Ron Lavy MD, Yehuda Hershkovitz MD, Bar Chikman MD, Zahar Shapira MD, Natan Poluksht MD, Nirit Yarom MD, Judth Sandbank MD and Ariel Halevy MD
Background: Despite the ongoing decrease in the incidence of gastric cancer, this disease is still a major cause of death. It is still debatable whether D2 lymphadenectomy improves survival and whether this procedure should be performed routinely or selectively.
Objectives: To compare the pathological and short-term results following radical D2-type gastric resection and lymphadenectomy versus the more limited D1 type resection and lymphadenectomy.
Methods: We conducted a retrospective study on 4 years experience treating 164 patients suffering from gastric cancer. We compared the results between the group of patients who underwent a radical D2 type gastric resection and lymphadenectomy (n=100) and those of a relatively small group of patients who intentionally underwent the more limited D1 type (n=34).
Results: The overall number of harvested lymph nodes was 9 ± 4 in the D1 group compared to 30 ± 12 (range 16–69) in the D2 group (P = 0.001). Of the 100 patients undergoing a D2 lymphadenectomy, 57% had positive nodes compared to 38% of the 34 patients in the D1 group (P = 0.045).
Conclusions: We showed statistically significant differences between D1 and D2 procedures in the overall number of harvested lymph nodes and the proportion of positive nodes to the overall number. Our results support the fact that D2 resection should be recommended as the standard approach of treatment for gastric cancer patients, ensuring a larger number of retrieved lymph nodes and a comparable rate of complications and mortality.
Delfino Legnani MD, Maurizio Rizzi MD, Piercarlo Sarzi-Puttini MD, Andrea Cristiano MD, Tiziana La Spina MD, Francesca Frassanito MD, Airoldi Andrea MD and Fabiola Atzeni MD
Background: Interstitial lung involvement is common and potentially limits the quality of life in patients with systemic limited sclerosis (SScl).
Objectives: To study the lung carbon monoxide diffusion (DLCO) measured during effort in order to identify a possible subclinical impairment.
Methods: We enrolled 20 SScl patients without interstitial lung involement and 20 healthy controls. At enrolment all subjetcs underwent plethysmography, DLCO by single-breath technique and evaluation of pulmonary blood flow (Qc) with the rebreathing CO2 method. Skin involvement in the SScl patients was rated using the modified Rodman skin score (mRSS). During exercise on a cycle ergometer, DLCO, DLCO/alveolar volume (Kco) and Qc were calculated at 25% and 50% of predicted maximum workload (25% pmw and 50% pmw).
Results: At baseline two groups did not differ in age, body mass index, lung function and Qc. In the controls, DLCO, Kco and DLCO/Qc measured at 25% pmw and 50% pmw were significantly higher than in SScl patients, while Qc was not different. Based on response to effort, SScl patients were divided into two groups: responders, with an increase of DLCO25%pmw and DLCO50%pmw at least 5% and 10% respectively, and non-responders. The non-responders showed greater skin involvement and significantly reduced DLCO, Kco and DLCO/Qc values at rest than responders.
Conclusions: Moderate effort in SScl patients may reveal a latent impairment in gas diffusion through the alveolar/capillary membrane, thus confirmig that exertional DLCO can identify lung damage at an earlier stage than DLCO at rest.
Adi Abulafia MD, Eli Rosen MD, Ehud I. Assia MD and Guy Kleinmann MD
Background: Cataract extraction is the most commonly performed ophthalmic surgical procedure. There is no registry for documenting cataract surgical procedures and the overall risk of its complications over time in Israel.
Objectives: To present trends in the number and type of selected parameters associated with cataract surgical procedures in Israel between 1990 and 2014.
Methods: Questionnaires had been sent annually to all surgical centers in which cataract surgery was performed in Israel during the study period. The trends that were investigated included annual rates, surgical sites, surgical techniques, use of an intraocular lens (IOL) and type and rates of postoperative endophthalmitis (POE).
Results: A total of 812,112 cataract surgical procedures were reported during the 25 year study period. Responses to the questionnaire increased from 75% in 1990 to 100% in 2006 onwards. The annual number of reported cataract surgical procedures increased from 16,841 (3.5 per 1000) in 1990 to 57,419 in 2014 (6.9 per 1000), representing an increase of 197%. There was a shift from performing the surgery in the public health system to private medical centers. The surgical technique changed from predominantly manual extracapsular cataract extraction (56% in 1999) to predominantly phacoemulsification (98.7% in 2014). POE rates decreased from 0.25% in 2002 to 0.028% in 2014.
Conclusions: There was a continuous increase in the rate of surgical cataract procedures, and more were performed in private medical facilities. There was also a major shift towards advanced cataract procedures and a decreased rate of POE.
Yuval Konstantino MD, Tali Shafat BSc, Victor Novack MD PhD, Lena Novack PhD and Guy Amit MD MPH
Background: Implantable cardioverter defibrillators (ICDs) reduce mortality in patients implanted for primary and secondary prevention of sudden cardiac death. Data on the incidence of appropriate ICD therapies in primary vs. secondary prevention are limited.
Objectives: To compare ICD therapies and mortality in primary vs. secondary prevention of sudden cardiac death.
Methods: We conducted a retrospective analysis of 581 consecutive patients receiving an ICD for primary (66%) or secondary (34%) prevention indications.
Results: During long-term follow-up, 29% of patients implanted for secondary prevention received appropriate ICD therapy vs. 18% implanted for primary prevention. However, the overall 7 year mortality rate was not significantly different between the two groups (26.9%, P = 0.292). Multivariate analysis showed that patients implanted for primary prevention had a significantly lower risk of appropriate ICD therapy even after adjustment for age, left ventricular ejection fraction < 0.35 and chronic renal failure (HR 1.63, 95%CI 1.10–2.41, P = 0.015).
Conclusions: Patients implanted for secondary prevention were more likely to receive appropriate ICD therapy, with a significantly shorter time period from ICD implant to the first therapy. However, all-cause mortality was comparable between primary and secondary prevention groups.