Nos gustaría dar las gracias al personal de la UCSF y de la Piel Psoriasis Treatment Center por su trabajo, especialmente nuestro coordinador Goeckerman, Sarah Hulse RN

1. Evaluación y Preparación <ol><li> Realizar una historia clínica completa y físico antes de iniciar el tratamiento. En la historia y, documento de información física importante como los medicamentos actuales / pasadas, la respuesta a anteriores terapias psoriasis, cualquier antecedente de reacciones adversas a la luz ambiente o la fototerapia, la gravedad del prurito y la calidad del sueño. </li><li> Crear una sala clínica con todo el material necesario para la aplicación dérmica de los medicamentos y la oclusión [véase la sección de Materiales y Figura 1]. Colocar además otros materiales en la sala, como guantes, envolturas de plástico, calcetines y peelings / vestidos de pijama. </li><li> Evaluar al paciente para eritema difuso e intenso antes de comenzar la terapia. </li><li> Si el paciente presenta eritema generalizado o intensa, realizar un procedimiento de &quot;enfriamiento&quot; (ver más abajo) hasta que el eritema se reduce significativamente. Si no se observa eritema generalizado o intensa, continúe con el paso &quot;fototerapia + tar&quot;. </li&gt; </ol> 2. Enfríe (si es necesario) <ol><li> Aplicar los corticosteroides tópicos a las zonas afectadas. Aplicar triamcinolona 0,1% pomada para el tronco y las extremidades, desonida 0,05% de crema / ungüento en la cara / axilas / la ingle, y 0,01% de aceite de fluocinolona o triamcinolona 0,1% loción para el cuero cabelludo. Reserva de clobetasol 0,05% pomada para las áreas con la más intensa inflamación. </li><li> Ocluir los medicamentos tópicos con una envoltura de plástico para el tronco y las extremidades, guantes impermeables para las tapas de mano y ducha dentro de los calcetines para los pies, y una gorra de baño para el cuero cabelludo. </li><li> Enfriar el paciente hasta que se reduzca significativamente el eritema (rango de 3-14 días). </li></ol> 3. Fototerapia + Tar <ol><li> Después de que el paciente termina el período de enfriamiento, administrar fototerapia día por la mañana antes de la aplicación de alquitrán de hulla crudo [Figura 2]. Opciones fototerapia UVB de banda estrecha son (más comúnmente utilizado en psoriasis) o UVB de banda ancha (más comúnmente usado en el eccema). Determinar la dosis inicial de fototerapia por Fitzpatrick tipo de piel [ver Tabla 1 y Tabla 2]. </li><li> Lentamente titule las dosis de fototerapia al alza que se toleran. Régimen de dosificación y el horario deben individualizarse según la respuesta del paciente a la fototerapia. </li><li> Después de la fototerapia, aplicar el 2% de alquitrán de hulla crudo (CCT) en Aquaphor tópicamente a las zonas afectadas del cuerpo [Figura 3]. Si el paciente tiene participación cuero cabelludo, aplicar 20% de líquido carbonis detergens (LCD) en Nutraderm en el cuero cabelludo. </li><li> Inicialmente, el 2% del AAC (resistencia baja). En posteriores días de tratamiento, aumentar la fuerza de la brea según la tolerancia del paciente a partir de 2% a 5% y luego al 10% para lograr mejores resultados. </li><li> Para las áreas engrosadas de la psoriasis, usar tar compuesto con ácido salicílico (2% / 5% / ácido salicílico 10%) para ayudar a reducir la escala y la induración de las placas. Inicialmente utilizar preparaciones de2% de ácido salicílico con 10% CCT, y valorar el porcentaje de ácido salicílico como tolerado por el paciente en los días posteriores. El ácido salicílico puede estar contraindicado en pacientes con diabetes o úlceras gástricas. </li><li> Ocluir alquitrán tópico de la misma manera como se describe en el paso 2.2 para el procedimiento de enfriamiento hacia abajo. </li><li> Mantenga los medicamentos tópicos en la piel durante al menos 4 horas. Después de un mínimo de 4 horas, retire los materiales de oclusión y lavar el alquitrán en la ducha con aceite mineral y jabón [Figura 4]. </li><li> Dale la pantalla LCD 20% paciente en Aquaphor y 20% de LCD en Nutraderm para aplicar sobre el cuerpo y el cuero cabelludo, respectivamente, en el hogar. </li><li> Los pacientes con eccema tienden a tener la piel sensible. Utilice 2% CCT inicialmente para pacientes con eccema. Tenga cuidado al fijar la dosis hasta un 5% CCT, ya que los pacientes con eccema tienden a tener la piel sensible. No use 10% CCT (o cualquier porcentaje de CCT superior al 5%) y no utilizar cualquier preparación con ácido salicílico. </li></ol> 4.Evaluación diaria <ol><li> Cada día, lleve a cabo una evaluación y evaluar la piel y la respuesta al tratamiento del paciente. Evaluar específicamente para las sensaciones de ardor, que pueden indicar la incapacidad del paciente para tolerar la terapia de luz o picazón, que puede indicar la irritación de la brea y / o una envoltura de plástico. </li><li> Si un paciente presenta síntomas de ardor (quemazón, eritema significativo aumento, o rara vez mayor picor como un presagio de la inminente quemadura si dosimetría es aún mayor), la dosis de fototerapia disminución o no dan fototerapia ese día, ya que puede haber sido causado por una reacción fototóxica a la dosis de luz UV anterior. </li><li> No es infrecuente que los pacientes tienen diferentes respuestas anatómicas regionales y la tolerabilidad a la fototerapia. Para el tratamiento óptimo, ajustar la cantidad de la dosis de fototerapia expuestos a diferentes regiones del cuerpo de acuerdo a la respuesta del paciente. Por ejemplo, si un paciente experimenta bu leveRT ENCIA del tronco, luego la primera a tratar todo el cuerpo con la dosis de fototerapia baja, que cubre el tronco, y dar más luz a las extremidades. </li></ol> 5. Planificación del alta y mantenimiento <ol><li> Continuar la terapia Goeckerman hasta que se borre la enfermedad y el paciente está listo para ser dado de alta. </li><li> Coloque los pacientes en un programa de mantenimiento, que pueden incluir la fototerapia ambulatoria y medicamentos tópicos </li><li> Administrar fototerapia ambulatorio tres veces a la semana (por lo menos durante el primer mes). Con el tiempo la frecuencia se reduce gradualmente hacia abajo a dos veces por semana y luego una vez a la semana) </li><li> Medicamentos tópicos para pacientes externos incluyen: crema de triamcinolona / ungüento en el cuerpo dos veces al día, clobetasol a lesiones recalcitrantes (si es necesario) dos veces al día, 20% de LCD en Aquaphor para el cuerpo y el 20% en Nutraderm LCD para el cuero cabelludo. </li><li> Un mes después de la descarga, programar una visita de seguimiento médico con el paciente para supervisar estado de enfermedad. </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 es un altavoz para Abbott, Leo y Stiefel-GSK. Dr. Koo realiza investigación de Amgen, Janssen, Novartis, Photomedex, Galderma, y ​​Pfizer. Dr. Koo no tiene existencias, el empleo, o membresías de mesa con ninguna compañía farmacéutica. No hay conflictos de interés revelados por cualquier otros autores.

El régimen de Goeckerman protocolo descrito anteriormente se utiliza en la UCSF y se puede variar de múltiples maneras según la respuesta del paciente a la terapia. Dado que el paciente es visto y examinado todos los días, el protocolo puede ser individualizada para cada paciente para asegurar la máxima eficacia. El tratamiento tradicional Goeckerman únicamente consistía en el uso de CCT y fototerapia UVB. 2 Sin embargo, el régimen se ha modificado para incluir el uso de corticosteroides tópicos (y, ...

La psoriasis es una enfermedad crónica, inmune mediada inflamatoria de la piel que afecta a aproximadamente el 2-3% de la población. 1 Un tercio de los pacientes experimentan la psoriasis generalizada que causa efectos físicos y psicológicos debilitantes. El Goeckerman régimen, publicado por primera vez en 1925 para el tratamiento de psoriasis generalizada, consiste en la exposición a (UVB) y la aplicación de alquitrán de hulla crudo (CCT) ultravioleta B. 2 Aunque los agentes internos más recientes, como la biología han mejorado el tratamiento de la psoriasis, terapia Goeckerman permanece como una opción muy eficaz, al tiempo que proporciona una larga duración de la remisión. 3,4 En un estudio publicado realizado en la UCSF, el 100% de los pacientes en tratamiento con Goeckerman logró PASI 75 (75% de mejora de la evaluación del Índice de Severidad de Psoriasis [PASI] desde el inicio) a los 3 meses. 5 En comparación (aunque no cara a cara), los pacientes en los tratamientos biológicos más poderosos lograron sólo 67 a 68% PASI 75 en 3 lun. mls 6 El régimen de Goeckerman tiene un inicio rápido y se ha utilizado con éxito en pacientes con psoriasis resistente al tratamiento refractarios a fototerapia o interno medicamentos. 7 El régimen de Goeckerman también tiene un perfil de toxicidad extremadamente seguro esencialmente sin efectos secundarios internos, que son los riesgos más graves asociados con otros tratamientos de la psoriasis. Por otra parte, la terapia se ha demostrado que tienen un efecto significativo y positivo en la calidad de vida de los pacientes con psoriasis generalizada. 8 Goeckerman régimen se administra antes de 24 horas de un día en un centro hospitalario hasta que el paciente se borró de su psoriasis. Sin embargo, debido a los cambios en los reembolsos y de atención médica administrada, los pacientes son tratados en instalaciones de la guardería por un mínimo de 4-8 horas / día y 5 días / semanas hasta que su enfermedad se cura. Terapia Goeckerman se formuló inicialmente para el tratamiento de la psoriasis, pero una versión modificadase ha utilizado recientemente para el tratamiento de otras condiciones de la piel tales como eczema con éxito. El siguiente protocolo se utiliza en la UCSF específicamente para la psoriasis, pero pequeños cambios en los procedimientos se puede adaptar para el eczema, prurito generalizado, prurigo nodular, pitiriasis liquenoide crónica, eritrodermia, y otros trastornos de la piel relacionados. 9 A pesar de que es una de las más antiguas terapias disponibles para la psoriasis, hay una ausencia de cualquier vídeos publicados que demuestran el proceso. Un vídeo puede tener un gran atractivo, ya que puede ser utilizado como un recurso para los profesionales de la salud se refiere (médicos de atención primaria y dermatólogos) para entender el proceso y se sienten cómodos recomendando la terapia. Un video que demuestra el proceso Goeckerman también será fundamental para educar a los residentes y estudiantes de medicina que no están expuestos a la pauta ya que sólo hay unas pocas instituciones dejan que siga prestando este tipo de iLa terapia intensiva de. Un video también será beneficioso para los pacientes potenciales que están interesados ​​en recibir la terapia Goeckerman.

<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

La psoriasis es una enfermedad crónica, inmune mediada inflamatoria de la piel que afecta a aproximadamente el 2-3% de la población. El régimen Goeckerman consiste en la exposición a (UVB) y la aplicación de alquitrán de hulla crudo (CCT) ultravioleta B. Terapia Goeckerman es extremadamente eficaz y relativamente seguro para el tratamiento de la psoriasis y para mejorar la calidad de vida de un paciente. En el siguiente artículo, presentamos nuestro protocolo para la terapia Goeckerman que se utiliza específicamente en la Universidad de California, San Francisco. Detalles del presente Protocolo, la preparación de los suministros, la administración de la fototerapia y la aplicación tópica de alquitrán. Este protocolo también se describe la forma de evaluar al paciente todos los días, para vigilar los efectos adversos (incluyendo prurito y ardor), y ajustar el tratamiento según la respuesta del paciente. A pesar de que es una de las más antiguas terapias disponibles para la psoriasis, hay una ausencia de cualquier vídeos publicados que demuestran el proceso en detail. El video es beneficioso para los profesionales médicos que quieren administrar el tratamiento, para los alumnos que quieren aprender más sobre el proceso, y de los posibles pacientes que quieren someterse a un tratamiento para su enfermedad cutánea.

En un estudio realizado en nuestro centro en la Universidad de California en San Francisco, se logró la respuesta PASI 75 (una mejora del 75% en el Índice de Severidad de Psoriasis) en el 100% de los pacientes que recibieron Goeckerman (n = 25) durante un período de tiempo de 3 meses . 5 24/25 pacientes necesitan sólo 2 meses para lograr PASI 75, mientras que el paciente restante obtuvo una respuesta PASI 75 a los 3 meses. En otro estudio, Menter et al. Administró el régimen de Goeckerman para ...

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

La psoriasis es una enfermedad cutánea inflamatoria crónica de naturaleza inmune. El Goeckerman régimen, formulado para el tratamiento de la psoriasis, consiste en la exposición a (UVB) y la aplicación de alquitrán de hulla crudo (CCT) ultravioleta B. El siguiente protocolo es para la administración de la terapia Goeckerman para el tratamiento de la psoriasis moderada a severa.

El Régimen Goeckerman para el tratamiento de psoriasis moderada a grave

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

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38.7K vistas.  University of Southern California. La psoriasis es una enfermedad cutánea inflamatoria crónica de naturaleza inmune. El Goeckerman régimen, formulado para el tratamiento de la psoriasis, consiste en la exposición a (UVB) y la aplicación de alquitrán de hulla crudo (CCT) ultravioleta B. El siguiente protocolo es para la administración de la terapia Goeckerman para el tratamiento de la psoriasis moderada a severa.

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.

Bronquial termoplastia: un nuevo enfoque terapéutico para el asma grave

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

Investigación

Medicina

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.

La ablación térmica para el tratamiento de los tumores abdominales

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.

La medición y tratamiento de la represión en la ambliopía

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.

De liberación lenta Drug Delivery través Elvax 40W a la Rata Retina: Implicaciones para el tratamiento de condiciones crónicas

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.

Análisis de la red de foramen oval de electrodos Grabaciones en epilepsia del lóbulo temporal pacientes resistentes a los medicamentos

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-metacriloiloxietil fosforilcolina Tratamiento Polímero de dentaduras completas para inhibir la dentadura placa Deposición

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.

Intensa luz pulsada para el tratamiento del ojo seco debido a la disfunción de la glándula de Meibomio

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.

Establecimiento de un modelo de pancreatitis aguda grave en ratones mediante inyección retrógrada de taurocolato de sodio en el conducto biliopancreático

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.

Cirugía cooperativa laparoscopia-endoscopia para el tratamiento de tumores del estroma gástrico gastrointestinal

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.

Resección microscópica de quistes para el tratamiento de pacientes diagnosticados con quiste epididimario

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