Toxicity
When prostaglandin E2 (PGE2) is given in excess, hyper-stimulation of the uterus occurs and immediate discontinuation of the drug usually results in resolution of toxic effects. If symptoms continue a beta adrenergic drug (e.g. terbutaline) can be used.There are many different dosage forms of PGE2. The pharmacokinetic properties vary between dosage forms and should not be interchanged. A medication error was cited in the Institute for Safe Medication Practices where Prostin E2 was used in place of Cervidil. The hospital had run out of Cervidil which is a 10 mg endocervical insert and the provider decided to use half of a 20 mg Prostin E2 vaginal suppository. Cervidil delivers the drug at a constant rate and can be removed as necessary while Prostin E2 dissolves immediately and can not be removed. This error resulted in an emergency C-section since the fetuss heart rate dropped suddenly. Pharmacokinetics
The synthetic PGE2 dinoprostone has a plasma half-life of approximately 2.5–5 minutes, after vaginal administration, with most metabolites being excreted in the urine. History
Swedish physiologist Ulf von Euler and British physiologist M.W. Goldblatt, first discovered prostaglandins independently in 1935 as factors contained in human seminal fluid. Prostaglandins were noted for having blood pressure reducing effects and smooth muscle regulation effects. Prostaglandin E2 itself was identified in 1962 by Swedish biochemist Sune Bergström in the seminal fluid of sheep. The structure of prostaglandins is conserved in mammals, but it is also produced by marine organisms which allowed for more research into their biological roles.
Meaning that the program these patients were participated in consisted of physiotherapy exercises and orthopedic shoe inserts in addition to that program. There were fourteen patients that had supplementary tibial nerve mobilization exercises. They were instructed to sit on the edge of a table in a slumped position, have their ankle taken into dorsiflexion and ankle eversion then the knee was extended and flexed to obtain the optimal tibial nerve mobilization. Patients in both groups showed positive progress from both programs. The medial calcaneal, medial plantar and lateral plantar nerve areas all had a reduction in pain after successful nonoperative or conservative treatment. There is also the option of localized steroid or cortisone injection that may reduce the inflammation in the area, therefore relieving pain. Or just a simple reduction in the patients weight to reduce the pressure in the area. Surgical treatment
If non-invasive treatment measures fail, tarsal tunnel release surgery may be recommended to decompress the area. The incision is made behind the ankle bone and then down towards but not as far as the bottom of foot. The posterior tibial nerve is identified above the ankle. It is separated from the accompanying artery and vein and then followed into the tunnel. The nerves are released. Cysts or other space-occupying problems may be corrected at this time. If there is scarring within the nerve or branches, this is relieved by internal neurolysis. Neurolysis is when the outer layer of nerve wrapping is opened and the scar tissue is removed from within nerve.