PURPOSE: To identify magnetic resonance imaging (MRI) findings of leukemic infiltration of optic nerve and optic neuritis in leukemic patients with emphasis of clinical findings as reference standard to differentiate them. MATERIALS AND METHODS: MRI and clinical findings of 7 patients diagnosed as leukemic infiltration of optic nerve (n = 5) and optic neuritis (n = 2) in our institution between July 2006 and August 2015were reviewed retrospectively. In particular, MR imaging findings involved perineural enhancement and thickening of optic nerve and its degree, signal intensity, laterality (unilateral/bilateral), intraconal fat infiltration and its degree, and associated central nervous system abnormalities. RESULTS: Of 5 cases of leukemic infiltration of optic nerve, 4 cases showed positive cerebrospinal fluid (CSF) study for leukemia relapse and 1 case was positive on bone marrow (BM) biopsy only. Moreover, of 5 leukemic infiltration of optic nerve, 2 cases showed the most specific MR findings for leukemic central nervous system involvement including 1 prominent leptomeningeal enhancement and 1 chloroma. However, other MR imaging findings of the patients with leukemic infiltration or optic neuritis such as thickening and perineural enhancement of optic nerves are overlapped. CONCLUSION: Enhancement and thickening of optic nerve were overlapped MR findings in leukemic infiltration of optic nerve and optic neuritis. Our findings suggest that enhancing optic nerve thickening with associated central nervous system MR abnormality favors the diagnosis of leukemic infiltration of optic nerve, especially in patients with history of acute lymphoblastic leukemia. However, CSF and BM study were required for differentiation between leukemic infiltration of optic nerve and optic neuritis.
Biopsy ; Bone Marrow ; Central Nervous System ; Cerebrospinal Fluid ; Diagnosis ; Humans ; Leukemia ; Leukemic Infiltration* ; Magnetic Resonance Imaging ; Optic Nerve Diseases ; Optic Nerve* ; Optic Neuritis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Retrospective Studies ; Sarcoma, Myeloid

Dermatomyositis is a systemic connective tissue disease affecting the skeletal muscles and skin. Necrotizing cutaneous vasculitis and subsequent diffuse subcutaneous and muscular calcification in patients with dermatomyositis is uncommon and has not been reported. A 23-year-old female with dermatomyositis developed necrotizing cutaneous vasculitis in the knee, elbow, buttock, toe and fingers associated with large ulcer formation. Her left 5th finger was amputated due to massive soft tissue destruction, and her right 5th finger later auto-amputated. Thereafter, she developed small subcutaneous nodules on both wrists, elbows, upper arms, neck, buttocks and thighs. X-ray, computerized tomography and gracilis muscle biopsy confirmed diffuse subcutaneous, fascia and muscular calcifications.
Arm ; Biopsy ; Buttocks ; Connective Tissue Diseases ; Dermatomyositis ; Elbow ; Fascia ; Female ; Fingers ; Humans ; Knee ; Muscle, Skeletal ; Muscles ; Neck ; Skin ; Thigh ; Toes ; Ulcer ; Vasculitis ; Wrist ; Young Adult

Oseltamivir is the drug of choice for patients with pandemic influenza (H1N1 2009). However, sporadic cases of oseltamivir resistance have been described worldwide. Up to March 2010, a total of 11 strains (2.2% of tested isolates) of oseltamivir-resistant pandemic influenza (H1N1 2009) have been discovered in South Korea. We report a case of 46-year-old man with acute myeloid leukemia in whom an oseltamivir-resistant pandemic (H1N1) 2009 virus was isolated. Despite high dose oseltamivir therapy for 10 days he had persistent symptoms and showed positive results in repeated real-time RT-PCR for pandemic influenza (H1N1 2009) virus from nasopharyngeal specimen. The patient improved eventually after oseltamivir was replaced by zanamivir inhalation.
Humans ; Influenza, Human ; Inhalation ; Leukemia ; Leukemia, Myeloid, Acute ; Middle Aged ; Oseltamivir ; Pandemics ; Republic of Korea ; Viruses ; Zanamivir

PURPOSE: To analyze the controversies surrounding therapeutic decision-making and the withholding of life- sustaining treatments, values held concerning therapeutic interventions of terminal cancer patients are compared between physicians and family members. MATERIALS AND METHODS: 42 advanced or terminal stage cancer patients were enrolled for the study. The questionnaires were administered to the duty doctor and the family of the patients. Questions included whether to use new agents with a 15% partial efficacy and whether to use opioid analgesics, intravenous nutrition, a feeding tube, antibiotics, and hemodialysis. Additionally, we asked about the administration of CPR, ventilator application, and euthanasia. If the family permitted, the same questionnaires were given to the patients. RESULTS: Of the 42 cases, 5 families refused to answer the questionnaire. Of the available 37 families, only 5 families permitted access to the patients. Of the 5 patients, 2 patients refused the questionnaire. Only 67.6% and 8.1% of families and the patients clearly understood the stage of cancer. The use of a new agent was accepted by 45.2% of the physicians and 45.9% of the families. The rankings of the acceptance of treatment in the physicians and in the families were similar. The concordance rate between the physicians and the families was lowest on ventilator application and CPR. 31% of the physicians and 43.2% of the families agreed on the issue of euthanasia. CONCLUSION: Values held on issues like therapeutic decision-making and the withholding of life-sustaining treatments in terminal cancer patients are discordant between physicians and family members. In order to resolve controversies on the role of physicians in end-of-life decisions, the values of physicians as well as patients and their family members should be considered in the final decision-making process.
Analgesics, Opioid ; Anti-Bacterial Agents ; Cardiopulmonary Resuscitation ; Euthanasia ; Humans ; Medical Futility ; Renal Dialysis ; Ventilators, Mechanical ; Withholding Treatment ; Surveys and Questionnaires