Vorremmo ringraziare il personale della Psoriasi UCSF e trattamento della pelle Centro per il lavoro svolto in particolare la nostra Goeckerman Coordinatore, Sarah Hulse RN

1. La valutazione e la preparazione <ol><li> Eseguire una storia completa e fisica prima di iniziare la terapia. Nella storia e fisica, documento informazioni importanti come i farmaci attuali / passato, la risposta alle terapie psoriasi passato, una storia di reazioni avverse alla luce del sole ambiente o fototerapia, la gravità del prurito, e la qualità del sonno. </li><li> Impostare una stanza clinica con tutto il materiale necessario per l&#39;applicazione cutanea di farmaci e occlusione [Vedere la sezione Materiali e Figura 1]. Inoltre, inserire altri materiali nella stanza come guanti, Pellicole di plastica, calze, e scrub / abiti pigiama. </li><li> Valutare il paziente per l&#39;eritema diffuso e intenso prima di iniziare la terapia. </li><li> Se il paziente manifesta eritema diffuso o intenso, eseguire una procedura di &quot;raffreddare&quot; (vedi sotto) finché l&#39;eritema è significativamente ridotta. Se nessun eritema diffuso e intenso è visto, procedere con il &quot;+ fototerapia tar&quot; step. </li&gt; </ol> 2. Cool Down (se necessario) <ol><li> Applicare corticosteroidi topici per le zone colpite. Applicare triamcinolone 0,1% unguento al tronco e agli arti, desonide 0.05% crema / unguento per il viso / ascelle / inguine e fluocinolone 0,01% di olio o di triamcinolone 0,1% lozione per il cuoio capelluto. Riserva clobetasolo 0,05% unguento per le aree con l&#39;infiammazione più intensa. </li><li> Occludere i farmaci topici con pellicola trasparente per il tronco e le estremità, guanti impermeabili per i tappi a mano e doccia all&#39;interno di calzini per i piedi, e una cuffia per la doccia per il cuoio capelluto. </li><li> Raffreddare il paziente fino a quando l&#39;eritema è significativamente ridotta (range 3-14 giorni). </li></ol> 3. Fototerapia + Tar <ol><li> Dopo che il paziente finisce il periodo di raffreddamento, amministrare fototerapia al giorno al mattino prima della domanda di catrame di carbone grezzo [Figura 2]. Opzioni includono fototerapia UVB a banda stretta (più comunemente usato in psoriASIS) oa banda larga UVB (più comunemente usato in eczema). Determinare la dose iniziale di fototerapia da Fitzpatrick tipo di pelle [vedi Tabella 1 e Tabella 2]. </li><li> Titolare lentamente le dosi fototerapia successive verso l&#39;alto, come tollerato. Regime di dosaggio e il calendario devono essere individualizzata in base alla risposta del paziente alla fototerapia. </li><li> Dopo la fototerapia, applicare catrame di carbone grezzo 2% (CCT) in Aquaphor localmente per le aree colpite del corpo [Figura 3]. Se il paziente ha il coinvolgimento del cuoio capelluto, applicare il 20% di liquido carbonis detergens (LCD) in nutraderm al cuoio capelluto. </li><li> Inizialmente, utilizzare 2% CCT (resistenza più bassa). Su successivi giorni di trattamento, aumentare la resistenza del catrame tollerato dal paziente dal 2% al 5%, poi al 10% per ottenere risultati migliori. </li><li> Per le zone ispessite di psoriasi, usare tar composto con acido salicilico (2% / 5% / 10% di acido salicilico) per contribuire a ridurre la scala e indurimento delle placche. Inizialmente utilizzare preparazioni di2% di acido salicilico con il 10% CCT e titolare la percentuale di acido salicilico fino tollerato dal paziente nei giorni successivi. L&#39;acido salicilico può essere controindicato in pazienti con ulcere da diabete o gastriche. </li><li> Occludere tar topico nello stesso modo descritto nel passo 2.2 per la procedura di raffreddamento. </li><li> Tenere farmaci topici sulla pelle per almeno 4 ore. Dopo un minimo di 4 ore, rimuovere i materiali di occlusione e di lavare via il catrame sotto la doccia con olio minerale e sapone [Figura 4]. </li><li> Dare al paziente LCD 20% in Aquaphor e il 20% LCD in nutraderm applicare sul corpo e del cuoio capelluto, rispettivamente, a casa. </li><li> I pazienti con eczema tendono ad avere la pelle sensibile. Utilizzare 2% CCT inizialmente per pazienti affetti da eczema. Fare attenzione quando si titolazione fino al 5% CCT, come i pazienti con eczema tendono ad avere la pelle sensibile. Non utilizzare il 10% CCT (o qualsiasi percentuale di CCT superiore al 5%) e non utilizzare i preparati con acido salicilico. </li></ol> 4.Valutazione giornaliera <ol><li> Ogni giorno, una valutazione e di valutare la pelle e la risposta al trattamento del paziente. Valutare specificamente per le sensazioni di bruciore, che può indicare l&#39;incapacità del paziente di tollerare la terapia della luce, o prurito, che può indicare l&#39;irritazione dal catrame e / o pellicola trasparente. </li><li> Se un paziente espone i segni di bruciatura (sensazione di bruciore, eritema significativo aumento, o raramente aumentato prurito come un presagio di ustione imminente se dosimetria è aumentata ulteriormente), la dose fototerapia diminuzione o non dare fototerapia quel giorno, come può essere stato causato da una reazione fototossica alla precedente dose di luce UV. </li><li> Non è raro per i pazienti di avere diverse risposte anatomiche regionali e tollerabilità alla fototerapia. Per il trattamento ottimale, regolare la quantità di dose di fototerapia esposti a differenti regioni del corpo in base alla risposta del paziente. Ad esempio, se un paziente presenta lievi burning del tronco, quindi prima trattare tutto il corpo con la dose fototerapia abbassata, che copre il tronco, e dare luce supplementare alle estremità. </li></ol> 5. Progettazione e manutenzione di scarico <ol><li> Continuare la terapia Goeckerman fino malattia viene cancellata e il paziente è pronto per essere scaricato. </li><li> Posizionare i pazienti in un programma di manutenzione, che possono includere ambulatoriale fototerapia e farmaci topici </li><li> Amministrare ambulatoriale fototerapia tre volte alla settimana (almeno per il primo mese). Alla fine, la frequenza è diminuita gradualmente fino a due volte a settimana e poi una volta a settimana) </li><li> Ambulatoriali farmaci topici comprendono: Triamcinolone crema / unguento per il corpo due volte al giorno, Clobetasol per lesioni recalcitranti (se necessario) due volte al giorno, il 20% LCD in Aquaphor per il corpo e il 20% LCD in nutraderm al cuoio capelluto. </li><li> Entro un mese dalla dimissione, programmare una visita di controllo medico con il paziente per il monitoraggio dello stato della malattia. </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>

Dott. Koo è un altoparlante per Abbott, Leo, e Stiefel-GSK. Dott. Koo svolge attività di ricerca per la Amgen, Janssen, Novartis, PhotoMedex, Galderma, e Pfizer. Dott. Koo non ha scorte, occupazione, o di società appartenenze con qualsiasi società farmaceutica. Nessun conflitto di interessi diffusi per altri autori.

Il protocollo Regimen Goeckerman delineato sopra è utilizzato a UCSF e può essere variata in diversi modi a seconda della risposta del paziente alla terapia. Poiché il paziente è visto ed esaminato ogni giorno, il protocollo può essere personalizzato per ciascun paziente per garantire la massima efficacia. Il trattamento tradizionale Goeckerman unicamente consisteva l&#39;uso di CCT e fototerapia UVB. 2 Tuttavia, il regime è stato modificato per includere l&#39;uso di corticosteroidi topici (e talvolta ...

La psoriasi è una malattia immuno-mediata cronica infiammatoria della pelle che colpisce circa il 2-3% della popolazione. 1 Un terzo dei pazienti sperimentano psoriasi generalizzata che provoca effetti fisici e psicologici debilitanti. Il regime Goeckerman, pubblicato nel 1925 per il trattamento della psoriasi generalizzata, consiste di esposizione a B (UVB) luce ultravioletta e applicazione di catrame di carbone grezzo (CCT). 2 Sebbene agenti interni più recenti come biologici hanno migliorato il trattamento della psoriasi, La terapia Goeckerman rimane come un&#39;opzione estremamente efficace, fornendo al contempo una lunga durata della remissione. 3,4 In uno studio pubblicato condotto presso UCSF, il 100% dei pazienti in terapia Goeckerman raggiunto PASI 75 (il 75% di miglioramento della valutazione Psoriasi di Severity Index [PASI] dal basale) da 3 mesi. 5 In confronto (anche se non un testa a testa), i pazienti in più potenti farmaci biologici ottenuti solo 67-68% PASI 75 nel 3 monTHS. 6 Il regime Goeckerman ha una rapida insorgenza ed è stato utilizzato con successo nei pazienti con psoriasi resistente al trattamento refrattari alla fototerapia o interne farmaci. 7 Il regime Goeckerman ha anche un profilo di tossicità estremamente sicuro con essenzialmente senza effetti collaterali interni, che sono i più gravi rischi associati con altri trattamenti per la psoriasi. Inoltre, la terapia ha dimostrato di avere un effetto significativo e positivo sulla qualità della vita dei pazienti con psoriasi generalizzata. 8 Goeckerman regime è stato precedentemente somministrato 24 ore al giorno presso una struttura ospedaliera fino a quando il paziente è stato scagionato da loro psoriasi. Tuttavia, a causa di cambiamenti di rimborsi e di managed care, i pazienti sono ora trattati in strutture di asilo nido per un minimo di 4-8 ore / giorno e 5 giorni / settimana fino a quando la malattia scompare. La terapia Goeckerman stato inizialmente formulato per il trattamento della psoriasi, ma una versione modificataè stato recentemente utilizzato per il trattamento di altre malattie della pelle come eczema con successo. Il seguente protocollo è utilizzato presso UCSF specificamente per la psoriasi, ma lievi modifiche alle procedure può essere adattata per l&#39;eczema, prurito generalizzato, prurigo nodulare, pitiriasi lichenoide Chronica, eritrodermia, e altri disturbi della pelle correlati. 9 Se è uno dei più antichi terapie disponibili per la psoriasi, vi è una mancanza di video pubblicati dimostrano il processo. Un video può avere un ampio ricorso in quanto può essere utilizzato come risorsa per riferimento gli operatori sanitari (medici di medicina generale e dermatologi) per capire il processo e stare tranquillo raccomandare la terapia. Un video che dimostra il processo Goeckerman sarà anche strumentale per educare i residenti e studenti di medicina che non sono esposti al regime in quanto ci sono solo poche istituzioni rimaste che continuano a fornire questo tipo di iterapia ntensive. Un video sarà anche utile per i pazienti futuri che sono interessati a ricevere 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 psoriasi è una, immuno-mediata malattia della pelle infiammatoria cronica che colpisce circa il 2-3% della popolazione. Il regime Goeckerman consiste di esposizione a B (UVB), la luce ultravioletta e l&#39;applicazione di catrame di carbone grezzo (CCT). Goeckerman terapia è estremamente efficace e relativamente sicuro per il trattamento della psoriasi e per migliorare la qualità della vita del paziente. Nel seguente articolo, vi presentiamo il nostro protocollo per la terapia Goeckerman che viene utilizzata specificamente presso l&#39;Università della California, San Francisco. Dettagli Questo protocollo la preparazione delle forniture, somministrazione di fototerapia e l&#39;applicazione topica di catrame. Questo protocollo descrive inoltre come valutare il paziente ogni giorno, monitorare gli effetti avversi (compresi prurito e bruciore), e regolare il trattamento in base alla risposta del paziente. Se è uno dei più antichi terapie disponibili per la psoriasi, vi è una mancanza di video pubblicati dimostrando il processo in detaIL. Il video è vantaggioso per gli operatori sanitari che vogliono somministrare la terapia, per i tirocinanti che vogliono saperne di più sul processo, e per i potenziali pazienti che desiderano sottoporsi a cure per la loro malattia cutanea.

In uno studio eseguito presso il nostro centro presso l&#39;Università della California di San Francisco, una risposta PASI 75 (un miglioramento del 75% nella psoriasi valutazione Severity Index) è stato raggiunto nel 100% dei pazienti trattati con Goeckerman (n = 25) per un periodo di tempo di 3 mesi . 5 24/25 pazienti necessari solo 2 mesi per ottenere PASI 75, mentre il restante paziente ha ottenuto una risposta PASI 75 a 3 mesi. In un altro studio, Menter et al. Somministrato il regime Goeckerm...

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 psoriasi è una malattia della pelle infiammatoria immunomediata cronica. Il regime Goeckerman, formulata per il trattamento della psoriasi, consiste di esposizione a B (UVB) luce ultravioletta e applicazione di catrame di carbone grezzo (CCT). Il seguente protocollo è per la somministrazione della terapia Goeckerman per il trattamento di moderata-grave della psoriasi.

Il Regimen Goeckerman per il trattamento di moderata a grave psoriasi

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

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

Research

JoVE Journal

Medicine

38.7K Views.  University of Southern California. La psoriasi è una malattia della pelle infiammatoria immunomediata cronica. Il regime Goeckerman, formulata per il trattamento della psoriasi, consiste di esposizione a B (UVB) luce ultravioletta e applicazione di catrame di carbone grezzo (CCT). Il seguente protocollo è per la somministrazione della terapia Goeckerman per il trattamento di moderata-grave della psoriasi.

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.

Termoplastica bronchiale: un nuovo approccio terapeutico per l&#39;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 ...

Ricerca

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.

Ablazione termica nel trattamento dei tumori addominali

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 misurazione e trattamento di soppressione in Ambliopia

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.

Lento rilascio Drug Delivery attraverso Elvax 40W al Rat Retina: Implicazioni per il trattamento di condizioni croniche

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.

Network Analysis di forame ovale elettrodi Recordings in farmaco-resistenti epilessia del lobo temporale pazienti

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-metacriloilossietil fosforilcolina Polymer Trattamento di protesi totale per l&#39;inibizione della protesi Plaque Deposizione

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 luce pulsata per il trattamento dell'occhio asciutto a causa di disfunzione della ghiandola Meibomian

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.

Creazione di un modello di pancreatite acuta grave del topo mediante iniezione retrograda di taurocolato di sodio nel dotto biliopancreatico

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.

Laparoscopia-endoscopia Chirurgia Cooperativa per il Trattamento dei Tumori Stromali Gastrointestinali Gastrici

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.

Resezione microscopica della cisti per il trattamento di pazienti con diagnosi di cisti epididimica

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