Management of diabetic ulcers of the dorsum of the foot and distal leg ulcers.

OBJECTIVE: Diabetic foot ulceration of toes, forefoot and heel have been extensively studied; however, the dorsum of the foot and the distal leg have rarely been addressed. The objective of this study was to assess diabetic ulcers of the dorsum of the foot and of the distal leg (DUDFDLs) as primary sites, or extended lesions from other foot locations, with regard to possible causes, management and outcomes. METHOD: This was a retrospective study conducted in Jabir Abu Eliz Diabetic Centre (JADC) in Khartoum from January 2018 to August 2019. All patients with a primary DUDFDL, or one extending from a plantar or heel ulcer, were included. RESULTS: A cohort of 102 patients with DUDFDLs were studied; 74 (72.5%) were male and 28 (27.5%) were female, with a male-to-female ratio of 2.6:1, and a mean age of 57±12 years. The ulcer was a primary DUDFDL in 38 patients and a secondary ulcer in 64 patients. The outcome in 38 patients with primary DUDFDL was healing without amputation in 26 cases (68.4%), amputation of toes in 12 cases (31.6%), and no major amputation or death. Of the 64 patients presenting with secondary DUDFDL extending from the plantar surface, there was extension to the dorsum of the foot through the forefoot ulcer in 54 patients and through the ankle joint to the distal leg in 10 patients. For the plantar ulcers extending to the dorsum, five cases healed without amputation (9.3%), minor amputation was necessary in 29 cases (53.7%), major amputation in 14 cases (25.9%) and six patients died (11.1%). For the distal leg ulcers with extension through the ankle joint, five healed without amputation and five required minor amputation. CONCLUSION: Primary DUDFDLs had a favourable outcome. Dorsum extension of diabetic foot ulcer from the plantar aspect of the foot carries a high risk for major limb amputation and death.

The surgical treatment of esophageal cancer in Sudan: A 100 consecutive cases.

OBJECTIVE: Esophageal cancer is the most common gastrointestinal (GI) cancer in The Sudan. This study aimed to evaluate the outcome of the surgical management. METHODS: A 100 consecutive patients who underwent esophagectomy in Shaab Hospital in Khartoum during the period June 2003-Aug 2007 were studied. RESULTS: The mean age was 55 ± 14 years with an equal sex ratio. Fifty five per cent of patients presented with stage III&IV locally advanced and or metastatic disease. Sixty seven percent of the patients underwent a 2-stage resection, Lewis Tanner type while 27% underwent a 3-stage resection, McKeon operation and 6% had total gastrectomy with distal esophagectomy and roux-en-y reconstruction. The 30 days postoperative mortality was 10%. In 75 patients who could be traced, the overall 5 years survival was 21% (n = 16) and the 10 years survival was 8% (n = 6). CONCLUSION: There was great improvement in the early postoperative mortality from 27% in 1986 to 10% in this series. The surgical treatment offered a rapid symptoms relief which suited most patients coming from distant locations and couldn't afford to stay for long in the Capital as will be required if chemo-radiotherapy was used as sole or as a neo-adjuvant treatment.