Although early surgical intervention to avoid muscle degeneration in patients with blowout fractures (BOFs) and extraocular muscle entrapment is recommended, there is still no gold standard for the surgical timing of extraocular muscle release. This study aimed to present our 10-year experience with surgical outcomes in BOF patients with extraocular muscle entrapment to provide supporting data for determining the surgical timing for better outcomes. We conducted a retrospective study of patients with BOFs with extraocular muscle entrapment who underwent surgery at a tertiary hospital between December 2009 and October 2019. Their demographics, causes of injury and clinical features including limitation of extraocular movement (EOM) and diplopia were collected. Patients diagnosed with BOF with extraocular muscle entrapment accounted for 3.08% (21/681) of all cases of BOFs over a 10-year period. The patients comprised 20 males and 1 female, with a median age of 17.0 years (IQR, 13–25 years). All 21 patients had diplopia preoperatively, and 20 had EOM limitations. Nausea and vomiting were observed in 5 patients (23.8%). Surgery was performed within 48 hours after injury in 19 cases (within 24 hours in 13 cases), with a median of 17.0 hours (IQR, 11–27). The median operative time was 47.5 minutes (IQR, 31.2–73.7 minutes). The median follow-up period was 9.0 months (IQR, 7–12). At the last follow-up, 4 patients still had EOM limitations and 3 had residual diplopia; however, this did not interfere with their daily activities. Early diagnosis through facial computed tomography and physical examinations and early intervention showed successful surgical outcomes of BOF with extraocular muscle entrapment.

Background and Objectives: Laryngopharyngeal reflux (LPR) is an increasingly common disease, characterized by stomach acid reflux reaching the upper airways. Postnasal drip (PND) is a known consequence of LPR, defined as mucus accumulation perceived in the posterior areas of the nose and throat. PND is among the most common causes of persistent cough, hoarseness, sore throat, and other symptoms, affecting the quality of life. This study aimed to evaluate the effects of a proton-pump inhibitor (PPI) on PND symptoms in patients with LPR.Methods: We prospectively enrolled patients diagnosed with LPR at our institution between September 2019 and June 2020. The patients were randomly assigned to either the treatment group (20 mg of ilaprazole daily for 8 weeks) or the control group. The scores for the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and Sino-Nasal Outcome Test (SNOT)-20 were evaluated at baseline and at the end of treatment, focusing on PND symptoms.Results: Eighty patients (28 men and 52 women; mean age, 48.8 years, range, 22–78 years) were enrolled, with 43 in the treatment group and 37 in the control group. The initial RSI, RFS, and SNOT-20 scores were similar between the two groups, and they decreased significantly only in the treatment group (p=0.002, p<0.001, and p=0.015, respectively). However, the PND symptom scores showed a significant decrease in the treatment group only in the RSI (p=0.012).Conclusion: PPI treatment for 8 weeks may be effective in improving PND symptoms in patients with LPR.

Few cases of injuries caused by wild boars have been reported in the literature. Here, we present the case of a 64-year-old male patient who was attacked by a wild boar. The patient had a laceration to the right forehead and a penetrating wound in the area before the right auricle. Computed tomography scan revealed traumatic subarachnoid hemorrhage, subdural hemorrhage, right temporal lobe contusion hemorrhage, pneumocephalus, right zygomatic arch and temporal bone fracture, and right coronal process fracture of the mandible. Prophylactically, 2,000 mg of ceftriaxone and 400 mg of moxifloxacin were intravenously administered every 24 hours. An emergency craniectomy was performed because the skull fracture was an open fracture and control of the increased intracranial pressure was necessary. Inactivated Rabies Virus Vaccine was also administered postoperatively. We concluded that, unlike typical wounds from other traumatic causes, the risk of wound infection is higher. In order to reduce morbidity and mortality due to wild boar attacks, rapid stabilization of the patient’s vital signs, prevention of infection with appropriate antibiotics, and surgical intervention at the appropriate time and method are necessary.

Background: This study aimed to examine the anti-inflammatory effects of esomeprazole (ESO) and fexuprazan (FEXU) in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages and evaluated voltage-gated potassium channel 1.3 (Kv1.3) to infer the involved mechanism. Methods: The production of nitric oxide (NO) and the expression of pro-inflammatory mediators and Kv1.3, influenced by ESO and FEXU, were measured by means of a quantitative analysis of NO production and by a quantitative real-time polymerase chain reaction (qRT-PCR), respectively. In addition, we assessed the inhibitory effects of ESO and FEXU on the activation of the mitogen-activated protein kinase (MAPK) signaling pathway by examining the phosphorylation states of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38, via a Western blot analysis. We also investigated the effects of ESO and FEXU on macrophage polarization by evaluating the expressions of inducible nitric oxide synthase (iNOS) and cluster of differentiation (CD) 206 through immunocytochemistry (ICC) staining. Results: The production of NO and the expression of pro-inflammatory mediators, as well as Kv1.3, were reduced by both ESO and FEXU. FEXU showed a greater inhibitory effect for pro-inflammatory mediators and Kv1.3. Both agents were found to suppress the activation of the MAPK signaling pathway, with FEXU reducing JNK and p38 phosphorylation and ESO reducing p38 phosphorylation. FEXU led to reduced iNOS expression with a consequent increase in CD206. In contrast, ESO did not induce significant changes in iNOS and CD206 expression levels. Conclusion: These results suggest that FEXU has a superior anti-inflammatory effect relative to that of ESO, indicating its potential as an anti-inflammatory agent.

BACKGROUND AND PURPOSE: During stent-assisted coiling of ICA aneurysms, stent tips are sometimes unintentionally embedded into ICA branches. Stent tips can be visualized because they have radiopaque markers. Concerns regarding stent tip misplacement include risks of artery perforation and occlusion. The aim of this study was to evaluate the long-term outcomes of ICA branches with embedded stent tips. MATERIALS AND METHODS: ICA branches with embedded stent tips were identified among 35 patients with unruptured ICA aneurysms treated with stent-assisted coiling between November 2003 and November 2014. Patient clinical and angiographic outcomes associated with the embedded stent tip were analyzed. RESULTS: Most of the 35 studied aneurysms were paraclinoid ICA aneurysms (n = 30). The most commonly involved ICA branch was the posterior communicating artery (26 patients, 74.3%), followed by the anterior choroidal artery (8 patients, 22.9%) and ophthalmic artery (1 patient, 2.9%). During the follow-up period (38.6 ± 17.9 months), no new neurologic deficits developed. Neither hemorrhagic nor thromboembolic events occurred. Angiography was performed during the final follow-up evaluation at a mean of 32.7 ± 18.0 months, and all ICA branches with embedded stent tips showed patent blood flow without severe luminal narrowing. CONCLUSIONS: In our experience, placement of a stent tip into ICA branches during stent-assisted coiling was not associated with any major adverse events.

Spontaneous rupture of the oesophageal artery is rarely observed in clinical practice and may lead to a haemomediastinum, which is a potentially life-threatening condition. Among these conditions, a mediastinal haemorrhage from oesophageal branches of the bronchial artery is the most frequently reported. However, rupture of oesophageal branches arising from the inferior thyroid artery (ITA) has never been reported to date. This current case report describes a male patient in his mid-70s who experienced sudden chest pain with haemomediastinum caused by the rupture of oesophageal artery branches after vomiting. This patient was successfully treated with separate transcatheter arterial embolization of the two oesophageal branches arising from the ITA and the bronchial artery using N-butyl-cyanoacrylate. Awareness of the various potential sources of haemomediastinum is important to increase the success rate of transcatheter arterial embolization.