Y HOC VIET NAM THANG 3 - SO 1/2013 cdt tuy viem xffdng nen so va viem mang nao,
mac dil dieu trj khang sinh meropenem vdi ciproxacin va khoet xffdng chum, benh nhan van tien trien xau di va tff vong. Theo Raines, trong cac trffdng hdp nay nen chi dinh cat xffdng thai dffdng (5).
Tieu chuan khdi benh, da sd cac tac gia thong nhat dffng dieu t n khi:
Ve lam sang: benh nhan het dau tai, ngffng chay tai, nhiet do binh thffdng, t d chffc hat bien mat.
Ve sinh hda: sd Iffdng bach cau, mau lang va CRP trd ve binh thffdng
Ve dien quang: am tfnh vdi xa hinh Gallium.
V. KET LUAN
Ngay nay, vdi t i le dai thao dffdng gia tang, viem tal ngoai hoai tff tien trien cd ve thffdng g§p hdn. Chan doan sdm rat quan trgng, lam thay doi hoan toan tien Iffdng benh, giam ti le tff vong mdt each dang ke. Hieu biet sau ve benh ly nay giup cho cac nha lam sang tranh bd sdt giai doan ban dau. Nen theo doi va chan doan viem
dng tai ngoai hoai tff khi cd cac dau hieu nghi ngd nhff viem ong tal ngoai xay ra d ngffdi nhieu tudi dai dffdng, cd dau dai dang, dff dgi ve dem vdi u hat viem d ong tai ngoai mac dii da dieu trj ndi khoa thdng thffdng. Ngoai ra can tff van cho benh nhan dai thao dffdng tranh lay ray tai lam ton thffdng da ong tai ngoai, yeu to nguy cd thffdng lien quan den benh ly nay.
TAI LIEU THAAA K H A O
1. Chandler J.R, 1968. Malignant external otitis.
Laryngoscope 78, 1257-94
2. Handzel O, Halperin D, 2003 Necrotizing (malignant) external otitis Am Fam Physician.
15;68(2):309-12.
.J. Franco-Vidal V, Blanchet H, Bebear C et al, 2007. Necrotizing external otitis: a report of 46 cases. Otol Neurotol. 28(6):771-3.
4. Chen YA, Chan KC, Chen CK et al, 2011.
Differential diagnosis and treatments of necrotizing otitis externa: a report of 19 cases.
Auns Nasus Larynx. 38(6):666-70
5 Jacobsen LM, Antonelli PJ, 2010. Errors in the diagnosis and management of necrotizing otitis externa. 143(4): 506-9.
DANH GIA KET QUA DIEU TRj UNG THlTBIEU MO BUONG TRUfNG TAI PHAT TAI BENH VIEN K
N g u y e n V a n T u y e n * , N g u y e n Trpng T a o * *
TOM T A T
Myc tieu; Danh gia ket qua dieu tri ung thu" bieu mo buong trffng (UTBMBT) tai phat bang phau thuat ket help vdi hoa trj.
b o i Wtfng nghien cuti: 60 benh nhan (BN) dffdc chan doan la LTTSMBT dffdc dieu tri tai Benh vien K tff 1.1.2005 den 31.12.2011 bSng phffdng phap phau thuat lay u toi da va dieu trj hoa chat bo trd.
Ket qua: Dieu tn phlu thuat lay u toi u chiem 61,7% BN, khong toi u'u la 38,3% BN. Dieu tn hoa chat dap uhg hoan toan 63, 3% BN, dap ffng mot phan la 31,7%, khong dap ffng 5%. Thdi gian song them toan bg trung binh la 23,4± 2,2 thang, song them Idiong b^nh trung binh la 18,1± 2,2 thang.
Ket luan : Oieu tri bffdc hai b§ng phau thuat ket hdp vdi hoa chat co ket qua song them 23,4 ± 2,2 thang.
SUMMARY
EVALUATING THE RESULTS OF TREATMENT OF RECURRENT OVARIAN CARCINOMA BY SURGERY COMBINED WITH CHEMOTHERAPY
Objects: Researching on clinical, paraclinicai characteristics of recurrent ovanan carcinoma.
Evaluating the results of treatment of recurrent ovanan carcinoma by surgery combined with chemotherapy.
Subjects. 60 patients were diagnosed with ovanan caranoma and were treated with maximum removal surgery of tumor and adjuvant chemotherapy at K hospitai from 01.01.2005 to 31.12.2011.
Results: Optimal surgery account for 61.7% of the patients, non-optimal surgery account for 38.3%
of patients. The complete response rate with chemotherapy is 63, 3% , partial response is 31.7%,
* Benh vien K; ** Benh vien ung bddu ti'nh Nghe An Phin bi$n khoa hpc: PGS.TS. Nguyin Vlin Hilu
Y HQC VlgT NAM THANG 3 • S6 1/2013 no response is 5%. Media overall survival is 23.4 ±
2.2 months more, media disease free survival is 18.1
± 2.2 months.
Conclusion: The result of second treatment with surgery combined with chemotherapy is 23.4 ± 2.2 months of overall sun/ival.
1.
OAT VAN DE"UTBMBT la benh hay g§p trong cac ung thff phy khoa, chi dffng sau ung thff vu va ung thff CO tff cung [1].
Ve md benh hpc, cd 80 - 9 0 % UTBT la loai bieu md, 10 - 15% la ung thff te bao mam, va khoang 5% ung thff cd nguon gde md dem [2],
Khoang 70 - 7 5 % benh nhan (BN) UTBMBT dffdc chan doan d giai doan benh da lan tran ra 6 phiic mac [2], nen viec dieu tr; gap nhieu khd khan. Benh cang d giai doan mudn ty le tai phat cang cao.
UTBT tai phat dffdc djnh nghTa la benh xuat hien trd lai sau 6 thang ke tff khi hoan thanh dieu tri ban dau.
Odi vdi UTBMBT tai phat d bung, co the dieu tri bffdc 2 bang phau thuat cong pha u tdi da ket hdp vdi hoa chat bo trd,
Tai benh vien K, ngay cang nhieu BN UTBMBT tai phat dffdc phat hien va dieu trj bffdc 2. Tuy vay cho den thdi diem hien tai, d Viet nam chffa cd nghien cffu nao ve chan doan va dieu trj UTBMBT tai phat. Chung tdi tien hanh nghien cffu de tai nay vdi muc tieu: Danh gia ket qua dieu tri UTBMBT tai phat bang phau thuat ket hop hoa tn.
II. o d l TUONG VA PHI/ONG P H A P NGHIEN ClTU 2 . 1 . Boi tu'dng nghien cii'u: Gom 60 BN dffdc chan doan la UTBMBT tai phat dffdc dieu tri tai Benh vien K tff 01/01/2005 den 31/12/2011, thda man cac tieu chuan \da chpn dffdi day:
+ Oa dffdc dieu trj bang phau thuat ket hdp vdl hda chat bffdc 1, tai phat d bung sau 6 thang ke tff ngay ket thuc dieu trj.
+ Dffdc Chan doan m d benh hoc la UTBMBT + Cd hd sd benh an ghi chep day dii va dffdc theo doi sau dieu t n (kham lai trffc tiep, thdng tin qua thff va dien thoai).
2.2. Phu'dng p h a p n g h i e n cu'u 2.2.1. Thiet ke nghien ciiV Nghien cffu hoi cffu md ta tien cffu cd theo ddi doc.
2.2.2. Cff mau Z ^ i . a / 2 ) x p ( l - p )
(£.p)2
Trong d d : p=0,75: Ty le tai phat cua UTBMBT theo nghien cffu cua D.Lerusso [ 6 ] ; E = 0,2; 0 = 0,05; Z = 1,96.
C3 mau toi thieu la 33 BN. Trong de tai nay n = 60.
2.2.3. Cac bu'dc tien hanh 2.2.3.1. Chan doan UTBMBT tai phat vaghi nhan thdl glan tal phat ke td khi ket thuc dieu tri bddc 1.
2.2.3.2.Dieu tri UTBMBT tal phat - D i e u trj phau t h u a t : BN dffdc mo lai, lay tdi da tdn thffdng tai phat ung thff trong o bung.
Phau thuat dffdc coi la tdi ffu khi tdn thffdng ung thff cdn lai sau md < 1 cm.
• D i e u trj hoa chat: Can cff vao phac do dieu tri hda chat bffdc 1, cd the chon 1 trong nhffng phac do sau:
+ Phac do Paclitaxel - Carboplatin + Phac do Carboplatin - Cydophosphamid + Phac do Gemcitabin ddn thuan
•h Phac do Doxorubidn (Lipodox) ddn thi^n Dieu t n hda chat dffdc tien hanh sau khi BN dn djnh sau md (2 - 3 t u a n ) . Lieu toi thieu phai dat 8 5 % lieu chuan. Danh gla dap u'ng sau moi d d t dieu t n .
2.2.4 Xiy ly so lieu:
Phan tfch thdi gian sdng them bang phffdng phap Kaplan - Mayer.
III. KET QUA NGHIEN COU
3 . 1 . Tuol; Tudi trung binh cua cac benh nhan nghien cffu 51,7 ± 9,5. Tre nhat 3 1 , cao tuoi nhat 75.
Nhom tudl 41 - 60 chiem da sd vdi 80% sd benh nhan.
3 . 2 . Thdi gian t a i phat sau dieu tri bu'dc 1 Bang i.-Thdi qian tai phat sau dieu trj bffdc 1
Thcfi gian 6 - 1 2 thanq 12 - 24 thanq
> 36 thanq Tong
SoBN 22 26 12 60
T y l e ( % ) 37 43 20 100
Y HQC VIET NAM THANG 3 • SO 1/2013
Nlwn xet Thdi gian tal phat trung binh 17,4 ± 9,8 thang, sdm nhat la 7 thang, mudn nhat la 45 thang.
3 . 3 . Dac diem mo benh hoc
Bang 2: Mo benh hqc sau mo UTBMBT tai phat Mo benh iioc
UTBM tuven thanh dich UTBM dang noi mac UTBM tuyen te bao sanq UTBM tuyen khonq biet hoa UTBM tuyen nhay
Tonq
SoBN 33
5 6 2 14 60
Tv le ( % ) 55 8.3 10 3.3 23.4 100 NhSn xet LfTBMBT tuyen thanh dich cd ty le cao nhat 55% BN. UTBMBT tuyen khdng biet hoa cd ty le thap nhat 3,3% BN.
3.4. Ket qua dieu trj 3.4.1. Bieu tri phau thuat 3.4.1.1. Ton thddng trong mo.
Bang 3: V| tri ton thffdng trong mo.
Trieu chihig U tai phat tieu khung Dich 6 bung Hach 6 bunq Tai phat phuc mac
SoBN 60 43 12 35
Tv le ( % ) 100 71,7 20 58,3 Nhan xet: Tai phat tieu khung trong mo cd d 100% BN. Djch 6 bung cd d 71,7 ^ trong 6 bung cd ty le it gap nhat chiem 2 0 % BN.
Bang 4: Kich thffdc td'n thffdng tai phat ldn nhat trong md Kich thu'dc u
< 5cm 5 - 1 0 cm
> 10cm Tonq
SoBN 21 22 17 60
Tv le ( % ) 35 36. 7 28.3 100%
Nhan xet. Kich thffdc u tai phat Idn nhat < Scm 35% BN, u > 5 cm 6 5 % BN.
Bang 5: Sd vj tri ton thffdng tai phat trong mo So vi tri ton thUdnq
1 - 2 VI tri
> 3 VI tri Tonq
SoBN 16 44 60
Tvie(%)
26,7 73,3 100 Nhanxet:2i,7% BN c6 1-2 vi tri, 73,3% so BN c6 > 3 vi tri tai piiat.3.4.1.2. Phau thuat iay u toi da
Bang 6: Kich thu'cic ton thtfOnq con iai sau mo Ton thu'dng con lai
Khonq toi Lfu Tonq
Ty le (%) 61,7
Nhan xet: (il,T>/ii BN du'dc phau thuat iay u toi ifu, khong toi u'u 38,3% BN.
3,4,2, Bleu tri hoa chat
3.4.2.1. Phac do hoa chat Mdc tita chgn dieu tri Bang 7: Phac do hoa chat
Phac ib Paciitaxei - Carbooiatin Carboplatin-CydoDhosphamid Phac do khac
Tonq
SoBN 35 21 4 60
Tv le ( % ) 58.3
35 6.7 100
Nhan xet: So BN du'dc dieu tri phac do Paciitaxei - Carbopiatin chiem ty ie 58,3%, phac do Carbopla'tin-Cyciophosphamid chiem 35%, cac phac do khac chiem 6,7%.
Y HQC VlgT NAM THANG 3 • s 6 1/2013
3.1.2.2. So chu ky hoa chat da dieu tri
So chu kv hoa chat 4 6 7 8 9 Tong
SoBN 4 42 2 6 6 60
Tv le (%)
6. 770 3.3 10 10 100
Nh$n xet: BN dieu trj 6 chu ky chiem ty le cao nhat 70%. Cd 10% BN dieu trj den 9 chu (thffdng cd doi phac do).
3.4.2.3. Danh gia dap uhg sau dieu tri hoa chat gang g; Danh gia dap ffng sau dieu trj hda chat
Ket qua Dap Lfnq hoan toan Dap ufiq mot phan Khong dap Lfng Benh tien tnen
Tonq
SoBN 38 19 3 0 60
Tv le % 63,3 31,7 5 0 100%
Nhan xet: Ty le BN dap ffng hoan toan vdi hda chat ti'nh chung cho cac phac dd la 63,3%, ffng 1 phan la 31,7%, khdng dap ffng la 5%.
3.5.Thdi gian song them 3.5. l.Thdi gian song them toan bp
Bieu doi: Jhii\ gian sdng them toan bd
Nhan xet: Thdi gian sdng them toan bd trung binh la 23,4 ± 2,2 thang, thap nhat 3 thang, cao nhat 57 thang, Tai thdi diem ket thuc nghien cffu, cd 48/60 BN (80%) da tff vong.
3.5.2. Thdi gian song them khong benh
Bieu do Z'Thdi gian sdng them khdng benh
Y HQC V l g T NAW T H A N G 3 - S 6 1/2013
NhSnxeflhbi gian sdng them khdng benh trung binh la 18,1 ± 2,2 thang, thap nhat 1 thang, cao nhat 57 thang. Ty le song them khdng benh sau 12 thang la 53% (32 BN), sau 24 thang la 20% (12 BN), sau 36 thang la 10% (6 BN) va sau 48 thang la 5% (3 BN).
IV. BAN LUAN
4 . 1 . Tuoi: Trong so 60 BN nghien cffu cua chung tdi, tuoi trung binh cua cac BN vao vien dieu tri UTBMBT tai phat la 51,7 ± 9,5, dao dong tff 31 den 75. Nhdm tuoi tff 41 - 60 chlem da sd (80%). Mdt sd tac gia nffdc ngoai khuyen cao khdng nen phau thuat lai d BN UTBMBT tai phat CO tud'i tren 75 [ 5 ] .
4.2. Thdi gian tai p h a t sau dieu trj bu'dc 1 : Thdl glan tai phat sau dieu trj bffdc 1 trong nghien cffu cua chung tdi trung binh la 17,4 ± 9,8 thang. BN tai phat sdm nhat la 7 thang,mupn nhat la 45 thang. Mot sd tac gia cho rang: thdi gian tai phat cang mupn, ty le dap ffng dieu tn bffdc 2 cang cao. Nghien cifu cua R. Salanl va CS[7] cho thay: thdi gian nay trung binh la 32 thang. Nhdm BN tai phat sau 18 thang cd thdi gian sdng them sau dieu trj bffdc 2 la 49 thang so vdi thdi gian sdng them 3 thang cua nhdm BN tai phat trffdc 18 thang.
4.3. Ton thu'dng trong mo: Trong nghien cffu cua chiing toi, 100% BNco tai phat tieu khung,vj tri tai phat thffdng gap d mdm cut am dao hoac canh diem cat dong mach buong trffng.
T^i phat 6 phuc mac cd d 58,3% BN. Hach di can trong d bung cd ty le it nhat gap d 2 0 % BN.
Dich 6 bung cd d 71,7 % BN. Kich thffdc u tai phat < Scm gap d 3 5 % BN, 6 5 % con lai cd tdn thffdng tai phat ldn nhat > 5cm. Sd vj tri tai phat: 26,7% BN cd 1-2 vj t r i tai phat, 73,3% co 3 vj trf trd len.
Nghien cffu cua cac tac gia R. Salani va CS [7] cho ket qua: tai phat khung chau 47,3%, mac treo rudt 16%, hach chau 16%, phuc mac thanh 13%, bao gan va cd hoanh 7%. Cung nghien cffu nay, tac gia cho biet cd 76,4% BN cua hp co 1-2 vi tri tai phat, 23,6% cd tren 3 vi tri tdn thffdng.
Nhff vay BN UTBMBT tai phat trong nghien cffu cua chung tdi dffdc phat hien tffdng ddi mudn. Benh tal phat d nhieu vj tri,chu yeu d tieu khung va 6 phuc mac, it gap tai hach. Kich thffdc khoi tai phat Idn.
4 . 4 . Phau t h u a t lay u toi da
Trong nghien cffu cua chung tdi 37/60 BN (61,7%) dffdc phau thuat tdi ffu. Cd 27/60 BN (38,3%) phau thuat khdng toi ffu do nhieu nguyen nhan: u xam lan rdng vung Douglas, lan
rpng dffdi vdm hoanh; cung cd khi ton thffdng lan tran ca vung cudng lach, mac ndi be, cudng gan hoac BN qua suy kiet, gia yeu khdng cho phep cupc md keo dai...
Nghien cffu cua R. Salani ve phau thuat UTBMBT tai phat cho ket qua 74,5% BN khong cdn u ton dff tren dai the, 14,5% BN cdn u tdn dff < 1cm, 10,9% BN con u ton dff > 1cm [7].
4 . 5 . Lu'a chpn phac do dieu trj hoa chat Ddi vdi UTBMBT tai phat, viec Iffa chpn phac do dieu tri bffdc 2 phu thudc phac dd hda chat da dieu trj bffdc 1 va thdi gian tai phat.
Trong nghien cffu cua chung tdi, sd BN difdc dieu trj phac do Paclitaxel -Carboplatin chiem ty le 58,3%, phac do Carboplatin-Cyclophosphamid chiem 35%, cac phac do khac chiem 6,7%. Mdt sd phac dd khac d Benh vien K hay dung la:
Gemcitabin + Carboplatin, Doxorubicine ddn chat, Etoposid uong.
Cac tac gia R.Salani va CS [7] khi nghien cffu 55 BN UTBMBT tai phat cho thay phac dd Paclitaxel - Carboplatin dffdc sff dung nhieu nhat (87,3%).
Trong nghien cffu nay chung tdi chi Iffa chpn nhffng BN sau mo lai, dffdc dieu tri hda chat tff 4 ddt trd len. Sd BN dffdc dieu tn 6 ddt chiem ty le cao nhat (70%). Co 10% BN dffdc dieu trj den 9 ddt hoa chat (thffdng cd dd'i phac do).
Ty le BN dap ffng hoan toan vdi hoa chat tinh chung cho cac phac do la 63,3%, dap ffng 1 phan la 31,7%, khdng dap ffng la 5%.
4.6. Thdi gian sdng t h e m toan bo Trong nghien cffu cua chiing toi, thdi gian sdng them toan bd trung binh la 23,4 ± 2,2 thang, thap nhat 3 thang, cao nhat 57 thang. 6 thdi diem ket thiic nghien cffu cd 48/60 BN (80%) da tff vong. Nghien cffu ciia tac gia Antonios va CS [3] cho thdi gian sdng them toan bp trung binh la 34 thang, ty le sdng tren 5 nam tinh chung la 30%. Nghien cffu ciia Chl Dennis S.
[4] ve UTBMBT tai phat cho thdl gian sdng them la 41,7 thang .
4.7. Thdi gian sdng t h e m khong benh Thdi gian sdng them khdng benh trung binh trong nghien cffu ciia chiing tdi la 18,1 ± 2,2 thang. Ty le sdng them khdng benh sau 12 thang la 5 3 % (32 BN), sau 24 thang la 20% (12 BN), sau 36 thang la 10% (6 BN) va sau 48 thang la 5% (3 BN).
Y HQC VlgT NAM THANG 3 - s 6 1/2013 Nghien cffu cua R. Salani
UTBMBT tai phat cho thdi gian benh trung binh la 50 thang.
Ket qua nghien cffu cua ngoai cho thdi glan song them benh cao hdn ket qua trong chiing toi co the vi benh nhan ciia hp dffdc phat hien tal phat qua dieu trj cung tot hdn,
va cdng sff [7] ve sdng them khdng cac tac gla nffdc toan bd va khdng nghien cuff ciia trong nghien cffu sdm hdn nen ket
V. KET LUAN
Qua nghien cffu 60 BN UTBMBT tai phat tai Benh vien K, chung tdi rut ra mdt sd ket luan nhff sau:
Da 50 BN (83%) dffdc phat hien tal phat tffdng ddi mudn, khi da cd bieu hien lam sang, Chl cd 17% BN dffdc phat hien khi chffa cd tneu chffng lam sang. Thdi gian tai phat sau dieu tri bffdc 1 trung binh la 17,4 ± 9,8 thang. Thdi gian sdng them toan bd trung binh sau dieu trj bffdc 2 la 23,4 ± 2,2 thang, thap nhat 3 thang, cao nhat 57 thang. Sdng them khdng benh trung binh la 18,1±2,2 thang.
TAI LIEU T H A M K H A O
1. Nguyen Bd Dii'c (2010), "Ung thi/ buSng tnJYig", Dik tn n0i khoa binh ung thU. Nha xuSt ban Y hpc, tr.lB9 197.
2. Nguyen V i n Hieu (2010), "Ung thU buong tmng', Diiu tn phiu thuat benh ung tttu; Nha xuat ban y hgc, Hk Noi, 346-355.
3. Antonios-Apostolos K Tentes (2010}, Cytoreductlve surgery and penoperative intrapentoneal chemotherapy in recurrent ovanan cancer", Tumori, 96:411-416.
4 Chi Denis S, McCaughty K, Diaz JP (2006),
"Guidelines and selection cntena for s^ndary cytoreductlve surgery in patients with recurrent pfatlnum-sensitive epithelial ovanan caranoma". Cancer 2006;106(9):1933
5 Ertg-Hseon Tay, Peter T Grant (2002), "Seconctary cytoreducttve surgery for recurrent epithelial ovarian cancer", Obstetncs & Gynecology, Vol.99, No.6,June 2002.
6 Menczer J, Chetrit A, et al (2006), "Rillow-up ovanan and pnmary pentoneal carcinoma: the value tf physical examination in patients with pretreatment elevated CA 125 levels" Gynecol Oncol, 2006;103:137- 140.
', Ruti Salani, Antonio Santillan (2007), "Secor^ry cytoreductive surgery for localized recurrent epithtelial ovarian cancer", American cancer soaety. Publish online I I January 2007
NHAN XET CAC YEU TO LIEN QUAN DEN BENH LY BAN CHAN GT BENH NHAN DAI THAO DUtTNG CAO TUOI
Vu Thj Thanh Huyen^ ^ N g u y e n Tien Dung^, Pham Thang^
TOM T A T
Muc tieu. Nhan xet cac yeu to hen quan den benh ly ban chan d benh nhan DTD cao tuoi. Doi tddng vi phddng phip nghien ctiir. Mo ta c3t ngang tren 300 benh nhan DTD typ 2 tren 60 tuoi tff 3/2011- 9/2011. Kei qua: Ton thu'ong ban chan do DTD la 64%. Cac yeu to nguy cO gay ton thffOng ban chan DTD bao gom thdi gian mac benh, mffc dp kiem soat du'dng mau, hiit thuoc. Bien chffng vi mach nhff bien chffng tai than co nguy cO cao hOn 2,6 I3n, bien chffng m§t nguy cP cao hOn 4,2 fan, chi so ABI thap nguy cd cao hdn 18 lan. Ket luan. Ty le bien chffng ban_chan do DTD d ngu'cJi cao tuoi rat cao, ty le mac ty le thuan vdi thdi gian m3c benh, hut thuoc la^ bien chffng vi mach va mffc do kiem soat dffdng mau.
Tu' khoa: Dai thao dudng, benh ly ban chan do DTO
* Trddng dai hgc YHa Noi, ^Benh vien Lio khoa tmng ddng Phan bl0n khoa hpc: PGS.TS. Dang Thj Ngpc Dung
SUMMARY
FACTORS RELATED TO DIABETIC FOOT IN ELDERLY DIABETIC PATIENTS Objectives, to identify some factors related to diabetic foot in elderly patients. Methods.
observational study on 300 elderly diabetic patients from March to September 2011. Results: Jhe rateof diabebc foot complications among diabetic elderly patients was 64%. Risk factors of diabetic foot diseases are duration of diagnosed diabetes, levels of blood glucose control, micro-vascular complication, smoke. Higher risk for diabetic foot disease with micro- vascular complications such as rena Icomplications, eye complications and low ABI. Conclusion: the prevalence of diabetic foot in older ages was ralher high and increased with the duration of diabetes, level
