Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction.

BACKGROUND: The safe upper limit of lidocaine dosage in tumescent anesthesia for liposuction has been reported to be 35 mg/kg. OBJECTIVE: This study was undertaken to: 1) evaluate the safety of tumescent anesthesia in liposuction when lidocaine doses greater than 35 mg/kg are required, 2) determine the time interval when the peak plasma lidocaine level occurs following administration of tumescent anesthesia, and 3) assess if the safety of large volume tumescent anesthesia is due to significant lidocaine removed by liposuction. METHODS: Sixty patients who underwent liposuction with a mean lidocaine dose of 57 mg/kg were prospectively evaluated for development of any signs or symptoms of lidocaine toxicity by multiple interviews over a 24-hour period. In addition, another 10 patients who received a mean lidocaine dose of 55 mg/kg had serial plasma lidocaine level measurements over a 24-hour period following liposuction. The lidocaine level of the aspirate was also measured to assess any significant lidocaine removed by liposuction. RESULTS: No evidence of lidocaine toxicity was found based on subjective evaluation of 60 patients as well as determined by plasma sampling of 10 patients. The peak plasma lidocaine concentration occurred at approximately 4 or 8 hours after infusion of tumescent anesthesia. The 24-hour plasma lidocaine level suggests that residual lidocaine is present in the subcutaneous tissue allowing for postoperative analgesia beyond this time. A negligible amount of lidocaine was removed by liposuction as determined by the lidocaine level of the aspirate. CONCLUSION: This study suggests that tumescent anesthesia with a total lidocaine dose of up to 55 mg/kg is safe for use in liposuction.

[The effect of hyperthermia and antitumor drugs on brain tumor cell lines].

The effects of heat and antitumor drugs on malignant brain tumor cell lines were studied. A human glioblastoma cell line (SKMG1) and rat malignant brain tumor cell lines (T9, EB 679 and TR 481) were used in this experiment. Five different modalities of treatment with heat and drugs were used as follows: (Group 1) exposure to heat alone at 42 degrees C for one hour; (Group 2) exposure to antitumor drug alone for one hour (ACNU 2.5 or 5 micrograms/ml, ACR 0.02 micrograms/ml and CDDP 1 microgram/ml); (Group 3) simultaneous exposure to heat at 42 degrees C and drug for one hour; (Group 4) heat at 42 degrees C given first for one hour, followed by one hour exposure to drug one hour later ("preheating"); (Group 5) drug given first for one hour, followed by one hour exposure to heat at 42 degrees C one hour later ("postheating"). After each treatment, the inhibition rate at 4 days was evaluated and compared for each group. A synergistic effect was observed in Group 3. For example, when T9 cells were exposed to ACNU and to heat at 42 degrees C at the same time for one hour, inhibition rate was 78%, while the rates for Group 1 and Group 2 were 7% and 21%, respectively. The cytotoxicity of simultaneous treatment with antitumor drugs (ACNU, ACR and CDDP) and hyperthermia at 42 degrees C was apparently superior to that of other treatment modalities.

Magnetic induction hyperthermia for brain tumor using ferromagnetic implant with low Curie temperature. I. Experimental study.

Experimental study was made on magnetic induction hyperthermia for brain tumor using ferromagnetic implant with low Curie temperature. Thermoseed (implant) was made of nickel-palladium alloy, which was confirmed to produce enough heat by eddy current and also to have low Curie point between 43 degrees C-58 degrees C. Using this implant heating system, the effect of hyperthermia on normal rat brain and intracutaneously inoculated rat gliosarcoma (T9) were studied. Heat conduction from seed was twice as much in tumor tissue as in normal brain. It was also found that the intradermal brain tumors were completely diminished within 4 weeks by single local hyperthermia at 45 degrees C for 60 min.

Distribution, biosynthesis, and physiological role of corticotropin-releasing factor in the human: an overview.

Our findings to date indicate that: A peptide resembling oCRF is present in human and mammalian hypothalamus. oCRF is present in human lumbar cerebrospinal fluid. oCRF concentrations do not differ in CSF from normal individuals and from patients with Cushing's syndrome. oCRF appears to be synthesized via a large oligopeptide precursor. An oCRF-like molecule (oCRF-LI) is present in hypothalamic brain tissue. We have also observed more tentative evidence of low levels of oCRF-LI outside of the brain. oCRF is likely to be a central mediator of stress in its multiple forms. We believe that oCRF is clearly of major physiological importance, but that many critical unanswered questions remain. Probably, the most fascinating of these, which we are only beginning to comprehend, concerns the functions of CRF in extrahypothalamic brain as well as the CRF which appears to be present outside the brain.

Sensitivity to 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) of glioma cells in vivo and in vitro.

A new water-soluble nitrosourea (ACNU) was tested for its antitumor activity against four glioma cell lines. Four factors were studied to determine its antitumor activity: inhibition of cell growth, morphologic observation, analysis of DNA histogram with flow microfluorometry, and sensitivity testing with microtest plate. Growth inhibition in response to ACNU was seen in two cell lines (EA285, U251-MG), whereas two cell lines (YE2-02, T98) were resistant to ACNU. The results of the present sensitivity test concur with those of other examinations that this test is useful in selecting a drug and determining the effective dose.

Microsurgical anatomy of the pineal region.

Thirty cadaver brains were examined under X 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.

Effect of subarachnoid haemorrhage on micro-circulation in hypothalamus and brain stem of dogs.

In order to investigate the relationship between cerebral vasospasm and microvasculature in the hypothalamus and brain stem, colloidal carbon was infused into the vertebral artery at various time intervals after experimental subarachnoid haemorrhage in dogs. Experiments which demonstrated vasospasm on angiogram were always accompanied by ischaemic changes in serial sections taken from the anterior hypothalamus to the brain stem. However, when it was demonstrated by angiography that the vasospasm had disappeared, the micro-circulation was restored to normal. Electron microscopy of the hypothalamus 48 hours and one week after subarachnoid haemorrhage, demonstrated swelling of the endothelial cells, enlargement of the perivascular glia and increase in number of the pinocytic vesicles in the cytoplasm, thus showing vasogenic oedema in this area. It is assumed that in addition to the vasogenic substance in extravasated blood, changes in irritability of cerebral vessels through the vasomotor pathways in the hypothalamus and brain stem might play an important role in the production of cerebral vasospasm.