ABSTRACT
BACKGROUND: Glycolic acid (GA) peel is one of the most versatile agents in the treatment of melasma. GA peeling alone or in combination with topical hypopigmenting agents has shown encouraging results. However, there is paucity of controlled trial demonstrating the efficacy of glycolic peel in conjunction with topical azelaic acid (AA). We therefore sought to highlight the efficacy and safety of this combination in melasma. OBJECTIVE: To assess the clinical efficacy, safety and reduction in melasma quality of life (MELASQOL) scores on combining serial GA peels with topical 20% AA cream in epidermal melasma. MATERIALS AND METHOD: Sixty patients of epidermal melasma were enrolled for 24 weeks. Patients were divided into two groups: (1) Study group received serial GA peel every 3 weeks with twice daily 20% AA cream, and (2) control group received only 20% AA cream. Clinical improvement was assessed objectively using Melasma Area Severity Index (MASI). Melasma-related quality of life was measured by MELASQOL scale in both groups. Side effects were observed at each visit. RESULTS: The improvement in MASI and percentage decrease in MASI scoring were statistically significant 12 weeks onwards in study group as compared to control group. There was also a significant reduction in MELASQOL scores in study group as compared to control group after treatment. Minor reversible side effects were observed in both groups, which did not require cessation of therapy. CONCLUSION: GA peel enhances therapeutic efficacy of topical AA cream for treatment of melasma, with improvement in quality of life without serious side effects.
Subject(s)
Chemexfoliation , Dermatologic Agents/administration & dosage , Dicarboxylic Acids/administration & dosage , Glycolates/therapeutic use , Keratolytic Agents/therapeutic use , Melanosis/therapy , Administration, Cutaneous , Adult , Chemexfoliation/adverse effects , Combined Modality Therapy/adverse effects , Dermatologic Agents/adverse effects , Dicarboxylic Acids/adverse effects , Female , Glycolates/adverse effects , Humans , Keratolytic Agents/adverse effects , Male , Middle Aged , Prospective Studies , Quality of Life , Severity of Illness Index , Skin Cream/administration & dosage , Skin Cream/adverse effects , Young AdultABSTRACT
PURPOSE: We aimed to evaluate the efficacy of computed tomography (CT)-guided percutaneous lung biopsy of pulmonary nodules with indeterminate radiologic characteristics in patients at risk for malignant and nonmalignant processes such as infection or inflammation. PATIENTS AND METHODS: From January 2003 to September 2008, 262 patients (mean age, 59 years; range, 18-92 years) with pulmonary nodules or a mass of uncertain etiology and with indeterminate radiologic characteristics underwent CT-guided percutaneous lung biopsy. Patients with discordant clinical history and imaging findings or immunocompromised patients at risk for both etiologies were included. Specimens were submitted for both cytology and microbiology. RESULTS: Of the entire cohort, 166 patients (63.4%) had a nonmalignant process, and 96 patients (36.6%) had a malignancy. CT-guided percutaneous lung biopsy established a diagnosis in 166 patients (63.4%). Of the 166 patients with a nonmalignant etiology and 96 patients with malignancy, it provided a definitive diagnosis in 91 patients (54.8%) and 75 patients (78.1%), respectively, a difference that was statistically significant (P = .0001). Overall diagnostic efficacy between immunocompetent and immunocompromised patients was comparable (P = .2); however, detection of infection or inflammation in individual groups was lower compared with detection of malignancy (P = .002 and P = .06, respectively). CONCLUSION: CT-guided percutaneous lung biopsy in patients who are clinically at risk for both nonmalignant and malignant processes continues to be a challenge. Although CT-guided percutaneous biopsy can establish an accurate diagnosis in a large majority of patients with malignancy, it is significantly less sensitive for infectious or inflammatory processes.
Subject(s)
Immunocompromised Host , Lung Neoplasms/diagnosis , Lung Neoplasms/immunology , Lung/pathology , Solitary Pulmonary Nodule/pathology , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Female , Humans , Immunocompetence , Lung/diagnostic imaging , Lung Neoplasms/surgery , Male , Middle Aged , Radiography, Interventional , Solitary Pulmonary Nodule/diagnostic imaging , Young AdultABSTRACT
The diagnosis of pelvic congestion syndrome (PCS) continues to challenge all physicians involved especially those in such specialties as anesthesia, gastroenterology, general surgery, obstetrics and gynecology, and interventional radiology. When other pelvic pathology is ruled out, an interventional radiologist may be consulted for additional evaluation and treatment of PCS. A heightened awareness and clinical suspicion for the specific symptomatology and associated findings may bring about a more rapid progression toward treatment. For most interventional radiologists who treat PCS patients, magnetic resonance imaging/MR venography (MRI/MRV), diagnostic venogram, and embolotherapy are at the center of diagnosis and treatment of PCS.
