Chronic Edema Research Articles

Supporting patients and raising staff awareness of lymphoedema.

Rachel Mayall, Lead Lymphoedema Practitioner, Rochdale Care Organisation, Northern Care Alliance (Rachel.Mayall@nca.nhs.uk), winner of a Bronze Award in the Chronic Oedema Nurse of the Year category of the BJN Awards 2023.

Supporting patients with head and neck cancer-related lymphoedema.

Joanne Dodd-Stokes, and the LymphCare UK Team, LymphCare UK (jdodd-stokes@lymphcare.co.uk) winners of a Silver Award in the Chronic Oedema Nurse of the Year category of the BJN Awards 2023.

Factores de riesgo para la celulitis de miembros inferiores: revisión sistemática y metaanálisis

IntroductionCellulitis is a bacterial infection characterized by affecting the deep dermis and subcutaneous cellular tissue, mainly in the lower limbs. Identifying the associated risk factors is a key objective to prevent its appearance. ObjectiveTo determine the risk factors for cellulitis of the lower limbs. MethodologyA systematic review and meta-analysis was completed and included 3 studies in a definitive way. Data from 933 participants were analyzed, 311 of whom had cellulitis. ResultsRisk factors are: history of cellulitis OR 15.37 (95% CI: 3.19; 74.16), saphenectomy OR 13.03 (95% CI: 4.33; 39.16), skin diseases OR 11.8 (95% CI: 4.42; 31.53), lower limb ulcers OR 10.93 (95% CI: 2. 92; 40.96), deep vein thrombosis OR 10.19 (95% CI: 2.88; 36.05), skin barrier disruption OR 7.17 (95% CI: 4.88; 10.55), blunt trauma to lower limbs OR 6.95 (95% CI: 3.04; 15.90), interdigital region intertrigo OR 6. 27 (95% CI: 2.25; 20.03), chronic lower limb edema OR 5.01 (95% CI: 1.37; 18.30), orthopedic surgery on lower limbs OR 3.91 (95% CI: 1.87; 8.18), previous lower limb surgery OR 3.53 (95% CI: 2.42; 5.16), dermatomycosis OR 3. 17 (95% CI: 2.03; 4.94), white race OR 2.95 (95% CI: 1.83; 4.76), toenail dystrophy OR 2.73 (95% CI: 1.46; 5.09), swimming OR 2.61 (95% CI: 1.59; 4.28), obesity OR 2.45 (95% CI: 1.39; 4.32) and xeroderma OR 2.29 (95% CI, 1.21; 4.33). ConclusionsThe risk factors described should be considered and evaluated to mitigate or suspect cases of cellulitis in the lower limbs.

The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review.

Background and Objectives: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with, the first-line treatment, anti-vascular endothelial growth factor (VEGF). Materials and Methods: A comprehensive literature search to identify studies that evaluated the efficacy of laser photocoagulation therapy in the management of DME was performed. The relevant findings of the efficacy of focal/grid laser therapy from data in randomized, controlled trials were synthesized, and the potential of new laser technologies, such as navigated laser systems, pattern scan lasers, and subthreshold lasers, was explored. The usefulness of multimodal imaging-guided laser therapy was also evaluated, with a focus on the potential contribution to anti-VEGF therapy. Results: Focal laser photocoagulation targeting microaneurysms remains an effective therapeutic approach to chronic refractory edema, despite the widespread use of anti-VEGF therapy. To achieve the best possible treatment outcomes, precise identification of microaneurysms is essential. This requires the use of multimodal imaging-guided, highly accurate, minimally invasive coagulation techniques. Subthreshold laser therapy can also reduce the frequency of anti-VEGF injections and minimize treatment burden. Conclusions: Further studies are needed to determine the optimal timing and settings for laser photocoagulation therapy and the potential of new laser technologies in the management of DME. Nevertheless, laser photocoagulation therapy plays an important role in the management of DME, in conjunction with anti-VEGF therapy.

Necrotizing plasma cell-rich aortitis and sudden cardiac death: Late sequelae of COVID-19?

The ongoing epidemic caused by the coronavirus SARS-CoV-2 is characterized by a variety of pathologic processes within the syndrome of COVID-19. Usually beginning as an upper respiratory infection with potential progression to a pneumonitis, many cases of COVID-19 that show minimal signs or symptoms initially may develop adverse systemic sequelae later, such as widespread thrombo-embolic phenomena, systemic inflammatory disorders (especially in children), or vasculitis. Here, we present a patient who suffered a sudden cardiac death following persistent SARS-CoV-2 viral positivity for four-and-one-half months after a mild clinical viral course. At routine autopsy, a remarkable plasma cell-rich necrotizing aortitis was uncovered. The aortic intima displayed diffuse, circumferential ongoing chronic intimal edema, inflammation, and neo-vascularization. The plasma cell-rich inflammatory process also involved the origin of the left main coronary artery (LM) causing a coronary arteritis accompanied by subacute, stenosing intimal vascular smooth muscle cell (VSMC) proliferation resulting in acute myocardial necrosis as a cause of death. A similar vasculitis and plaque were noted during the routine autopsy at the ostium of the celiac artery; vasculitis was not found systemically or in smaller caliber vessels. Through a variety of techniques including extensive histopathologic and immunohistochemical characterization, immunostaining localization of viral antigen, and transmission electron microscopy we present highly suggestive evidence that this unique necrotizing, plasma cell-rich aortitis is a rare sequela of COVID-19.

A Prospective Study of Comparison between Open Trendelenburg Operation, Radiofrequency Ablation, EVLA, and Glue Technique for the Management of Varicose Veins

Background: Varicose veins are a subset of Chronic Venous disorders, including spider, reticular, varicose, and leg oedema. In our country, varicose veins are common surgical problems most commonly seen in low socio-economic groups and associated with certain occupation(s). Varicose veins have been known to affect the quality of life (QoL) leading to changes in occupation. Surgical treatment methods such as Saphenofemoral Junction (SFJ) Ligation and Great Saphenous Vein (GSV) stripping with spinal or general anaesthesia, Radio Frequency Ablation (RFA), Endovascular Laser Ablation (EVLA) and GLUE Technique within the operating room are considered in patients who remain refractory to conservative management and continue being symptomatic. Aim & Objectives: The study aimed to compare the outcome and associated post-operative complications, including Deep Venous Thrombosis, Pulmonary Embolism or Paresthesia, and Ecchymosis, with various modalities in the management of varicose veins. Material and Methods: The study was performed at a tertiary care centre which included 200 patients over a period of one year and was evaluated in the basis of VCSS & VDS scores. Results: We observed that all treatment protocols demonstrated results which improved the general physical condition of patients with the least number of complications. Treatment for varicose veins encompasses open surgeries and Endovenous techniques (EVLA and RFA), which show comparative results in clinical improvement, complications and postoperative hospital stay. Both VCSS and VDS are sensitive tools for measuring clinical outcomes of treatments of venous disease. However, the choice of appropriate tool is dependent upon the type of treatment, the Surgeon ‘s personal experience, availability of resources, durations of hospital admission and cost of treatment.

Anti –Inflammatory Effect of Methanolic and Aqueous Extracts of Urtica pilulifera L. Seed in Rats

Wide range of acute and chronic inflammatory ailments, side effects of their available therapies and incomplete treatment of such patients push the researches to find new and more effective drugs. To reach this aim, in the current study, we evaluate Urtica pilulifera L. (family Urticaceae) as an introduced traditional herb for treatment of inflammation in Persian Medicine (PM). In an animal study, Anti-inflammatory effects of U. pilulifera were assessed in formalin-induced hind paw edema in rats. Sodium salicylate (300 mg/kg, i.p., SS) injection was used as a positive control drug and compared with methanolic extract of U. pilulifera (20 mg/kg; i.p.) (MUP), three different doses of aqueous extract of U. pilulifera (20, 40 and 80 mg/kg; i.p.) (AUP) and a group of distilled water (6 mL/kg; i.p.). As acute anti-inflammatory effect, AUP in doses 40 and 80 mg/kg decreased edema significantly (p<0.05). In chronic anti-inflammatory response, results indicated that all AUP doses had anti-inflammatory effects (p <0.05) with no significant difference with SS group. In conclusion, AUP had anti-inflammatory effects on both acute and chronic edema; while MUP was only effective in chronic inflammation.

Fluocinolone Acetonide Implant Injected 1Month after Dexamethasone Implant for Diabetic Macular Oedema: the ILUVI1MOIS Study.

The aim of this study was to assess the efficacy and safety of fluocinolone acetonide implant (FAci) injected 1month after the last dexamethasone intravitreal implant (DEXi) in chronic diabetic macular oedema (DME) patients. Retrospective multicentric study conducted in pseudophakic patients with chronic DME frequently treated with dexamethasone intravitreal implant (DEXi; time to DME recurrence ≤ 6months), receiving FAci 1month after the last DEXi, with at least a 6-month follow-up. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure (IOP) and additional treatments were assessed on the day of FAci injection (M0), 1 (M1) and 3months (M3) later and then every 3months. A total of 41 eyes from 34 patients were included. At M0, patients' mean age was 68.7 ± 9.8years, the mean DME duration was 63.9 ± 22.9months, the mean interval between two DEXi was 14.2 ± 3.3weeks. M12 data were available for 71% of patients. At baseline, the mean BCVA, CMT and IOP were 63.2 ± 16.6letters, 299.4 ± 103.3µm, and 16.2 ± 4.5mmHg, respectively, and remained stable during the follow-up. At M12, 14% of patients required additional intravitreal treatments. In pseudophakic patients with chronic DME showing good response to DEXi but requiring repeated injections every < 6months, switching to FAci 1month after the last DEXi was effective and safe. Further prospective randomized controlled studies are needed to confirm these findings, and to determine the best interval between the last DEXi and the first FAci.

CORNEAL EDEMA AFTER CATARACT SURGERY - CHANGES IN CORNEAL ENDOTHELIUM CELL CHARACTERISTICS

&#x0D; Corneal edema is a common complication of cataract surgery, although tremendous improvements have been made in the surgical techniques, which decreased surgical eye trauma and complication rates. Normal endothelial cell density is 2000-3000 cells/mm2 in older individuals, which maintains the corneal clarity. Even ‘perfect’ cataract surgery does some damage to the endothelium. A significant postoperative endothelium density decrease can impair its ability to maintain corneal clarity, resulting in corneal edema, blurring of vision and ocular pain. Aggressive topical treatment in the first month after surgery may lead to recovery of the endothelial cells. Our aim was to establish the effects of cataract surgery on the characteristics of the corneal endothelium. We performed a prospective interventional clinical study of 30 patients, mean age 65±12 years, with senile cataract. Over 80% were hard cataracts: 18% hypermature, 66% grade 4 (brunescent) and 16% grade 3 cataracts. Uneventful phacoemulsification with IOL implantation was performed by one experienced phaco-surgeon in an outpatient setting. Preoperative parameters included: best-corrected visual acuity (BCVA) in Snellen decimal units, IOP, cataract density (slit lamp examination), corneal endothelium cell density (ECD) and hexagonality measured with a specular microscope. Intraoperative parameters included: phacoemulsification time and energy, irrigation–aspiration suction time. Standard phacoemulsification cataract surgery was performed with in-the-bag IOL implantation. Mean baseline parameters were: BCVA=0.1±0.13, IOP=15.7±2.7 mmHg, ECD=2,497±290 cells/mm2, cell hexagonality was 54.3±9.4%. Mean surgical parameters were: surgical time=9,3±2.9 minutes, phacoemulsification time=35.6±26.1 seconds, phacoemulsification energy=13.3±10.9J, irrigation–aspiration suction time=81.3±45.9 seconds. Acute postoperative corneal edema occurred in 4 eyes (13.3%). After one-week BCVA was 0.5±0.2. 9 eyes (30%) had visual acuity ≤0.5. They were treated aggressively with antibiotics (moxifloxacine), corticosteroid (dexamethasone) and hypertonic eye drops (sodium chloride (5%) and mannitol (20%)), every hour during the first week and gradually tapered in the 1 month. Antiglaucomatose eyedrops (timolol, brinzolamide) were used to control the IOP below 20 mmHg. After 1 month mean BCVA increased to 0.85±0.15 and all eyes reached BCVA higher than 0.6. IOP was stable at 15.4±2.0 mmHg. The mean endothelial cell loss was 19,1%. None of the eyes progressed to chronic edema. Corneal edema is a common complication after surgery of difficult cataracts. Even though the cataract density directly influences the postoperative condition of the corneal endothelium, surgical trauma is still considered the most common cause of corneal endothelial decompensation. Preoperative specular microscopy is very important to predict possible postoperative complications of the corneal endothelium and apply appropriate surgical techniques and materials. Modern phaco-techniques (low phaco-energy, small incision site, new irrigation solutions and OVDs) can significantly reduce endothelial cell loss after cataract surgery. It is recommended to treat postoperative corneal edema and inflammation with topical corticosteroids, topical hypertonic agents and to maintain intraocular pressure below 20 mmHg.&#x0D;

Rationales and methodology of the noninvasive ventilation in CPAP mode in pre‑hospital care for exacerbations of chronic obstructive pulmonary disease and cardiac pulmonary edema

Review of literature on the rationale and features of the application of noninvasive mechanical ventilation in CPAP mode in providing emergency medical care to patients with exacerbation of COPD and acute cardiogenic pulmonary edema.

0.18 MG FLUOCINOLONE ACETONIDE INSERT FOR THE TREATMENT OF CHRONIC POSTOPERATIVE PSEUDOPHAKIC CYSTOID MACULAR EDEMA.

To report the outcomes of the 0.18 mg fluocinolone acetonide insert (FAi) in the treatment of chronic (>6 months) postoperative cystoid macular edema after cataract surgery. This was a retrospective consecutive case series of eyes with chronic postoperative cystoid macular edema treated with the FAi. Visual acuity, intraocular pressure, optical coherence tomography metrics, and supplemental therapies were extracted from the charts before and at 3, 6, 12, 18, and 21 months after FAi placement, when available. Nineteen eyes of 13 patients with chronic postoperative cystoid macular edema after cataract surgery underwent FAi placement with an average follow-up of 15.4 months. Ten eyes (52.6%) had a ≥2-line gain in visual acuity. Sixteen eyes (84.2%) had a ≥20% reduction in optical coherence tomography central subfield thickness. Eight eyes (42.1%) had complete resolution of CME. Improvements in central subfield thickness and visual acuity were sustained throughout individual follow-up. Compared with 18 eyes (94.7%) requiring local corticosteroid supplementation before FAi, only six eyes (31.6%) required supplementation after FAi. Similarly, of the 12 eyes (63.2%) that were on corticosteroid drops before FAi, only 3 (15.8%) required drops after FAi. Eyes with chronic postoperative cystoid macular edema after cataract surgery treated with the FAi had improved and sustained visual acuity and optical coherence tomography metrics, along with a reduction in supplemental treatment burden.

Injectable Fluocinolone Implant for the Management of Chronic Postsurgical Cystoid Macular Edema in Vitrectomized Eyes.

Long-acting injectable steroids are changing the treatment paradigm for patients with chronic intraocular inflammation and cystoid macular edema (CME). We report the use of the fluocinolone implant (FAI) 0.18 mg in patients with chronic postsurgical CME following pars plana vitrectomy (PPV). This is a retrospective case series of 24 vitrectomized eyes which received FAI for the management postsurgical CME. Clinical outcomes and requirement for rescue therapy were studied. Median length of follow-up was 19.3 months (range 8.3-23.2 months). There was an improvement in median central subfield thickness from 412 μm (range 167-806 μm) to 311 μm (range 157-686 μm) following FAI (p < 0.001). The injection burden decreased significantly following study treatment (p < 0.001); however, there was no significant change in visual acuity (p = 0.334). Eighteen eyes had control of CME that did not require additional intravitreal therapy. Four eyes had initially controlled but recurrent CME requiring intravitreal steroid therapy at median of 7.8 months (range 7.6-15.4 months). One eye never attained sufficient inflammatory control despite rescue therapy. FAI can be an effective treatment in vitrectomized patients with chronic postsurgical CME and can help decrease the overall injection burden.

Putting patient wellbeing and confidence at the heart of the service.

Margaret Anne Garner, Lymphoedema Specialist, Strathcarron Hospice, NHS Forth Valley (fv.strathcarron.lymphoedema@nhs.scot), was the winner in the Chronic Oedema Nurse of the Year category of the BJN Awards 2023.

Histological changes of electric yellow (Labidochromis caeruleus) exposed to three different copper concentrations

The water pollution is affecting rivers, lakes, and seas. Therefore, all aquatic organiss may influenced by it. In this study, it was intended to examine and assess histological changes in the electric yellow cichlid exposed to three different periods of copper concentrations (acute, chronic and not containing copper). Firstly, this study was formed in three parts of acute and chronic exposures and recovery. Electric yellow cichlid were exposed to 0, 10, 20, 30, 40 mg l-1 of copper sulfate for 96-h acute trial. Secondly, they were exposed to 0.0, 0.5, 1.0, 2.0, 4.0 mg l-1 of copper sulfate for 20-d chronic trial. Thirdly, survived fish from the chronic trial were holded in clean water without copper for 10-d recovery. At the end of three trials, gill, liver and spleen samples of fish were collected and stained with hematoxylin-eosin (H&amp;E) techniques. Preparations were examined and detected by the light microscope and significant pictures were saved by the digital camera. As a results of acute and chronic copper trials, edema, aneurism and serious degenerations of gills, necrosis and vacuolations in the hepatocytes and blood vessels of liver, and degenerations, granulamas and black spots in the spleen were indicated. It is detected that copper had vital effects on physiology of electric yellow cichlid and caused important tissue damages in fish.

Ruptured arteriovenous malformation mortality: Incidence, risk factors, and inpatient outcome score.

Limited literature exists on the morbidity and mortality of AVM associated intracerebral hemorrhage (ICH) compared with non-AVM ICH. We examine morbidity and mortality in cAVM in a large nationwide inpatient sample to create a prognostic inpatient ruptured AVM mortality score. This retrospective cohort study from 2008 to 2014 compares outcomes in cAVM related hemorrhages and ICH utilizing the National Inpatient Sample database. Diagnostic codes for ICH and AVM underlying ICH were identified. We compared case fatality according to medical complications. Multivariate analysis was used to derive hazard ratios and 95% confidence intervals to assess odds of mortality. We identified 6496 patients with ruptured AVMs comparing them to 627,185 admitted with ICH. Mortality was lower for ruptured AVMs (11%) compared to ICH (22%) [p < 0.01]. Mortality associated factors were liver disease (OR 2.64, CI 1.81-3.85, p < .001), diabetes mellitus (OR 2.42, CI 1.38-4.22, p = 0.002), alcohol abuse (OR 1.81, CI 1.31-2.49, p = 0.001), hydrocephalus (OR 3.35 CI 2.81-4.00, p < 0.001), cerebral edema (OR 1.5, 1.25-1.85, p < 0.001), cardiac arrest (OR 15, CI 7.9-30, p < 0.001), and pneumonia (OR 1.93, CI 1.51-2.47, p < 0.001). A 0-5 ruptured AVM mortality score was developed: Cardiac arrest (=3), age >60 (=1), Black race (=1), chronic liver failure (=1) diabetes mellitus (=1), pneumonia (=1), alcohol abuse (=1) and cerebral edema (=1). Mortality increased with score. No patient with 5 or more points survived. The Ruptured AVM Mortality Score allows for risk stratification on patients with ICH due to ruptured AVM. This scale could prove useful in prognostication and patient education.

Aquaporin-4 and GPRC5B: old and new players in controlling brain oedema.

Brain oedema is a life-threatening complication of various neurological conditions. Understanding molecular mechanisms of brain volume regulation is critical for therapy development. Unique insight comes from monogenic diseases characterized by chronic brain oedema, of which megalencephalic leukoencephalopathy with subcortical cysts (MLC) is the prototype. Variants in MLC1 or GLIALCAM, encoding proteins involved in astrocyte volume regulation, are the main causes of MLC. In some patients, the genetic cause remains unknown. We performed genetic studies to identify novel gene variants in MLC patients, diagnosed by clinical and MRI features, without MLC1 or GLIALCAM variants. We determined subcellular localization of the related novel proteins in cells and in human brain tissue. We investigated functional consequences of the newly identified variants on volume regulation pathways using cell volume measurements, biochemical analysis and electrophysiology. We identified a novel homozygous variant in AQP4, encoding the water channel aquaporin-4, in two siblings, and two de novo heterozygous variants in GPRC5B, encoding the orphan G protein-coupled receptor GPRC5B, in three unrelated patients. The AQP4 variant disrupts membrane localization and thereby channel function. GPRC5B, like MLC1, GlialCAM and aquaporin-4, is expressed in astrocyte endfeet in human brain. Cell volume regulation is disrupted in GPRC5B patient-derived lymphoblasts. GPRC5B functionally interacts with ion channels involved in astrocyte volume regulation. In conclusion, we identify aquaporin-4 and GPRC5B as old and new players in genetic brain oedema. Our findings shed light on the protein complex involved in astrocyte volume regulation and identify GPRC5B as novel potentially druggable target for treating brain oedema.

PixelPrint: A collection of three-dimensional printed CT phantoms of different respiratory diseases.

Imaging is often a first-line method for diagnostics and treatment. Radiological workflows increasingly mine medical images for quantifiable features. Variability in device/vendor, acquisition protocol, data processing, etc., can dramatically affect quantitative measures, including radiomics. We recently developed a method (PixelPrint) for 3D-printing lifelike computed tomography (CT) lung phantoms, paving the way for future diagnostic imaging standardization. PixelPrint generates phantoms with accurate attenuation profiles and textures by directly translating clinical images into printer instructions that control density on a voxel-by-voxel basis. The present study introduces a library of 3D printed lung phantoms covering a wide range of lung diseases, including usual interstitial pneumonia with advanced fibrosis, chronic hypersensitivity pneumonitis, secondary tuberculosis, cystic fibrosis, Kaposi sarcoma, and pulmonary edema. CT images of the patient-based phantom are qualitatively comparable to original CT images, both in texture, resolution and contrast levels allowing for clear visualization of even subtle imaging abnormalities. The variety of cases chosen for printing include both benign and malignant pathology causing a variety of alveolar and advanced interstitial abnormalities, both clearly visualized on the phantoms. A comparison of regions of interest revealed differences in attenuation below 6 HU. Identical features on the patient and the phantom have a high degree of geometrical correlation, with differences smaller than the intrinsic spatial resolution of the scans. Using PixelPrint, it is possible to generate CT phantoms that accurately represent different pulmonary diseases and their characteristic imaging features.

Review of De Quervain's tendinopathy

The tendons of the long thumb abductor (APL) and short thumb extensor (EPB), which travel through a fibroosseous tunnel in the styloid process of the radius, are afflicted by De Quervain's tendinopathy. This condition causes the tendons and the tunnel (or sheath) through which they pass to thicken non-inflammatorily. Individuals with this illness report radial side wrist discomfort that gets worse when the wrist and thumb are moved. The radial side of the wrist often has some swelling and discomfort. The physical examination findings, such as sensitivity and enlargement of the radial styloid in the first dorsal compartment and radial styloid pain with active or passive stretching of the thumb tendons over the radial styloids at thumb flexion, are used to make the diagnosis of de Quervain's tendinopathy (Finkelstein manoeuvre or test). The differential diagnosis includes calcified arthritis or tenosynovitis, intersection syndrome, ganglia, radial sensory nerve entrapment in the forearm, and osteoarthritis of the trapeziometacarpal joint (TMC). De Quervain's tendinopathy typically responds well to self-limiting therapies that alleviate symptoms. The patient's unique values and preferences have a significant role in the therapeutic decision. Nonsteroidal anti-inflammatory medicines (NSAIDs) for pain management, a forearm-based thumb splint, glucocorticoid injections, and surgery are all possible treatments. A forearm-based thumb splint with a free interphalangeal joint and a simultaneous NSAID pain reduction test are advised for individuals with de Quervain's tendinopathy. Patients with chronic pain and edema despite non-surgical therapy with splints and NSAIDs are advised to have glucocorticoid injections. Those who continue to experience symptoms despite nonsurgical treatment and glucocorticoid injection are typically the only ones who need surgery. De Quervain's tendinopathy is benign and self-limiting, therefore most patients are aware of this.

Visual function and retinal morphological changes after single suprachoroidal delivery of fluocinolone acetonide (Iluvien®) implant in eyes with chronic diabetic macular edema

BackgroundTo assess the efficacy and safety of supra-choroidal (SC) Iluvien in the management of chronic diabetic macular edema (DME).MethodsA retrospective interventional non-comparative consecutive case series including patients with chronic DME who received an SC Iluvien implant. All patients had persistent central macular thickness (CMT) ≥ 300µ after previous treatment with anti-vascular endothelial growth factor (VEGF) agents or laser photocoagulation. The main outcome measures were improvement of best-corrected visual acuity (BCVA), reduction of CMT, and detection of ocular hypertension/glaucoma or cataract formation. Friedman’s two-way ANOVA was used to analyze BCVA, intraocular pressure (IOP), and DME across different time points. P-value = 0.05.ResultsThe study included 12 eyes of 12 patients. Six patients (50%) were males. The median age was 58 years (range 52–76 years). The median duration of DM was 13 years (range 8–20 years). Ten patients (83.3%) were phakic and 2 patients (17%) were pseudophakic. The median pre-operative BCVA was 0.07 (range 0.05–0.8). The median pre-operative CMT was 544µ (range 354–745µ). The median pre-operative IOP was 17 mmHg (range 14-21mmHg). The median follow-up period was 12 months, range (12–42). Post-operatively, the median final BCVA was 0.15 (range 0.03-1), p 0.02, the median CMT was 404µ (range 213–747), p 0.4 and the median IOP was 19.5 mmHg (range 15–22), p 1. Two out of 10 phakic patients (20%) developed nuclear sclerosis grade I by 12 months. Six patients (50%) developed a transient rise in IOP < 10 mmHg from the baseline that resolved within 3 weeks with antiglaucoma drops.ConclusionSC Iluvien is potentially effective in improving visual function, reducing macular edema, and reducing the incidence of steroid-induced cataracts and glaucoma.

First diagnosed invasive lobular carcinoma of the breast combined with gastric metastasis and bone metastasis: a case report and review of the literature

RationaleChinese women topped the list of new breast cancers, the first diagnosed gastric metastasis and bone metastasis is extremely infrequent. The clinical and pathological diagnosis of metastatic breast cancer is difficult. To our knowledge, this is the first reported case of the first diagnosis of breast cancer with both gastric metastasis and bone metastasis.Case reportThe female patient was found to have abdominal distension for 15 days with nausea and vomiting. The patient underwent a gastroscopy at an outside hospital 4 days ago, showing: duodenal bulb changes, gastric retention and chronic non-atrophic gastritis. Gastroscopic biopsy showed chronic inflammation and edema of the duodenal mucosa with glandular hyperplasia. Conservative treatment was given with no relief of symptoms. She was seen in our hepatobiliary and pancreatic surgery department. After admission, palliative surgery was performed, and the swelling and surrounding involved tissues were taken for examination during surgery. The rapid pathological return could not exclude tumor lesions, and the postoperative pathology confirmed the diagnosis of invasive lobular carcinoma of the breast with gastric metastases, and the systemic examination revealed combined bone metastases.DiagnosisPathology and immunohistochemistry(IHC), a whole-body bone scan confirmed the first diagnosis of breast cancer with both gastric and bone metastases.InterventionsPalliative treatment with bisphosphonates and CDK4/6i (Palbociclib) in combination with AI (Exemestane) was administered.OutcomesThe patient is currently under regular evaluation and is being followed up.