Uncommon Picture Research Articles

Limb shaking transient ischemic attacks: A follow-up of 28 patients

BackgroundLimb shaking transient ischemic attack (LSTIA) is an uncommon picture of carotid-occlusive disease. The symptoms are a seizure like activity and misdiagnosed as partial motor seizures. We here present a series of patients in our registry who had limb-shaking activities and their long-term outcome after treatment of their disease. MethodsA total of 28 patients with limb shaking symptoms were recruited among 798 patients with TIA in our stroke registry. Risk factors and etiology of LSTIA were examined within hospitalization. After the initiaition of treatment patients were followed for a median of 6months. ResultsLimb-shaking was observed mainly on the hand-arms (46%), and secondly on the legs (39%). We found five different DWI lesion patterns in patients with LSTIA, including unilateral or bilateral either cortical or borderzone ischemic hyperintensities. Carotid endarterectomy was performed in 9 (32%) patients and carotid angioplasty-stent (CAS) in 10 (36%), and after 6-months of follow-up none of the patients had LSTIA. Limb shaking continued only in a patient with chronic carotid occlusion who received only conservative treatment. ConclusionsLimb shaking TIA point to carotid artery disease in the majority of patients and vertebrobasilar artery disease in one third. Fast and timely treatment with either surgical or CAS eliminates the attacks and also reduce their risk of stroke.

Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

Background: Differentiated diagnosis of meningoencephalitis in elderly patients, when an uncommon picture of respiratory infection leading to acute hypercapnic respiratory failure (AHRF) and without neurological signs is present, may raise serious difficulties.Case report: Two patients aged 72 (patient 1) and 75 (patient 2), without any medical history of respiratory problems, were hospitalized during spring with influenza symptoms. Within less than 24 hours from their admission, patients developed AHFR, which led to disturbances of arterial blood gases (ABGs). They were intubated and transferred, mechanically ventilated, to our intensive care unit (ICU). After normalization of ABGs, a weaning process followed. Weaning was unsuccessful, as unexpected neurological semiotics occurred. The imaging of neurological MRI revealed no special damage apart from microangiopathy. Further investigations through lumbar puncture with cerebrospinal fluid (CSF) testing revealed meningoencephalitis. Antiviral treatment was applied and the outcome was successful for both patients.Conclusion: Critical care medical personnel should be aware of the event of viral meningoencephalitis in elderly patients with AHRF. Especially in the middle of influenza endemic periods, the management of elderly patients may not be appropriate, thus resulting in serious delays for a proper treatment of disease. Laboratory screening of blood and urine, as well as other body fluids, can help detect and determine brain infection. Results from these tests can help exclude other diseases that mimic meningoencephalitis. In cases of patients who are hospitalized in the ICU due to AHRF and do not exhibit neurological abnormalities from the onset of illness, lumbar puncture and check of CSF should be a routine examination. Prophylactic vaccination of high-risk groups may be of crucial importance for preventing complications in patients who develop meningoencephalitis. However, once infected with this disease, the positive outcome is highly dependent on the immediate diagnosis and proper treatment of patients in the ICU.

An uncommon picture of endomyocardial fibrosis: no embolism yet

We present here a review of the various gradings of endomyocardial fibrosis from autopsy (Shaper's types). Echocardiography accurately delineates the extent of fibrosis of either the right or left ventricle...

Eosinophilic Enterocolitis Diagnosed by Means of Upper Endoscopy and Colonoscopy with Random Biopsies Treated with Budenoside: A Case Report and Review of the Literature

Intense infiltration of gastrointestinal and colonic mucosa with eosinophils or acidophilic gastroenteritis (EG) is a relatively uncommon picture for a pathologist endoscopist especially outside the pediatric age group and is highly suggestive of an ongoing chronic inflammatory process. Existing literature projected a hypothetical association with allergy but the exact pathophysiology is still unknown. Association with malabsorption, protein losing enteropathy, and refractory ulcers with gastrointestinal bleeding makes the clinical presentation more complicated. We present a unique case of diarrhea and abdominal pain in the clinical presentation with associated peripheral eosinophilia, asthma, and gastroesophageal reflux disease (GERD). The patient's symptoms abated after initiation of budesonide.

Cellulitis and Nodular Skin Lesions Due to Fusarium spp in Liver Transplant: Case Report

Fusariosis is one of the emerging invasive fungal infections over the last decade. However, its recent rise has been in its ability to produce disseminated infection in severely immunosuppressed patients with neutropenia. In solid organ transplantation, fusariosis remains an uncommon picture mainly with nodules, subcutaneous abscesses, ulcers, or necrotic skin lesions resembling erthyma gangrenosum. Herein, we have reported a case of cellulitis, subcutaneous nodules, and abscesses due to Fusarium spp in a liver transplantation patient who was successfully treated with polyenes and surgical resection.

Shot Noise and Charge at the2/3Composite Fractional Quantum Hall State

The exact structure of edge modes in "hole conjugate" fractional quantum Hall states remains an unsolved issue despite significant experimental and theoretical efforts devoted to their understanding. Recently, there has been a surge of interest in such studies led by the search for neutral modes, which in some cases may lead to exotic statistical properties of the excitations. In this Letter, we report on detailed measurements of shot noise, produced by partitioning of the more familiar 2/3 state. We find a fractional charge of (2/3)e at the lowest temperature, decreasing to e/3 at an elevated temperature. Surprisingly, strong shot noise had been measured on a clear 1/3 plateau upon partitioning the 2/3 state. This behavior suggests an uncommon picture of the composite edge channels quite different from the accepted one.

"Pictures Have Now Become a Necessity": The Use of Images in American History Textbooks

When the second edition of Out of Many arrived, my initial desire, checked only by a squeamishness about defacing books, was to slice off volume i's cover and stick it on my office wall. It was that striking. In full color, bled to the edge, and wrapped around to the back is Richard Caton Woodville's The Sailors Wedding (1852). A genre painting intended to highlight a supposed scene of everyday life, the image, read left to right, shows a patriarchal figure being introduced to a small wedding party while black family servants, among others, stand in the doorway and watch. Woodville's canvas marks only the beginning of an extensive pictorial feast that includes paintings reproduced in both full color and black-and-white, lithographs, cartoons, maps, and photographs. Hardly a page passes without a visual supplement to the written text. The publisher even preens that it is the first to produce a four-color book directly from computer disk to printer plate.' So it goes with every textbook in American history. Publishers spend tens of thousands of dollars to include hundreds of images. They compete for uncommon pictures that might distinguish their products, since the survey market is highly competitive, and a successful book can mean millions of dollars in sales. Marketing experts understand that students today are visually aware in ways different from previous generations. This is the age of video games and 3-D graphics, of pixels and digital imaging. No wonder that between the first and second editions of Out of Many the publisher shifted the cover illustration from a textile design by a modern artist to a painting that directly evokes a sense of history. And yet, for all the money, research, and creativity employed in selecting pictures, textbooks do not provide students with even a superficial understanding of the place and meaning of images in American history. Authors do not situate the images in their historical context or locate those images within the history of visual

The electrodermal orienting response and memory: an analysis of age differences in picture recall.

ABSTRACTYoung and elderly women were compared on electrodermal measures of the orienting response (OR) to picture stimuli presented during the study phase of a free recall task. Responses were also recorded during a subsequent simple habituation paradigm which was designed to investigate stimulus priming effects. Young subjects recalled more pictures than the elderly and both groups remembered more pictures with common word names than pictures with uncommon verbal labels. Young and older subjects displayed larger skin conductance responses to recalled pictures, especially to recalled uncommon pictures. Older women, however, displayed consistently smaller SCRs than the young. Stimulus priming was observed on the first trial of habituation training where not‐recalled pictures evoked smaller SCRs than pictures not shown in the study phase. There were no age differences in habituation across trials. In general, the results indicated that the electrodermal OR is functionally related to recall performance and that the age decrement in recall may be attributed to reduced cognitive effort in the elderly.