ونود أن نشكر موظفي الصدفية سان فرانسيسكو ومركز علاج الجلد لعملهم خصوصا لدينا غوكرمان منسق، سارة هالس RN

1. التقييم وإعداد <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> إجراء التاريخ الكامل والجسدية قبل بدء العلاج. في التاريخ وثيقة المعلومات المادية، الهامة مثل الأدوية الحالية / الماضي، استجابة للعلاجات الصدفية الماضي، أي تاريخ من ردود الفعل السلبية لأشعة الشمس المحيطة أو العلاج بالضوء، شدة الحكة، ونوعية النوم. </li><li style=";text-align:right;direction:rtl"> انشاء غرفة العيادة مع جميع المواد اللازمة لتطبيق الجلد انسداد [المقطع انظر المواد والشكل 1] الأدوية و. أيضا، ضع مواد أخرى في غرفة مثل القفازات، والاغطية البلاستيكية والجوارب، والدعك / العباءات بيجامة. </li><li style=";text-align:right;direction:rtl"> تقييم المريض لحمامي منتشر ومكثفة قبل بدء العلاج. </li><li style=";text-align:right;direction:rtl"> إذا كان المريض يسلك حمامي واسع النطاق أو مكثفة، وتنفيذ &quot;تهدئة&quot; الإجراء (انظر أدناه) حتى يتم تقليل الحمامي بشكل ملحوظ. إذا رأيت أي حمامي واسع النطاق أو مكثفة، انتقل إلى &quot;العلاج بالضوء + القطران&quot; خطوة. </لى&gt; </ol> 2. يبرد (إذا لزم الأمر) <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> تطبيق الستيرويدات الموضعية إلى المناطق المتضررة. تطبيق تريامسينولون 0.1٪ مرهم إلى الجذع والأطراف، ديزونيد 0.05٪ كريم / مرهم على الوجه / الإبطين / الفخذ، وفلوسينولون النفط 0.01٪ أو 0.1٪ محلول تريامسينولون إلى فروة الرأس. احتياطي clobetasol 0.05٪ مرهم للمناطق مع التهاب أشده. </li><li style=";text-align:right;direction:rtl"> تسد الأدوية الموضعية مع غلاف بلاستيكي لالجذع والأطراف، وقفازات غير منفذة للجهة، وقبعات الاستحمام داخل الجوارب للقدمين، وقبعة الدش لفروة الرأس. </li><li style=";text-align:right;direction:rtl"> تهدئة المريض حتى يتم خفض كبير في حمامي (تتراوح بين 3-14 أيام). </li></ol> 3. العلاج بالضوء + قطران <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> بعد انتهاء المريض فترة تهدئة وإدارة العلاج بالضوء يوميا في الصباح قبل تطبيق قطران الفحم الخام [الشكل 2]. وتشمل خيارات العلاج بالضوء فوق البنفسجية ضيقة النطاق (الأكثر استخداما في psoriأسيس) أو النطاق العريض UVB (الأكثر استخداما في الأكزيما). تحديد جرعة العلاج بالضوء الأولية التي فيتزباتريك نوع الجلد [انظر الجدول 1 والجدول 2]. </li><li style=";text-align:right;direction:rtl"> عاير ببطء جرعات العلاج بالضوء اللاحقة صعودا والتسامح. الجرعات نظام والجدول الزمني بحاجة إلى أن تكون فردية يعتمد على استجابة المريض إلى العلاج بالضوء. </li><li style=";text-align:right;direction:rtl"> بعد العلاج بالضوء، وتطبيق 2٪ قطران الفحم الخام (CCT) في الأكوافور موضعيا للمناطق المتضررة من الجسم [الشكل 3]. إذا كان المريض لديه تورط فروة الرأس، وتطبيق 20٪ السائل carbonis detergens (LCD) في nutraderm إلى فروة الرأس. </li><li style=";text-align:right;direction:rtl"> في البداية، استخدم CCT 2٪ (أقل قوة). في أيام معالجة لاحقة، وزيادة قوة القطران والتسامح من قبل المريض من 2٪ إلى 5٪ ثم إلى 10٪ لتحقيق نتائج أفضل. </li><li style=";text-align:right;direction:rtl"> للمناطق سميكة من الصدفية، واستخدام القطران تتفاقم مع حمض الصفصاف (2٪ / 5٪ / 10٪ حمض الصفصاف) للمساعدة في تقليل التحجيم ومتصلبة من لويحات. استخدام في البداية تحضيراتحمض الصفصاف 2٪ مع 10٪ CCT، ويعاير نسبة حمض الصفصاف على النحو التسامح من قبل المريض في أيام لاحقة. قد يكون بطلان حمض الصفصاف في المرضى الذين يعانون من مرض السكري أو قرحة المعدة. </li><li style=";text-align:right;direction:rtl"> حبس القطران الموضعية بنفس الطريقة كما هو موضح في الخطوة 2.2 لتهدئة الإجراء. </li><li style=";text-align:right;direction:rtl"> إبقاء الأدوية الموضعية على الجلد لمدة 4 ساعة على الأقل. بعد مدة لا تقل عن 4 ساعات، وإزالة المواد انسداد ويغسل القطران في الحمام مع الصابون والزيوت المعدنية [الشكل 4]. </li><li style=";text-align:right;direction:rtl"> إعطاء المريض LCD 20٪ في الأكوافور وLCD 20٪ في nutraderm أن يطبق على الجسم وفروة الرأس، على التوالي، في المنزل. </li><li style=";text-align:right;direction:rtl"> المرضى الذين يعانون من الأكزيما تميل إلى أن تكون البشرة الحساسة. استخدام 2٪ CCT في البداية لمرضى الأكزيما. كن حذرا عند المعايرة تصل إلى 5٪ CCT، والمرضى الذين يعانون من الأكزيما تميل إلى أن تكون البشرة الحساسة. لا تستخدم CCT 10٪ (أو أي نسبة مئوية من CCT أعلى من 5٪) وعدم استخدام أي مستحضرات مع حمض الصفصاف. </li></ol> 4.التقييم اليومي <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> كل يوم، إجراء التقييم وتقييم جلد المريض والاستجابة للعلاج. تقييم خصيصا لالأحاسيس من حرق، والتي يمكن أن تشير إلى عدم قدرة المريض على تحمل العلاج بالضوء، أو الحكة، والتي يمكن أن تشير تهيج من القطران و / أو غلاف بلاستيكي. </li><li style=";text-align:right;direction:rtl"> إذا كان المريض أظهرت علامات حرق (حرقان، حمامي كبيرة زيادة، أو نادرا ما زادت حكة كما بشيرا حرق وشيكة إذا زاد قياس الجرعات أكثر من ذلك)، جرعة العلاج بالضوء نقصان أو لا تعطي العلاج بالضوء ذلك اليوم، كما قد يكون سببه رد فعل الضوئية إلى جرعة سابقة ضوء الأشعة فوق البنفسجية. </li><li style=";text-align:right;direction:rtl"> ليس من غير المألوف للمرضى لديهم استجابات مختلفة التشريحية الإقليمية والتحمل إلى العلاج بالضوء. لتلقي العلاج الأمثل، وضبط كمية من جرعة العلاج بالضوء يتعرض لمناطق مختلفة من الجسم وفقا لاستجابة المريض. على سبيل المثال، إذا كان المريض يواجه بو معتدلrning من الجذع، ثم التعامل الأول كامل الجسم مع جرعة العلاج بالضوء خفضت، من تغطية الجذع، واعطاء الضوء إضافية إلى الحدود القصوى. </li></ol> 5. التخطيط التفريغ والصيانة <ol style=";text-align:right;direction:rtl"><li style=";text-align:right;direction:rtl"> مواصلة العلاج غوكرمان حتى يتم مسح المرض والمريض هو على استعداد لتصريفها. </li><li style=";text-align:right;direction:rtl"> مكان المرضى على برنامج الصيانة، التي يمكن أن تشمل العلاج بالضوء العيادات الخارجية والأدوية الموضعية </li><li style=";text-align:right;direction:rtl"> إدارة العلاج بالضوء العيادات الخارجية ثلاث مرات في الأسبوع (على الأقل خلال الشهر الأول). في نهاية المطاف التردد هو مدبب تدريجيا إلى مرتين في الأسبوع ثم مرة واحدة في الأسبوع) </li><li style=";text-align:right;direction:rtl"> العيادات الخارجية الأدوية الموضعية تشمل: كريم تريامسينولون / مرهم للجسم مرتين يوميا، Clobetasol إلى آفات المتمردة (إذا لزم الأمر) مرتين يوميا، LCD 20٪ في الأكوافور إلى الجسم وLCD 20٪ في nutraderm إلى فروة الرأس. </li><li style=";text-align:right;direction:rtl"> في غضون شهر من التفريغ، تحديد موعد لزيارة الطبيب متابعة مع المريض لرصد حالة المرض. </li></ol>

<ol>
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Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy.</a> Journal of the American Academy of Dermatology. 62, 114-135 (2010).</li><li>de Miguel, R., el-Azhary, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy,+safety,+and+cost+of+Goeckerman+therapy+compared+with+biologics+in+the+treatment+of+moderate+to+severe+psoriasis.">Efficacy, safety, and cost of Goeckerman therapy compared with biologics in the treatment of moderate to severe psoriasis.</a> International Journal of Dermatology. 48, 653-658 (2009).</li><li>Busse, K., Koo, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Introducing+the+delayed+retinoid+burn:+a+case+report+and+discussion+of+this+potential+risk+of+retinoid-phototherapy+combination+management.">Introducing the delayed retinoid burn: a case report and discussion of this potential risk of retinoid-phototherapy combination management.</a> Journal of the American Academy of Dermatology. 64, 1011-1012 (2011).</li><li>Maughan, W. 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الدكتور كو هو المتكلم لابوت، ليو، وستيفل-GSK. الدكتور كو يجري أبحاثا لأمجين، يانسن، نوفارتيس، Photomedex، GALDERMA، وشركة فايزر. الدكتور كو لا يوجد لديه مخزون، والعمالة، أو عضوية المجلس مع أي شركة ادوية. أي تضارب مصالح يفصح عن أي مؤلفين آخرين.

ويستخدم غوكرمان حمية بروتوكول المبينة أعلاه في سان فرانسيسكو، ويمكن أن تختلف في نواح متعددة وفقا لاستجابة المريض للعلاج. منذ وينظر المريض وفحص كل يوم، ويمكن أن تكون فردية بروتوكول لكل مريض لضمان أقصى قدر من الفعالية. علاج غوكرمان التقليدية تتألف فقط من استخدام التح?...

الصدفية هو، مناعية مرض جلدي التهابي مزمن يؤثر على ما يقرب 2-3٪ من السكان. 1-ثلث المرضى تجربة الصدفية المعمم الذي يسبب الآثار الجسدية والنفسية المنهكة. وغوكرمان نظام، نشرت لأول مرة في عام 1925 لعلاج الصدفية معممة، ويتألف من التعرض للأشعة فوق البنفسجية B (UVB) الخفيفة وتطبيق قطران الفحم الخام (CCT). 2 على الرغم من أحدث وكلاء الداخلية مثل البيولوجية عززت علاج الصدفية، لا يزال العلاج غوكرمان كخيار فعالة للغاية، في الوقت الذي توفر مدة طويلة من مغفرة. 3،4 في دراسة نشرت أجريت في سان فرانسيسكو، و 100٪ من المرضى على العلاج غوكرمان تحقيق PASI75 (75٪ تحسن من تقييم الصدفية مؤشر خطورة [باسي] من خط الأساس) من خلال 3 أشهر. 5 في المقارنة (ولكن ليس وجها لوجه)، والمرضى على البيولوجية أقوى حققت٪ فقط 67-68 PASI75 في 3 الإثنينتي إتش إس. 6 غوكرمان نظام له بداية سريعة ووقد استخدمت بنجاح في المرضى الذين يعانون من الصدفية مقاومة للعلاج الحرارية إلى العلاج بالضوء أو الداخلية الأدوية. لديه 7 ونظام غوكرمان أيضا سمية آمنة للغاية مع أساسا ليس له آثار جانبية الداخلية، والتي هي مخاطر أكثر الخطيرة المرتبطة علاجات الصدفية الأخرى. وعلاوة على ذلك، وقد تبين أن العلاج ليكون لها تأثير كبير وإيجابي على نوعية حياة المرضى الذين يعانون من الصدفية معممة 8. كانت تدار سابقا غوكرمان نظام 24 ساعة في اليوم في منشأة للمرضى الداخليين حتى تم إبعاد المريض من الصدفية بهم. ولكن نظرا للتغيرات في التسديدات والرعاية المدارة، يتم التعامل مع المرضى في مرافق الرعاية النهارية الآن مدة لا تقل عن 4-8 ساعة / يوم و 5 أيام / أسبوع حتى ثبات مرضهم. وقد وضعت العلاج غوكرمان في البداية لعلاج الصدفية، ولكن نسخة معدلةوقد استخدم مؤخرا لعلاج الأمراض الجلدية الأخرى مثل الأكزيما مع النجاح. ويستخدم بروتوكول التالية في سان فرانسيسكو تحديدا لعلاج الصدفية، ولكن تغييرات طفيفة في الإجراءات يمكن أن تكون مصممة لالأكزيما، حكة معممة، الأكال العقيدي، النخالية حزازي المزمن، احمرار الجلد، وغيرها من اضطرابات الجلد ذات الصلة. 9 على الرغم من أنه هو واحد من أقدم العلاجات المتوفرة لمرض الصدفية، هناك غياب أية لقطات فيديو نشرت يدل على العملية. شريط فيديو يمكن أن يكون نداء واسع كما أنها يمكن أن تستخدم كمصدر للاشارة ممارسي الرعاية الصحية (أطباء الرعاية الصحية الأولية والأمراض الجلدية والتناسلية) لفهم عملية وتشعر بالراحة التوصية العلاج. سوف شريط فيديو يوضح عملية غوكرمان تكون أيضا مفيدة لتثقيف المقيمين وطلاب الطب الذين لا يتعرضون لنظام لأن هناك سوى عدد قليل من المؤسسات التي تركت مواصلة تقديم هذا النوع من أناالعلاج ntensive. وسوف يكون الفيديو مفيد أيضا لمرضى المحتملين الذين يرغبون في تلقي العلاج غوكرمان.

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		<tr>
			<td>Name of Medication </td>
			<td>Company</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>2% Crude Coal Tar in White Petrolatum or Cetaphil</td>
			<td>Compounded at Pharmacy</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>5% Crude Coal Tar in White Petrolatum or Cetaphil</td>
			<td>Compounded at Pharmacy</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>10% Crude Coal Tar in White Petrolatum +/- 2/5/10% Salicyclic Acid</td>
			<td>Compounded at Pharmacy</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>10% Crude Coal Tar in Cetaphil</td>
			<td>Compounded at Pharmacy</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>20% Liquid Carbonis Detergenis in Nutraderm</td>
			<td>Compounded at Pharmacy</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>20% Liquid Carbonis Detergenis in Aquaphor or Cetaphil</td>
			<td>Compounded at Pharmacy</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Triamcinolone 0.1% ointment/cream/lotion</td>
			<td>Prescription Medication - Generic</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Desonide 0.05% cream/ointment</td>
			<td>Prescription Medication - Generic</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Fluocinolone 0.01% oil</td>
			<td>Prescription Medication - Generic</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Clobetasol 0.05% ointment/cream</td>
			<td>Prescription Medication - Generic</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Hydrophillic Ointment</td>
			<td>Over the Counter - Generic</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Mineral Oil</td>
			<td>Over the Counter - Generic</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Name of Equipment </td>
			<td>Company</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Narrow-Band Phototherapy Unit</td>
			<td>National Biologic Corporation</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>Broad-Band Phototherapy Unit</td>
			<td>National Biologic Corporation</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
	</tbody>
</table>

the goeckerman regimen for the treatment of moderate to severe psoriasis

الصدفية هو، مناعية مرض جلدي التهابي مزمن يؤثر على ما يقرب 2-3٪ من السكان. وغوكرمان نظام يتكون من التعرض للأشعة فوق البنفسجية B (UVB) الخفيفة وتطبيق قطران الفحم الخام (CCT). العلاج غوكرمان هو فعالة للغاية وآمنة نسبيا لعلاج الصدفية وتحسين نوعية المريض من الحياة. في المقالة التالية، نقدم لدينا بروتوكول للعلاج غوكرمان التي يتم استخدامها على وجه التحديد في جامعة كاليفورنيا، سان فرانسيسكو. تفاصيل هذا البروتوكول إعداد اللوازم، وإدارة العلاج بالضوء وتطبيق القطران الموضعية. يصف هذا البروتوكول أيضا كيفية تقييم المريض اليومية، لرصد الآثار السلبية (بما في ذلك الحكة وحرق)، وضبط العلاج بناء على استجابة المريض. على الرغم من أنه هو واحد من أقدم العلاجات المتوفرة لمرض الصدفية، هناك غياب أية لقطات فيديو نشرت يدل على عملية في ديتاIL. شريط الفيديو هو مفيد لمقدمي الرعاية الصحية الذين يرغبون في إدارة العلاج، للمتدربين الذين يرغبون في معرفة المزيد عن هذه العملية، وبالنسبة للمرضى المحتملين الذين يرغبون في الخضوع لعلاج لمرضهم الجلدي.

في دراسة أجريت في مركزنا في جامعة كاليفورنيا في سان فرانسيسكو، وقد تحقق PASI75 استجابة (75٪ تحسنا في مؤشر خطورة الصدفية تقييم) في 100٪ من المرضى الذين يتلقون غوكرمان (ن = 25) على مدى فترة زمنية 3 أشهر 5 24/25 المرضى يحتاج فقط 2 أشهر لتحقيق PASI75، في حين أن المريض المتبقية الحصو...

Watch this Scientific Journal Video about The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis at JoVE.com

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

الصدفية هو، مناعية مرض جلدي التهابي مزمن. وغوكرمان نظام، وضعت لعلاج الصدفية، ويتألف من التعرض للأشعة فوق البنفسجية B (UVB) الخفيفة وتطبيق قطران الفحم الخام (CCT). بروتوكول التالية هي لإدارة العلاج غوكرمان لعلاج الصدفية المعتدلة إلى شديدة.

لحمية غوكرمان لمعاملة معتدل لمرض الصدفية

Psoriasis is a  chronic, immune-mediated inflammatory skin disease affecting approximately 2-3%  of the population. The Goeckerman regimen consists of ...

the-goeckerman-regimen-for-treatment-moderate-to-severe

Research

JoVE Journal

Medicine

38.7K Views.  University of Southern California. الصدفية هو، مناعية مرض جلدي التهابي مزمن. وغوكرمان نظام، وضعت لعلاج الصدفية، ويتألف من التعرض للأشعة فوق البنفسجية B (UVB) الخفيفة وتطبيق قطران الفحم الخام (CCT). بروتوكول التالية هي لإدارة العلاج غوكرمان لعلاج الصدفية المعتدلة إلى شديدة.

Video: The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

القصبي Thermoplasty : رواية نهج علاجي لمرض الربو الحاد

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 &deg;C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide.
During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates1,2. Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma3-5. However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)6,7. Microwaves may alleviate some of these problems by producing faster, volumetric heating8-10. To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices11-13.
Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 &deg;C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver14-16. Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications17. Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock 16.
Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.

A thermal tumor ablation procedure is described. The entire procedure is detailed, including pretreatment planning and imaging studies, anesthesia, adjuvant techniques to facilitate a percutaneous approach, imaging guidance of the ablation device to the tumor, thermal treatment, post-treatment care and follow-up.

تذرية الحرارية لعلاج أورام البطن

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ...

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

قياس وعلاج الحول في قمع

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

Slow-release Drug Delivery through Elvax 40W to the Rat Retina: Implications for the Treatment of Chronic Conditions

Diseases of the retina are difficult to treat as the retina lies deep within the eye. Invasive methods of drug delivery are often needed to treat these diseases. Chronic retinal diseases such as retinal oedema or neovascularization usually require multiple intraocular injections to effectively treat the condition. However, the risks associated with these injections increase with repeated delivery of the drug. Therefore, alternative delivery methods need to be established in order to minimize the risks of reinjection. Several other investigations have developed methods to deliver drugs over extended time, through materials capable of releasing chemicals slowly into the eye. In this investigation, we outline the use of Elvax 40W, a copolymer resin, to act as a vehicle for drug delivery to the adult rat retina. The resin is made and loaded with the drug. The drug-resin complex is then implanted into the vitreous cavity, where it will slowly release the drug over time. This method was tested using 2-amino-4-phosphonobutyrate (APB), a glutamate analogue that blocks the light response of the retina. It was demonstrated that the APB was slowly released from the resin, and was able to block the retinal response by 7 days after implantation. This indicates that slow-release drug delivery using this copolymer resin is effective for treating the retina, and could be used therapeutically with further testing.

This paper details how Elvax 40W can be used as a slow-release method for drug delivery to the adult rat retina. The protocol for preparing, loading, and delivering the drug-resin complex to the eye is described.

بطء الإفراج تسليم المخدرات من خلال Elvax 40W إلى الجرذ الشبكية: الآثار المترتبة على علاج الحالات المزمنة

Diseases of the retina are difficult to treat as the retina lies deep within the eye. Invasive methods of drug delivery are often needed to treat these ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

تحليل شبكة الثقبة البيضوية الكهربائي تسجيلات في الفص الصدغي الصرع المرضى المقاوم للأدوية

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

2-Methacryloyloxyethyl Phosphorylcholine Polymer Treatment of Complete Dentures to Inhibit Denture Plaque Deposition

Removable dentures made of poly (methyl methacrylate) (PMMA) are prone to bacterial adherence and dental plaque formation, which is called denture plaque. Denture plaque-associated infection is a source of serious dental and medical complications in the elderly. 2-Methacryloyloxyethyl phosphorylcholine (MPC) is a well-known biomedical material that exhibits marked antithrombogenicity and tissue compatibility because of its high resistance to protein adsorption and cell adhesion. Therefore, MPC polymer coatings are suggested to have the potential to inhibit plaque deposition on the surface of PMMA dentures. However, coating MPC polymer on the surface of a PMMA denture is a complex procedure that requires specialized equipment, which is regarded as a major barrier to its clinical application. 
Here, we introduce a new MPC polymer treatment procedure that uses poly (MPC-co-BMA-co-MPAz) (PMBPAz) to prevent denture plaque deposition on removable dentures. This procedure enables the MPC coating of PMMA denture surfaces in a simple and stable manner that is resistant to various chemical and mechanical stresses due to the MPC layer of PMBPAz that is covalently bound to the PMMA surface by ultraviolet light irradiation. In addition, the procedure does not require any specialized equipment and can be completed by clinicians within 2 min. We applied this procedure in a clinical setting and demonstrated its clinical utility and efficacy in inhibiting plaque deposition on removable dentures.

Removable poly(methyl methacrylate) (PMMA) dentures are prone to bacterial adherence and plaque formation. Denture plaque-associated infection is a source of serious dental and medical complications in the elderly. This paper introduces a novel protocol to treat PMMA dentures with 2-methacryloyloxyethyl phosphorylcholine polymer, poly(MPC-co-BMA-co-MPAz), to suppress plaque deposition on PMMA dentures.

2-Methacryloyloxyethyl فسفوريل كولين بوليمر علاج أطقم الأسنان الكاملة لتمنع أسنان البلاك ترسب

Removable dentures made of poly (methyl methacrylate) (PMMA) are prone to bacterial adherence and dental plaque formation, which is called denture plaque. ...

Intense Pulsed Light for the Treatment of Dry Eye Owing to Meibomian Gland Dysfunction

Dry eye disease (DED) is an increasingly common condition and one of the most common complaints of patients. The vast majority of DED is caused by the so-called &#34;evaporative&#34; subtype, that is mainly caused by meibomian gland dysfunction (MGD). Intense pulsed light (IPL) devices employ high intensity pulses of polychromatic lights with a broad range of wavelength (515-1200 nm). IPL treatment has been utilized for years in the field of dermatology, and then its use was applied to ophthalmology for the treatment of MGD. Recently, a new device employing IPL was specifically designed for the periocular application. This procedure determines the thermal selective coagulation and ablation of superficial blood vessels and telangiectasias of the eyelids skin, reducing the release of inflammatory mediators and tear cytokines levels, and improving meibomian glands outflow. IPL treatment is noninvasive and easy to perform, lasts for only a few minutes and can be conducted in an office setting. In the present study, 19 patients underwent 3 sessions of IPL treatment. After treatment, both mean noninvasive break-up time and lipid layer thickness grade significantly increased, as a result of an improvement of tear film stability and quality, respectively. Conversely, no statistically significant changes were found for meibomian gland loss and tear osmolarity. Furthermore, the vast majority of the treated patients (17/19; 89.5% of the total) perceived an improvement of their ocular discomfort symptoms after IPL treatment. Although IPL treatment provides an improvement of both ocular surface parameters and ocular discomfort symptoms after one cycle of three sessions, regular repeated treatments are usually required to maintain the persistence over the time of its beneficial effects.

Dry eye disease is an increasingly common condition, which strongly impair patients&#39; life quality. Recently, a new device employing intense pulsed light, specifically designed for the periocular area, has been shown to improve tear film stability and ocular discomfort symptoms in dry eye disease owing to meibomian gland dysfunction.

نابض ضوء لعلاج العين الجافة نظراً للخلل في الغدة الميبوميه

Dry eye disease (DED) is an increasingly common condition and one of the most common complaints of patients. The vast majority of DED is caused by the ...

Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a lack of effective treatments in the current clinical practice. With the easy accessibility of transgenic and knockout strains and their small size, which allows minimal doses of drugs required for in vivo evaluation, a well-established experimental model in mice is preferred for AP research. Moreover, SAP induced through sodium taurocholate (TC) is currently one of the most widely used and best characterized models. This model has been investigated for novel therapies and possible molecular events during the process of AP. Here, we present the generation of an AP mouse model using sodium taurocholate and a simple homemade microsyringe. Moreover, we also provide the methodology for the subsequent histology and serological testing.

A mouse model of severe acute pancreatitis is described herein. The procedure presented here is very rapid, simple, and accessible, thereby potentially allowing the study of the molecular mechanisms and different therapeutic interventions in acute pancreatitis in a convenient way.

إنشاء نموذج التهاب البنكرياس الحاد الوخيم للفأر باستخدام الحقن الرجعي لتاوروكولات الصوديوم في القناة الصفراوية البنكرياسية

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

جراحة تعاونية بالمنظار لعلاج أورام الجهاز الهضمي في المعدة

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

استئصال الكيس المجهري لعلاج المرضى الذين تم تشخيص إصابتهم بكيس البربخ

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...