The Journal of foot surgery
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Review
Vasoconstrictive agents commonly used in combination with local anesthetics: a literature review.
A review of the current medical literature concerning the use of various vasoconstrictive agents with local anesthetics is presented. These agents are employed in podiatry primarily for the purpose of prolonging the duration of anesthesia and surgical hemostasis. Epinephrine, phenylephrine, levonordefrin, felypressin, and norepinephrine have all been utilized in conjunction with the local anesthetics by the various medical professions. Although controversy surrounds the use of these agents, this article should assist the podiatric physician in making an informed decision.
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Spinal anesthesia is a frequently used technique for surgery of the lower extremities. A complication of this form of regional anesthesia is post-lumbar puncture headache. Rapid diagnosis and treatment are essential in preventing prolonged disability and neurologic sequelae. Two case reports are presented, followed by a review of the literature concerning etiology, diagnosis, and treatment of post-lumbar puncture headache.
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Gunshot wounds to the lower extremity consist of three types: 1) low velocity, 2) high velocity, and 3) shotgun wounds. High velocity wounds are generally seen in military practice, whereas low velocity wounds are of concern in civilian practice. Adequate management of the gunshot wound necessitates a rigid protocol consisting of history and detailed physical examination. It is the purpose of this article to describe in detail the proper protocol for gunshot wound evaluation.
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The differentiation between diabetic osteoarthropathy and osteomyelitis is a very difficult one to make, even in the presence of a pedal ulceration. However, considering present medical costs, the incorrect diagnosis of osteomyelitis can be a costly one, not only for the hospital, but also for the patient. In light of a normal white blood cell count, a benign 67Ga-citrate scan, and two noncontiguous areas of bone destruction, the diagnosis of diabetic osteoarthropathy can be made without the necessity of a bone biopsy.
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Cholinesterase deficiency is a relatively rare condition. However, if unrecognized, this condition can be potentially fatal. The authors present a case report of cholinesterase deficiency and a review of the literature. Discussion of the preoperative evaluation and preventive measures is also included.