Dermatologic clinics
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Dermatologic clinics · Jul 1990
ReviewThe 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. ⋯ 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.
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Lepidopterism is the term used to describe the aggregate adverse medical effects resulting from contact with adult or larval forms of butterflies and moths. Histamine, histamine-releasing substances, kinin activators, and other as yet undefined proteins are responsible for cutaneous, cardiovascular, neurologic, and constitutional signs and symptoms of lepidopterism. Insect venom is likely injected into the skin through specialized caterpillar hairs when contact occurs with the insect (or vegetation laden with insect debris). Mild cases of lepidopterism will resolve spontaneously; systemic corticosteroids may aid in the treatment of more serious cases.
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Stinging insect envenomation and allergy remain important clinical and research problems. Approximately 40 deaths occur annually as a result of these stings. ⋯ Bee-sting kits should be encouraged for sensitive individuals. Dermatologists should be alert to the increasing imported fire ant problem, be able to make the diagnosis, and help the patient recognize and avoid these pesky arthropods.
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Eight patients are described with adverse skin reactions to povidone-iodine-containing preparations (Betadine). Patch test reactions were positive to povidone-iodine 5 or 10 per cent in petrolatum or to Betadine Solution, Ointment, or Scrub. ⋯ Open tests with iodine tincture performed in three patients were completely negative. Allergy to povidone-iodine seems not to be based on sensitization to iodine.
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Sarcoidosis is characterized by noncaseating granuloma that can occur in any organ of the body. The lymph nodes, lungs, skin, liver, spleen, phalangeal bones, parotid glands, and eyes are the most common sites of involvement. Although sarcoidosis rarely causes death, its course is highly variable, and its treatment can be challenging to the clinician. This article presents an updated review of the clinical manifestations of sarcoidosis as well as discussions of the diagnostic evaluation and treatment of this idiopathic disease.