The cost of diabetic foot conditions.

OBJECTIVES: To estimate the cost of management of diabetic foot ulcers and the standards of foot-care practices. METHODS: Patients admitted with diabetic foot ulcers (DFU) to the University Surgical Unit, Colombo South Teaching Hospital during 6 months were audited. Costs were obtained from the Medical Supplies Division, Central Blood Bank, Director General of Laboratory Services and 3 leading private hospitals. RESULTS: 144 (4.3% of admissions) diabetic patients occupied 10.1% of hospital beds. Average stay was 10.9 days. 55 daily-paid workers lost Rs.1076.36 for each admission. Each family has spent Rs.1811.60. The State has spent Rs.14 936 during the hospital stay of each patient. Majority of 61.8%, DFUs started as preventable minor trauma. 48% knew the importance of foot-care but practices remained poor. Worst affected were the patients followed up at peripheral units. Only 11.1% feet were completely assessed by a doctor. CONCLUSIONS: DFUs have a serious impact on patients and the State. Standards of foot-care remain poor among patients. A well planned foot-care program will be highly cost-effective.

Adenocarcinoma of the stomach in a tertiary care hospital in Sri Lanka.

OBJECTIVES: Adenocarcinoma of the stomach carries a dismal prognosis when it presents late. Our objective was to describe the location of the tumour, stage at presentation, resectability and survival in a cohort of patients with adenocarcinoma of the stomach, presenting to a tertiary referral centre. DESIGN AND SETTING: Data were collected retrospectively from all patients with gastric neoplasms who presented to the University Surgical Unit, Colombo South Teaching Hospital from May 2000 to October 2006. RESULTS: Ninety three patients presented with malignant gastric neoplasms during this period. Majority (86/93) were adenocarcinomas. Mean age at presentation was 58.3 (range 33-83) years. Male to female ratio was 3.15:1. 52.6% of tumours were in the proximal stomach involving the cardia. Thirty per cent involved the body, and 17.5% the distal stomach. 93% had Stage III or IV disease at presentation. Twenty seven patients (32.5%) had resectable tumours with a mean survival of 25.3 months. Five year survival was less than 5%, in patients who were not offered surgical resection. There were no patients in our series with early gastric cancer. CONCLUSION: All our patients presented with advanced gastric cancer and the majority had unresectable disease. The high proportion of patients having proximal gastric carcinoma is similar to the recent changes seen in the west.