Purpose: To report a rare case of differentiation syndrome with ocular manifestations in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA).Case summary: A 27-year-old female complained of yellowing of vision and decreased visual acuity during an ATRA medication course for acute promyelocytic leukemia. Bilateral diffuse drusen-like lesions were found at the posterior pole along with multiple pigment epithelial detachment on optical coherence tomography (OCT) scans. Fluorescein angiography showed multiple hyperfluorescent lesions with leakage at the late phase corresponding to drusen-like lesions in fundus photography. Indocyanine green angiography revealed multiple hypocyanescent lesions. ATRA treatment was discontinued and replaced with high-dose dexamethasone. Accordingly, the patient experienced a rapid improvement in visual symptoms and the chorioretinal lesions on OCT scans showed marked resolution. Conclusions Differentiation syndrome-associated chorioretinopathy may occur in patients with acute promyelocytic leukemia treated with ATRA. Because the occurrence of chorioretinopathy may be associated with systemic aggravation of the ATRA syndrome, preemptive treatment with early detection is required.

Purpose: To report a rare case of differentiation syndrome with ocular manifestations in a patient with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA).Case summary: A 27-year-old female complained of yellowing of vision and decreased visual acuity during an ATRA medication course for acute promyelocytic leukemia. Bilateral diffuse drusen-like lesions were found at the posterior pole along with multiple pigment epithelial detachment on optical coherence tomography (OCT) scans. Fluorescein angiography showed multiple hyperfluorescent lesions with leakage at the late phase corresponding to drusen-like lesions in fundus photography. Indocyanine green angiography revealed multiple hypocyanescent lesions. ATRA treatment was discontinued and replaced with high-dose dexamethasone. Accordingly, the patient experienced a rapid improvement in visual symptoms and the chorioretinal lesions on OCT scans showed marked resolution. Conclusions Differentiation syndrome-associated chorioretinopathy may occur in patients with acute promyelocytic leukemia treated with ATRA. Because the occurrence of chorioretinopathy may be associated with systemic aggravation of the ATRA syndrome, preemptive treatment with early detection is required.

The generation and maintenance of consciousness are fundamental but difficult subjects in the fields of psychology, philosophy, neuroscience, and medicine. However, recent developments in neuro-imaging techniques coupled with network analysis have greatly advanced our understanding of consciousness. The present review focuses on large-scale functional brain networks based on neuro-imaging data to explain the awareness (contents) and wakefulness of consciousness.Despite limitations, neuroimaging data suggests brain maps for important psychological and cognitive processes such as attention, language, self-referential, emotion, motivation, social behavior, and wakefulness. We considered a review of these advancements would provide new insights into research on the neural correlates of consciousness.

Purpose: To compare the refractive measurements from a wavefront aberrometer, autorefractor, and retinoscopy after cycloplegia in evaluating the usefulness and validity of refractive measurements by a wavefront aberrometer in children. Methods: A total of 130 eyes of 65 children, aged from 3 to 16 years, were examined using retinoscopy, a wavefront aberrometer (OPD-Scan III), and an autorefractor (KR-1) after cycloplegia. Refractive measurements were converted to power vectors (M, J0, and J45) and cylindrical absolute values for statistical analysis. The agreement between instruments was assessed and the correlations of measurements were evaluated. Subgroup analysis was performed on two subgroups: one representing less refractive error (|M| < 2 D on cycloplegic retinoscopy) and the other with larger refractive error (|M| ≥ 2 D on cycloplegic retinoscopy). Results: Compared with retinoscopy readings, the aberrometer and autorefractor yielded more myopic values (p = 0.007, p < 0.001). In the less refractive error group, the autorefractor results showed statistically significant differences from retinoscopy readings for M, J0, and J45 and the cylindrical absolute value (all p < 0.05); there were no statistically significant differences between M, J0, and J45 vectors of the aberrometer and those obtained using retinoscopy (p = 0.674, p = 0.699, p = 0.766). With the larger refractive error group, the M vectors of the aberrometer and autorefractor showed more myopic values than the M vector retinoscopy readings; the differences were statistically significant (all p < 0.001). Conclusions The wavefront aberrometer yielded refraction readings closer to those obtained with retinoscopy than the automated refraction in the less refractive error group. With a larger refractive error, statistically significant differences (all p < 0.001) were found among the aberrometer, autorefractor, and retinoscopy readings.

Purpose: To compare the refractive measurements from a wavefront aberrometer, autorefractor, and retinoscopy after cycloplegia in evaluating the usefulness and validity of refractive measurements by a wavefront aberrometer in children. Methods: A total of 130 eyes of 65 children, aged from 3 to 16 years, were examined using retinoscopy, a wavefront aberrometer (OPD-Scan III), and an autorefractor (KR-1) after cycloplegia. Refractive measurements were converted to power vectors (M, J0, and J45) and cylindrical absolute values for statistical analysis. The agreement between instruments was assessed and the correlations of measurements were evaluated. Subgroup analysis was performed on two subgroups: one representing less refractive error (|M| < 2 D on cycloplegic retinoscopy) and the other with larger refractive error (|M| ≥ 2 D on cycloplegic retinoscopy). Results: Compared with retinoscopy readings, the aberrometer and autorefractor yielded more myopic values (p = 0.007, p < 0.001). In the less refractive error group, the autorefractor results showed statistically significant differences from retinoscopy readings for M, J0, and J45 and the cylindrical absolute value (all p < 0.05); there were no statistically significant differences between M, J0, and J45 vectors of the aberrometer and those obtained using retinoscopy (p = 0.674, p = 0.699, p = 0.766). With the larger refractive error group, the M vectors of the aberrometer and autorefractor showed more myopic values than the M vector retinoscopy readings; the differences were statistically significant (all p < 0.001). Conclusions The wavefront aberrometer yielded refraction readings closer to those obtained with retinoscopy than the automated refraction in the less refractive error group. With a larger refractive error, statistically significant differences (all p < 0.001) were found among the aberrometer, autorefractor, and retinoscopy readings.

The generation and maintenance of consciousness are fundamental but difficult subjects in the fields of psychology, philosophy, neuroscience, and medicine. However, recent developments in neuro-imaging techniques coupled with network analysis have greatly advanced our understanding of consciousness. The present review focuses on large-scale functional brain networks based on neuro-imaging data to explain the awareness (contents) and wakefulness of consciousness.Despite limitations, neuroimaging data suggests brain maps for important psychological and cognitive processes such as attention, language, self-referential, emotion, motivation, social behavior, and wakefulness. We considered a review of these advancements would provide new insights into research on the neural correlates of consciousness.

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.
Cellulitis ; Critical Care ; Depression ; Diagnosis ; Disasters ; Female ; Gyeonggi-do ; Humans ; Immunization ; Lacerations ; Ligaments ; Male ; Medical Records ; Mental Health ; Northern Territory ; Shoes ; Stress Disorders, Post-Traumatic ; Tetanus ; Wounds and Injuries

BACKGROUND: Propofol (2,6-diisopropylphenol) is one of the intravenous anesthetic drugs used for induction and maintenance of general anesthesia as well as for sedation in ICU patients and one-day surgery. The monitoring of propofol in blood helps to maintain anesthetic state and promote earlier recovery. So we attempted to find the rapid and simple method for blood propofol determination. METHODS: We compared the precipitation method with extraction one using whole blood, plasma and deionized water added a fixed amount of propofol. According to the extraction method, propofol was extracted from 500 microliter sample adding KH2PO4, ethyl acetate, and tetra-ethylammonium hydroxide using thymol as an internal standard. For the precipitation method, the precipitating solution (500 microliter) containing thymol was added to a 500 microliter sample, then mixed. After centrifugation, the supernatant was injected into HPLC system. A Waters 2690 separations module, Waters 474 fluorescence and 486 UV detector and a Symmetry column were used. We used Millennium software to control analyzing process and quantify propofol. RESULTS: The precipitation method using thymol as an internal standard and Waters 474 fluorescence detector showed the most excellent results. For the calibration curves, we found very good linearity in whole blood, plasma and deionized water (r> or =9976). Intra-assay and inter-assay coefficient of variation (CV) values of propofol for the precipitation method were 4.4% and 8.9% at 2 microgram/mL of propofol and 2.0% and 6.2% at 8 microgram/mL, respectively. The recovery rates of propofol for plasma and whole blood were 104.1% and 92.7% at 2 microgram/mL and 99.4% and 91.6% at 7 microgram/mL, respectively. CONCLUSIONS: For the measurement of the blood propofol level, the precipitation method using thymol as an internal standard and fluorescence detector seemed to be the rapid and simple method to apply for the clinical purpose.
Anesthesia, General ; Anesthetics ; Calibration ; Centrifugation ; Chromatography, High Pressure Liquid* ; Fluorescence ; Humans ; Plasma ; Propofol* ; Thymol ; Water

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult

OBJECTIVE: We tried to evaluate the driving ability of stroke patients using Cognitive Behavioral Driver's Inventory (CBDI), Psychological Software Service, U.S.A. to find out whether it is helpful in predicting the outcome of driving rehabilitation. METHOD: Subjects were 18 stroke patients who had driven a car before the stroke. Each patient was evaluated with CBDI and got a driving test. We compared driving test results with CBDI scores. RESULTS: Average CBDI score was 63.0 +/- 19.3. There was no significant difference according to lesion sides or types of stroke. Average score of driving test was 85.3 +/- 10.9. Twelve of 18 subjects passed the driving test and six subjects failed. Average score among right hemiplegics was significantly higher than that of left hemiplegics (p<0.05). Average CBDI score of the subjects who passed the driving test was 52.3 +/- 4.7, while that of the failed subjects was 84.7 +/- 19.6. There was significant difference in CBDI score between 2 groups (p<0.05). Among the 28 items of CBDI, 11 items including brake reaction time, Wechsler Adult Intelligence Scale-Revised Picture Completion showed significant correlation with the total score of the driving test (p<0.05). CONCLUSION: CBDI can be used as a useful tool for predicting driving ability of stroke patients.
Adult ; Humans ; Intelligence ; Reaction Time ; Rehabilitation ; Stroke*