Hemodynamic effect of 2% lidocaine with 1:80,000 epinephrine infiltration in maxillofacial surgeries under general anesthesia

Epinephrine-containing lidocaine is the most used anestheic drug in dentistry. The aim of this study was to investigate the hemodynamic changes following local infiltration of 2% lidocaine with 1:80,000 epinephrine in subjects undergoing orthognatic surgery under general anesthesia. Twenty five patients without any systemic disease participated. After general anesthesia, two cartridges of 2% lidocaine + 1:80,000 epinephrine were infiltrated around the surgery site. Systolic [SBP] and diastolic [DBP] blood pressure, mean arterial blood pressure [MAP], heart rate [HR], and blood sugar [BS] were measured in three stages: before the injection [M1], at the end of injection [M2], and 10 min after injection [M3]. No significant difference observed in SBP, DBP, and MAP at the end of injection and 10 min later. HR was increased significantly after injection and remained significantly higher than baseline after 10 min. BS increased slightly at the end of injection and continued to increase after 10 min. However, changes in BS were not significant. Using two cartridges of epinephrine-containing lidocaine have slight systemic changes in healthy subjects; as a result, this dosage could be used in patients with cardiovascular complications undergoing general anesthesia

Causes of hepatic granuloma: a 12-year single center experience from Southern Iran

Hepatic granuloma is reported in 2 - 15% of liver biopsy specimens. It is relatively easy for the pathologist to diagnose, but sometimes arriving at a specific etiology is quite difficult. Until now, there are few published studies about the etiology of hepatic granuloma in Iran. In this study, we attempt to determine the causes of hepatic granuloma from one of the largest referral centers in this country. In a retrospective study over 12 years, a hepatopathologist reviewed all liver biopsies with granuloma. The medical records, including clinical findings, autoantibodies, viral markers, imaging studies, drug histories, and all other specialized tests, such as molecular studies, were reviewed to reach a definite diagnosis. During 12 years, there were 72 cases diagnosed with liver granuloma. The most common cause of hepatic granuloma was infectious, with Mycobacterium tuberculosis [52.8%]. The second most common cause was visceral leishmaniasis in 8.3% of biopsies. Other less common causes were fungal infections, visceral larva migrans, primary biliary cirrhosis, and hepatitis C, each in 4.2% of cases. Autoimmune hepatitis was diagnosed in 2.8% of patients. Lymphoma, drug induced, disseminated BCGitis, CMV infection, foreign body reaction and sarcoidosis, were each found in 1.4% of the liver biopsies. After all investigations, there were 12.5% idiopathic hepatic granulomas. According to this study, the most common cause of hepatic granuloma in Iran is tuberculosis. This finding is completely different from western countries and very similar to the results of countries such as Saudi Arabia