我々は、特に我々のGoeckermanコーディネーター、サラハルスRN自分の仕事のためにUCSF乾癬や皮膚治療センターのスタッフに感謝したいと思います

1。評価と準備<ol><li>完全な歴史と前治療を開始する物理を実行します。歴史と、現在/過去の薬のような物理的、文書の重要な情報、過去の乾癬治療への応答、周囲日光や光線療法、そう痒の重症度、および睡眠の質への副作用のいずれかの歴史の中で。 </li><li>薬や閉塞[参照マテリアルセクションおよび図1]の皮膚適用のために必要なすべての材料と診療室をセットアップします。また、手袋、ラップ、靴下、そしてスクラブ/パジャマのガウンのような部屋に他の材料を配置する。 </li><li>前に治療を開始する拡散と激しい紅斑のために患者を評価する。 </li><li>患者が広まったり、強烈な紅斑を呈する場合、紅斑が大幅に減少するまで、 &quot;クールダウン&quot;の手順（下記参照）を行ってください。全く広まっまたは強烈な紅斑が見られない場合は、 &quot;光線療法+タール&quot;のステップに進みます。 </李&gt; </ol> 2。クールダウン（必要な場合） <ol><li>被災地への局所コルチコステロイドを適用します。体幹と四肢、顔面/腋窩/鼠径部へデソニド0.05％クリーム/軟膏、そして頭皮にフルオシノロン0.01％オイルやトリアムシノロン0.1％ローションにトリアムシノロン0.1％軟膏を適用します。最も強烈な炎症領域引当クロベタゾール0.05％軟膏。 </li><li>足に靴下の内側の手とシャワーキャップと頭皮のためのシャワーキャップのための体幹と四肢、不浸透性の手袋のためにラップで外用薬を塞ぐ。 </li><li>紅斑が有意（3-14日の範囲）減少するまで患者を冷やす。 </li></ol> 3。光線療法+タール<ol><li>患者がクールダウン期間が終了した後、原油コールタールのアプリケーション[ 図2]の前に午前中に毎日の光線療法を管理することができます。光線療法のオプションはナローバンドUVB（最も一般psoriで使用を含むASIS）またはブロードバンドUVB（最も一般的に湿疹で使用）。フィッツパトリック皮膚のタイプによって初期光線療法投与量を決定〔 表1と表2を参照してください]を。 </li><li>ゆっくり上向きとして容認その後の光線療法の用量を滴定。投与計画とスケジュールは光線療法に対する患者の応答に基づいて個別化する必要があります。 </li><li>光線療法の後、身体の被災地[ 図3]に局所aquaphorで2％粗製コールタール（CCT）を適用。患者は頭皮の関与がある場合は、頭皮にnutradermで20％液体carbonis detergens（LCD）を適用。 </li><li>当初は、2％CCT（最低強度）を使用します。患者によって許容として後段の治療の日に、良好な結果を達成するために、2％〜5％、次いで10％のタールの強度を高める。 </li><li>乾癬の肥厚領域については、プラークのスケーリングと硬結を軽減するためにサリチル酸（2％/ 5％/ 10％サリチル酸）を配合したtarを使用しています。当初の準備を使用2％サリチル酸10％CCTと酸、およびその後の日に患者によって許容としてサリチル酸の割合（％）を滴定する。サリチル酸は、糖尿病や胃潰瘍のある患者には禁忌される。 </li><li>手順ダウン冷却工程2.2に記載したのと同じ方法で、局所的なタールを塞ぐ。 </li><li>少なくとも4時間皮膚に外用薬を保管してください。 4時間の最小値の後、閉塞物質を除去し、[ 図4]鉱物油と石鹸でシャワーでタールを洗い流してください。 </li><li>自宅で、それぞれ、体と頭皮に適用するaquaphorにおける患者の20％、LCDとnutraderm 20％の液晶を与える。 </li><li>湿疹患者は敏感な肌を持っている傾向がある。湿疹患者のために、最初は2％CCTを使用します。湿疹の患者は敏感な肌を持っている傾向があるように、5％CCTまで滴定するときは注意してください。 10％CCT（または5％より高いCCTのいずれかの割合）を使用しないでくださいとサリチル酸を持つ任意の製剤を使用しないでください。 </li></ol> 4。毎日のアセスメント<ol><li>毎日、評価を実行し、患者の皮膚および処置に対する応答を評価する。タールおよび/ ​​またはラップから刺激を示すことができる光療法を容認するために患者の無力を示すことができる燃焼の感覚、またはかゆみ 、のために特別に評価します。 </li><li>患者の兆候を示した場合、それがによって引き起こされた可能性があるので、（線量測定がさらに増加すると差し迫った火傷の前触れとしての感覚、著しい増加紅斑、またはめったに増加しないかゆみを燃焼）燃焼減少光線療法の用量またはその日の光線療法を与えていない以前の紫外線量に光毒性反応。 </li><li>患者は光線療法とは異なる地域の解剖学的応答性と忍容性を持つことは珍しいことではありません。最適な治療のために、患者の反応に応じて、身体のさまざまな地域にさらされる光線線量の量を調整します。例えば、患者が軽度のBUが発生する場合トランクのrning、その後最初のトランクをカバーするのではなく、低下光線療法の用量で体全体を治療し、四肢に追加の光を与える。 </li></ol> 5。退院計画とメンテナンス<ol><li>病気がクリアされるまでGoeckerman療法を継続し、患者が排出されて準備ができています。 </li><li>外来光線療法と外用薬を含むことができ、メンテナンスプログラムの上に置いて患者、 </li><li> （少なくとも最初の月のために）外来光線療法を週に三回を管理します。最終的には周波数が徐々に週に二度にダウンしてテーパーしてから週1回）です。 </li><li>外来外用薬が含まれます：反抗病変クロベタゾール回毎日体にトリアムシノロンクリーム/軟膏、（必要な場合）を2回、毎日、身体や頭皮にnutraderm 20％のLCDにaquaphor 20％の液晶。 </li><li>放電ヶ月以内に、病気の状態を監視するために、患者と医師の訪問をフォローアップスケジュール。 </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>

博士クーはアボット、レオ、そしてスティーフェル·GSK用のスピーカーです。博士クーはアムジェン、ヤンセン、ノバルティス、Photomedex、ガルデルマとファイザーの研究を行っています。博士クーは製薬会社でない株式、雇用、またはボードのメンバーシップを持っていません。利害の衝突は、他の作家のために開示されません。

上記で概説GoeckermanレジメンプロトコルはUCSFで利用され、治療に対する患者の反応に応じて複数の方法で変更することができる。患者が見られ、毎日検査されるので、プロトコルは、最大の効果を確実にするために、各患者のために個別化することができる。従来のGoeckerman処理は、単にCCTおよびUVB光線療法の使用から成っていた。2しかしながら、レジメンは、ステロイド外?...

乾癬は、人口の約2〜3％に影響を与える慢性、免疫介在性炎症性皮膚疾患である。1人の患者の3分の1が衰弱物理的および心理的影響の原因となる一般的な乾癬を経験。最初に一般的な乾癬の治療のために1925年に出版さGoeckermanレジメンは、紫外線B（UVB）光と原油コールタールのアプリケーション（CCT）への暴露から構成されています2は、そのような生物学的製剤などの新しい内部エージェントが乾癬の治療を強化してきたが、寛解の長い持続時間を提供しながら、Goeckerman療法は、極めて効果的な選択肢として残っている。UCSFで行われた発表された研究では、3,4、Goeckerman治療を受けている患者の100％がPASI75（75％重要度指数の乾癬の評価の改善を達成した[PASI] 3ヶ月）のベースラインから。比較で5（ただし、頭に頭）、最も強力な生物製剤の患者は、3月だけで67から68パーセントPASI75を達成しましたトレーダー。6 Goeckermanレジメンは、迅速な発現を有し、光線療法または内部薬に抵抗性治療抵抗性乾癬を有する患者において成功して利用されている。7 Goeckermanレジメンでもある本質的に内部副作用と非常に安全な毒性プロファイルを有する他の乾癬治療に関連付けられているより深刻なリスク。さらに、治療は一般化された乾癬患者の生活の質に重要な正の効果を有することが示されている。8 患者が自分の乾癬がクリアされるまでGoeckermanレジメンは、以前入院施設で一日24時間投与した。自分の病気が解消されるまでただし、払い戻しの変化により、ケア管理、患者は今4-8時間/日、5日/週、最低保育施設で処理されています。 Goeckerman療法は当初は乾癬の治療ですが、修正版のために処方されました最近、このような成功を収めて湿疹のような他の皮膚状態の治療のために使用されている。以下のプロトコルは、乾癬のために特別にUCSFで利用されているが、手続きはわずかに変化は湿疹、一般的なそう痒、結節性痒疹、慢性苔癬状粃糠疹、紅皮症、およびその他の関連する皮膚疾患のために調整することができます。9 それは乾癬のために利用できる最も古い治療法の一つですが、プロセスを示す任意のパブリッシュされたビデオが存在しないことがあります。それはプロセスを理解し、治療を推奨快適に感じるように医療従事者を参照するためのリソース（プライマリケア医と皮膚科医）として使用することができ、ビデオは、広範な魅力を持つことができます。私のこのタイプを提供し続けることが残された唯一のいくつかの機関があるのでGoeckermanプロセスを示すビデオも養生法にさらされていない住民や医学生の教育のために尽力されますntensive療法。ビデオはまたGoeckerman療法を受けに興味を持っている将来の患者のために有益なものとなる。

<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

乾癬は、人口の約2〜3％に影響を及ぼす慢性の、免疫媒介性炎症性皮膚疾患である。 Goeckermanレジメンは原油コールタール（CCT）の紫外線B（UVB）ライトおよびアプリケーションへの暴露から構成されています。 Goeckerman療法は、乾癬の治療のための患者の生活の質を改善するための非常に効果的で比較的安全である。次の記事では、カリフォルニア大学、サンフランシスコで特に利用されているGoeckerman療法のための我々のプロトコルを提示する。このプロトコルの詳細物資の準備、局所タールの光線療法とアプリケーションの管理。このプロトコルはまた、日常の患者を評価する副作用（痒みと燃焼を含む）のために監視し、患者の応答に基づいて治療を調整する方法について説明します。それは乾癬のために利用できる最も古い治療法の一つですが、DETAでプロセスを実証する任意のパブリッシュされたビデオが存在しないことがありますIL。ビデオは治療を管理する医療提供のために、プロセスに関する詳細を知りたい研修生のための、そして彼らの皮膚疾患の治療を受けることを望む将来の患者のために有益である。

カリフォルニア大学サンフランシスコ校で私たちのセンターで行われた研究では、PASI75応答（乾癬アセスメント重大度指数の75％改善）が3ヶ月の期間にわたってGoeckerman（N = 25）を受けた患者の100％で達成された5 24/25患者は、残りの患者は3ヶ月でPASI75レスポンスを得ながら、PASI75を達成するためにわずか2ヶ月必要としていました。別の研究では、デクリメンタらは 300人の患者...

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

乾癬は、慢性の免疫媒介性炎症性皮膚疾患である。乾癬の治療のために処方Goeckermanレジメンは、原油コールタール（CCT）の紫外線B（UVB）ライトおよびアプリケーションへの暴露から構成されています。以下のプロトコルは、中等度から重度の乾癬の治療のためGoeckerman療法の投与用である。

中等度から重度の乾癬の治療のためにGoeckermanレジメン

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 ビュー.  University of Southern California. 乾癬は、慢性の免疫媒介性炎症性皮膚疾患である。乾癬の治療のために処方Goeckermanレジメンは、原油コールタール（CCT）の紫外線B（UVB）ライトおよびアプリケーションへの暴露から構成されています。以下のプロトコルは、中等度から重度の乾癬の治療のためGoeckerman療法の投与用である。

ビデオ: 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.

気管支熱形成術：重篤な喘息の新しい治療アプローチ

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

医学

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.

腹部腫瘍の治療のための熱的アブレーション

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.

弱視における抑制の測定と治療

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.

ラット網膜へのエルバックス40Wを通じて徐放性ドラッグデリバリー：慢性症状の治療のための含意

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.

薬剤耐性側頭葉てんかん患者における孔開存電極レコーディングのネットワーク解析

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.

義歯プラーク沈着を阻害するための総義歯の2-メタクリロイルオキシエチルホスホリルコリンポリマートリートメント

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

Trans-Tympanic Drug Delivery for the Treatment of Ototoxicity

The systemic administration of protective agents to treat drug-induced ototoxicity is limited by the possibility that these protective agents could interfere with the chemotherapeutic efficacy of the primary drugs. This is especially true for the drug cisplatin, whose anticancer actions are attenuated by antioxidants which provide adequate protection against hearing loss. Other current or potential otoprotective agents could pose a similar problem, if administered systemically. The application of various biologicals or protective agents directly to the cochlea would allow for high levels of these agents locally with limited systemic side effects. In this report, we demonstrate a trans-tympanic method of delivery of various drugs or biological reagents to the cochlea, which should enhance basic science research on the cochlea and provide a simple way of directing the use of otoprotective agents in the clinics. This report details a method of trans-tympanic drug delivery and provides examples of how this technique has been used successfully in experimental animals to treat cisplatin ototoxicity.

We present a technique for localized administration of drugs through the trans-tympanic route into the cochlea. Drug delivery through this route would not interfere with the anti-cancer efficacy of the chemotherapeutic drugs such as cisplatin.

難聴の治療のためのトランス鼓膜ドラッグデリバリー

The systemic administration of protective agents to treat drug-induced ototoxicity is limited by the possibility that these protective agents could ...

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.

強烈なパルス光マイボーム腺機能不全によりドライアイの治療のため

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.

ビリオ膵管へのタウロコール酸ナトリウムの逆行性注入を用いたマウス重症急性膵炎モデルの確立

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.

胃腸間質腫瘍の治療のための腹腔鏡内視鏡検査共同外科

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