Violent traumatic events and drug abuse severity.

We examined the occurrence of violent traumatic events, DSM-III-R diagnosis of posttraumatic stress disorder (PTSD), and PTSD symptoms, and the relationship of these variables to drug abuse severity. One-hundred fifty opioid-dependent drug abusers who were participants in a randomized trial of two methadone treatment interventions were interviewed using the Diagnostic Interview Schedule, the Addiction Severity Index, and the Beck Depression Inventory. Twenty-nine percent met diagnostic criteria for PTSD. With the exception of rape, no gender differences in the prevalence of violent traumatic events were observed. The occurrence of PTSD-related symptoms was associated with greater drug abuse severity after controlling for gender, depression, and lifetime diagnosis of PTSD. The high rate of PTSD among these methadone patients, the nature of the traumatic events to which they are exposed, and subsequent violence-related psychiatric sequelae have important implications for identification and treatment of PTSD among those seeking drug abuse treatment.

[Reconstruction of the silhouette after gastroplasty]. / Reconstruction de la silhouette après gastroplastie.

The authors report their experience in reconstruction of the silhouette in patients experiencing rapid and marked weight loss after calibrated vertical gastroplasty, usually greater than 50 kg. They present a one-stage strategy for reconstruction of the silhouette, combining repair of the abdomen, waist and thighs. The serious nature of surgical procedure requires a very precise preoperative assessment and, most importantly, very detailed information of the patient concerning this operation and the expected results. Very intensive preoperative, intraoperative and postoperative psychological support is essential.

[Treatment of burns in infants]. / Traitement des brûlures du nourrisson.

Because of the potential severity of their residual deformities, burn injuries in infants justify an early management in specialized centres when they cover more than 5% of body surface and in every case when hands, face, or external genitalia are concerned. Cooling with cold water is the first aid treatment to be performed as early as possible after the injury. The treatment in specialized centres must be both general and surgical. General treatment includes fluid and electrolyte therapy, temperature control, appropriate nutrition and pain suppression. Pain suppression is a major part of the treatment and morphine must be largely used. Surgical treatment starts as soon as the patient arrives in the centre and is eventually performed under general anesthesia: all the burned areas are covered with occlusive dressings. Infections are prevented by systematic cultures and adjusted antibiotic therapy. A vigorous rehabilitation program must be instituted as soon as possible: massages, compressive clothes, splints, physical therapy, plastic surgery. Primary prevention by sustained parental education is important in order to reduce the frequency of burn injuries in infants.

Clinic appointment attendance for sexually transmitted infection screening among Filipina sex workers: a multilevel analysis.

This study evaluates putative individual- and contextual-level social risk factors that may influence the likelihood that Filipina female sex workers (FSWs) attend and utilize health services for STI screening. Face-to-face interviews were conducted with 1004 FSWs and their 86 employers. Research staff also collected clinic appointment attendance data. Hierarchical linear modelling was used to estimate the simultaneous effects of individual- and workplace-level factors. Results showed that both individual- and contextual-level characteristics were associated with STI screening appointment attendance. Individual characteristics found to have significant effects on clinic attendance included occupation, income, length of work and commercial sex involvement. City of establishment was a workplace characteristic significantly associated with appointment attendance. In addition to cross-level interactions, the impact of individual-level occupation depended upon characteristics of the workplace. These findings suggest that individual health service utilization is contingent upon contextual-level risk factors in the workplace. Intervention implications aimed at increasing clinic attendance are discussed.

Cardiovascular responses to a quantified dose of nicotine as a function of personality and nicotine tolerance.

Correlations between cardiovascular effects of a quantified dose of nicotine and personality measures previously shown to predict coronary heart disease were obtained. Thirty male smokers smoked a popular brand of a regular strength cigarette (1.0 mg FTC-estimated nicotine delivery) on one occasion and a nicotine-free cigarette on another occasion by means of a quantified smoke delivery system. Partial correlations controlling for effects of body weight, questionnaire-assessed nicotine tolerance, and cardiovascular responses to the nicotine-free control cigarette showed Jenkins Activity Survey Type A scores to correlate positively with nicotine-induced increase in diastolic blood pressure but negatively with nicotine-induced increase in systolic blood pressure. Partial correlations indicated that trait anxiety and depression were significantly associated with nicotine-induced heart rate increases but not with nicotine-induced blood pressure responses.

Cardiovascular and mood responses to quantified doses of cigarette smoke in oral contraceptive users and nonusers.

Previous research suggests that the female sex hormones may moderate cardiovascular and mood responses to cigarette smoking and abstinence. To test this possibility, acute effects of cigarette smoking on cardiovascular reactivity and mood were examined in 12 oral contraceptive users and 12 nonusers across two menstrual phases (early and late cycle). After overnight deprivation, each participant attended two sessions in which they first sham-smoked and then smoked two standard cigarettes, via a quantified smoke delivery system. Oral contraceptive users exhibited larger cigarette smoking-induced increases in heart rate compared with nonusers. In addition, cigarette smoking-induced cardiovascular changes varied with both the phase of the menstrual cycle and oral contraceptive use. No menstrual phase-dependent effects were observed for tobacco withdrawal symptoms, premenstrual symptoms, or moods prior to smoking. Cardiovascular hyperreactivity to cigarette smoke in oral contraceptive users may help explain the mechanisms by which smoking and oral contraceptive use contribute to an elevated risk for coronary heart disease.

[Skin flaps and expanded full-thickness skin grafts. Indications in the repair of burn sequelae]. / Les lambeaux cutanés et greffes de peau totale expansée. Indications dans la réparation des séquelles de brûlures.

The great majority of sequelae of deep burns concern the skin. Their correction essentially raises problems of replacement of scarred skin by good quality skin. Sequelae of burns logically constitute one of the best indications for progressive mechanical skin expansion by prosthesis, which allows for considerable improvement of the aesthetic results. This improvement is related to the use of skin replacement tissues with the same quality as the original tissue. Local expanded flaps and expanded full-thickness skin grafts are the two essential techniques used. The authors review the general rules concerning the use of expansion prostheses, then describe the various indications for expanded flaps and expanded full-thickness skin grafts in the sequelae of burns of the face, neck, thorax and limbs. The main indications are illustrated by clinical cases.

[Transposition flaps adn full-thickness skin grafts used as interposition tissue: progressive physiological expansion]. / Lambeaux de transposition et greffes de peau totale utilisés comme tissu d'interposition: l'expansion physiologique progressive.

The capacity of health skin to expand, which has been known for a long time, has been used in plastic surgery since the work by Radovan. The sequelae of deep burns are sometimes responsible for retraction, particularly in flexion folds of the limbs, which are treated in our department by interposition of healthy skin in the form of local flaps or full-thickness skin grafts. The follow-up of several hundred patients over several years demonstrated that, in addition to the immediate skin gain, expansion or extension of the interposed healthy skin occurs. Nevertheless, only histological examination could confirm the reality of this progressive physiological expansion observed during the follow-up of our patients.

[Rapid tissue expansion]. / L'expansion tissulaire rapide.

The authors, who already have a wide experience of classical tissue expansion with slow inflation of prostheses over about 8 weeks, now present their experience of very rapid, virtually intraoperative expansion for the treatment of large scars and moderately large cicatricial zones. The operative technique which they use is described and the postoperative results are analysed.

Predictors of medical service utilization among individuals with co-occurring HIV infection and substance abuse disorders.

This study examined factors affecting medical service use among HIV-infected persons with a substance abuse disorder. The sample comprised 190 participants enrolled in a randomized trial of a case management intervention. Participants were interviewed about their backgrounds, housing status, income, alcohol and drug use problems, health status and depressive symptoms at study entry. Electronic medical records were used to assess medical service use. Poisson regression models were tested to determine the effects of need, enabling and predisposing factors on the dependent variables of emergency department visits, inpatient admissions and ambulatory care visits. During a two-year period, 71% were treated in the emergency department, 64% had been hospitalized and the sample averaged 12.9 ambulatory care visits. Homelessness was associated with higher utilization of emergency department and inpatient services; drug use severity was associated with higher inpatient and ambulatory care service use; and alcohol use severity was associated with greater use of emergency medical services. Homelessness and substance abuse exacerbate the health care needs of HIV-infected persons and result in increased use of emergency department and inpatient services. Interventions are needed that target HIV-infected persons with substance abuse disorders, particularly those that increase entry and retention in outpatient health care and thus decrease reliance on acute hospital-based services.

[Use of a neutral paraffin dressing (Jelonet) at the Burn Care Center at the Saint Luc Hospital in Lyon]. / Utilisation d'un pansement gras neutre imprégné de paraffine (Jelonet) au Centre des Grands Brûlés de l'Hôpital Saint-Luc de Lyon.

Several thousand dressings are performed each year to treat the patients admitted to the St Luc Hospital Burn Care Unit. The use of paraffin gauze dressing (Jelonet) allowed standardization and rationalization of the four different types of dressings used in burns. Positive features of this product include ease of use, good tolerance, and low cost.

[Forum on tissue expansion. Expansion of the scalp. Surgical techniques and clinical applications]. / Forum: l'expansion tissulaire. L'expansion du cuir chevelu. Techniques chirurgicales et applications cliniques.

Repair of all forms of alopecia is one of the principal applications of scalp expansion. The authors have inserted 400 expansion prostheses, including 20 in the scalp. The surgical technique, choice of material and various types of flaps are described and illustrated by clinical cases of extensive alopecia.

[Previously expanded full-thickness skin grafts. Technical principles. Indications in the repair of sequelae of burns. Apropos of 22 cases]. / Les greffes de peau totale préalablement expansée. Principes techniques. Indications dans la réparation des séquelles de brûlures. A propos de 22 cas.

Burns raise difficult repair problems. Previously expanded full-thickness skin grafts represent a good solution in many situations. Based on their experience of 22 cases, the authors present a review of the various indications for this technique.

[Forum on tissue expansion. Repair of sequelae of facial burns by cervical cutaneous expansion]. / Forum: l'expansion tissulaire. Réparation des séquelles de brûlure de la face par expansion cutanée cervicale.

Burn scars of the lower part of the face are a difficult problem in plastic surgery. Full thickness skin graft or local flaps usually give poor cosmetic result. Over the last 5 years, we used 24 skin expanders in the neck area to cover burn scars of the chin and jaw. Discussion of the method and 4 cases are reported.