Cavernous Hemangioma in the Orbital Cavity: Case Report

Cavernous hemangiomas are benign malformations of vascular origin, usually well circumscribed and slow to grow. These lesions can be asymptomatic, being discovered unintentionally in imaging exams or symptomatic, indicated mainly by the presence of proptosis, diplopia, and visual disturbances by optic nerve compression. The complementary exams involve computed tomography associated with contrast, color Doppler, magnetic resonance, and angiography. Treatment can be conservative or surgical depending on the case, and the open therapy usually involves lateral, supraorbital, transconjunctival, transantral, pterional, transnasal, and extradural endoscopic orbitotomy. The present study aims to report a recurrent case of hemangioma in the orbital cavity signaled by ocular proptosis, hyperemia, and ocular pain.The lesion was achieved through the Weber-Ferguson access with zygomatic osteotomy and preservation of the infraorbital nerve. The excision of the lesion was performed, and the previously displaced fragments were fixed with 1.5 mm mini plates. The patient has a chance of progressing with visual impairment due to considerable manipulation of the optic nerve and is being followed up.The reported case showed a successful diagnosis and therapeutic conduct, remaining now in the evolution and follow-up scenario.

Diagnostic performance of deep learning on 12-leads electrocardiography for recurrence after pulmonary vein isolation in patients with persistent atrial fibrillation

Background Several patients with persistent atrial fibrillation (per-AF) suffer from recurrence after pulmonary vein isolation (PVI). Various methods to predict the recurrence were tried, but deep learning on 12-leads electrocardiography (ECG) after PVI was not studied. Purpose To elucidate diagnostic performance of deep learning on 12-leads ECG after PVI in patients with per-AF Methods We enrolled consecutive 109 patients with per-AF who underwent PVI (68.8±10.0 years, 83 males) excluding failure cases. We defined recurrence in 3–12 months after PVI. From the ECG just after PVI, five beats of each lead were sampled separately. Deep learning (convolutional neural network on bitmap ECG image) was performed by transfer learning of Inception-Resnet-V2 model. Gradient weighted class activation color mapping (GradCam) was performed to detect convolutional importance in the lead. Results Thirty-six patients showed recurrence in the period. Lead II (accuracy 0.701), aVR (0.690) were the top 2 leads of prediction, which showed larger accuracy than statistical accuracies of Non PV foci = SVC (accuracy = 0.541) and left atrial diameter >50mm (0.596). In lead II, GradCam spotlighted strong convolution of latter half of P wave in recurrent case, and former half of P wave and T wave in no-recurrent case. Conclusions Deep learning on ECG was a powerful tool to predict recurrence of per-AF after PVI. FUNDunding Acknowledgement Type of funding sources: None. Results of deep learning Results of GradCam

Recurrent transperineal aggressive angiomyxoma: a case report

Background: aggressive angiomyxoma is a rare disease that may cause misdiagnosed in the clinical work and the characteristic of this disease is low potential malignancy. This case show a recurrent case of aggressive angiomyxoma 7 years after the surgery which was mistakenly diagnosed at that time.Case presentation: the patient presented a large mass in the right labium majus without any pain. This mass was recurrent 7 years after she received a surgery about the mass occurred at the same place which was diagnosed as vulvar angiomyofibroblastoma. She took the ultrasound scan and MRI scan and underwent the surgery again. This mass was excision completely. At this time, pathologist checked the HE stained slides and immunohistochemistry staining slides, then come the conclusion that this mass was aggressive angiomyxoma. We rechecked the pathological slides 7 tears ago and found out it was misdiagnosed at that time.Conclusions: Aggressive angiomyxoma is a rare tumor. This case presents a rare disease that may be misdiagnosed as other benign vulvar disease even after the surgery which get pathologic evidence. So we need to know more abou this disease.

Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms

Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery.Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated.Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery.Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.

Hamlet’s Displacement as a Recurrent Case in Cather’s A Lost Lady and Al Halaby’s Once in a Promised Land

Freudian neurosis, despite being a psychological disorder rather than a literary topic, has been used in literature to conceptualise characters’ suffering. Freud contends that the suppression of desires due to hidden and unhidden causes leads to neurosis. Being unable to succeed in life, individuals feel neurotic and tend to displace their frustrations onto other persons or objects. Starting with the Renaissance, this article explores how displacement in Shakespeare’s Hamlet is tacitly approached and how this reaction has become a recurrent case in Willa Cather’s A Lost Lady (1923) and Laila Al Halaby’s Once in a Promised Land (2007). The article analyses the incentives of neurosis in each work, how these reasons lead to the onset of displacement and how literary works share relatively similar implications about displacement despite being about different issues.