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Biomedical subjects

J A Klein

Publications and source records attributed to J A Klein.

At least 37 records · Page 2Linked to original sources
PubMed1993

Tumescent technique for local anesthesia improves safety in large-volume liposuction.

The tumescent technique for local anesthesia improves the safety of large-volume liposuction ( > or = 1500 ml of fat) by virtually eliminating surgical blood loss and by completely eliminating the risks of general anesthesia. Results of two prospective studies of large-volume liposuction using the tumescent technique are reported. In 112 patients, the mean lidocaine dosage was 33.3 mg/kg, the mean volume of aspirated material was 2657 ml, and the mean volume of supernatant fat was 1945 ml. The mean volume of whole blood aspirated by liposuction was 18.5 ml. For each 1000 ml of fat removed, 9.7 ml of whole blood was suctioned. In 31 large-volume liposuction patients treated in 1991, the mean difference between preoperative and 1-week postoperative hematocrits was -1.9 percent. The last 87 patients received no parenteral sedation. In a second study, a 75-kg woman received 35 mg/kg of lidocaine on two separate occasions, first without liposuction and 25 days later with liposuction; peak plasma lidocaine concentrations occurred at 14 and 11 hours after beginning the infiltration and were 2.37 and 1.86 micrograms/ml, respectively.

Anesthesia, General↗
PubMed1992

Use of the tumescent technique for scalp surgery, dermabrasion, and soft tissue reconstruction.

Application of the tumescent anesthetic technique in scalp surgery, dermabrasion, and soft tissue reconstruction is discussed. Vasoconstriction achieved by using tumescent anesthesia reduces bleeding even with dilute (1:320,000) epinephrine. Tumescent anesthesia also offers the advantages of decreased absorption at the site of infiltration, increased anesthetic infiltration, delayed absorption and lower peak blood plasma levels, and a longer lasting anesthetic effect.

Anesthesia, Local↗
PubMed1990

Neutralized lidocaine with epinephrine for local anesthesia--II.

The pain usually associated with intradermal injection of lidocaine and epinephrine is significantly attenuated by the addition of either sodium bicarbonate or sodium hydroxide to 1% lidocaine with epinephrine. This suggests that sodium bicarbonate attenuates pain by increasing the pH of the anesthetic solution. The clinical effects of a solution of lidocaine (1%) with epinephrine (1:100,000) and sodium bicarbonate (80 meq/L) were assessed after infiltration in skin. Anesthetic stored for 1 week caused nearly equal areas of anesthesia and vasoconstriction as an identical solution prepared on the day of use.

Anesthesia, Local↗
PubMed1990

Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction.

The tumescent technique for local anesthesia permits regional local anesthesia of the skin and subcutaneous tissues by direct infiltration. The tumescent technique uses large volumes of a dilute anesthetic solution to produce swelling and firmness of targeted areas. This investigation examines the absorption pharmacokinetics of dilute solutions of lidocaine (0.1% or 0.05%) and epinephrine (1:1,000,000) in physiologic saline following infiltration into subcutaneous fat of liposuction surgery patients. Plasma lidocaine concentrations were measured repeatedly over more than 24 hours following the infiltration. Peak plasma lidocaine levels occurred 12-14 hours after beginning the infiltration. Clinical local anesthesia is apparent for up to 18 hours, obviating the need for postoperative analgesia. Dilution of lidocaine diminishes and delays the peak plasma lidocaine concentrations, thereby reducing potential toxicity. Liposuction reduces the total amount of lidocaine absorbed systemically, but does not dramatically reduce peak plasma lidocaine levels. A safe upper limit for lidocaine dosage using the tumescent technique is estimated to be 35 mg/kg. Infiltrating a large volume of dilute epinephrine assures diffusion throughout the entire targeted area while avoiding tachycardia and hypertension. The associated vasoconstriction is so complete that there is virtually no blood loss with liposuction. The tumescent technique can be used with general anesthesia or IV sedation. However, with appropriate instrumentation and surgical method, the tumescent technique permits liposuction of large volumes of fat totally by local anesthesia, without IV sedation or narcotic analgesia.

Absorption↗
PubMed1990

Bannayan-Zonana syndrome associated with lymphangiomyomatous lesions.

Bannayan-Zonana syndrome is an autosomal dominant condition that has not been well described in the dermatology literature. The typical case is characterized by macrocephaly, multiple angiomas, and multiple encapsulated or infiltrating lipomas. As in other autosomal dominant hamartoneoplastic syndromes, the degree of expression within one family frequently varies widely. Our patient had macrocephaly and angiomas, as well as lipomas with peculiar histologic features similar to lymphangiomyomas. Her father had a large nevus flameus on his leg, and lipomas with normal histologic appearance. The paternal grandfather had multiple encapsulated lipomas with normal histologic appearance. Neither father nor grandfather had macrocephaly.

Angiokeratoma↗
PubMed1990

How-to-do-it quit-smoking strategies for the dental office team: an eight-step program.

Dental personnel have an ethical responsibility to inform their patients about the hazards of tobacco use. Because oral health team members generally see their patients on a frequent and recurring basis, these treatment providers have unparalleled opportunities to educate and help those who smoke to adopt a smokefree lifestyle. Dental practitioners can readily incorporate smoking cessation efforts into their routine dental practices by using an eight-phase smoking intervention program. The overall focus of this program is to: "Ask" patients about smoking or smokeless tobacco usage; "Advise" tobacco-using patients to quit; "Assist" interested patients in quitting; and "Arrange" for supportive follow-up. By providing these services, dental professionals can do their part to help create a smokefree America by the year 2000.

Dentist-Patient Relations↗
PubMed1990

The tumescent technique. Anesthesia and modified liposuction technique.

Using the tumescent technique, liposuction can remove large volumes of fat with minimal blood loss. A maximal safe dosage of dilute lidocaine using the tumescent technique is estimated to be 35 mg/kg. The slow infiltration of a local anesthetic solution of lidocaine and epinephrine minimizes the rate of systemic absorption and reduces the potential for toxicity. Dilution of lidocaine (0.05% of 0.1%) and epinephrine (1:1,000,000) further delays absorption and reduces the magnitude of peak plasma lidocaine concentrations. Using the tumescent technique for liposuction, peak plasma lidocaine levels occur 12 hours after the initial injection. Clinically significant local anesthesia persists for up to 18 hours. For liposuction, it is not necessary to use local anesthetics, which are longer acting and potentially more cardiotoxic than lidocaine.

Anesthesia, General↗
PubMed1989

Neutralized lidocaine with epinephrine for local anesthesia.

The pain of infiltrating lidocaine with epinephrine into skin is reduced by the addition of sodium bicarbonate. The effect of varied concentrations of sodium bicarbonate on pain of infiltration of 1% lidocaine with epinephrine 1:100,000 was measured. Sodium bicarbonate at 40 and 100 meq/L of anesthetic solution caused significantly less pain than did 0 or 10 meq/L. The stability of epinephrine in a solution at pH 7.3 was also determined. Epinephrine concentration declined approximately 25% per week in anesthetic solution containing 100 meq/L sodium bicarbonate.

Adult↗
PubMed1988

Anesthesia for liposuction in dermatologic surgery.

Liposuction is now a well-established procedure in dermatologic surgery. The relative advantages and risks of the various forms of primary anesthesia and supplemental analgesia used for liposuction surgery in the office by dermatologic surgeons is described. Effective anesthetic techniques include infiltration of local anesthesia (LA) with or without intramuscular (IM), intravenous (IV), or nitrous oxide sedation, cryoanesthesia, and IV or inhalation general anesthesia (GA). Local anesthesia, using large volumes of dilute anesthetic solution containing lidocaine (0.05%), epinephrine (1:1,000,000), and sodium bicarbonate (12.5 meq/L), is a safe and effective modality for liposuction by dermatologists. In a study of 12 liposuction patients treated with this technique, the average lidocaine dose was 1181 mg (9.4 mg/kg/hr). The highest peak lidocaine blood level among all patients was 0.484 microgram/ml. Dermatologists should not assume the dual responsibility of surgeon and of monitoring patients given IV sedation. Any form of anesthesia has the potential for serious complications. The surgeon and office staff must be well trained and equipped to perform emergency resuscitation.

Anesthesia↗
PubMed1986

Topical tritiated thymidine for epidermal growth fraction determination.

Direct autoradiographic identification of the epidermal growth fraction (GF) requires the delivery of tritiated thymidine ([3H]dThd) to the skin during the time interval of an entire cell cycle. The GF in normal human epidermis has not been directly measured using this technique because the systemic infusion of radioactive [3H]dThd in benign skin conditions is precluded by ethical considerations. Studies were undertaken to assess the feasibility of measuring the epidermal GF in vivo by the topical delivery of [3H]dThd. The percutaneous penetration of [3H]dThd in various vehicles was evaluated to select an effective topical delivery system. A vehicle consisting of Azone, isopropanol, and water (2:49:49) was the best of 4 different vehicles tested. The optimal penetration of [3H]dThd, with respect to the concentration of Azone over a range of 0-4%, was achieved at 2%. During the initial 24 h following a single topical application of [3H]dThd to hairless mice the labeling increased linearly with time. In vivo studies in hairless mice produced a GF of 95% by both continuous systemic [3H]dThd infusion, and by twice daily topical [3H]dThd. Azone vehicles induced epidermal hyperplasia which was minimized by lowering the Azone concentration and by decreasing the frequency of applications from 24 to 48 h. These studies establish the rationale for using topical delivery of [3H]dThd for the in vivo measurement of epidermal GF.

1-Propanol↗
PubMed1986

Diffuse lipomatosis and tuberous sclerosis.

Diffuse lipomatosis, a classic example of an infiltrating fatty tumor, is a rare entity characterized by infiltration of adult-type adipose tissue into skin, subcutaneous tissue, and muscle. It usually involves a large portion of an extremity or the trunk. Some cases are associated with distant lipomas or angiomas, or hypertrophy of subjacent bone. The association of diffuse lipomatosis with tuberous sclerosis is reported.

Adolescent↗
PubMed1985

Verrucous hemangioma.

Two patients with verrucous hemangioma, a congenital vascular malformation, were seen. The typical lesion is a unilateral group of hyperkeratotic papules and nodules on a lower extremity. Unlike the more common capillary or cavernous hemangiomas, verrucous hemangiomas tend to enlarge and spread with time, and to recur after excision.

Adolescent↗
PubMed1985

Paraffinomas of the scalp.

Four cases of scalp paraffinoma were seen in our clinics within the past year. This unusual condition results from intradermal injection of substances containing paraffin. The presence of paraffin in excised tissue was confirmed by thin-layer chromatography and infrared absorption spectrophotometry. Our patients received their treatments 35 to 42 years ago after responding to radio or newspaper advertisements that promised a cure for baldness. Two patients were initially observed with severe scalp inflammation and two were completely asymptomatic other than having lumpy scalps. Although these cases were readily diagnosed by history, eliminating other possibilities was greatly aided by use of xeroradiography, obviating the need for biopsy in asymptomatic cases.

Aged↗
PubMed1984

Algorithm for the determination of projected urethral lumen cross-sections and shape functions.

A method used to obtain computer graphic representations of projected urethral lumen cross-sections is described. The cross-sectional area of the lumen is measured accurately at all stages of voiding. Two methods of background subtraction are considered, direct subtraction from nonvoiding x-rays and subtraction from a least squares regression line. The projected cross-sections are described by simple shape functions. These shape descriptors increase the technique's potential application by providing a quantitative measure of the projected cross-sections.

Computers↗
PubMed1984

Quality circles in a department of dietetics.

Quality circles can be an excellent approach to managerial effectiveness in the 1980s. For the Department of Dietetics at Miami Valley Hospital, Dayton , Ohio, quality circles have demonstrated excellent return on investment. Their many benefits include increased productivity, improved employee satisfaction and morale, and cost savings. In order to ensure success, the team needs to be selected carefully and trained thoroughly in problem-solving techniques. Initial meetings should be directed to defining the objectives and code of conduct as well as establishing a trusting environment in which to grow and develop.

Adult↗