Aviv Weinstein PhD, Yafa Yaacov BA, Michal Manning BA, Pinhas Danon MD and Abraham Weizman MD
Background: Use of the internet and videogames by children and adolescents has risen dramatically over the last decade. Increasing evidence of internet and videogame addiction among children is causing concern due to its harmful physical, emotional and social consequences. There is also emerging evidence for an association between computer and videogame addiction and attention deficit/hyperactivity disorder (ADHD).
Objectives: To investigate the relationship between ADHD and internet addiction.
Methods: We compared 50 male schoolchildren, mean age 13 years, diagnosed with ADHD to 50 male schoolchildren without ADHD on measures of internet addiction, internet use and sleep patterns.
Results: Children with ADHD had higher scores on the Internet Addiction Test (IAT), used the internet for longer hours, and went to sleep later than those without ADHD.
Conclusions: These findings indicate an association of ADHD, sleep disorders and internet/videogame addiction.
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.
Ori Segal MD, Joseph R. Ferencz MD, Michael Mimouni MD, Ronit Nesher MD, Perri Cohen MA and Arie Y. Nemet MD
Background: Reports of lamellar macular holes (LMHs) with underlying age-related macular degeneration (AMD) are rare and the specific definition, pathogenesis, and surgical recommendations for this macular condition remain unclear.
Objectives: To present a series of LMHs in eyes with underlying end-stage AMD, and describe optical coherence tomography (OCT) detection of associated morphologic abnormalities.
Methods: We reviewed the files of consecutive patients diagnosed with LMH and underlying end-stage AMD between September 2007 and September 2011.
Results: Sixteen eyes of 14 patients were included in this study. The average follow-up after the OCT-established diagnosis of LMH was 19.8 months (range 4–48). The average visual acuity (VA) at last follow-up visit was 20/400 (20/60–20/1200). The best-corrected VA was stable in 10 eyes (62.5%) and deteriorated in 6 (37.5%). There was a statistically significant correlation between VA and minimal foveal thickness (r = -0.598, P = 0.014).
Conclusions: In this series of LMHs with underlying AMD the OCT findings were intraretinal fluid, cystic spaces and window defect.
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.
Shmuel Avital MD and Baruch Shpitz MD
Shai Luria MD, Sharon Eylon MD and Amos Peyser MD
Abdulla Watad MD, Qasim Odeh MD, Nora Balint Lahat MD and Howard Amital MD MHA
Shai Rosenberg MD PhD, John M. Gomori MD, Avinoam Reches MD and Marc Gotkine MD
Francesca Cainelli MD and Sandro Vento MD
Orly Goitein MD, Elio Di Segni MD, Yael Eshet MD, Victor Guetta MD, Amit Segev MD, Eyal Nahum MD, Ehud Raanani MD, Eli Konen MD and Ashraf Hamdan MD
Background: Trans-catheter valve implantation (TAVI) is a non-surgical alternative for patients with severe aortic stenosis (AS). Pre-procedural computed tomography angiography (CTA) allows accurate “road mapping,” aortic annulus sizing and the detection of incidental findings.
Objectives: To document the prevalence of non-valvular extra-cardiac findings on CTA prior to TAVI and the impact of these findings on the procedure.
Methods: Ninety AS patients underwent CTA as part of pre-TAVI planning. Scans extended from the clavicles to the groin. Non-vascular non-valvular findings were documented and graded as follows: (A) significant findings causing TAVI cancellation or postponement, (B) significant findings leading to a change in the TAVI procedure approach, (C) non-significant findings not affecting the TAVI procedure.
Results: TAVI was planned for 90 patients; their average age was 80.2 ± 7.5 years, 53% were females. Overall, non-valvular cardiac, extra-cardiac and extra-vascular significant and non-significant incidental findings were documented in 97% of scans (87/90). Significant pathologies causing TAVI cancellation or postponement (category A) were documented in 8%. Significant findings affecting the TAVI procedure (category B) were found in 16% of patients.
Conclusions: Pre-TAVI CTA detected non-valvular extra-vascular pathologies leading to procedure cancellation/postponement or procedure modification in 8% and 16%, respectively. Comprehensive CTA evaluation that acknowledges the importance of such findings is of major importance since it might alter the TAVI procedure or even render it inappropriate.