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Various effective therapeutic treatments in the disorder of the Parknsosn's disease are important, but it is more important to keep the partient in good physical condition. The patient should admit the reality, and be told that the disease is developing very slow and doesn't have any metal or the Possibility of prevention and / or detention of the disorder should be emphasized. The patient needs to be led to overcome the worry, anxiety, gear over the disease and to participate in social activities as frequently as possible.
The palpation of spinous process and transverse process of vertebra are important part of the assesment and treatment from Orthopedic manual therapy. But the palpation area is descriptive differently each of literatures. So we generally got these outcomes. : There are C2, C3, C4 and C6 process as a bony landmarks and these are important part of establish the precise location of pain appears from cervical spine. Even though C7 process regard a prominent part, it is hard to distinguish C6 and process of T1. Thru that differentiation, grab the patient's forehead and try them cervical and hyper-extension check any movement of process or put on the fingers on C7 preocess and check the movement. The palpation of thoracic spine process is the land mark which determines general level orientation in the spine easily, there are T2, T7 spinous process. However, It is depends on how do you test the patient's arm when you palpate it and it can effect on spinous process. The transverse process of C1 is the only spot for palpation in cervical spine, and T1-3, T12 transverse process can palpate it when it stands on the process. The end of T4-6, T11 is placed on middle on vertebra of transverse process and transverse process. T7-9, T10 transverse process is place on same position as spinous process which is upper part of the spine.
The Skin Concentration and Minimal Phototoxic Dose Following Administration of Phototoxic Drugs as a Function of Time Yoon-Kee Park, M.D., Moo Yon Cho, M.D., Saung Kyung Hann, M.D., Sungbin im, M.D. Department of Dermatology Yonsei Univeraity College of Medicine, Seoul, Korea Psoralen photochemotherapy(PUVA) is defined as a treatment that depends on the interaction of a photosensitizing substance, psoralen, and long wave jltraviolet(UVA) radiation that results in therapeutically beneficial effects. The rationale of its use is to clear skin disease by repeated controlled phototoxic reactions. The efficacy of PUVA depends on the drug, the UVA dose and wave length, the individual sensitivity to the phototoxic reaction and on the disease to be treated. However, the major factor is the amount of psoralen at the site of photochemical reaction in skin. Daspite the extensive experiences which have now accumulated in the use of PUVA, the relationship between the therapeutic response and phototoxicity as it occurs in normal skin is not established. Comparative data on different psoralen molecules and their skin sensitizing ability are required. From studies on the skin concentration using HPLC and minimal phototoxic dose following oral administration, intraperitoneal administration, a bath of phototoxic drugs as a function of time in guinea pigs, the following results are obtained. 1. The skin concentration of phototoxic drugs after oral administration peaked at 1.5 hours, and the concentration of 8-methoxypsoralen(8-MOP) was 3.7 times greater than that of 5-methoxypsoralen(5-MOP). The skin concetration of 4,5,8-trimethylpsoralen(TMP) was not detected in this study(limit of sensitivity 5ng/g). 2. The skin conentration of phototoxic drugs after intraperitoneal administration peaked at 30 minutes, and the concentration of 8-MOP was slightly greater than that of 5-MOP. The skin concentration of TMP was not detected in this study(limit of sensitivity 5ng/g). 3. The skin concentration of phototoxic drugs after bathing peaked immediately after bathing, and the skin concentrations of phototoxic drugs after bathing decreased in the order of 5-MOP, TMP, and 8-MOP. 4. The minimal phototoxic dose of phototoxic drugs after oral administration was lowest at 1.5 hours, and the minimal phototoxic dose of 8-MOP was 8 times less than 5-MOP, 24 times less than TMP. The phototoxicity of 8-Mop after oral administration was strongest. The time of lowest phototoxic dose and highest skin concentration was the same. 5. The minimal phototoxic dose of phototoxic drugs after intraperitoneal administration was lowest at 30 minutes, and the minimal phototoxic dose of 8-MOP was 1.3 times less than 5-MOP, 5.7 times less than TMP. The phototoxicity of 8-MOP after intraperitoneal administration was strongest. The time of lowest phototoxic dose and highest skin concentration was same. 6. The minimal phototoxic dose of phototoxic drugs after bathing was lowest at 15 minutes. The minimal phototoxic dose of 8-MOP was not significantly different but was significantly greater than that of 5-MOP.
We evaluated the treatment schedule of a 4 week course of methotrexate followed by UVB radiation therapy on 18 patients of generalized psoriasis. The patients received the weekly triple doses of methotrexa,te(MTX), 5 mg given every 12 hours for three doses on weekend for 3 weeks. On 4 th weekend, the doses was halved to 2.5 mg every 12 hours for three doses, and then stopped. After a 4 week course of methotrexate, total doses 52.5 mg, UVB treatment was commenced. The results are as follows: 1. 13 patients showed clearing of psoriatic involvolvement over 50, after 4 week course of MTX therapy. 2. Complete clearing of skin lesions was achieved in all 18 patients with the average,$quot;j, 8 times of UVB exposure in trunk and 5 6 times in extremities respect ively. 3. The average dose of UVB exposure at clearance was 187 mJ/cm in trunk lesion and 263.6 mJ/cm in extremities, The mean cummulative dose of UVB exposure at clearance was 800.7 mJ/cm in trunk lesion and 994.3 mJ/cm in extremities. In conculuaion, the brief 4 week course of MTX allows for clearing of psoriasis at relatively low dose of UVR, and thus may reduce the long-term cumrnulative toxicity of both agents.
A 13 years old girl came to our department with complaints of multiple ulcerating and non-ulcerating nodules on her back and buttocks since 1 month prior to visit. Skin biopsy specimen showed diffuse monomorphous infiltration of leukemic cells in the dermis and subcutis. Bone marrow biopsy specimen showed changes of erythroleukemia. Treatment was initiated with combined chemotherapy which was a combination of cytosine arabinoside, adriamyein and 6 thioguanine. When combined chemotherapy was finished, she was in complete remission state and the nodules cured after 1 month of combined chemotherapy.
Granuloma pyogenicum is a benign vascular tumor, usually about 0.5 to 2cm in diameter. It occurs as a single lesion with few exceptions and consists of pedunulated nodule with a dull red or slightly purplish color. We observed a 29-year old man who had multiple satellite recurrences in the scapular region which developed after excision of a single lesion of granuloma pyogenicum. Histapathologic findings showed many newly formed capillaries that had prominant endothelial cells and showed varying degrees of dilation without appearance of epiderrnal collarette sign. The lesions were much improved by X-ray irradiation.