Alcohol dependence is associated with a wide array of physical and psychiatric complications and is a major cause of morbidity and mortality worldwide. Recent randomized trials of baclofen, with a total daily dose 30 mg administered in 3 divided doses, have supported its efficacy in reducing craving and promoting abstinence from alcohol. Individual case studies support a possible increased effect at higher doses for treatment-resistant patients. Here, we report on 4 alcohol-dependent patients resistant to standard treatments who responded to higher doses of baclofen ranging from 75 to 125 mg daily. Further research into the use of high-dose baclofen for treatment-resistant alcohol dependence is warranted.
London PRIMARY or recurrent malignant lesions of the face are usually small but require wide excision. If primary suture of such wounds is attempted, the eyelids, lips, or nostrils may be distorted. As a result, there is a temptation to slimp the excision. The postauricular Wolfe graft enables the excision to be complete and healing to occur without deformity. The operation can be done quickly and satisfactorily under local analgesia as an outpatient. Free full-thickness skin grafting was not an established technique until 1875, when Wolfe published the results of his experiments. Prior to this, though full-thickness skin grafting had been frequently attempted, it was rarely successful and then only with small-size grafts. The failures were due to the fact that fat retained on the deeper surface of the graft prevented it from taking (Lawson, 1870; Wolfe, 1884). Early in his studies of ophthalmic surgery Wolfe questioned the usefulness of the pedicle graft as then practised for the correction of ectropion. The donor site always left a granulating
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