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Materials and Methods Patients. A protocol using topical bath water delivery ofpsoralens plus UVA irradiation in patients with moderate to severe psoriasis was approved by The RockefellerUniversity Hospital Institutional Review Board. All patients entered into this protocol had either failed management with topical agents or had such extensivediseasethat managementwith topicalagentswas not feasible. Patients were at least 18 yrs old ranging from 28 to 74 age ; and had no pre-existing photosensitizing diseases, history of melanoma squamous cell carcinoma, or evidence of cataracts before therapy. If patients were skin types I or II, or if they were on any potentiallyphotosensitizing medications, a smallarea on their backs was phototested before the initiation of therapy. Procedures. If patients met entry criteria, they underwent pretreatment biopsies and were begun on therapy three times per week. Patients bathed in 200 liters of water at body temperature, to which the dissolved8-methoxypsoralen 8-MOP ; had been added final concentration, 0.5 rag liter ; . UVA was deliveredwith a phototherapy unit model 57000; Psoralite, Columbia, SC ; using an initial UVA dose of 0.5 J cm2 as recently described 30 ; . Clinical evaluations and photographs were performed weekly to assess efficacy.Diseaseactivity was assessedby quantitating percent body coverage by degrees oferythema, scaling, and skin thickness in the psoriatic plaques. Each was rated by assigning a score from 1 to 7 based upon severity as follows: 1, absent; 2, trace, 3, mild; 4, mild to moderate; 5, moderate; 6, moderate to severe; and 7, severe. The scores for erythema, scaling, and skin thickness were summed for a maximum obtainable score of 21 and a minimum of 3. The sum was called the severityindex 27 ; . The patients were treated until complete resolution of their diseasetook place, or until it became clear that treatment was ineffective. Immunoperoxidase Studies. Immunoperoxidase studies of freshfrozen skin biopsies were done using the VectastainABC kit Vector Laboratories, Burlingame, CA ; as described 4, 31 ; . IL-2R + , CD3 CD4 + , and CD8 + T cells were quantitated by averaging the number of positively staining cells in three x40 fields in each of three regions-epidermis, dermo-epidermaljunction, and dermis. Statistics were performed using either the Parametric t test, or the WflcoxonSign Rank Test if the data were not normaUydistributed. The antibodiesdirectedagainst HLA-DR 4 ; , IL-2R 4 ; , Langerhans cells 4 ; , K16 2, 32 ; , TGF-cx 33 ; , involucrin 34 ; , filaggrin 34 ; , Ib6 31 ; , IGF-I receptors 35 ; , and EGF receptors 35 ; have been reported previously. Epidermal Thickness. Measurements were made directly on cryostat-processedbiopsy specimensusing a calibrated microscope micrometer. The thickness of the stratum corneum, and stratum Malpighi were calculated in four separate areas of each biopsy and averaged. Pre- and posttreatment measurements were performed on lesional and nonlesional skin. In Vitro Cell Culture and UVA Irradiation. Human keratinocytes were cultured as previously described in keratinocyte growth medium KGM; Clonetics, Corp., San Diego, CA ; 35 ; and were used after the first or second subculture. Mononuclear leukocytes from human blood were prepared by centrifugation on Ficoll den.

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Or compensatory techniques to improve the level of independence in the activities of daily living. B. In all cases, therapy must be designed to achieve a specific diagnosisrelated goal for a patient who has a reasonable expectation of achieving measurable improvement in a reasonable and predictable period of time. The treatment provided must be specific, effective, and reasonable for the patient's diagnosis and physical condition. This study is not 8 table of contents designed to demonstrate statistically significant differences in efficacy as compared to placebo and tylenol.

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Jain, 2007 WL 1248413, * 8, |26 Pa. Super. 2007 Freed v. Geisinger Medical Center, 910 A.2d 68, 72 Pa. Super. 2006 Birt v. Firstenergy Corp., GPU, Inc., 891 A.2d 1281, 1287 Pa. Super. 2006 ; . An abuse of discretion "may not be found merely because an appellate court might have reached a different conclusion, but requires a result of manifest unreasonableness, or partiality, prejudice, bias, or ill-will, or such lack of support so as to clearly erroneous." Jacobs v. Chatwani, 922 A.2d 950, 960 Pa. Super. 2007 Freed, supra. In addition, to constitute reversible error, an evidentiary ruling must not only be erroneous, but also harmful or prejudicial to the complaining party." Winschel, supra; Jacobs, supra. The scope and limits of cross-examination are likewise within the discretion of the trial court which should confine the scope of cross-examination to subjects addressed on direct examination. See McManamon v. Washko, 906 A.2d 1259, 1277 Pa. Super. 2006 ; , app. denied, 921 A.2d 497 Pa. 2007 Carroll v. Avallone, 869 A.2d 522, 528 Pa. Super. 2005 ; . Pennsylvania Rule of Evidence 611 b ; governs the scope of cross-examination of witnesses and specifically provides that "[cjross-examination of a witness other than a party in a civil case should be limited to the subject matter of the direct examination and matters affecting credibility." Pa. R.E. 611 b ; . Instantly, Dr. Miller did not discuss the degree of force used by Dr. Magalski in extracting the tooth, nor did he express any opinion relating to that subject. Indeed, since Dr. Miller's pre-trial report made no reference to the extent of force exerted by Dr. Magalski, Dr. Miller would not have been permitted to address that topic on direct examination. See Pa. R.C.P. 4003.5 c ; stating that "the direct testimony of the expert at the trial may not be inconsistent with or go beyond the fair scope of his or her. parate report, or supplement thereto." ; . Thus, it was not an abuse of discretion or direct examination. If Dr. Miller had mentioned or analyzed Dr. Magalski's use of force in his pre-trial report and defense counsel had intentionally or inadvertently failed to question him on that matter during direct examination, the issue of excessive force would have been an appropriate area of inquiry on cross-examination. SeeChicchi v. SEPTA, 727 A.2d 604, 607-608 Pa. Cmwlth. 1999 ; although expert was not questioned about certain medical information on direct examination, he could be cross-examined about that information since it was referenced in his pre-trial report ; , app. denied, 560 Pa. 750, 747 A.2d 371 1999 ; . Similarly, if Dr. Miller had voluntarily raised the subject of force during his direct or cross-examination, the issue of unreasonable force would have been legitimate fodder for cross-examination, even if it had not been mentioned in Dr. Miller's pre-trial report. See Rittenhouse v. Hanks, 777 A.2d 1113, 1117-18 Pa. Super. 2001 ; party opened the door to evidence concerning post-treatment standard of care by raising issue during questioning of medical witness Foster v. City of Pittsburgh, 162 Pa. Cmwlth. 553, 558-559, 639 A.2d 929, 932 1994 ; plaintiff motorist's direct examination of police officer regarding his high rate of speed in pursuing driver, in an attempt to prove that officer violated Motor Vehicle Code, opened door to cross-examination as to whether officer activated siren and warning lights, notwithstanding claim that such cross examination permitted defendant to present its defense during motorist's case in chief ; , app. denied, 538 Pa. 660, 648 A.2d 791 1994 ; . Accord, Commonwealth v. Fletcher, 580 Pa. 403, 433-434, 861 A.2d 898, 915-916 2004 ; defendant's mother could be cross-examined about defendant's prior conviction where mother testified on direct examination that defendant was not "the type of person to go around harming people." ; , cert, denied, 547 U. S. 1041 2006 ; . However, that was not the case in the matter sub judice in that Dr. Miller did not reference the question of force in his report or direct testimony. 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If you are sensitive to or have ever had an allergic reaction to naprosyn, ec-naprosyn, anaprox, anaprox ds, or aleve, you should not take this drug. Thomas L. Petty, MD Thomas L. Petty received his md at the University of Colorado in 1958. He interned at Philadelphia General Hospital and received his residency training at the University of Michigan and the University of Colorado. His pulmonary training was at the University of Colorado. He is a pulmonologist and Professor of Medicine at the University of Colorado Health Sciences Center in Denver and at Rush University in Chicago. He was previously Head of the Division of Pulmonary Sciences at the University of Colorado and Director of the Fellowship Training Program. Dr. Petty was founding President of the Association of Pulmonary Program Directors appd ; , and has served as President of the American College of Chest Physicians. He is a former member of the Board of Governors of the American Board of Internal Medicine. Dr. Petty received the Distinguished Service Award of the American Thoracic Society 1995 ; , was elected to the Colorado Pulmonary Physicians' "Hall of Fame" 1995 ; and received the annual award for excellence by the American Association for Respiratory and Cardiovascular Rehabilitation 1995 ; and the designation of faarc in 1999. He was elected to Master Fellow of the American College of Chest Physicians 1995 ; . He also received the Master Award of the American College of Physicians in 1996. Dr. Petty has been named Chairman of the National Lung Health Education Program nlhep ; . Its goal is the early diagnosis of copd and lung cancer. He is also Editor-inchief of the newsletter, Lung Cancer Frontiers. Today, Dr. Petty also remains active in teaching, patient care and research. He enjoys fishing, small game hunting and playing with his three "kids" and eight grandchildren.

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