A 28-year old woman in DM (Ed note: Define DM) and chronic renal failure underwent an uneventful open reduction and internal fixation for an ankle fracture under spinal anesthesia. PCA with fentanyl and tramadol was started in the operating room with a background infusion of 2 ml/hr (10 microgram/h of fentanyl and 6 mg/h of tramadol), a bolus dose of 2 ml and a lockout interval of fifteen minutes. Approximately eight hours after initiating PCA the patient was found unresponsive in the ward with respiratory failure. Resuscitation was started with endotracheal intubation and cardiac massage with an injection of epinephrine and atropine. The patient made a full and immediate recovery two hours later.
Analgesia, Patient-Controlled ; Anesthesia, Spinal ; Animals ; Ankle ; Atropine ; Epinephrine ; Female ; Fentanyl ; Heart Massage ; Humans ; Intubation, Intratracheal ; Kidney Failure, Chronic ; Operating Rooms ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Resuscitation ; Tramadol

Objectives: The objective of this study is to compare a nutritionally balanced soft blend diet (SBD) with a soft fluid diet (SFD) on the health of inpatients who have undergone oral and maxillofacial (OMF) surgery, ultimately aiming to enhance care outcomes, improve healthrelated quality of life (QOL), and increase satisfaction with the hospital. Methods: Thirty-two patients were randomized into two groups: sixteen received SFD and sixteen received SBD. Anthropometric, laboratory evaluations were conducted upon admission and discharge. Patients filled out questionnaires on demographics, diet satisfaction, food intake amount, and health-related QOL on the day of discharge, assessed using the EuroQoL 5 Dimensions 3 Level and EuroQoL Visual Analogue Scale (EQ-VAS) instruments. Data were analyzed with descriptive statistics, χ 2 tests for group differences, and paired nonparametric t-tests for within-group comparisons. The Mann-Whitney U test evaluated inter-group differences in preoperative weight and body mass index (BMI), postoperative changes, meal satisfaction, intake, health-related QOL, and self-assessed health status. P-values were set at a significance level of 0.05. Results: The SBD group had higher dietary intake (63.2% vs. 51.0%) and greater diet satisfaction (80.6 vs. 48.1, P < 0.0001) compared to SFD group. Health-related QOL, measured by EQ-VAS, was better in SBD group (70.3 vs. 58.8, P < 0.05). Postoperative weight and BMI decreased in SFD group but increased in SBD group (P < 0.01). Changes in laboratory results showed more stability in the SBD group. No postoperative infections were reported in SBD group, whereas SFD group had a 31.25% complication rate. Conclusions While SFD is often recommended after OMF surgery to protect oral wound healing process, our study reveals that SBD not only enhances physical and psychological outcomes but also, somewhat unexpectedly, supports wound healing and reduces complications. Essentially, SBD promotes physical recovery and enhances health-related QOL than SFD by supporting both somatic and mental healing aspects.

Under median sternotomy and left thoracotomy, extra-anatomic aorta bypass between ascending aorta and descending thoracic aorta without cardiopulmonary bypass support has been done effectively and easily without complications for a selected case of atypical coarctation associated with hypoplasia of aortic arch. It should be considered as an alternative operative technique for complex aortic arch reconstruction.
Aorta* ; Aorta, Thoracic ; Aortic Coarctation ; Cardiopulmonary Bypass ; Sternotomy ; Thoracotomy ; Transplants*

PURPOSE: To evaluate influence of phacoemulsification on the progression of diabetic retinopathy METHODS: The medical charts of 82 eyes of 41 patients with nonproliferative diabetic retinopathy (DR) who had unilateral phacoemulsification were retrospectively reviewed. The course of diabetic retinopathy was followed up for more than 2 years. Each stage of DR progression was indicated by a unique score, and a comparison of the progression of DR between operated and non-operated eyes was performed using the devised scoring system. RESULTS: The progression of 82 eyes at a mean follow-up period of 28 months was evaluated. DR progressed more in operated eyes than in non-operated eyes (P=0.006). The progression of proliferative DR in operated eyes (19.5%, 8 eyes) was significantly greater (P=0.029) than in non-operated eyes (2.4%, 2 eyes). CONCLUSIONS: Phacoemulsification resulted in a progression of diabetic retinopathy. Careful approach to the cataract patients with diabetic retinopathy would be recommended.
Cataract ; Diabetic Retinopathy* ; Follow-Up Studies ; Humans ; Phacoemulsification* ; Retrospective Studies

Background: The obesity epidemic is associated with the emergence of new kidney diseases including obesity-related glomerulopathy (ORG) and metabolic syndrome-associated disorders. However, the effects of obesity on prevalence and outcome of biopsy-proven kidney disease are not well known. Methods: We analyzed 14,492 kidney biopsies in 18 hospitals from 1979 to 2018 in Korea.Obesity was defined as a body mass index value of ≥ 30 kg/m 2 . Results: The most common disease was IgA nephropathy (IgAN) in both obese and nonobese participants (33.7% vs. 38.9%). Obesity was associated with a higher risk of focal segmental glomerulosclerosis (FSGS) and hypertensive nephropathy (HT-N) (odds ratio [OR], 1.72, 95% confidence interval [CI], 1.37–2.17; OR, 1.96, 95% CI, 1.21–3.19) and a lower risk of IgAN (OR, 0.74, 95% CI, 0.62–0.88). During the median follow up of 93.1 ± 88.7 months, obesity increased the risk of end-stage kidney disease (ESKD) in patients with IgAN (relative risk [RR], 1.49, 95% CI, 1.01–2.20) and lupus nephritis (LN) (RR, 3.43, 95% CI, 1.36–8.67). Of 947 obese individuals, ORG was detected in 298 (31.5%), and 230 participants had other kidney diseases, most commonly, IgAN (40.9%) followed by diabetic nephropathy (15.2%). Participants with ORG, when combined with other renal diseases, showed higher risks for developing ESKD compared to those with ORG alone (RR, 2.48, 95% CI, 1.09–5.64). Conclusion Obesity is associated with an increased risk of FSGS and HT-N, and also increase the ESKD risk in IgAN and LN patients. ORG in obese participants may have favorable renal outcomes if it occurs alone without any other renal disease.