The purpose of this study was to assess the long-term effects of a high-complex-carbohydrate, high-fiber, low-fat diet and exercise on 69 NIDDM patients. During the initial 26-day program, fasting glucose was reduced from 179.5 +/- 10.6 to 133.5 +/- 4.0 mg/dl. This decrease in fasting glucose was achieved along with the discontinuation of oral hypoglycemic agents in 24 of 31 patients and of insulin in 13 of 18 patients; one patient was placed on insulin. Serum cholesterol and triglycerides were reduced by 25% and 27%, respectively. At 2-3 yr of follow-up, fasting glucose was not significantly different from the value observed at the end of the 26-day program. Compared with the end of the 26-day program, seven more patients were taking oral agents and four more were on insulin. Exercise and diet inventories obtained at follow-up indicated good compliance to the program and also indicated that the main difference between those patients who went back on medication at follow-up compared with those remaining off medication was the percent of calories derived from fat.
The optimal management strategy for acute limb ischemia (ALI) in patients with a concomitant malignancy is not well established. A very high mortality rate (83-100%) at 1 year has been reported in those who are treated surgically. Accordingly, a conservative management approach has been suggested as the main therapeutic modality. Our aim was to evaluate the survival outcomes of cancer patients treated for ALI at our cancer center. Cancer patients treated for ALI at the MD Anderson Cancer Center from 2001 to 2011 were included in this study. Overall survival and amputation-free survival rates were calculated. A total of 74 cancer patients with concomitant ALI were included in the study. Surgery was the most common therapy (36 patients; 49%). Percutaneous catheter-based interventions were used in 21 patients (28%). Eighteen patients (24%) received anticoagulation therapy only, and six patients (8%) received no therapy. The 30-day, 6-month, and 1-year overall survival rates were 80% (95% confidence interval [CI], 69% to 87%), 59% (95% CI, 47% to 69%), and 48% (95% CI, 36% to 59%), respectively. Eight patients (11%) underwent amputation. The 1-year amputation-free survival rate was 47% (95% CI, 35% to 58%). In conclusion, we did not find an invasive approach for the treatment of ALI in cancer patients to be associated with the very high mortality rates previously reported. In our opinion, the indications for surgery or catheter-based intervention in these patients should not differ from patients without cancer.
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