Chemically dependent patients in recovery: roles for the family physician.

Successful recovery from chemical dependency usually requires at least two years of abstinence and has complex medical, psychologic, and social aspects. In addition to the multiple medical problems associated with substance abuse, patients are at risk for conditions resulting from impaired judgment during addiction, including sexually transmitted diseases. In addition, therapeutic doses of ongoing medications (e.g., antihypertensive agents) may need to be reestablished because of the physiologic changes that occur during recovery. Patient attitudes toward physicians and medications may range from overuse to avoidance, depending on personal experiences and vulnerabilities. These factors may also influence the efforts of physicians, family members and support groups who are trying to help recovering patients. Twelve-step programs, supportive medical follow-up and the judicious use of medications in specific circumstances can greatly increase the probability of successful and sustained recovery for previously addicted patients.

Nine cases of bilateral femoral shaft fractures: a composite view.

Nine cases of bilateral femoral shaft fractures were seen in a series of 126 patients treated from 1973--1977. Patients were multitrauma cases from automobile accidents. Treatment by traction followed by cast-bracing resulted in a high percentage of unsatisfactory results, lengthy recoveries, and the necessity of secondary surgical procedures to improve the results.