During the last three years, from 1967 to 1970, three hundred and three cases of psoriasis were treated by Goeckrman's regimen and oral methotrexate, 270 cases and 33 cases respectively. Authors evaluated the clinical effectivness and side effect of methotrexate and it compared with the result of Goeckermans method and review about the articles. Of the 303 psoriatics, 140 were male(44%) and 163 were female(55.6%). The majority of the primary manifestation appeared in 16 to 30 year .age group with maximal occurence in the 16 year to 20 year age group (53 cases), but 33 cases were noted below the 10 years old age(Fig.2). The duration of the disease in most cases was 1 to 10 years,but the highest number, in 72 cases, was 1 to 5 years group(Fig 3 A, 3 B). 40 cases was in below 6 months. The methotrexate were administered orally, 2. 5 mg. tab., twice daily(5 mg) for 5 to 7 days, followed by 3 to 5 days resting in accordance with the, patient's condittion. The Goeckerman regirnen of 2% coal tar and 2% salicylic acid in vaselin applied to whole skin lesions in the night and the excess tar was removed frorn skin by gentle wiping with a gauze pat, saturated with Arachis oil, in the next morning, follawed by ultra-violet ray irradiation for 30 second at first day, then the dose increased 30 second daily to reach 5 min. After the ultra-violet irradiation bath was done, and one hour later 2% coal tar and 2% salicylic acid vaselin were applied again. These schedules were repeated 2 to 3 courses (20 to 30 days) in mast cases. In occasion of Goeckerman treatment, among the completely cleared 93 cases during the preveous treatment, the most cases were recurred within 3 to 12 months but 16 cases within 1 month. In occasion of methotrexate, the lesions recurred within 6 months to 2 years in 17 cases of the 33 cases, but 3 cases were within one month after completely cured preveously. The starting of remission, in Goeckerman methods, was noted within 7 to 14 days in most cases(13 cases), and in 3 cases it started within 3 to 4 days. And the completely clearing of the lesions noted within 20 to 25 days in most cases(16 to 21 cases). The starting of remission, in methotrexate treatment of 33 cases, was occurred within 1 to 2 weeks in most cases(27 cases), and completely clearing of lesions noticed within 14 ta 20 days in 28 cases. But in 2 cases it needed only 7 days to make completely clearing the skin lesions. The side effects of the Goeckerman's method were as follow : 1) Contact dermatitis due to tar hypersensitivity in 3 cases. 2) Mild local burn due to over dose irradiation of ultra-violet ray in 5 eases, otherwise no appreciable side effects were noted. The side effecst of methotrexate were noted in 17 cases among the 33 cases. 1) Aphtous ulcer in 4 cases, 2) Peptic ulcer in one case, 3) Tinitus in one case, 4) Other side effects such as dizziness, loss of appetite, headache, fatiguability were notable in 10 cases. 5) In addition to above mentioned sidle effects the blood chemistry include L.P.T., wbc count, platelet count, ESR, Hgb, and creatinine showed as follow before and after administration of methotrexate. a) The white blood cells, platelet count were tend to decrease after the administration of methotrexate than before one. b) Among 33 cases the SGPT levels were checked in 16 cases, and in most cases it raised more and less than before the administration of methotrexate, but only 8 cases were ahove the normal ranges(35 units). The SGOT level also raised after one course, but only 8 cases were above normal ranges(40 units). c) Hgb, ESR, creatinine showed no remarkable changes. In many references the effects and side effects of methotrexate were discussed, but their view were not uniform and variable. In the clinical improvement, recurrency, and side effects, the large single weekly dose of methotrexate had no fundamental differences compare with the author's small daily doses. We agree with the Ryan's report(11), in which the large single dose were not always safer and more effective than the small dose. Still there are many important problems to study about the dosage, interval of administration, and resting period in the treatment of psoriasis with methotrexate.
Alanine Transaminase ; Appetite ; Appointments and Schedules ; Arachis ; Aspartate Aminotransferases ; Baths ; Burns ; Chemistry ; Child ; Coal Tar ; Creatinine ; Dermatitis, Contact ; Dizziness ; Headache ; Humans ; Hypersensitivity ; Leukocytes ; Methotrexate* ; Peptic Ulcer ; Platelet Count ; Psoriasis* ; Salicylic Acid ; Skin ; Ulcer ; Ultraviolet Rays

Talus tuberculosis is a rare disease, even in an endemic tuberculosis area. In reviews of the worldwide literature, only 18 cases of talus tuberculosis have been reported. Recently, we experienced a case of a 70-year-old polycythemia vera patient with right metatarsopharyngeal joint pain for 2 months duration who was diagnosed with talus tuberculosis with prostate involvement. Tuberculosis should be considered as one of the causes of monoarticulitis, especially in countries, where the disease is endemic. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.
Aged ; Arthralgia ; Biopsy ; Early Diagnosis ; Humans ; Osteomyelitis ; Polycythemia ; Polycythemia Vera ; Prostate ; Rare Diseases ; Talus ; Tarsal Bones ; Tuberculosis

Diabetic neuropathy is one of the most common complications of diabetic mellitus and has myriad clinical presentations. Amitriptyline is an effective drug for painful diabetic neuropathy, but has a wide variety of cardiovascular effects. We report a case of amitriptyline-induced ventricular tachycardia in a patient with painful diabetic neuropathy. A 48-year-old man with no history of heart disease was treated with amitriptyline for the past 2 months. The dosage of this drug was gradually increased and the maximal dose was 170 mg per day. Prior to administration of this drug, his chest X-ray and electrocardiogram were normal. On admission he complained of chest discomfort and palpitation for 3 days, but his vital sign was stable. The electrocardiogram showed a wide QRS complex with a rate of 170 beats per minute. The ventricular tachycardia was successfully treated with electrical cardioversion.
Amitriptyline* ; Diabetic Neuropathies* ; Electric Countershock ; Electrocardiography ; Heart Diseases ; Humans ; Middle Aged ; Tachycardia, Ventricular* ; Thorax ; Vital Signs

PURPOSE: The purpose of this study was to examine differences in the perceived importance and frequency of nurse role behaviors for medical and surgical nurses and to examine the relationship between perceived importance and frequency of nurse role behaviors in the two groups. METHOD: A descriptive design was used with convenience sampling of 351 medical and surgical nurses in the 40 hospitals with over 500 beds. Data were collected using a structured questionnaire. RESULTS: 1) The total score for perceived importance of nurse role behaviors was 4.09+/-.53 for medical nurses and 4.13+/-.53 for surgical nurses. 2) The total score for frequency was 3.15+/-.54 for medical nurses and 3.24+/-.56 for surgical nurses. 3) The perceived importance of nurse role behaviors was higher than the frequency, but the difference between two groups was not significant. 4) The perceived importance of nurse role behaviors was highly correlated with frequency (r=.579, p=.000) for the two groups. CONCLUSION: Medical and surgical nurses perceived the importance nurse role behavior but the frequency of the behavior is lower. Therefore, further research is needed to develop strategies to increase the frequency of nurse role behaviors.
Nurse's Role* ; Surveys and Questionnaires

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Background: Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM). Methods: From March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated. Results: In total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9± 14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, –1.1%±1.2%; P<0.001). The number of patients with HbA1c <7% increased significantly from 5 to 68 (P<0.005). In addition, lipid profiles and liver enzyme levels were also improved whereas no changes in body weight. There was no significant safety issue in patients treated with quadruple OHA therapy. Conclusion This study shows the therapeutic efficacy of the quadruple OHA regimen T2DM and demonstrates that it can be an option for the management of T2DM patients who cannot use insulin or reject injectable therapy.

Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).