Unusual Brain Trauma Injury

Unusual head trauma is rare with various mechanisms of occurrence. The injuries can be similar to those of road accidents but sometimes with significant complexities. The objective was to determine the frequency of this pathology in our practice, describe the different mechanisms and report the craniocerebral lesions caused by this type of trauma. Materials and Method: This was a descriptive study with retrospective collection spread over a period of 3 years. After selecting the files, the patients and/or their companions were contacted by telephone to inquire about them and then returned to the consultation for reassessment. Disease history and information were obtained from patients’ medical records. Result: The frequency of this pathology was 1.78% and his incidence was 0.4 cases per month. The average age of the patients was 13.47 years. All the victims were male. 41.17% of patients were in school. The mechanisms of trauma were the hoof blow 47.1%, the horn blow 29.4% and the stone blow 11.7% respectively. 23.5% of patients were confused and 11.7% children were in coma. One patient presented an anisocoria. The motor deficit was present in 5 cases. CT-scan made it possible to highlight a skull depressing fracture 58.8% and confirm a craniocerebral wound in 35.3%. The average time between patient admission to hospital and completion of surgery was 24.5 hours. The surgery had consisted of the trimming of cranio-cerebral wounds, exploration, duroplasty and lifting of skull depressing fracture. After 15 months of follow-up, the evolution was favorable in 53.3%, the morbidity was 33.4% and the mortality 17.6%. Conclusion: These are rare but serious conditions because they are fatal and disabling. An early and multidisciplinary management can hope to have a good favorable.

An Unusual Punishment

One day Jack broke his mother's glass. When shesaw the broken glass, she cried, "Jack, your father isgoing to punish(惩罚)you." "I'm too upset(沮丧)to punish you now." said Jack'sfather."I'll do it after supper."

Eosinophilic gastroenteritis:An unusual type of gastroenteritis

Eosinophilic gastroenteritis(EGE) is a rare disorder characterized by eosinophilic infiltration of the bowel wall with various gastrointestinal manifestations.Till date only 280 cases have been described in the literature.A high index of suspicion,by excluding other causes of peripheral eosinophilia,is a pre requisite for accurate diagnosis.EGE is an uncommon gastrointestinal disease affecting both children and adults.It was first described by Kaijser in 1937.Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course.This condition can respond to low dose steroid therapy,thereby preventing grave complications like ascites and intestinal obstruction that might need surgical intervention.The natural history of EGE has not been well documented.Eosinophilic gastroenteritis is a chronic,waxing and waning condition.Mild and sporadic symptoms can be managed with reassurance and observation,whereas disabling gastrointestinal(GI) symptom flare-ups can often be controlled with oral corticosteroids.When the disease manifests in infancy and specific food sensitization can be identified,the likelihood of disease remission by late childhood is high.GI obstruction is the most common complication.Fatal outcomes are rare.

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

Evolution of IPv6 Internet topology with unusual sudden changes

The evolution of Internet topology is not always smooth but sometimes with unusual sudden changes. Consequently, identifying patterns of unusual topology evolution is critical for Internet topology modeling and simulation. We analyze IPv6 Internet topology evolution in IP-level graph to demonstrate how it changes in uncommon ways to restructure the Internet. After evaluating the changes of average degree, average path length, and some other metrics over time, we find that in the case of a large-scale growing the Internet becomes more robust; whereas in a top–bottom connection enhancement the Internet maintains its efficiency with links largely decreased.

Unusual presentations of cutaneous leishmaniasis in clinical practice and potential challenges in diagnosis:a comprehensive analysis of literature reviews

Cutaneous leishmaniasis is regarded as a re-emerging disease due to its increase in spread and rate of transmission over the past decade due to a proportionate increase in global human movements.This study was therefore carried out to review epidemiology,laboratory diagnosis and treatment with in-depth discussion on some of the rare clinical presentations of the disease capable of influencing its control.The study was based on literature review on clinical and laboratory features of cutaneous leishmaniasis from original research articles,review articles, short communications,letters to editor and case reports on the disease for the past 10 years(April 2000 to April 2010).The results were analysed using simple descriptive methods.The rarest presentations of leishmaniasis encountered were peritibial ulcerations,hard painful nipple in a male,swollen upper lip,dermatofibro sarcoma protuberans,sternal proliferative growth,turban tumour,post operative granuloma,chalazion-like 0.00%,and cutaneous sterile pyogranuloma with asymmetrical alopecia 0.00%each.Others include infected sebaceous cysts 0.45%,syphilis 0.19%,yaws 0.13%,thrombotic ulcerations 0.40%,mycetoma 0.90%,sarcoidosis 0.67%,painless nasal solitary nodule 0.00%,tuberculous lymphadenopathy 0.25%and unilateral erythema nodosum 0.28%.Physicians practicing in cutaneous leishmaniasis endemic,but most especially in the non-endemic areas should bear in mind that the disease may not be that rare in the context of the present global village phenomenon:and that,the next case could just be that of cutaneous leishmaniasis,the clinical picture of the patient notwithstanding.

ON THE RELATIONSHIPS BETWEEN THE UNUSUAL TRACK OF TYPHOON MORAKOT(0908)AND THE UPPER WESTERLY TROUGH

In this paper,by carrying out sensitivity tests of initial conditions and diagnostic analysis of physical fields,the impact factors and the physical mechanism of the unusual track of Morakot in the Taiwan Strait are discussed and examined based on the potential vorticity(PV)inversion.The diagnostic results of NCEP data showed that Morakot's track was mainly steered by the subtropical high.The breaking of a high-pressure zone was the main cause for the northward turn of Morakot.A sensitivity test of initial conditions showed that the existence of upper-level trough was the leading factor for the breaking of the high-pressure zone.When the intensity was strengthened of the upper-level trough at initial time,the high-pressure zone would break ahead of time,leading to the early northward turn of Morakot.Conversely,when the intensity was weakened,the breaking of the high-pressure zone would be delayed.Especially,when the intensity was weakened to a certain extent,the high-pressure zone would not break.The typhoon,steered by the easterly flow to the south of the high-pressure zone,would keep moving westward,with no turn in the test.The diagnostic analysis of the physical fields based on the sensitivity test revealed that positive vorticity advection and cold advection associated with the upper-level trough weakened the intensity of the high-pressure zone.The upper-level trough affected typhoon's track indirectly by influencing the high-pressure zone.

Unusual histopathological findings in appendectomy specimens:A retrospective analysis and literature review

AIM: To document unusual findings in appendectomy specimens. METHODS: The clinicopathological data of 5262 patients who underwent appendectomies for presumed acute appendicitis from January 2006 to October 2010 were reviewed retrospectively. Appendectomies performed as incidental procedures during some other operation were excluded. We focused on 54 patients who had unusual findings in their appendectomy specimens. We conducted a literature review via the PubMed and Google Scholar databases of English language studies published between 2000 and 2010 on unusual findings in appendectomy specimens. RESULTS: Unusual findings were determined in 54 (1%) cases by histopathology. Thirty were male and 24 were female with ages ranging from 15 to 84 years (median, 32.2 ± 15.1 years). Final pathology revealed 37 cases of enterobiasis, five cases of carcinoids, four mucinous cystadenomas, two eosinophilic infiltrations, two mucoceles, two tuberculosis, one goblet-cell carcinoid, and one neurogenic hyperplasia. While 52 patients underwent a standard appendectomy, two patients who were diagnosed with tuberculous appendicitis underwent a right hemicolectomy. All tumors were located at the distal part of the appendix with a mean diameter of 6.8 mm (range, 4-10 mm). All patients with tumors were alive and disease-free during a mean follow-up of 17.8 mo. A review of 1366 cases reported in the English literature is also discussed. CONCLUSION: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

Thoracic hydatid disease:A radiologic review of unusual cases

Hydatid disease or echinococcosis is a zoonotic parasitic disease.The lung is the second most commonly affected organ after the liver.Intra-thoracic and extrapulmonary hydatid disease is uncommon and may involve the pleura,mediastinum,heart,diaphragm,and chest wall.Unusual locations or complications of thoracic hydatid disease may pose a diagnostic challenge.We present imaging findings of cases with unusual location and presentations of thoracic hydatid disease with emphasis on their clinical implications.

Seismic Precursory Phenomenology in Unusual Animal Behaviour in Val Pellice, Western Piedmont, in Comparison with Anomalies of Some Physical Parameters

The unusual animal behaviour, often observed before earthquakes in a moderate seismic area in Western Piedmont (NW Italy), can be connected with the anomalies of some physical parameters, recorded in a multiple parameters monitoring. Physical phenomena such as radioactive decay, gas emission, soil temperature increase, water pH variations in creeks and lakes, magnetic declination anomalies, air electricity and infra-sound, can generate damages to biological structures or, sometimes, death. A multiple parameters physical monitoring started recently in Western Piedmont, which is useful to propose the study of seismic precursors possibly linked to animal behaviour. Observations of unusual animal behaviour as vocal communications and movements were collected in the same area. A statistical analysis of strange behaviours in dogs and cats may indicate the probable early warning factor of the sense of smell.

Unusual Normal and Superconducting State Properties Observed in Hydrothermal Fe_(1-δ)Se Flakes

The electronic and superconducting properties of Fe_(1-δ)Se single-crystal flakes grown hydrothermally are studied by the transport measurements under zero and high magnetic fields up to 38.5 T.The results contrast sharply with those previously reported for nematically ordered Fe Se by chemical-vapor-transport(CVT)growth.No signature of the electronic nematicity,but an evident metal-to-nonmetal crossover with increasing temperature,is detected in the normal state of the present hydrothermal samples.Interestingly,a higher superconducting critical temperature T_c of 13.2 K is observed compared to a suppressed T_c of 9 K in the presence of the nematicity in the CVT Fe Se.Moreover,the upper critical field in the zero-temperature limit is found to be isotropic with respect to the field direction and to reach a higher value of-42 T,which breaks the Pauli limit by a factor of 1.8.

Identification and geochemical significance of unusual C24 tetracyclic terpanes in Shahejie Formation source rocks in the Bozhong subbasin,Bohai Bay Basin

C_(24)tetracyclic terpanes are common compounds in source rocks and crude oils,and C_(24)17,21-secohopane is the most common and widely used source-related indicator.In this study,three unusual C_(24)tetracyclic terpanes were detected on the m/z 191 chromatogram of saturated hydrocarbons in the Shahejie Formation source rocks in the Bozhong subbasin.Based on the mass spectra characteristics,diagnostic ion fragments,retention time and comparisons with published literature,three unusual C_(24)tetracyclic terpanes were identified as 10β(H)-des-A-oleanane,10β(H)-des-A-lupane and C_(24)des-Ahopane.To the best of our knowledge,this is the first study to detect and publicly report these three compounds in source rock samples from the Shahejie Formation of the Bozhong subbasin,Bohai Bay Basin.The results indicated that 10β(H)-des-A-oleanane and 10β(H)-des-A-lupane likely originated from terre strial angiosperms,while C_(24)des-A-hopane likely originated fro m prokaryotic o rganisms.Te rrestrial angiosperms provide the material basis for the generation of compounds A and B,and the distribution and concentration of these two compounds are affected by thermal maturity.In the low maturity stage(0.5%<R_(0)<0.7%),compounds A and B are relatively enriched in the source rocks.

Unusual neural connection between injured cingulum and brainstem in a patient with subarachnoid hemorrhage

The human brain is known to have six cholinergic nudei （Selden et al., 1998; Nieuwenhuys et al., 2008）. The cerebral cortex obtains cholinergic innervation mainly from the basalis nucleus of Meynert （Ch 4） in the bas- al forebrain through the medial and lateral cholinergic pathways （Selden et al., 1998; Mesulam et al., 1983）. The cingulum, the neural fiber bundle connecting the basal forebrain and the medial temporal lobe, contains the medial cholinergic pathway （Selden et al., 1998; Hong and Jang, 2010）.

An unusual cause of simultaneous bilateral spontaneous pneumothorax

INTRODUCTIONScrub typhus, a tropical febrile vector borne disease also known as ＂Tsutsugamushi disease＂, is caused by Orientia tsutsugamushi, a gram negative obligate intracellular slow growing bacteria. The infection is transmitted by the bite of larval stage （chiggers） mites belonging to the family Trombiculidae.

Unusual Quartz Phenocrysts in a Newly Discovered Porphyritic Granite near the Giant Dongping Gold Deposit in Northern Hebei Province, China

Objective The giant Dongping gold deposit, situated in northern Hebei Province, is the first recognized deposit among the alkaline complex-hosted gold system in China. The gold deposits in the Dongping district are usually defined as alkaline rock-related gold deposits because they are hosted by the Middle Devonian Shuiquangou alkaline complex （SAC）. However, geochronological data show that these gold deposits were formed in Late Jurassic （Jiang Sihong and Nie Fengjun, 2000; Zhang Guorui et al., 2012）.

Mucosa-associated lymphoid tissue lymphoma with unusual 18F-FDG hypermetabolism arising at the colorectal anastomosis

Mucosa-associated lymphoid tissue (MALT) lymphoma usually originates from the stomach and presents with low ^(18)F-fluorodeoxyglucose (FDG) avidity with average maximum standard uptake value of 3.6. Colorectal MALT lymphoma is a rare entity that contributes to 1.6% of all MALT lymphomas and < 0.2% of large intestinal malignancies. The case reported herein firstly revealed stage Ⅱ MALT lymphoma with unexpected higher ^(18)F-FDG avidity of 18.9 arising at the colorectal anastomosis in a patient with a surgical history for sigmoid adenocarcinoma, which was strongly suspected as local recurrence before histopathological and immunohistochemical examinations. After accurate diagnosis, the patient received four cycles of standard R-CVP regimen (rituximab, cyclophosphamide, vincristine and prednisone), combined target therapy and chemotherapy, instead of radiotherapy recommended by National Comprehensive Cancer Network guidelines. He tolerated the treatment well and reached complete remission.

An unusual case of renal calculi leading to myocardial infarction and cardiogenic shock

INTRODUCTION The presentation of cardiogenic shock （CS） is usually straightforward, and includes hypotension, absence of hypovolemia, and clinical signs of poor tissue perfusion such as oliguria, cyanosis, cool extremities and altered mentation. The most common etiology of CS is acute myocardial infarction, Here, we report a case of a 42-year-old male who presented with right flank pain, nausea and vomiting initially thought to be nephrolithiasis, which he had a history of but was ultimately diagnosed with CS due to a type II myocardial infarction. This case illustrates the importance of having a broad differential diagnosis especially when a patient＇s vital signs take a drastic turn since this patient initially resembled someone with nephrolithiasis.

Unusual Findings in Appendectomy: Experience in a Third Level Hospital with More than 1000 Specimens

Introduction and Aims: Acute appendicitis is a commonly established diagnosis in the approach of abdominal pain. It is usually due to an acute inflammatory process in the appendix. Nevertheless, there is a small percentage of cases due to non-frequent etiologies that are only identifiable based on histopathological analysis. The aim of this study was to determine the prevalence and characterization of these unusual findings. Materials and Methods: The present study was a cross-sectional study in a third-level hospital in Mexico City. Clinical information was collected from unusual findings in the histopathological analysis of 1018 appendectomy specimens between January 2012 and April 2017. Results: In total, 1018 appendectomy specimens were included. In 11 of those appendices (1.08%), unusual findings compatible with appendicular tumors were identified. Carcinoid tumor found in the tip of the appendix was the most frequently reported finding. The muscular layer was affected in most cases;up to 25% of regional ganglia were invaded. Most of the patients presented with abdominal pain and clinical signs suggestive of acute appendicitis. The preferred approach for surgical treatment was laparoscopic. Discussion and Conclusion: The prevalence of unusual findings in our population was 1.08%, with carcinoid tumors the most frequently established diagnosis among those (0.58%), according to previously reported literature data.

Discovery of Unusual Highly Branched Galactomannan from Seeds of <i>Desmanthus illinoensis</i>

A galactomannan was isolated from seeds of a leguminous plant, Desmanthus illinoensis, which is grown in Okinawa, Japan. D-Galactose (molar ratio, 1.0) and D-mannose (0.82) were identified via High-performance Anion Exchange Chromatography Coupled with a Pulse Amperometric Detector. The molecular mass and specific rotation were estimated to be 1000 kDa and +53.8&deg;, respectively. The infrared spectrum indicated that the galactomannan was involved in both α- and β-linkages, and two types of α-linkages were detected at 814 and 830 cm-1. The 1H- and 13C-NMR spectra indicated that the majority of the β-D-mannan main chain was substituted with mono α-D-galactose or α-D-galacto-disaccharide-side chains. Methylation analysis was used to identify 2,3,4,6-tetra-O-methyl-D-galactose (molar ratio, 3.3), 2,3,4-tri-O-methyl- D-galactose (1.0) and 2,3-di-O-methyl-D-mannose (3.1). Specifically, unique 2,3,4-tri-O-methyl D-galactose residue was identified from mass spectrum. The results suggested that the galactomannan was 1,4-linked-β-D-mannan substituted with α-D-galactose or 1,6-linked-α-D-galacto-disaccharide side chains at C-6 on the main chain. The galactomannan isolated from D. illinoensis was an unusual highly branched polysaccharide, and its chemical structure was proposed. This work is the first to report on the galactomannan involving 1,6-linked α-D-galacto-disaccharide side chains in addition to α-D-galactose mono side chains.

An unusual case report of Burkholderia cepacia endophthalmitis

Dear Editor,I am Huan Chen from the Department of Ophthalmology,Peking Union Medical College Hospital in Beijing,China.I am writing this letter to present an unusual case of Burkholderia cepacia endophthalmitis.Burkholderia cepacia[Burkholderia cepacian complex(Bcc)]is a group of genetically unique Gram-negative bacilli with similar phenotypes,belonging to the genus pseudomonas,which is widely found in water,soil and plants.