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With the introduction of chlordiazepoxide in 1960 and the benzodiazepine drugs that followed (particularly diazepam), the older sedative drugs (barbiturates, paraldehyde, chloral hydrate) have become virtually obsolete Indeed, the benzodiazepines are among the most commonly prescribed drugs in the world today According to Hollister, 15 percent of all adults in the United States use a benzodiazepine at least once yearly and about half this number use the drug for a month or longer As mentioned earlier, these drugs, compared with the older sedatives, have relatively minor hypnotic effects and low abuse potential and are relatively safe when taken in overdose The benzodiazepines have been prescribed frequently for the treatment of anxiety and insomnia, and they are especially effective when the anxiety symptoms are severe Also, they have been used to control overactivity and destructive behavior in children and the symptoms of alcohol withdrawal in adults Diazepam is particularly useful in the treatment of delirious patients who require parenteral medication The benzodiazepines possess anticonvulsant properties, and the intravenous use of diazepam, lorazepam, and midazolam is an effective means of controlling status epilepticus, as described on page 297 Diazepam in massive doses has been used with considerable success in the management of muscle spasm in tetanus and in the stiff man syndrome (page 1279) Diazepam has been far less successful in the treatment of extrapyramidal movement disorders and dystonic spasms Alprazolam (Xanax) has

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Further studies echo keloid recurrence problems For a 1989 study by Apfelberg and colleagues, nine keloids were excised on seven patients The majority of treatments were given with a continuous CO2 laser, although a superpulsed laser was used on two patients Steroids were administered to ve patients Results appeared promising 12 months after treatment as all 8 patients initially demonstrated atter, softer, and less pruritic scars However, 8 of these 9 keloids recurred to original or nearly original size as early as 10 months and as late as 22 months post treatment The only patient who did not experience a recurrence had only been followed for 9 months and required pressure dressings for her earlobe keloid constantly Researchers determined that the laser had limited bene t over prolonged periods48 In 1989, Stern and Lucente excised 27 keloids on 18 patients Four patients returned for more than one follow up, and these patients received 02 mL of corticosteroid triamcinolone (40 mg/mL), which was repeated up to 4 times at 3-week intervals depending on the severity of hypertrophic scarring33 Of the 23 keloids that received CO2 laser therapy, 17 had recurrences Stern and Lucente concluded that although CO2 laser keloid excision followed by injections may improve the overall success rate of the laser treatment, it is unlikely that CO2 laser excision would be superior to scalpel excision, due to the known occurrence of hypertrophic scarring and keloid formation associated with the treatment33 In other studies, combination therapy has been shown to help, albeit with limited results In 1991, Norris treated 23 patients with the continuous CO2 laser in combination with steroids Out of the 23 patients, only 1 patient had no recurrence, 9 patients had recurrences suppressed with steroids, and 13 patients had recurrences with or without concomitant steroid therapy Norris concluded that CO2 laser excision alone of keloids failed to suppress keloid growth or recurrence It is noted that failures may also be tied to poor patient compliance, the inability to control the keloid with steroids, and the involved area being too large to be effectively treated with steroids49 Some limited success in treating keloids has been achieved with the CO2 device Results of other studies indicate keloid broblasts secrete more TGF- 1 than normal broblasts61 Nowak and colleagues published an in vitro study in 2000 that examined the effects of the superpulsed CO2 laser on broblast proliferation and growth factors50 Results showed the CO2 laser caused keloid cell growth to regress to normal dermal broblast levels CO2 laser treatment caused statistically signi cant.

Comparing the algorithms for sorting and median- nding we notice that, beyond the common divide-and-conquer philosophy and structure, they are exact opposites Mergesort splits the array in two in the most convenient way ( rst half, second half), without any regard to the magnitudes of the elements in each half; but then it works hard to put the sorted subarrays together In contrast, the median algorithm is careful about its splitting (smaller numbers rst, then the larger ones), but its work ends with the recursive call Quicksort is a sorting algorithm that splits the array in exactly the same way as the median algorithm; and once the subarrays are sorted, by two recursive calls, there is nothing more to do Its worst-case performance is (n 2 ), like that of median- nding But it can be proved (Exercise 224) that its average case is O(n log n); furthermore, empirically it outperforms other sorting algorithms This has made quicksort a favorite in many applications for instance, it is the basis of the code by which really enormous les are sorted

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