[Short- and medium-term outcome of outpatient treatment of alcohol dependent patients. A 6-, 18- and 36-month follow-up]. / Kurz- und mittelfristige Erfolgsraten ambulanter Entwöhnungsbehandlungen für alkoholabhängige Patienten. Eine 6-, 18- und 36-Monats-Katamnese.

The aim of this study was to investigate the short- and medium-term outcome of alcohol dependent patients in Germany after a one-year outpatient treatment. For this purpose, a 6-, 18- and 36-month follow-up of 97 socially well adapted alcohol dependent patients treated between 1992 and 1997 at three "psychosocial advice center" run by the Diakonie Württemberg, Germany, was carried out. Based on the time period between treatment and follow-up, all 97 patients could be followed up for 6 months, 71 for 18 months, and 33 for 36 months. 83% of patients could be interviewed at 6 months, 80% at 18 months, and 78% at 36 months. The statistical analyses were based on the "intention to treat" model. All patients treated between 1992 and 1997 were included. Patients for whom no information was available were classified as relapsers. 6 months after the outpatient treatment 59% of patients were abstinent, 4% had lapsed and 37% were relapsers. At the 18- and 36-month follow-ups 61% of patients had been abstinent in the 6 months before the interview. 53% and 39% of patients respectively were continuously abstinent over the entire follow-up period of 18 and 36 months. Prognostic criteria for a relapse were regular completion of treatment (p < 0.001) and no prior detoxification or abstinence oriented treatment (p < 0.01). Patients without a partner showed a tendency towards higher relapse rates (p < 0.10). The results of this study indicate that an outpatient treatment program can be as effective as inpatient or combined inpatient/outpatient treatments, at least for some patients with good social integration.

Vapor-permeable membrane therapy for ulcers of osteomyelitis.

Two patients with chronic ulcerations secondary to arterial insufficiency of the distal extremities were found to have concomitant osteomyelitis immediately beneath the ulcers. An adjunctive would care regimen is described in which local excision or debridement of the involved bone with subsequent systemic antibiotic therapy was the initial treatment. The resultant cutaneous defect was then covered with a vapor-permeable membrane and allowed to close by secondary intention. Rapid and complete healing occurred in both cases in spite of the compromised arterial supply to both areas. This technique is a useful adjunct to the treatment of ulcerations associated with chronic osteomyelitis.