Background: In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation. Methods: We collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute. Results: Five year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable. Conclusion: Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days.Up to one-third of the half billion people with diabetes worldwide will develop a diabetic foot ulcer (DFU) over the course of their lifetime. Over half of DFUs will develop an infection. Of these, 17% will require an amputation [1][2][3][4]. Remarkably, people with diabetes fear amputation worse than death [5]. For patients who do not receive amputation and are able to heal their ulcer, 40% will develop a recurrence within 1 year, 65% within 5 years, and greater than 90% within 10 years [1,6]. The greatest risk factor for a DFU is a previously healed DFU. These silent, sinister complications are now a leading cause of disability worldwide [7,8]. Despite this high prevalence and morbidity, federal funding for studies related to DFUs remains at a 600-plus-fold disadvantage compared to other diabetes research in terms of public
The use of extradural injections to relieve backache has been the subject of a number of studies in recent years. The idea is not a new one; as long ago as 1901 Sicardl employed extradural cocaine by the caudal route to treat three cases of lumbago and four of sciatica-'recovery was maintained for 14 days'. In 1925 Vinerz published a small series of cases in whom sciatica was treated by caudal extradural injection of 2Oml 1 % procaine followed by 50-1oOml Ringers solution, normal saline or liquid petrolatum. In 1930 Evans3 reported on the use of sacral extradural injection of 60-8Oml normal saline or procaine in 40 patients; he claimed that the condition was improved in 14%. Many further reports of encouraging results following the administration of extradural saline and/or local analgesic have been published,4-8.The use of steroid preparations by the extradural route was first employed in 1953 by Lievreg and in 1961 Goebert et al. 10 reported a series of 113 patients with painful radiculopathy treated with epidural procaine and hydrocortisone acetate. Since then a number of similar series have been published which c o n m the value of the method11-14.The present study was carried out in the SaIford Group of Hospitals over the ten year period (mid-I958 to mid-1968). Of a total of over 5,000 patients complaining of backache 530 considered to be suffering from the lumbosciatic syndrome were treated by extradural injection of either normal saline, local analgesic or methyl-prednisolone acetate (Depomedrone). In the earlier years of the study the former two agents only were employed. They were given either by the lumbar or the caudal route and in random order. Since 1963 we have used methylprednisolone exclusively, and this has always been injected into the lumbar extradural space. All the 325 patients included in this report have been followed up for at least 12 months.
TECHNIQUELumbar extradural injection was performed with the patient lying on the
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.