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.
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.
Gleb Slobodin MD and Iris Eshed MD
The term non-radiographic axial spondyloarthritis (nrAxSpA) was coined for patients who have a clinical picture of ankylosing spondylitis (AS) but do not exhibit radiographic sacroiliitis. The ASAS classification criteria for nrAxSpA, ensuring the recruitment of homogenous study cohorts, were accepted in 2009, although the respective diagnostic criteria for daily clinical practice have not yet been developed. The clinical diagnosis should be based on the composite of clinical symptoms and signs of the disease, HLA B27 status, and magnetic resonance imaging (MRI) of sacroiliac joints. Notably, a negative MRI or HLA B27 does not exclude the diagnosis in patients with a high clinical suspicion for nrAxSpA. The prevalence of nrAxSpA is similar to that of AS, but the former has a higher female preponderance. The rate of progression of nrAxSpA to the radiographic stage of disease (AS) ranges from 10% to 20% over 2 years. Current treatment strategies for nrAxSpA are the same as for AS and include non-steroidal anti-inflammatory drugs and inhibitors of tumor necrosis factor-alpha. While this review summarizes the current achievements in the field of nrAxSpA, further understanding of the epidemiology and natural history of the disease and, particularly, mechanisms of inflammation and subsequent new bone formation is essential for the development of new treatment strategies for nrAxSpA patients.
Dan Levy Faber MD, Ronen Galili MD, Orna Nitzan MD and Erez Sharoni MD
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.