Most of human dirofilariasis are pulmonary or subcutaneous infections, but there have been a few reports of human dirofilariasis in unusual sites, such as large vessels, mesentery, peritoneal cavity, and spermatic cord. We present the first case of human hepatic dirofilariasis, which was surgically diagnosed. A 39-year-old man without any evidence of systemic symptom was found incidentally to have a hepatic nodule during routine physical check-up. The histologic findings of the resected lesion showed a granulomatous lesion with central necrosis containing up to 35 transverse sections of a nematode, ranging 30-80 micro m in diameter. Thin (1.5-5 micro m) cuticle with transverse striations surrounded polymyarian and muscle bundles occupied a sixth of both sides of outer body cavity. Central portion of the body cavity was occupied with an intestine-like tubular structure and a larger reproductive tube. These microscopic findings were consistent with degenerated Dirofilaria immitis. Antibody test by enzyme-linked immunosorbent assay for patient serum reacted positively against adult D. immitis antigen.

INTRODUCTIONMitral annular dilatation has been regarded as one of important geometric factors causing ischemic mitral regurgitation (MR) (1). Accordingly, the reduction of annular size by annuloplasty has been the conventional surgical treatment for ischemic . Several studies have demonstrated annular dilatation after left circumflex artery (LCX) occlusion (6,7). With the use of 3D imaging techniques, the appreciation of the non-planar geometry of the mitral annulus and its accurate measurement has been achieved (8, 9). Several previous studies by fluoroscopy of radiopaque markers or transesophageal echocardiography with a rotating transducer have revealed dilatation of the mitral annulus after LCX occlusion (10-13). However, acute geometric alterations including nonplanarity of the mitral annulus after LCX occlusion compared to left anterior descending artery (LAD) occlusion have not been described in detail. Real-time 3 dimensional echocardiography (RT3DE) has been validated for its quantitative accuracy of geometric measurement of cardiac structures (14).The present study, therefore, was conducted to detail and to compare the geometric changes in the mitral annulus immediately after LAD and LCX occlusion using RT3DE. MATERIALS AND METHODS Surgical preparationSixteen juvenile sheep weighing 43±8 kg (range 28 to 56) were studied. All of them had pre-existing apical aneurysm developed by chronic ligation of the distal LAD. The mid portion of LAD was ligated in 8 sheep and the proximal LCX in the other 8 sheep.During the acquisition of volumetric images using RT3DE, the sheep were anesthetized with intravenous sodium pentobarbital (25 mg/kg) and maintained with 1-2% isoflurane with oxygen. The animals were ventilated via an endotracheal tube using a volume-cycled ventilator. A median sternotomy was performed. Bleeding, insensible fluid loss and associated electrolyte disturbances were monitored frequently and corrected by continuous infusion of lactated Ringer's solution and 5% dextrose in water supplemented with potassium, if necessary. All operative and animal management procedures were approved by the Animal Care and Use Committee of the National Heart, Lung and Blood Institute (15). We performed real-time 3D echocardiography in sixteen sheep to compare acute geometric changes in the mitral annulus after left anterior descending coronary artery (LAD, n=8) ligation and those after left circumflex coronary artery (LCX, n=8) ligation. The mitral regurgitation (MR) was quantified by regurgitant volume (RV) using the proximal isovelocity surface area method. The mitral annulus was reconstructed through the hinge points of the annulus traced on 9 rotational apical planes (angle increment=20°). Mitral annular area (MAA) and the ratio of antero-posterior (AP) to commissure-commissure (CC) dimension of the annulus were calculated. Non-planar angle (NPA) representing non-planarity of the annulus was measured. After LCX occlusion, there were significant increases of the MAA during both early and late systole (p<0.01) wit...

BackgroundHepatocellular adenoma (HCA) is a rare benign tumor of the liver. A subtype classification of HCA (hepatocyte nuclear factor 1α [HNF1α]-mutated, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA) has recently been established based on a single institutional review of a HCA series by the Bordeaux group.MethodsWe used histologic and immunohistochemical parameters to classify and evaluate eight cases from our institution. We evaluated the new classification method and analyzed correlations between our results and those of other reports.ResultsSeven of our eight cases showed histologic and immunohistochemical results consistent with previous reports. However, one case showed overlapping histologic features, as previously described by the Bordeaux group. Four cases showed glutamine synthetase immunohistochemical staining inconsistent with their classification, indicating that glutamine synthetase staining may not be diagnostic for β-catenin-mutated HCA. HNF1α-mutated HCA may be indicated by the absence of liver fatty acid binding protein expression. Detection of amyloid A may indicate inflammatory HCA. HCA with no mutation in the HNF1α or β-catenin genes and no inflammatory protein expression is categorized as unclassified HCA.ConclusionsAlthough the new classification is now generally accepted, validation through follow-up studies is necessary.

No abstract