Interstitial lung abnormalities after hospitalization for COVID-19 in patients with cancer: A prospective cohort study.

INTRODUCTION: Survivors of SARS-CoV-2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS-CoV-2 infection are not well described in immunocompromised hosts, such as cancer patients. METHODS: We conducted a prospective cohort study of 95 patients at a major cancer center and 45 patients at a tertiary referral center. We collected clinical and radiographic data during the index hospitalization for COVID-19 pneumonia and measured pneumonia severity using a semi-quantitative radiographic score, the Radiologic Severity Index (RSI). Patients were evaluated in post-COVID-19 clinics at 3 and 6 months after discharge and underwent comprehensive pulmonary evaluations (symptom assessment, chest computed tomography, pulmonary function tests, 6-min walk test). The association of clinical and radiological factors with ILAs at 3 and 6 months post-discharge was measured using univariable and multivariable logistic regression. RESULTS: Sixty-six (70%) patients of cancer cohort had ILAs at 3 months, of whom 39 had persistent respiratory symptoms. Twenty-four (26%) patients had persistent ILA at 6 months after hospital discharge. In adjusted models, higher peak RSI at admission was associated with ILAs at 3 (OR 1.5 per 5-point increase, 95% CI 1.1-1.9) and 6 months (OR 1.3 per 5-point increase, 95% CI 1.1-1.6) post-discharge. Fibrotic ILAs (reticulation, traction bronchiectasis, and architectural distortion) were more common at 6 months post-discharge. CONCLUSIONS: Post-COVID-19 ILAs are common in cancer patients 3 months after hospital discharge, and peak RSI and older age are strong predictors of persistent ILAs.

The Use of the Transfemoral Transcaval Liver Biopsy Technique for Biopsies of Hepatic Masses.

The purpose of this study was to investigate the safety and effectiveness of the transfemoral transcaval (TFTC) liver biopsy technique in patients with hepatic masses with relative contraindications to percutaneous biopsy and/or mass location abutting the inferior vena cava. The medical records of 16 patients (56% men; age range, 21-88 years) who underwent TFTC biopsy of hepatic masses (ranging in diameter from 2.1 to 13.2 cm) from September 2015 to August 2021 were reviewed. Histopathologic diagnoses were made in 15 of 17 (88%) procedures. Two adverse events were noted: worsened preexisting hemobilia requiring embolization in 1 patient, and a decrease in hematocrit level in another patient, requiring only observation. In conclusion, this report showed that the TFTC technique is a relatively safe and effective method for sampling hepatic masses in select cases.

Large Transcalvarial Meningioma: Surgical Resection Aided by Preoperative Embolization.

Meningiomas are the most common type of primary brain tumors, accounting for about 30% of all brain tumors. Meningiomas originate from the meninges and can be associated with any part of the skull. Classification of meningiomas is based upon the World Health Organization (WHO) classification system and prognosis of meningiomas can be determined via histologic grading. Surgery is the gold standard treatment option for all types of meningiomas. Due to the high vascularity of some meningiomas, surgical resection can lead to certain complications including intraoperative blood loss and hemorrhage. Strategies for complication avoidance include preoperative embolization of the meningioma vascular supply. Preoperative embolization has been shown to assist in surgical resection of selected tumors and decrease intraoperative blood loss. We present a case of successful preoperative embolization for a large, complex, transcalvarial meningioma along with a literature review on this topic.

Subcutaneous and periorbital emphysema following dental procedure.

Subcutaneous emphysema following a dental procedure is a relatively uncommon phenomenon that may produce a dramatic clinical presentation. The advent of high-powered dental equipment that uses directed and highly pressurized air has increased the risk of this complication, but few cases have been described in the ophthalmic literature. The authors present a case of subcutaneous periorbital emphysema in a young woman following a dental procedure. Aside from a temporary ptosis, there were no other ophthalmic complications. An attempt to decompress the air produced minimal relief. The condition resolved spontaneously within 1 week.

Chronic, recurrent dacryocystitis from a BB in the lacrimal sac.

Metallic foreign bodies in the lacrimal outflow tract are a rarely reported cause of nasolacrimal duct obstruction. Among the few cases in the literature, 1 consisted of a BB in the nasolacrimal duct. This case report presents a second case of chronic, recurrent dacryocystitis in a child, which occurred secondary to a BB that had become lodged in the lacrimal sac. The metallic foreign body was identified on CT and successfully removed surgically. Exogenous sources of lacrimal sac foreign bodies should be considered in patients with a history of periorbital trauma and signs of chronic nasolacrimal duct obstruction. Evaluation with CT is recommended. Removal of the foreign body, with dacryocystorhinstomy as needed, is curative.

Logarithmic transformation of spectral-domain optical coherence tomography data in uveitis-associated macular edema.

PURPOSE: To determine the utility of logarithmic transformation of spectral-domain optical coherence tomography (logSD-OCT) retinal thickness data for assessment of clinically meaningful changes in uveitis-associated macular edema. METHODS: Patients with noninfectious uveitis-associated macular edema at our institution between August 2010 and March 2011 were identified. Only those with SD-OCT imaging were included. The clinical diagnoses, visual acuities, and central subfield thickness (CST) measurements were recorded. Logarithmic transformation of the retinal thickness was performed and frequency histograms plotted. A linear mixed-effects model of the logarithm minimum angle of resolution (logMAR) visual acuity on logSD-OCT was created to account for within-patient correlation among visits and between eyes. RESULTS: A total of 98 SD-OCT images from 34 patients were analyzed. The mean age at examination was 40 years (range, 11-69 years). Anatomic diagnoses included anterior/intermediate uveitis (23%), intermediate uveitis (21%), posterior uveitis (12%), and panuveitis (44%). LogSD-OCT data provided a more normal distribution than standard CST. Skewness and kurtosis of CST data were 1.04 and 0.37, respectively, and skewness and kurtosis of logSD-OCT data were 0.40 and -0.48, respectively. There was a positive correlation between logSD-OCT and logMAR visual acuity. Specifically, for each 0.1-unit increase in logSD-OCT, the logMAR visual acuities increased (worsened) by 0.082 units (95% CI: 0.057-0.107, P < 0.001). CONCLUSIONS: Logarithmic transformation of SD-OCT measurements provided a more normal distribution and positively correlated with logMAR visual acuity. This transformation of retinal thickness may be valuable for assessing clinically significant changes in SD-OCT measurements in future uveitis studies.

Intraoperative spectral-domain optical coherence tomography during complex retinal detachment repair.

Spectral-domain optical coherence tomography (SD-OCT) is a non-invasive imaging modality that generates detailed images of retinal microstructure. In this study, this technology was employed to investigate changes that occur intraoperatively during repair of complex rhegmatogenous retinal detachment using perfluorocarbon liquids. Intraoperative SD-OCT images were obtained for two patients who underwent pars plana vitrectomy, perfluoro-n-octane instillation, and silicone oil fill for rhegmatogenous retinal detachment. The results demonstrate the ability to obtain high-resolution images of retinal architecture intraoperatively through perfluoro-n-octane and silicone oil. Residual subretinal fluid may be identified intraoperatively despite tamponade with perfluoro-n-octane.