Attachment Therapy Using Deliberate Restraint: An Object Lesson on the Identification of Unvalidated Treatments

TOPIC: An unusual and potentially dangerous intervention called attachment therapy, used for children and adolescence. PURPOSE: To help clinicians understand the nature of attachment therapy and the ways in which it exemplifies unvalidated treatment approaches. SOURCES: Internet and published articles on evaluation of treatments. CONCLUSIONS: Attachment therapy has many characteristics associated with warning signals of an unvalidated treatment. Mental health professionals have responsibilities to educate individuals and the community about unvalidated treatments such as attachment therapy and to work toward legislation and policy change to make such treatments unavailable.     

Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study.

BACKGROUND: This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients. METHODS: Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index-Drug Use Composite score and the number of days of cocaine use in the past month. RESULTS: Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index-Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed. CONCLUSION: Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence.     

Androgen receptors in breast cancer

Androgen receptor assays have been performed on 1371 specimens of histologically confirmed primary and recurrent breast cancer. Forty-two patients who had received tamoxifen as treatment for advanced disease were assessed for objective response. Another 42 patients who had received chemotherapy were similarly studied. Patients with androgen receptor-negative tumors had a significantly poorer response rate to hormone therapy than those with receptor-positive tumors (P less than 0.05). This clinical correlation is supported by survival data of 1181 patients with primary breast cancer which showed that patients with androgen receptor-negative tumors had a highly significant trend toward shorter overall survival than those with receptor-positive tumors (P less than 0.001). Androgen receptor data added significantly to the information provided by estrogen receptor data both in terms of response to hormone treatment and survival.     

Varus and Valgus Deformities of the Foot in Cerebral Palsy

Dynamic gait studies of children with varus and valgus foot-deformities due to cerebral palsy show that the activity in the tibialis posterior is important in the development of such deformities. Varus is associated with increased activity and valgus with decreased activity.  

RÉSUMÉ

Déformations du pied en varus et valgus dans l'I. M. C.
Les études de la démarche dynamique d'enfants IMC présentant un pied varus ou un pied valgus montrent que l'activité du jambier postérieur joue un rôle important dans le développement de ces déformations. Le varus est associé à une activité accrue et le valgus à un déficit.  

ZUSAMMENFASSUNG

Varus-und Valgusstellungen des Fußes bei Cerebralparese
Dynamische Ganguntersuchungen bei Kindern mit Varus- und Valgusstellungen der Füße durch Cerebralparese haben ergeben, daß die Funktion des M. tibialis posterior eine wichtige Rolle bei der Entstehung solcher Mißbildungen spielt. Die Varusstellung entseht durch erhöhte Aktivität, die Valgusstellung durch herabgesetzte Aktivität.  

RESUMEN

Deformidades en varus y en valgus del pie en la parálisis cerebral
Estudios dinámicos de la marcha en niños con deformidades del pie en varus y en valgus debidas a parálisis cerebral, muestran que la actividad del tibial anterior es importante en el desarrollo de estas deformidades. El varus esta asociado con una actividad aumentada y el valgus con una actividad disminuida.     

Amelanotic lentigo malignant melanoma: a case report and review of the literature

A patient with an amelanotic lentigo malignant melanoma is presented which manifested itself initially as an erythematous flare with the subsequent development of nodules. The diagnosis was only made histologically. A computer search of the literature revealed 6 previous cases, and a review of these rare tumours is presented.     

3H－1，2－二氢－2－（4－甲基苯胺基）甲基－1－吡咯里嗪酮在家兔体内主要代谢产物的研究

用高效液相色谱法对家兔单剂量ｉｇ７５０ｍｇ新抗炎镇痛剂３Ｈ－１，２二氢－２－（４－甲基苯胺基）－甲基－１－吡咯里嗪酮（Ｚ－４７）后尿中的代谢物进行了分离、检测。根据代谢物的色谱行为及与Ｚ－４７结构有关的其它药物的代谢途径，推测Ｚ－４７羧基衍生物［４－（３Ｈ－１，２－二氢－１－吡咯里嗪酮－２－甲基胺基）苯甲酸］是一可能的代谢产物，遂用化学方法合成了该衍生物。利用色谱保留值、紫外双波长吸收比值等对代谢物和标准品进行比较，并对尿样的酶水解产物进行色谱分析，证实Ｚ－４７羧基衍生物及其酯型β－Ｄ－葡糖苷酸结合物是Ｚ－４７在家兔体内的主要代谢产物。     

An evaluation of iodine-123 iodoazomycinarabinoside as a marker of localized tissue hypoxia in patients with diabetes mellitus

Peripheral vascular disease is a serious and common complication in patients with diabetes mellitus (DM). Evaluation is, conventionally, by transcutaneous oxygen tension measurements (TcpO₂), although this technique has some limitations in the evaluation of tissue viability. We have evaluated a new, radiolabelled, in vivo marker of tissue hypoxia, iodoazomycinarabino-side (IAZA), by comparing TcpO₂ measurements with patterns of iodine-123 IAZA uptake in ten patients (19 lower limbs) with DM and peripheral vascular disease using conventional gamma camera imaging techniques. Normal uptake patterns were seen in limbs in which normal TcpO₂ measurements were obtained. Diffusely increased uptake of [¹²³I]IAZA was seen in limbs with reduced TcpO₂ Focally increased uptake was seen in ulcers or in areas of atrophic skin change. A semiquantitative measure showed an inverse correlation between [¹²³I]IAZA and TcpO₂ values. These data suggest that tissue hypoxia can be imaged in this population of patients and that severity of disease can be assessed. A longitudinal prospective trial is now being developed.