Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.
There is yet no established mode of curative treatment for notalgia paresthetica (NP). We had previously shown a correlation of NP localization with relevant spinal changes which led us to speculate on the possible role of spinal nerve impingement in the pathogenesis of this entity. Based on these findings we aimed to investigate the possible effect of physical therapy in selected cases of NP. Fifteen NP patients with a relevant spinal pathology (four men and 11 women) were included in the study. The mean age was 52.80 +/- 8.83 years (+/- SD; range, 39-73). NP duration was 8.9 +/- 8.13 years (range, 1.5-30). All patients received 10 conventional transcutaneous electrical nerve stimulation (TENS) sessions in the symptomatic area of 20 min duration and high frequency (50-100 Hz). From an initial pruritus score of 10, the mean score by the end of first week was 7.67 +/- 2.02 (range, 5-10) and by the end of second week it was 6.80 +/- 2.73 (range, 4-11). The differences between the pretreatment and post-treatment scores were statistically significant. There was no correlation of therapeutic benefit with age or disease duration. We believe that the partial therapeutic benefit of TENS in NP patients is of importance and further research on the effects of various physical therapeutic modalities would be worthwhile.
We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 mug NTG. Hemodynamic variables, tourniquet pain measured before and 1, 5, 10, 20, and 30 min after tourniquet inflation, and analgesic requirements were recorded during the operation. After the tourniquet deflation, at 1 and 30 min and 2 and 4 h, visual analog scale (VAS) score, time to first analgesic requirement, total analgesic consumption in the first 24 h after operation, and side effects were noted. Shortened sensory and motor block onset time (3.2 +/- 1.1 versus 4.5 +/- 1.2 min; P = 0.01 and 3.3 +/- 1.6 versus 5.2 +/- 1.8; P = 0.009 in group NTG and group C, respectively), prolonged sensory and motor block recovery times (6.8 +/- 1.6 versus 3.1 +/- 1.2 min P < 0.0001 and 7.3 +/- 1.3 versus 3.6 +/- 0.8 P < 0.0001 in group NTG and group C, respectively), shortened VAS scores of tourniquet pain (P = 0.023), and improved quality of anesthesia were found in group NTG (P < 0.05). VAS scores were lower in group NTG after tourniquet release and in the postoperative period (P = 0.001). First analgesic requirement time was longer in group NTG (225 +/- 74 min versus 39 +/- 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.
The addition of lornoxicam to lidocaine for intravenous regional anaesthesia shortens the onset of sensory and motor block, decreases tourniquet pain and improves postoperative analgesia without causing any side effect.
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