Retinoic Acid Syndrome and Pseudotumor Cerebri in Patients with Acute Promyelocytic Leukemia

PURPOSE: To report cases of a retinal, preretinal and vitreous hemorrhage due to retinoic acid syndrome and a papilledema caused by increased intracranial pressure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA). CASE SUMMARY: (Case 1) A 48-year-old female visited our clinic with headache, dyspnea, and visual disturbance during ATRA medications for acute promyelocytic leukemia. Her visual acuity of both eyes was hand motion, and fundus examination revealed extensive retinal, preretinal, and vitreous hemorrhage. The laboratory test showed leukocytosis and computed tomography of brain and chest revealed subarachnoid hemorrhage and pulmonary alveolar hemorrhage. She was diagnosed with retinoic acid syndrome and was treated with vitrectomy in both eyes. (Case 2) A 17-year-old male, who had been treated with ATRA for acute promyelocytic leukemia, had headache and visual disturbance. His best-corrected visual acuity was 1.0 in both eyes, but the fundus examination showed papilledema and retinal hemorrhage in both eyes. Goldmann visual field examination revealed an enlarged blind spot in both eyes. He was diagnosed with papilledema caused by ATRA induced increased intracranial pressure, and was observed. CONCLUSIONS: Patients with acute promyelocytic leukemia treated with ATRA may have retinoic acid syndrome and increased intracranial pressure that could result in retinal hemorrhage, vitreous hemorrhage, and papilledema.

Central Retinal Artery Occlusion by Left Atrial Myxoma

No abstract available.

Differences of Psychosocial Vulnerability Factors between Internet and Smartphone Addiction Groups Consisting of Children and Adolescents in a Small to Medium-Sized City

OBJECTIVES: The aim of this study was to investigate the relationship between internet addiction, smartphone addiction, and psychosocial factors. This study was designed to examine the vulnerability factors for internet and smartphone addiction. METHODS: The participants were 1041 children and adolescents in a small and medium-sized cities. All of the participants were evaluated in terms of their demographic characteristics and present use of the internet and smartphone, as well as using internet and smartphone addiction and other psychological scales. Statistical analyses were performed to compare the psychosocial factors between the high risk, potential risk, and general user groups of internet and smartphone addiction. RESULTS: The participants were classified into three groups, the high risk (N=33), potential risk (N=203), and general user (N=805) groups with regard to their internet and smartphone addiction level. There were statistical significantly differences between the groups in terms of the economic status of the family, academic performance, parents, use of internet and smartphone, loneliness, family cohesion, family adaptability, perceived social support, and peer relationship. CONCLUSION: These results suggest that the internet and smartphone addiction of children and adolescents is related to various psychosocial vulnerability factors.

Bilateral Candida albicans Endophthalmitis after Robot-Assisted Laparoscopic Radical Prostatectomy in a Patient with Prostate Adenocarcinoma

PURPOSE: To report a case of bilateral Candida albicans endophthalmitis after robot-assisted laparoscopic radical prostatectomy (RALP) in a patient with prostate adenocarcinoma. CASE SUMMARY: A 61-year-old male patient had RALP for prostate adenocarcinoma. Four days after the surgery, the patient had a fever and pancytopenia. Two weeks after the surgery, the patient complained of decreased visual acuity in both eyes. Best-corrected visual acuity (BCVA) was counting fingers at 60 cm in the right eye and 20/63 in the left eye. The fundus examination showed vitreous opacity and yellow circumscribed chorioretinal lesions in both eyes. The blood and urine cultures were negative. An intravitreal voriconazole injection (100 microg/0.1 ml) was given in both eyes. However, the vitritis worsened, and BCVA decreased to counting fingers at 30 cm in the right eye and 60 cm in the left eye. Thus, combined phacoemulsification and 23-gauge microincisional vitrectomy surgery with a silicone oil injection was performed in both eyes at 1-week intervals. The vitrectomy sample culture was positive for Candida albicans in both eyes. Four months after the vitrectomy, BCVA was 20/100 in both eyes without subretinal lesions. CONCLUSIONS: Clinicians should be aware that bilateral Candida albicans endophthalmitis could be complicated by RALP in a patient with prostate adenocarcinoma or with other risk factors.

Trypan Blue-Assisted Measurements of Anatomical Positions of the Superior Rectus Muscle and Superior Oblique Muscle in Enucleated Eyes

PURPOSE: To recognize the anatomical positions of the superior oblique muscle in enucleated eyes using trypan blue. METHODS: Twenty-two surgically-enucleated eyes of 11 bodies were studied. The shortest distance from the nasal insertion of superior rectus to the anterior end of the superior oblique tendon, the distance from the temporal insertion of superior rectus to the anterior end of the superior oblique insertion, and the greatest width of superior oblique tendon insertion were measured by caliper 3 consecutive times. The average values in each of the above 3 points were calculated, and values prior to and after trypan blue staining were compared. RESULTS: Prior to staining with trypan blue, the average distance from the nasal insertion of superior rectus to the anterior end of the superior oblique tendon was 4.97 mm and the average distance from the temporal insertion of superior rectus to the anterior end of the superior oblique insertion was 7.57 mm; after staining with trypan blue, the average values were 5.09 mm and 7.65 mm, respectively. There was no statistically meaningful difference in values prior to and after staining (p > 0.05). Prior to staining, the average value of the greatest width of the superior oblique tendon was 10.32 mm, and after staining with trypan blue, the average value increased to 10.76 mm. There was a statistically meaningful difference between the values (p = 0.02). CONCLUSIONS: Trypan blue staining helped to recognize the location and the width of the superior oblique tendon more precisely.

Cross Pubic Femoro-femoral Artery Bypass with Great Saphenous Vein / 대한혈관외과학회지

PURPOSE: The purpose of this study was to evaluate the great saphenous vein (GSV) as a conduit for crossover femoro-femoral bypass. Generally the conduit for crossover femoro-femoral bypass is a synthetic material because of the acceptable long-term patency and low complication rates. But, as the average life expectancy becomes extended, a better patency rate becomes more important. In this study, we compared the patency rates and hemodynamic results between crossover femoro-femoral bypass operations with GSVs and those with synthetic grafts. METHODS: From 1998 to 2008, 119 femoro-femoral bypass operations were done. Among them, 38 femoro-femoral bypass used GSV as a conduit (group I) and 79 operations used expanded polytetrafluoroethylene (group II). Two cases used arm veins and we excluded those cases. RESULTS: The 3 year primary patency rate of total cases was 75.1%, 93.7% in group I and 66.1% in group II. There were no statistical differences in hemodynamic results such as peak systolic velocity, volume flow and ankle/brachial systolic pressure index between the two groups. CONCLUSION: The 3 year primary patency rate of group I was better than that of group II. However there were no differences in hemodynamic changes. So GSV is recommended as a conduit for crossover femoro-femoral bypass especially in young patients who are eager to have longer patency rates after surgery instead of less invasive endovascular therapy.