Venous levels of lignocaine and bupivacaine after peribulbar block.

Twenty-five patients undergoing elective cataract day surgery were studied after receiving a dual-injection peribulbar block with a mixture consisting of equal volumes of 2% lignocaine and 0.75% bupivacaine with hyaluronidase. A maximum of 10 ml of solution was used for the initial block; supplementary injections of up to 10 ml were given to five patients. Venous blood was taken prior to the block and then 1, 10, 20, 30, 60 and 90 min after the block. The peak mean concentrations of lignocaine (0.722 microgram.ml-1) and bupivacaine (0.353 microgram.ml-1) were found at 10-20 min after injection when no top-up was given and at 10 min after the top-up injection when required. All measured serum concentrations of lignocaine and bupivacaine were below the accepted toxic levels of the two drugs. However, the highest individual toxicity score after a top-up was 0.915 which was very close to the toxicity threshold (= 1) when a scoring system was used to assess the combined levels.

Hepatic arterial floxuridine and leucovorin for unresectable liver metastases from colorectal carcinoma. New dose schedules and survival update.

BACKGROUND: We studied three new dose schedules of hepatic arterial infusion of floxuridine (FUDR) and leucovorin and update survival analysis of a previously reported trial using these drugs by hepatic arterial infusion for patients with hepatic metastases from colorectal carcinoma. METHODS: Untreated patients with hepatic metastases from colorectal cancer were treated with three dose schedules: Group D, FUDR (0.3 mg/kg/day) and leucovorin (30 mg/m2/day) as a 14-day continuous infusion through an implantable hepatic arterial pump alternating with a 4-week rest period; Group E, a lower dose of FUDR (0.25 mg/kg/day) and leucovorin (30 mg/m2/day) as a 14-day infusion alternating with 2 weeks of saline; and Group F, FUDR (0.3 mg/kg/day) with a lower leucovorin dose (15 mg/m2/day) for 2 weeks followed by a 2-week rest. RESULTS: In 42 patients with unresectable hepatic metastases, the complete-plus-partial response rate was 56%, with a median survival of 24.2 months. Complete-plus-partial response rates for groups D, E, and F were 30%, 54%, and 75%, respectively. Twelve percent of the 42 patients developed biliary sclerosis; the percentages of patients per group were 17%, 15%, and 6%, respectively. Updated median survival of the original 24 patients treated with FUDR and leucovorin by hepatic arterial infusion and these 42 new patients (66 total) was 28.8 months. One-, two-, three-, four-, and five-year survival rates were 86%, 62%, 31%, 15%, and 7%, respectively. CONCLUSIONS: Hepatic arterial chemotherapy with FUDR and leucovorin for patients with hepatic metastases from colorectal carcinoma yields a high response rate and 1- and 2-year survivals of 86% and 62%, respectively. Although a lower dose of leucovorin (15 mg/m2) with FUDR produces a high response rate with less toxicity, before larger scale trials are initiated, further investigation is needed to reduce toxicity. A study of hepatic arterial dexamethasone with FUDR and leucovorin has been initiated for this purpose.

Massive acute arsenic poisoning.

A 28-year-old male ingested 75 g of arsenic trioxide in a successful suicide attempt. The presentation, management and postmortem findings are presented and discussed.