治疗60例72处瘢痕治愈69处,无效3处,注射曲安奈得注射液＋局部贴敷硅凝胶膜治疗22例26处瘢痕治愈16处,无效10处。结论瘢痕疙瘩需采取综合治疗,尤以手术切除＋电子射线放射治疗为最佳选择。     

Retention in Treatment—Indicator or Illusion: An Essay

This article poses questions about the meaning of retention in substance user treatment. Retention has become a “gold standard” for substance user-treatment programs, suggesting it has become more than an indicator of positive outcomes, but a positive treatment outcome in its own right. Retention has been studied in numerous ways and has been associated with positive treatment outcomes, but questions remain about whether it has assumed greater importance than it merits. For example, it may be an artifact of other client personality characteristics that are also associated with more positive outcomes. Conversely, it may be a function of the interaction of treatment environment and client. This article suggests a need to broaden the scope of treatment-retention studies and to compare retention rates across other medical treatment environments to see if failure to complete treatment is a function of substance user treatment or of all treatment processes as well as other types of planned change processes.     

Measuring Practitioner Attitudes Toward Evidence-Based Treatments: A Validation Study

A better understanding of clinicians’ attitudes toward evidence-based treatments (EBT) will presumably enhance the transfer of EBTs for substance-abusing adolescents from research to clinical application. The reliability and validity of two measures of therapist attitudes toward EBT were examined: the Evidence-Based Practice Attitude Scale (Aarons, 2004 Aarons , G. A. ( 2004 ). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research , 6 , 61 – 74 .[PubMed] , [Google Scholar]), and Attitudes Toward Psychotherapy Treatment Manuals Scale (Addis & Krasnow, 2000 Addis , M. E. , & Krasnow , A. D. ( 2000 ). A national survey of practicing psychologists’ attitudes toward psychotherapy treatment manuals. Journal of Consulting and Clinical Psychology , 68 , 331 – 339 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Participants included 543 public sector, master's-level mental health and substance abuse therapists who treat adolescents. Factor analyses generally corroborated factor structures of the instruments found previously. Beliefs that EBTs negatively affect treatment process were associated with relatively low openness to new treatments and with beliefs that EBTs do not produce positive outcomes.     

痤疮的药物治疗评价

目的：对目前主要的治疗痤疮药物进行总结评价，为临床合理使用抗痤疮制剂提供参考依据。方法：检索、统计近年来国、内外相关文献。结果及结论：痤疮是一种慢性炎症性疾患，发病人数多，用药时间长，且常持续数年、迁延不愈对患者造成一定的心理负担。治疗中应根据痤疮的严重度分级合理选择药物，不主张单独应用外用抗生素以减少抗生素耐药的产生，推荐联合用药治疗痤疮。     

Examining Treatment Climate Across Prison-Based Substance Abuse Treatment Groups

Background: With notable exceptions, few studies have looked critically at the role and effects of factors other than individual or programmatic differences that contribute to the climate within substance abuse treatment programs. De Leon's work on the therapeutic community, however, indicates that factors beyond the individual and program can contribute to the overall functioning of similarly situated communities. Objectives: In this study, we introduce and examine the concept of the “treatment group,” the level of aggregation between the individual who participates in treatment and the organization that provides it. The treatment group refers to the social context and dynamics that operate among treatment participants, and we sought to study differences in treatment climate across 12 prison-based treatment groups within a single prison. Methods: Using data from 604 participants who were assigned at random to one of the 12 groups, we analyzed differences on seven treatment climate indicators from one month and six months into the program across the treatment groups. Results: No differences were found among the treatment groups at after one month; however, after 6 months, significant differences emerged across the groups on three treatment climate variables: program structure, counselor rapport, and counselor competence. Conclusions/Importance: This study is among the first of its kind to conceptualize and examine treatment climate across otherwise similar groups and find that differences emerge on several indicators of climate. As such, we argue that the treatment group may be important to consider in both the delivery and evaluation of substance abuse treatment.     

Financing strategies for drug abuse treatment programs

Contemporary drug abuse treatment programs exist in an extremely complex financing environment. Programs face a myriad of funding sources with different eligibility requirements and payment mechanisms that make it difficult for programs to develop a single financing strategy. To complicate the financing process, current funding sources are in a state of flux as managed care gains significance in health care reimbursement. This article will assist drug abuse treatment programs in several ways. First, it summarizes information about funding, eligibility requirements and payment mechanisms. Second, the information is geared toward drug treatment programs and less toward policymakers. Third, the article describes strategies for obtaining funding, including strategies for interacting with managed care. By using these methods for obtaining revenues, it is hoped the drug treatment programs will be able to increase their financing effectiveness.     

产后出血药物及手术治疗进展

产后出血在我国是目前产科最严重的并发症及孕产妇死亡的主要原因之一,其严重时直接危及产妇的生命。积极预防和控制产后出血是降低孕产妇死亡率的关键。目前临床治疗产后出血的药物及其他非药物方法 较多,其中药物治疗近年来得到很大进展,其中缩宫素、麦角新碱、前列腺素类药物是治疗产后出血的一线药物,另外一些辅助处理方法 也得到广泛应用,主要包括官腔填塞、官腔球囊压迫、血管结扎、介入治疗及子宫切除等,本文就产后出血的临床处理方法 进行综述。     

What has psychology ever done for British alcohol studies?

Abstract

Over the past forty years there have been significant changes in our ways of conceptualising and responding to people with alcohol problems. This paper provides a personal perspective upon what those changes have been and upon the role of psychologists in generating them. Further, it highlights the significant role played by a small multidisciplinary forum, The New Directions in the Study of Alcohol Group, in supporting workers move towards those changes particularly in the United Kingdom.     

贵州美沙酮维持治疗受治者间隔服药特点的观察

目的:了解贵州省8家美沙酮维持治疗(MMT)门诊的受治者间隔服药特点。方法:采用队列研究设计,从2006年6月到2007年6月,对1003名贵州省8家MMT门诊受治者进行服药情况调查。结果:有87.1%、74.9%、60.6%和50.3%受治者分别有过连续3d、7d、15d和30d间隔不到门诊服药情况。结论:MMT受治者间隔服药现象十分普遍。     

不稳定型心绞痛介入治疗疗效观察

目的比较经皮冠脉介入治疗(Percutaneouscoronaryintervention,PCI)和药物治疗不稳定型心绞痛(Unstableanginapectoris,UAP)的近期临床疗效。方法112例不稳定型心绞痛病人分两组,57例行PCI,55例给予阿司匹林、低分子肝素、硝酸酯类及β受体阻滞剂等治疗。分别观察两组病人临床症状和心电图变化以及6个月主要心血管事件的发生率。结果PCI组总有效率及显效率均显著高于药物治疗组(P<0.05),尤其是中高危病人,其主要心血管事件的发生率低于药物治疗组(P<0.01)。结论不稳定型心绞痛特别是中高危病人介入治疗优于药物治疗。     

Continuous morphine produces more tolerance than intermittent or acute treatment

Dosing protocol and analgesic efficacy have been proposed to be important determinants of the magnitude of opioid tolerance. The present study examined the effect of acute, intermittent and continuous treatment with the low analgesic efficacy agonist morphine on analgesic tolerance. Mice were implanted s.c. with a 25 mg morphine pellet for 1-7 days. Other mice were implanted s.c. with two 25 mg, or one 75 mg morphine pellet for 7 days. The release of morphine from subcutaneous implanted pellets was quantitated using a spectrophotometric assay. In other studies, mice were injected with morphine once (18.5-185 mg/kg/day; ≈ 10-100 times ED₅₀ for morphine analgesia) or once/day for 7 days. Controls were implanted with a placebo pellet or injected with saline. Analysis of drug release from a 25 mg pellet indicated that release was greatest during the first 24 h, declined and then remained relatively constant. The amount of morphine released over 7 days by a 75 mg pellet (23.9 mg) was more than that of a single 25 mg pellet (15.4 mg) but less than two 25 mg pellets (30.8 mg). Following treatment, morphine cumulative dose-response studies were conducted (tailflick). Continuous treatment with morphine using pellet implantation produced a dose-dependent shift in the morphine ED₅₀ by 3.3, 5.8 and 8.5 fold for one 25 mg pellet, one 75 mg pellet and two 25 mg pellets, respectively. Acute and intermittent morphine administration produced substantially less analgesic tolerance than continuous release of morphine by implant pellets. The maximum shift in the ED₅₀ was 1.6 for acute treatment and 2.7 for 7 day intermittent treatment; despite a larger total daily dose. The present results indicate that continuous treatment with morphine results in greater analgesic tolerance than acute or intermittent morphine treatment even at comparable daily doses. These results are consistent with the suggestion that intermittent dosing has reduced risk of producing opioid tolerance.