Spinal epidural lipomatosis (SEL) is a rare condition of adipose tissue accumulation in the epidural space. A total of 2,309 subjects from March 2011 to April 2012 were studied. We found different morphologic “variants” of dural sac compression in grade III. The trifid type, resembling the letter “Y", was the most common form. The round type and the localized mass in lateral recess were seen in other cases. Surgical decompression was performed regardless of morphologic variants in SEL grade III with neurologic symptoms. All patients recovered from neurologic symptoms. In subjects who received adequate conservative treatment, decompressive surgery could be helpful in treatment of SEL grade III with neurologic symptoms.

The purpose of this study is to evaluate perfusion density of an old myocardial infarction using cardiac multidetector computed tomography (MDCT) with arterial phase. We included 56 patients with an old myocardial infarction who had undergone medical treatment, primary angioplasty or bypass graft. Cardiac MDCT without stress perfusion was used for calculation of density of myocardial perfusion and global left ventricular function in patients was also analyzed according to initial and last follow-up echocardiography. All patients showed decreased perfusion in the left ventricular wall. Densities of normal ventricular wall, cavity of the left ventricle, and infracted wall were 105±29 HU, 471±117 HU, and 11±29 HU (-64 HU-57 HU), respectively. Subendocardial fat depositions were observed in 19 patients (34%). Ejection fractions of initial and last follow-up periods near to the date of cardiac CT were 61±9 % and 57±12 %, respectively. In conclusion, decreased perfusion less than 60 HU in cardiac CT with arterial phase was helpful in diagnosus of an old myocardial infarction.

Actinomycosis is a rare disease caused by the Gram-positive anaerobic filamentous bacterium, Actinomyces israelii. Due to its unusual clinical presentation, it is mainly diagnosed postoperatively. The risk of the disease increases with the use of intrauterine contraception device (IUD). A 46-year-old female was admitted to the hospital due to diffuse lower abdominal pain and had used an IUD until two weeks ago. Findings on abdominal computed tomography showed a large mass measuring approximately 9 cm, which was suspected of urachal cancer or omental sarcoma. After wide surgical resection, pathologic finding showed severe inflammation with sulfur granule, confirming abdominal actinomycosis.

Malignant salivary gland neoplasms constitute approximately 1% to 3% of all head and neck malignancies and only 0.3% of all malignant neoplasms. Malignant mixed tumors represent 2.2% of all salivary gland tumors. We experienced a huge malignant mixed tumor in the parotid gland, and obtained good results after surgical excision of the parotid gland and reconstructive operation. Therefore, we report on our experience and review the articles related to that tumor.

JAK2 V617F mutation is a common event in chronic myeloproliferative disorders. However, de novo acute myeloid leukemia with JAK2 V617F is rarely encountered. The authors report the case of a 74-year-old male with de novo acute myeloblastic leukemia without maturation (AML M1) and a JAk2 V617F heterozygotic mutation. Despite treatment with standard AML regimens, the patient died 2 months after a diagnosis of acute leukemia. This case of an AML patient with a JAK2 V617F mutation with a poor prognosis suggests that despite its rarity, a JAK2 V617F mutational study be considered for prognostic purposes in AML.

Cerebral infarction is one of the leading causes of death worldwide and the most common cause of death from a singledisease in South Korea. Each year, 795,000 people in the U.S. experience a new or recurrent stroke. Approximately 15-30% of cerebral infarctions are of embolic origin related to cardiac abnormalities. Because determination of the etiology of cerebral infarction is crucial to acute management and future prevention, clinicians should pay attention to finding the cardiac source of embolism in patients with cerebral infarction. We report on a case of cerebral infarction by a small papillary fibroelastoma on the mitral valve. The patient was treated with open heart surgery and closure of the patent foramen ovale to prevent further embolic events.

The transplantation of bone-marrow stem cells into the heart might restore viability after myocardial infarction, and the regenerative potentials of human autologous adult stem cells with respect to myocardial regeneration and neovascularization after myocardial infarction may contribute to healing in the infarcted areas. Here, we describe the results of this method in a patient with acute myocardial infarction who exhibited quantitative improvements in ventricular geometry and contractility. Furthermore, left ventricular ejection fraction and infarct area were improved at 3 month after stem cell transplantation as compared with baseline echocardiography and myocardial single photon emission computed tomography findings.

Acinetobacter baumannii is usually considered an opportunistic pathogen that it responsible for a variety of nosocomial infections, such as, pneumonia, tracheobronchitis, meningitis, endocarditis, peritonitis, skin and soft tissue infections, and urinary tract infections. However, over the years, the organism has developed substantial antimicrobial resistance, and thus, the management of infections has become more difficult. The less common infective endocarditis is one of the more serious consequences of nosocomial bacteremia. Here, we report the successful treatment of the first case of multidrug-resistant A. baumannii endocarditis in a 33-year-old patient.

Pulmonary embolism (PE) still has a high associated mortality. Anticoagulation should be continued until the benefit of preventing recurrent PE is outweighed by the risks of bleeding. Furthermore, D-dimer values and residual clot burden may predict recurrent thromboembolic events in patients that have completed anticoagulation therapy. The authors describe the case of a 69-year-old female who suffered multiple recurrent PE on aspirin, her medical history included idiopathic PE, and she had been on anticoagulant for a considerable time before switching to aspirin. It is important the possibility of recurrent PE be borne in mind to prevent secondary prevention, and that other treatment options be considered in cases of recurrent PE.

Spontaneous perirenal hematoma is an unusual but serious complication of tumors, vascular disease, ruptured cyst, or infection. The authors report the case of a diabetic patient who presented with spontaneous perirenal hematoma and who was subsequently diagnosed to have emphysematous pyelonephritis.

Demacort® is mixture of betamethasone (high-potency corticosteroid) and clotrimazole (antifungal agent), an inhibitor of CYP3A4, which can inhibit the metabolism of betamethasone. Interaction of these drugs may result in decreased clearance of betamethasone and increased risk for adverse events such as iatrogenic Cushing’s syndrome. A 26-year-old female was admitted to the hospital due to rapid weight gain after application of Demacort®. During a period of one month, she showed weight gain of 30 kg and developed several Cushingoid appearances. The result of an overnight dexamethasone suppression test was negative, thus, endogenous Cushing’s syndrome was ruled out. A negative cortisol response was observed for the rapid ACTH stimulation test; therefore, we made a diagnosis of iatrogenic Cushing’s syndrome combined with additional secondary adrenal insufficiency.

The association between human parvovirus B19 and aplastic crisis in patients with hemolytic anemia, such as sickle-cell anemia and hereditary spherocytosis, has been well described. However, most cases of parvovirus induced-aplastic crisis in patients with hereditary spherocytosis have been reported in children or adolescents. We report on a 31-year-old female with pancytopenia who was diagnosed with aplastic crisis caused by parvovirus B19 infection in hereditary spherocytosis. It should be kept in mind that hereditary spherocytosis may initially present with aplastic crisis induced by parvovirus B19 infection in adults

Development of two different histologic types of lymphoma in the same person is rare. Sequential lymphoma is defined as two different types of lymphoma occurring sequentially in the same person. In particular, sequential Hodgkin’s lymphoma (HL) following non-Hodgkin’s lymphoma (NHL) is extremely rare. A 63-year-old female diagnosed with B-cell NHL at the mass in T3 received treatment with an R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) protocol for six cycles. However, 12 months later, the patient complained of a left neck mass and excisional biopsy was performed. Microscopically the biopsied tissue showed Reed-Stemberg cells and confirmed the diagnosis of HL. The patient was treated with ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) for four cycles. Although the possibility of a secondary malignancy cannot be excluded, this is a rare case of sequential Hodgkin’s lymphoma following Non-Hodgkin’s lymphoma.

The goals of palliative chemotherapy are to improve overall survival and the quality of life through relief of symptoms. On the other hand, chemotherapy has many side effects, such as, myelosupression, neuropathy, gastro-intestinal symptoms, and infertility. On the many known side effects of chemotherapy, bleeding occurs in approximately 6-10% of patients with advanced cancer. Most of bleeding associated with chemotherapy is due to local vessel damage and systemic process, such as, disseminatated intravascular coagulopathy or abnormalities in platelet function or number. This symptom led to worse progression of quality of life and severe stress state in patient and their attendant. Here, the authors report a case of chemotherapy- related bleeding in maxillary cancer patient and successful achievement of hemostasis using interventional endovascular therapy.