A survey of Heterophyes nocens and Pygidiopsis summa metacercariae in mullets and gobies along the coastal areas of the Republic of Korea

The infection status of mullets Mugil cephalus (n = 139) and gobies (n = 35) Acanthogobius flavimanus with metacercariae of Heterophyes nocens and Pygidiopsis summa was examined in 11 western, southern, and eastern coastal areas of the Republic of Korea, using a digestion technique. Heterophyid metacercariae were highly prevalent in mullets from western and southern coastal areas; Shinan-gun (100% for H. nocens and 100% for P. summa), Muan-gun (93% and 100%), Buan-gun (42% and 75%), Seocheon-gun (73% and 53%), Ganghwa-gun (47% and 100%), Sacheon-shi (47% and 77%), and Gangjin-gun (50% and 70%, respectively). Only 1 (10%) of 10 mullets from an eastern coastal area, i.e., Donghae-shi, was positive for P. summa metacercariae. Metacercarial densities were the highest in the trunk of mullets for H. nocens and the gill for P. summa. Gobies from Muan-gun were positive for H. nocens (40%) and P. summa metacercariae (40%), and gobies from Seocheon-gun revealed H. nocens metacercariae (20%). The metacercarial density was remarkably higher in mullets than in gobies. The results revealed that H. nocens and P. summa metacercariae are prevalent in mullets and gobies from coastal areas of the Republic of Korea, and the prevalence and intensity of infection vary according to geographical locality.     

A new endemic focus of Heterophyes nocens and other heterophyid infections in a coastal area of Gangjin-gun, Jeollanam-do

To know the prevalence of heterophyid trematodes among inhabitants of a southern coastal village, i.e., Sacho-ri, Gangjin-gun, Jeollanam-do (Province), 82 stool samples were examined on helminth eggs and protozoan cysts using Kato-Katz and formalin-ether sedimentation techniques. Total 33 people (40.2%) were positive for trematodes (Heterophyes nocens 15 people, Pygidiopsis summa 3, Metagonimus sp.; 4, Clonorchis sinensis 7, Gymnophalloides seoi 6) and/or protozoa (Entamoeba coli 3). Among intestinal trematode egg positive cases, 17 were treated with praziquantel and their whole diarrheic stools were collected after purgation. Adult flukes of H. nocens (number of specimens = 1,294), P. summa (386), Stellantchasmus falcatus (5), Stictodora lari (4), and Heterophyopsis continua (1) were collected using a stereomicroscope. To know the source of human H. nocens infections in this village, metacercarial infections in mullets (10) were examined and most H. nocens metacercariae (101/105, 96.2%) were found in the trunk portion. From above results, the surveyed coastal village has been newly known as an endemic focus of human H. nocens infection and consuming raw mullets was the presumable source of human heterophyid infections.     

The carcinoid tumour in Meckel's diverticulum: how to treat young adults with appendicitis?--Case report

This case reports the concomitant and unexpected finding of carcinoid tumour within a Meckel's diverticulum presenting as an acute abdomen due to gangrenous appendicitis in a young adult male. Both Meckel's diverticula and carcinoid tumour are rare clinical entities, and carcinoid tumours occurring within a Meckel's diverticulum are even more uncommon. The initial clinical presentation of carcinoid tumours occurring in a Meckel's diverticulum is usually similar to that of appendicle carcinoids.Carcinoid tumours are the most common primary tumour of the small bowel. They resemble appendicle carcinoids to the extent that they are usually small, single, and asymptomatic. Surgical treatment of Meckel's diverticula is recommended procedure. By presenting this case we wished to stress the value of systematic identification and removal of the diverticulum during laparotomy and to underline the importance of exploration the Meckel's diverticulum particularly in case of young adult subjects.     

Meckel's diverticulum: its clinical significance; a report of 54 cases

Of 54 cases of Meckel's diverticulum observed at one hospital in a 20-year period, 27 were noted incidentally and 27 caused symptoms. In the latter group, the patients were preponderantly males. The most common symptoms, in order of frequency, were hemorrhage from the bowel, intestinal obstruction, acute diverticulitis, and intussusception. All the complications except intestinal obstruction occurred in infancy and childhood more often than in later life. Intestinal obstruction was limited to adults. There was strong coincidence of complications and ectopic tissue. Surgical excision was done in all cases of diverticulum causing symptoms, and all patients recovered.     

Early cancer in congenital choledochal cyst

We report a case of 35-yr-old woman with early cancer in congenital choledochal cyst. She had a five-year history of intermittent right upper abdominal pain and intermittent jaundice. In this period she had a few abdominal ultrasonographies, but the cholelithiasis had not been found. Now, she was admitted to our hospital because she felt right upper abdominal pain with slight jaundice and subfebrile temperature four weeks ago. Abdominal ultrasonography showed enormous dilatation of the common bile duct, which was suspected as choledochal cyst. Computed tomography and endoscopic retrograde cholangiopancreatography revealed cystic dilatation of extrahepatic bile duct. An anomalous pancreaticobiliary junction was not found. The patient with congenital choledochal cyst was operated on. The excision of choledochal cyst was done with hepaticojejunostomy Roux-en-Y. There were no lymph nodes metastases. On the central part of choledochal cysts mucosa, it was shown a white plain area of thickness 0.3 cm and 0.8 cm in diameter. Histologically it was well-differentiated tubular adenocarcinoma, which was limited to the mucosa and which did not penetrate to other parts of the bile duct wall. From our knowledge, only small number cases of early cholangiocarcinoma in choledochal cyst were until now reported. Nearly eight years after the operation the patient feels very well, and has optimal working ability (Karnofsky 100%).     

Ammonia absorption from different parts of chicken intestine and its quantitative evaluation in situ

Ammonia was more rapidly absorbed from the ileum than the jejunum, and the lower the small intestine was, the more rapid was the absorption of lumen fluid. About 95% of ammonia-15N introduced into the intestinal sac having Meckel's diverticulum in the middle part disappeared in 30 min, of which 90% was recovered as non-protein-N in the blood of the mesenteric vein draining the sac and in the mucosa of the tested portion in 30 min. About 57% of ammonia which disappeared from the intestinal lumen was found as ammonia-N and 26% as other non-protein-N in the mesenteric blood. Maximal rates of appearance of total non-protein-15N and ammonia-15N in the mesenteric blood were found within 10 min and returned to the levels at 0-5 min in 30 min.     

Human pentastomiasis in China: case report and literature review

A 13-yr-old boy was admitted because of persistent fever, abdominal pain and diarrhea for 3 mo. Abdomen CT revealed hepatomegaly and multiple nodular low-density pathological changes. At laparotomy considerable yellow and turbid ascites were seen in the abdominal cavity and miliary nodules were noted on the surface of the omentum majus, liver, and small intestine wall. Histological examination revealed parenchymal tubercles containing several worms. Pathological diagnosis was parasitic granuloma. These parasites were identified as Porocephalus taiwana sp.nov. The patient made an uneventful recovery after therapy and was discharged. Moreover, another 17 cases of human pentastomiasis reported from China were reviewed. Human pentastomiasis is an extremely rare disease and this is only the second case of human Porocephalus taiwana sp.nov infection. Pentastomiasis should be considered in differential diagnosis of patients with a history of abdominal symptoms and eating of poorly-cooked snakes.     

Congenital diverticulum of the ileum in a rat.

A congenital diverticulum of the ileum (Meckel's diverticulum), approximately 10 mm long, was detected in a rat and examined histologically. The histological findings were basically the same as in the ileum. Although Meckel's diverticulum is uncommon in the rat, the present report demonstrated the possibility of discovering new cases.     

A human case of Stellantchasmus falcatus infection

A human case infected with Stellantchasmus falcatus(Heterophyidae) is reported based on the adult worms collected after praziquantel treatment. The patient is a 33-year old male residing in Seoul. For several months he experienced vague abdominal discomfort and hunger pain. Praziquantel at a single dose of 600 mg was given followed by purgation with magnesium salt, and 17 adult S. falcatus specimens were collected from the diarrheal stools. He recalled he had eaten raw flesh of several kinds of brackish water fishes. This is the 4th human case of S. falcatus infection in Korea.     

Histological study on intestinal diverticulum of tree shrew (Tupaia javanica).

Tree shrews possess an intestinal diverticulum. We investigated this diverticulum with histological and immunohistochemical methods to determine whether this diverticulum was cecum or not. The ratio of the length of diverticulum/small intestine was apparently shorter than that of several primates. In the histological study, mucous membrane of the small intestine was shifted to that of the large intestine at the junction of the diverticulum. Histological features of the diverticulum were similar to those of the large intestine, but the shape of mucousal surface was rather simpler than that of the large intestine. Immunohistochemical study revealed 5-HT positive cells in the bottom of crypts and CD3- and CD 8-positive lymphocytes in lymphoid nodules. These findings suggest that the tree shrew has a cecum with primitive characteristics.     

An incidentally discovered case of Cushing's syndrome without clinical signs

This paper describes a middle-aged man in whom an adrenal mass was incidentally discovered by upper abdominal echogram. Physical examination revealed no signs of Cushing's syndrome. The plasma cortisol level at 0800 h was within the normal range, but the diurnal rhythm had disappeared. Plasma ACTH was undetectable throughout the whole day. Urinary 17-OHCS was slightly increased and was not suppressed by 2 mg or 8 mg dexamethasone. Metyrapone test and CRF test revealed no response. A left adrenalectomy was performed and histological diagnosis of the removed tumor was an adrenal adenoma. After operation, oral steroid supplementation was necessary. These data suggest that the autonomous cortisol secretion by the tumor accounted for all his daily cortisol secretion, but it was too small to be clinically functional. We propose that every patient with an incidentally discovered adrenal mass should be subjected to endocrinological evaluations.     

Anchitrema sanguineum (Digenea: Anchitrematidae) Accidentally Found during Colonoscopy of a Patient with Chronic Abdominal Pain: A Case Report

In November 2007, a 46-year-old male Thai patient presented with chronic abdominal pain for over 3 years. Colonoscopy revealed a small parasite of about 2 × 1 mm in size attached to the cecum mucosa. The worm was removed endoscopically, fixed, and stained for morphological observations. The specimen was identified as Anchitrema sanguineum (Digenea: Anchitrematidae), a trematode first reported in a reptile, Chamaeleo vulgaris, from Egypt, and then sporadically found in the intestines of insectivorous bats and other mammals. The patient was treated with praziquantel but no more worms were found in his stool. His symptoms improved slightly but not cured completely. It remains unclear whether the chronic abdominal pain of the patient was caused by this trematode infection. Whatever is the pathogenicity of this trematode, this is the first human case of A. sanguineum infection in the literature.     

Epstein�CBarr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature

We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.     

Primary hepatic carcinoid tumor

Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.     

Giardia muris: Correlation between oral dosage,course of infection,and trophozoite distribution in the mouse small intestine

Oral inoculations of Giardia muris cysts to CD-1 Swiss mice resulted in a reproducible pattern of infection measured by cyst excretion and the number of trophozoites in the small intestine. Housing of animals together or individually did not alter the pattern of cyst release for the first 30 days of infection. Administration of 10 to 10⁵ cysts/mouse resulted in a similar rate of cyst excretion from Day 10 to the end of the infection period. There was a direct correlation between the size of inoculum and the length of the latent period. Mice which received larger doses (10³, 10⁴, 10⁵) had significantly higher numbers of cysts in feces during the first week of infection, compared to those which received lower doses (10 or 100). The extent of trophozoite colonization and their distribution in the small intestine was not related to the size of inoculum. The location of trophozoites in the small intestine varied during the infection. In the first 3 to 8 days of infection the trophozoites were situated in the upper 25% of the small intestine, but moved posteriorly (upper 40%) during the period of peak cyst output. The number of trophozoites in the small intestine and cyst excretion were found to be proportional at all stages of infection.     

Effect of somatostatin on gastrointestinal contractility in Schistosoma mansoni infected mice

Schistosoma mansoni infection induces severe gastrointestinal motility disturbances which are characterised by hyperactivity of intestinal muscle, abdominal pain, diarrhoea, vomiting and nausea. During schistosomiasis, the neuropeptide somatostatin is generated within inflammatory granulomas. However, somatostatin is also an important inhibitory modulator of gastrointestinal motility. In the present study, we have investigated the potential of somatostatin to reduce schistosomiasis-induced hyperactivity of gastrointestinal smooth muscle. Organ bath experiments were performed to study the contractility of isolated smooth muscle strips of intestine from control mice and from mice that were infected with S. mansoni for 2, 4, 8 and 16 weeks. Electrical field stimulation (0.5-8 Hz) of enteric nerves induced frequency-dependent neurogenic contractions of cholinergic origin in all regions of the small intestine. Somatostatin (0.1-1 microM) concentration-dependently inhibited the contractions to enteric nerve stimulation in the small intestine from uninfected control mice and from acutely S. mansoni infected mice (2 and 4 weeks of infection). After 8 weeks of infection with S. mansoni, this inhibitory effect of somatostatin was less pronounced and after 16 weeks of infection it was completely abolished. Histology demonstrated that chronic infection of mice with S. mansoni was associated with significant alterations in the musculature of the small intestine. These alterations may be associated with physiological changes in the responsiveness to somatostatin and suggest that the somatostatin neuroregulatory circuit of enteric neurotransmission in the small intestine is disturbed during chronic schistosomiasis mansoni.     

Diagnosis of Strongyloides stercoralis in a peritoneal effusion from an HIV-seropositive man. A case report

BACKGROUND: Strongyloides stercoralis, a nematode parasite in humans with free-living and autoinfective cycles, is often an asymptomatic infection of the upper small intestine. If the host becomes immunocompromised, autoinfection may increase the intestinal worm burden and lead to disseminated strongyloidiasis. The parthenogenetic adult female larvae can remain embedded in the mucosa of the small intestine for years, producing eggs that develop into either rhabditiform, noninfective larvae or filariform, infective larvae. Manifestations of dissemination occur when the filariform larvae penetrate the intestinal wall and migrate into the blood. Pulmonary involvement is common, and the central nervous system may be affected. Blood eosinophilia is typical, and gram-negative sepsis from enteric bacteria may occur. Much less commonly described is invasion of the peritoneal cavity with peritoneal effusion. CASE: A 49-year-old man who came to the United States from Liberia 4 years earlier presented with sudden onset of severe abdominal distention, generalized weakness and marked pedal edema. Diagnostic paracentesis showed numerous filariform larvae of S stercoralis. Stool examination confirmed the presence of both rhabditiform and filariform larvae. Subsequently the patient was found to be HIV seropositive, with a CD4 lymphocyte count of 59. CONCLUSION: Early detection of S stercoralis may alter the often-fatal course of infection. The present case is the second reported one in the English-language literature of the diagnosis of S stercoralis in ascitic fluid.     

A case of biliary Fascioliasis by Fasciola gigantica in Turkey

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.     

A case of Moniliformis moniliformis (Acanthocephala) infection in Iran

Only a few cases of Acanthocephala infections have been reported in humans, and Moniliformis moniliformis is the most common species around the world. We report here a case of infection with M. moniliformis, which passed in the stool of a 2-year-old girl in Iran. The patient had abdominal pain, diarrhea, vomiting, and facial edema. According to her mother, the patient had habit of eating dirt and once a cockroach was discovered in her mouth. In stool examination, eggs of M. moniliformis were not found. She was treated with levamisole and the clinical symptoms reduced within 2 weeks. The specimen contained 2 pieces of a female worm with a total length of 148 mm lacking the posterior end. The spiral musculature of the proboscis receptacle and the shape of the trunk allowed its generic determination. Previously 2 cases of M. moniliformis infection were reported in Iran. This is the 3rd case of M. moniliformis infection in Iran.     

Studies on the intestine section to be sampled in broiler studies on precaecal amino acid digestibility

Measurements of precaecal amino acid digestibility with digesta sampled from slaughtered animals may be affected by the chosen length of the sampled section. The length needs standardization, therefore, when digestibility is understood to be a measure of feedstuff potential. It was our objective to study the change in the net disappearance of amino acids from the lower small intestine of broiler chicken. The section between Meckel's diverticulum and 2 cm anterior of the ileo-caeco-colonic junction was cut into three subsections of equal length: proximal, medial, and terminal. The contents of each subsection were pooled within the birds of each pen (12 in Experiment 1 and 10 in Experiment 2). TiO2 was used as an indigestible marker. Prior to digesta sampling, broilers had been fed the experimental diets for seven days. In Experiment 1, two diets with either soybean meal or a mix of soybean meal and peas as the main protein sources were used. Each diet was allocated to eight pens and feeding commenced on day 14 of age. Net disappearance was significantly affected by diet only in regard to aspartic acid and methionine. No significant interaction between diet and subsection occurred. Net disappearance was significantly affected by subsection for all amino acids. It ranged from 74-92% for individual amino acids without significant differences in the medial and terminal subsections. Net disappearance was, however, between 3% and 9% lower in the proximal subsection. In Experiment 2, diets contained soybean meal as the main protein source and were given to 18 pens from day 22 of age. Again, the effect of subsection on net disappearance was significant for all amino acids. Net disappearance was significantly lower in the proximal than in the middle subsection, and differences ranged from 5-10%. Significant differences in the net disappearance were also found for most of the amino acids between the middle and the terminal subsection ranging from 2-4%. In conclusion, when precaecal amino acid digestibility should be used as a measure for a protein source's potential, digesta sampling should not consider the proximal third of the section between Meckel's diverticulum and the end of the ileum.