Wir möchten die Mitarbeiter der UCSF Psoriasis und Haut Treatment Center für ihre Arbeit danken vor allem unseren Goeckerman Coordinator, Sarah Hulse RN

1. Evaluation und Vorbereitung <ol><li> Führen Sie eine vollständige Anamnese und körperliche vor Beginn der Therapie. In der Anamnese und körperliche, Dokument wichtige Informationen wie aktuellen / letzten Medikamente, Reaktion auf Vergangenheit Psoriasis-Therapien, eine Geschichte von Nebenwirkungen Umgebungssonnenlicht oder Phototherapie, die Schwere des Pruritus und Qualität des Schlafes. </li><li> Richten Sie eine Klinik Zimmer mit allem notwendigen Material für die dermale Applikation von Medikamenten und Okklusion [Siehe Abschnitt Materialien und Abbildung 1]. Auch legen andere Materialien im Raum wie Handschuhe, Frischhaltefolie, Socken und scheuert / Pyjama Kleider. </li><li> Beurteilen Sie den Patienten für diffuse und intensive Rötung vor Beginn der Therapie. </li><li> Wenn der Patient zeigt verbreitet oder intensive Rötung, führen Sie eine &quot;cool down&quot;-Verfahren (siehe unten), bis die Rötung deutlich reduziert wird. Wenn kein verbreitet oder intensive Rötung zu sehen ist, auf die &quot;Phototherapie + tar&quot; Schritt fort. </li&gt; </ol> 2. Cool Down (falls erforderlich) <ol><li> Bewerben topische Kortikosteroide in die betroffenen Gebiete. Bewerben Triamcinolon 0,1% Salbe auf Stamm und Extremitäten, Desonid 0,05% Creme / Salbe auf das Gesicht / Achseln / Leistengegend und Fluocinolon 0,01% Öl oder Triamcinolon 0,1% Lotion auf die Kopfhaut. Reserve clobetasol 0,05% Salbe für die Bereiche mit den intensiven Entzündung. </li><li> Verschließen Sie die topische Medikamente mit Plastikfolie für den Rumpf und Extremitäten, undurchlässige Handschuhe für die Hand-und Duschhauben innerhalb Socken für die Füße, und einer Duschhaube für die Kopfhaut. </li><li> Abkühlen lassen, bis der Patient Erythema deutlich reduziert wird (Bereich 3-14 Tage). </li></ol> 3. Phototherapie + Tar <ol><li> Nachdem der Patient beendet die Abkühlphase, verwalten Phototherapie täglich morgens vor der Anwendung von rohem Kohlenteer [Abb. 2]. Phototherapie Optionen gehören Schmalband UVB (am häufigsten in Psori verwendetasis) oder Breitband-UVB (am häufigsten bei Ekzemen verwendet). Bestimmen Sie die anfängliche Dosis von Phototherapie Fitzpatrick Hauttyp [siehe Tabelle 1 und Tabelle 2]. </li><li> Langsam titrieren die nachfolgenden Phototherapie Dosen nach oben als verträglich. Dosierungsschema und Zeitplan müssen auf der Grundlage Reaktion der Patienten auf Phototherapie individualisiert werden. </li><li> Nach Phototherapie, gelten 2% Rohteer (CCT) in Aquaphor topisch auf die betroffenen Flächen des Körpers [Abb. 3]. Wenn der Patient hat Kopfhaut Beteiligung gelten 20% Flüssigkeit carbonis detergens (LCD) in nutraderm auf die Kopfhaut. </li><li> Zunächst verwenden 2% CCT (niedrigste Festigkeit). Bei der anschließenden Behandlung Tage, um die Stärke der Teer durch den Patienten von 2% bis 5% toleriert und dann auf 10%, um bessere Ergebnisse zu erzielen. </li><li> Für Verdickungen der Psoriasis, benutzen tar mit Salicylsäure (2% / 5% / 10% Salicylsäure) zu helfen, die Skalierung und Verhärtung der Plaques verschärft. Zunächst benutzen Zubereitungen2% Salicylsäure mit 10% CCT nachgespült und der Prozentsatz der Salicylsäure als durch den Patienten an den nachfolgenden Tagen toleriert. Salicylsäure kann bei Patienten mit Diabetes oder Magengeschwüren kontraindiziert sein. </li><li> Verschließen topische Teer in der gleichen Weise wie in Schritt 2.2 der Abkühlung Verfahren beschrieben. </li><li> Halten topische Medikamente auf der Haut für mindestens 4 Stunden. Nach mindestens 4 Stunden, entfernen Sie die Okklusion Materialien und abwaschen der Teer in der Dusche mit Mineralöl und Seife [Abb. 4]. </li><li> Geben Sie dem Patienten 20% in Aquaphor LCD und 20% in LCD nutraderm auf den Körper und Kopfhaut auftragen, bzw. zu Hause. </li><li> Patienten mit Neurodermitis neigen dazu, empfindliche Haut haben. Mit 2% CCT zunächst für Ekzeme Patienten. Seien Sie vorsichtig bei der Titration von bis zu 5% CCT, als Patienten mit Ekzemen zu empfindlicher Haut neigen. Verwenden Sie keine 10% CCT (oder einem Prozentsatz der CCT höher als 5%) und verwenden Sie keine Präparate mit Salicylsäure. </li></ol> 4.Tägliche Bewertung <ol><li> Jeden Tag eine Auswertung und Beurteilung der Haut des Patienten und der Reaktion auf die Behandlung. Bewerten speziell für Empfindungen von Brennen, das die Unfähigkeit des Patienten, um Licht-Therapie, oder Juckreiz, Reizungen, die aus dem Teer und / oder Plastikfolie geben tolerieren hinweisen können. </li><li> Wenn ein Patient zeigte Anzeichen von Brennen (Brennen, signifikante Erhöhung Rötung, Juckreiz oder selten erhöht als Vorbote des drohenden burn wenn Dosimetrie weiter erhöht wird), Abnahme Phototherapie Dosis oder nicht geben Phototherapie an diesem Tag, so kann es durch verursacht worden eine phototoxische Reaktion auf die vorherige Dosis UV-Licht. </li><li> Es ist nicht ungewöhnlich für Patienten unterschiedlicher regionaler anatomischen Antworten und Verträglichkeit von Phototherapie müssen. Für eine optimale Behandlung, passen Sie die Höhe der Phototherapie Dosis ausgesetzt verschiedenen Regionen des Körpers nach Ansprechen des Patienten. Zum Beispiel, wenn ein Patient erfährt mild burning des Rumpfes, dann zuerst behandeln den ganzen Körper mit der abgesenkten Phototherapie Dosis, als decken den Stamm, und geben zusätzliches Licht auf die Extremitäten. </li></ol> 5. Discharge Planning und Wartung <ol><li> Weiter Goeckerman Therapie bis zur Krankheitsprogression wird gelöscht und Patient bereit ist, entladen werden. </li><li> Platz Patienten auf einem Wartungsprogramm, die ambulante Phototherapie und topische Medikamente umfassen kann </li><li> Verwalten ambulanten Phototherapie dreimal in der Woche (zumindest für den ersten Monat). Schließlich ist die Frequenz schrittweise verjüngt bis zweimal in der Woche und dann einmal pro Woche) </li><li> Ambulante topische Medikamente gehören: Triamcinolon Creme / Salbe auf den Körper zweimal täglich, um widerspenstige Clobetasol Läsionen (falls erforderlich) zweimal täglich, 20% in LCD Aquaphor auf den Körper und 20% in LCD nutraderm auf die Kopfhaut. </li><li> Innerhalb eines Monats nach Entladung, planen Sie ein Follow-up Arztbesuch mit dem Patienten, um Krankheiten Zustand überwachen. </li></ol>

<ol>
	<li>Parisi, R., Symmons, D. P., Griffiths, C. E., Ashcroft, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Global+Epidemiology+of+Psoriasis:+A+Systematic+Review+of+Incidence+and+Prevalence.">Global Epidemiology of Psoriasis: A Systematic Review of Incidence and Prevalence.</a> The Journal of Investigative Dermatology. , (2012).</li><li>H, G. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+treatment+of+psoriasis.">The treatment of psoriasis.</a> Northwest Med. 24, 229-230 (1925).</li><li>Koo, J., Lebwohl, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Duration+of+remission+of+psoriasis+therapies.">Duration of remission of psoriasis therapies.</a> Journal of the American Academy of Dermatology. 41, 51-59 (1999).</li><li>Menter, A., Cram, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Goeckerman+regimen+in+two+psoriasis+day+care+centers.">The Goeckerman regimen in two psoriasis day care centers.</a> Journal of the American Academy of Dermatology. 9, 59-65 (1983).</li><li>Lee, E., 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=Modern+modified+'ultra'+Goeckerman+therapy:+a+PASI+assessment+of+a+very+effective+therapy+for+psoriasis+resistant+to+both+prebiologic+and+biologic+therapies.">Modern modified 'ultra' Goeckerman therapy: a PASI assessment of a very effective therapy for psoriasis resistant to both prebiologic and biologic therapies.</a> The Journal of Dermatological Treatment. 16, 102-107 (2005).</li><li>Kim, I. H., West, C. E., Kwatra, S. G., Feldman, S. R., O'Neill, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+efficacy+of+biologics+in+psoriasis:+a+review.">Comparative efficacy of biologics in psoriasis: a review.</a> American journal of clinical dermatology. 13, 365-374 (2012).</li><li>Serrao, R., Davis, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Goeckerman+treatment+for+remission+of+psoriasis+refractory+to+biologic+therapy.">Goeckerman treatment for remission of psoriasis refractory to biologic therapy.</a> Journal of the American Academy of Dermatology. 60, 348-349 (2009).</li><li>Chern, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Positive+effect+of+modified+Goeckerman+regimen+on+quality+of+life+and+psychosocial+distress+in+moderate+and+severe+psoriasis.">Positive effect of modified Goeckerman regimen on quality of life and psychosocial distress in moderate and severe psoriasis.</a> Acta Dermato-venereologica. 91, 447-451 (2011).</li><li>Dennis, M., Bhutani, T., Koo, J., Liao, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Goeckerman+therapy+for+the+treatment+of+eczema:+a+practical+guide+and+review+of+efficacy.">Goeckerman therapy for the treatment of eczema: a practical guide and review of efficacy.</a> The Journal of Dermatological Treatment. , (2011).</li><li>Papp, K. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biologic+therapy+in+psoriasis:+perspectives+on+associated+risks+and+patient+management.">Biologic therapy in psoriasis: perspectives on associated risks and patient management.</a> Journal of Cutaneous Medicine and Surgery. 16, 153-168 (2012).</li><li>Menter, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+of+care+for+the+management+of+psoriasis+and+psoriatic+arthritis:+Section+5.+Guidelines+of+care+for+the+treatment+of+psoriasis+with+phototherapy+and+photochemotherapy.">Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. 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. Z., Muller, S. A., Perry, H. O., Pittelkow, M. R., O'Brien, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+skin+cancers+in+patients+with+atopic+dermatitis+treated+with+ocal+tar.+A+25-year+follow-up+study.">Incidence of skin cancers in patients with atopic dermatitis treated with ocal tar. A 25-year follow-up study.</a> Journal of the American Academy of Dermatology. 3, 612-615 (1980).</li><li>Pittelkow, M. R., Perry, H. O., Muller, S. A., Maughan, W. Z., O'Brien, P. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Skin+cancer+in+patients+with+psoriasis+treated+with+coal+tar.+A+25-year+follow-up+study.">Skin cancer in patients with psoriasis treated with coal tar. A 25-year follow-up study.</a> Archives of Dermatology. 117, 465-468 (1981).</li><li>Roelofzen, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=No+increased+risk+of+cancer+after+coal+tar+treatment+in+patients+with+psoriasis+or+eczema.">No increased risk of cancer after coal tar treatment in patients with psoriasis or eczema.</a> The Journal of Investigative Dermatology. 130, 953-961 (2010).</li></ol>

Dr. Koo ist ein Lautsprecher für Abbott, Leo und Stiefel-GSK. Dr. Koo forscht für Amgen, Janssen, Novartis, Photomedex, Galderma und Pfizer. Dr. Koo hat keine Lagerbestände, Beschäftigung, oder Aufsichtsratsmandate mit einem Pharma-Unternehmen. Keine Interessenkonflikte für alle anderen Autoren beschrieben.

Die Goeckerman Regimen Protokoll skizzierten an UCSF genutzt und kann in vielfältiger Weise nach Ansprechen des Patienten auf die Therapie verändert werden. Da der Patient gesehen und untersucht jeden Tag, kann das Protokoll für jeden Patienten individuell angepasst werden, um maximale Wirksamkeit zu gewährleisten. Die traditionelle Goeckerman Behandlung allein bestand aus dem Einsatz von CCT-und UVB-Phototherapie. 2 Allerdings ist die Therapie geändert wurde, um die Verwendung von topischen Kortikostero...

Psoriasis ist eine chronische, immun-vermittelte entzündliche Hauterkrankung, die bei etwa 2-3% der Bevölkerung. 1 Ein Drittel der Patienten Erfahrungen generalisierte Psoriasis, die lähmende körperliche und psychologische Effekte verursacht. Die Goeckerman Therapie, 1925 erstmals zur Behandlung von generalisierter Psoriasis veröffentlicht, besteht der Exposition gegenüber UV-B (UVB) Licht und Anwendung von rohem Kohlenteer (CCT). 2 Obwohl aktuelle interne Mittel wie Biologika die Behandlung von Psoriasis erhöht, Goeckerman Therapie bleibt als eine äußerst effektive Möglichkeit, gleichzeitig eine lange Dauer der Remission. 3,4 In einer veröffentlichten Studie an UCSF durchgeführt, erreicht 100% der Patienten unter Therapie Goeckerman PASI75 (75% ige Verbesserung der Psoriasis Beurteilung der Severity Index [PASI] vom Ausgangswert) von 3 Monaten. 5 Im Vergleich (wenn auch nicht Kopf an Kopf), erreichten die Patienten am stärksten Biologics nur 67-68% PASI75 in 3 months. 6 Die Goeckerman Regime hat einen schnellen Wirkungseintritt und hat mit Erfolg bei Patienten mit therapieresistenten Psoriasis refraktär Phototherapie oder interne Medikamente verwendet worden. 7 Die Goeckerman Regime hat auch eine extrem sichere Toxizität Profil mit im wesentlichen ohne interne Nebenwirkungen, die sind die weitere schwerwiegende Risiken mit anderen Psoriasis-Behandlungen zugeordnet. Darüber hinaus hat die Therapie gezeigt worden, um eine bedeutende und positive Auswirkungen auf die Lebensqualität der Patienten mit generalisierter Psoriasis haben. 8 Goeckerman Regime war früher 24 Stunden am Tag in einer stationären Einrichtung verabreicht werden, bis der Patient ihrer Psoriasis gelöscht wurde. Jedoch aufgrund von Änderungen in Erstattungen und Managed-Care-Patienten werden jetzt in Tageseinrichtungen für mindestens 4-8 Stunden / Tag und 5 Tage / Woche behandelt, bis ihre Krankheit löscht. Goeckerman Therapie wurde ursprünglich für die Behandlung von Psoriasis formuliert, aber eine modifizierte Versionwurde kürzlich für die Behandlung anderer Hauterkrankungen wie Ekzeme mit Erfolg eingesetzt. Das folgende Protokoll wird am UCSF speziell für Psoriasis eingesetzt, aber leichte Veränderungen in den Verfahren kann für Ekzeme, generalisierter Pruritus, Prurigo nodularis, Pityriasis lichenoides chronica, Erythrodermie und andere verwandte Erkrankungen der Haut abgestimmt werden. 9 Obwohl es eines der ältesten Therapien für Psoriasis ist, gibt es eine Abwesenheit von veröffentlichten Videos zeigen den Prozess. Ein Video kann einen breiten Anklang, da sie als eine Ressource für die Vermittlung im Gesundheitswesen Tätigen (Hausärzte und Dermatologen), um den Prozess zu verstehen und sich wohl fühlen und empfahl die Therapie verwendet werden kann. Ein Video demonstriert die Goeckerman Prozess wird auch instrumental für die Erziehung Bewohner und Studierende der Medizin, die nicht dem Regime ausgesetzt sind, da es nur wenige Institutionen verlassen, dass weiterhin diese Art von i bereitzustellen sindIntensivtierhaltung Therapie. Ein Video wird auch nützlich sein für potenzielle Patienten, die interessiert an Goeckerman Therapie sind.

<table border="1">
	<tbody>
		<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

Psoriasis ist eine chronische, immun-vermittelte entzündliche Hauterkrankung, die bei etwa 2-3% der Bevölkerung. Die Therapie besteht aus Goeckerman Exposition gegenüber UV-B (UVB) Licht und Anwendung von rohem Kohlenteer (CCT). Goeckerman Therapie ist äußerst effektiv und relativ sicher für die Behandlung von Psoriasis und zur Verbesserung eines Patienten Lebensqualität. Im folgenden Artikel präsentieren wir unser Protokoll für die Goeckerman Therapie, die speziell an der University of California, San Francisco eingesetzt. Dieses Protokoll Details der Vorbereitung von Lieferungen, die Verwaltung der Phototherapie und Anwendung von topischen Teer. Dieses Protokoll beschreibt auch, wie die Patienten täglich beurteilen, zu überwachen für Nebenwirkungen (einschließlich Juckreiz und Brennen), und stellen Sie die Behandlung auf die Reaktion des Patienten basieren. Obwohl es eines der ältesten Therapien für Psoriasis ist, gibt es eine Abwesenheit von veröffentlichten Videos Demonstration des Verfahrens in Detail. Das Video ist von Vorteil für Anbieter im Gesundheitswesen, die die Therapie verabreichen, für Auszubildende, die mehr über den Prozess erfahren möchten, und für potenzielle Patienten, die Behandlung für ihre Hautkrankheit unterziehen wollen.

In einer Studie in unserem Zentrum an der Universität von Kalifornien in San Francisco durchgeführt wurde PASI75 Ansprechen (eine 75% ige Verbesserung der Psoriasis Beurteilung Severity Index) in 100% der Patienten, die Goeckerman (n = 25) erreicht über eine 3-Monats-Zeitraum . 5 24/25 Patienten benötigten nur 2 Monaten bis PASI75 zu erreichen, während die übrigen Patienten eine PASI75 Antwort nach 3 Monaten erhalten. In einer anderen Studie, Menter et al. Den Goeckerman Therapie für 300 Patie...

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

Psoriasis ist eine chronische, immunvermittelte entzündliche Hauterkrankung. Die Goeckerman Therapie, zur Behandlung von Psoriasis formuliert, besteht der Exposition gegenüber UV-B (UVB) Licht und Anwendung von rohem Kohlenteer (CCT). Das folgende Protokoll ist für die Verwaltung der Goeckerman Therapie für die Behandlung von mittelschwerer bis schwerer Psoriasis.

Die Goeckerman Regimen für die Behandlung von mittelschwerer bis schwerer Psoriasis

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

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38.7K Aufrufe.  University of Southern California. Psoriasis ist eine chronische, immunvermittelte entzündliche Hauterkrankung. Die Goeckerman Therapie, zur Behandlung von Psoriasis formuliert, besteht der Exposition gegenüber UV-B (UVB) Licht und Anwendung von rohem Kohlenteer (CCT). Das folgende Protokoll ist für die Verwaltung der Goeckerman Therapie für die Behandlung von mittelschwerer bis schwerer Psoriasis.

Serie: 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.

Bronchial Thermoplastie: einen neuen therapeutischen Ansatz bis schwerem Asthma

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

Forschung

Medizin

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.

Thermische Ablation zur Behandlung von Abdominaltumoren

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.

Die Messung und Behandlung von Unterdrückung in Amblyopie

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.

Slow-Release-Drug Delivery durch Elvax 40W, um die Ratte Retina: Implikationen für die Behandlung von chronischen Erkrankungen

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.

Netzwerkanalyse von Foramen Ovale Elektrode Recordings in Resistente Temporallappen Epilepsie-Patienten

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 Phosphorylcholin Polymer-Behandlung von Complete Zahnersatz auf Inhibit Zahnersatz- Plaqueanlagerung

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.

Intense Pulsed Light für die Behandlung des trockenen Auges aufgrund der Meibom-Drüse Dysfunktion

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.

Etablierung eines Mausmodells für schwere akute Pankreatitis mittels retrograder Injektion von Natriumtaurocholat in den Gallengang

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.

Laparoskopie-Endoskopie Kooperative Chirurgie zur Behandlung von Magen-Darm-Stromatumoren

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.

Mikroskopische Zystenresektion zur Behandlung von Patienten mit Nebenhodenzyste

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