Algidas Basevičius

Ten-Year Follow-up of a Prospective, Randomized Clinical Study of Mosaic Osteochondral Autologous Transplantation Versus Microfracture for the Treatment of Osteochondral Defects in the Knee Joint of Athletes

Background: Various techniques have proven to be effective for treating articular cartilage defect (ACD) and osteochondral defect (OCD) of the knee joint, but knowledge regarding which method is best still remains uncertain. Purpose: To evaluate and compare the outcomes of mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of articular cartilage defects of the knee joint in young active athletes. This article represents an update of the clinical results at 10 years. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Between 1998 and 2002, a total of 60 athletes with a mean age of 24.3 years (range, 15-40 years) and with a symptomatic ACD or OCD in the knee were randomized to undergo either OAT or MF. Patients were then evaluated postoperatively using the International Cartilage Repair Society (ICRS) score, Tegner activity score, radiographs, and magnetic resonance imaging. The mean follow-up time was 10.4 years (range, 9-11 years). Results: Three to 10 years after the OAT and MF procedures, patients had lower ICRS and Tegner scores (P < .05), but both groups still had significant clinical improvement over presurgery scores according to ICRS scores at 10-year follow-up. Statistically significantly better results were detected in patients in the OAT group compared with those in the MF group at 10 years (P < .005). At 10-year follow-up, there were 15 failures (26%), including 4 failures (14%) of the OAT and 11 failures (38%) of MF treatment (P < .05). Seven patients (25%) from the OAT group and 14 patients (48%) from the MF group had radiographic evidence of Kellgren-Lawrence grade I osteoarthritis at 10 years, but these differences were not significant (P = .083) or related to the clinical results. The ICRS and Tegner scores of younger athletes (<25 years at the time of primary surgery) remained significantly higher after 10 years compared with older patients (P < .05); 15 of 20 patients (75%) in the OAT group and 8 of 22 patients (37%) in the MF group maintained the same physical activity level. Conclusion: The OAT technique for ACD or OCD repair in the athletic population allows for a higher rate of return to and maintenance of sports at the preinjury level compared with MF.

Multidimensional Volumetric Imaging of Pulmonary Infiltrates for Measuring Therapeutic Response to Antifungal Therapy in Experimental Invasive Pulmonary Aspergillosis

ABSTRACT Pulmonary infiltrates in neutropenic hosts with invasive pulmonary aspergillosis are caused by vascular invasion, hemorrhagic infarction, and tissue necrosis. Monitoring the dynamics of pulmonary infiltrates of invasive aspergillosis is an important tool for assessing response to antifungal therapy. We, therefore, introduced a multidimensional volumetric imaging (MDVI) method for analysis of the response of the volume of pulmonary infiltrates over time to antifungal therapy in experimental invasive pulmonary aspergillosis (IPA) in persistently neutropenic rabbits. We developed a semiautomatic method to measure the volume of lung lesions, which was implemented as an extension of the MEDx visualization and analysis software using ultrafast computerized tomography (UFCT). Volumetric infiltrate measures were compared with UFCT reading, histopathological resolution of lesions, microbiological clearance of Aspergillus fumigatus, and galactomannan index (GMI). We also studied the MDVI method for consistency and reproducibility in comparison to UFCT. Treatment groups consisted of deoxycholate amphotericin B (DAMB) at 0.5 or 1 mg/kg of body weight/day and untreated controls (UC). Therapeutic monitoring of pulmonary infiltrates using MDVI demonstrated a significant decrease in the infiltrate volume in DAMB-treated rabbits in comparison to UC (P ≤ 0.001). Volumetric data by MDVI correlated with conventional CT pulmonary scores (r = 0.83, P ≤ 0.001). These results correlated with validated biological endpoints: pulmonary infarct scores (r = 0.85, P ≤ 0.001), lung weights (r = 0.76, P ≤ 0.01), residual fungal burden (r = 0.65, P ≤ 0.05), and GMI (r = 0.78, P ≤ 0.01). MDVI correlated with key biological markers, improved the objectivity of radiological assessment of therapeutic response to antifungal therapy, and warrants evaluation for monitoring therapeutic response in immunocompromised patients with invasive aspergillosis.

The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia.

BACKGROUND AND OBJECTIVE The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year. MATERIALS AND METHODS In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated. RESULTS The HI injury groups detected during USG significantly correlated with the mental development groups (r=0.3; P=0.01) and the neurological evaluation groups (r=0.3; P<0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity - 100%, specificity - 93-100%, positive predictive value (PPV) - 60-100%, and NPV - 100%. In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P≤0.05), and mean resistive index (RI) values were significantly lower (P<0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development. CONCLUSIONS Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.

Cerebral computed tomographic angiography scan delay in subarachnoid hemorrhage

CONTEXT Computed tomographic angiography (CTA) is widely applied in the evaluation of cerebral vessels. Contrast enhancement in cerebral CTA without care or test bolus is not always sufficient for high-quality images. AIMS Evaluation of the possibilities of calculation of scan delay for cerebral CTA in case of subarachnoid hemorrhage (SAH), based on clinical data of a patient and to find out prognostic error of the model. SETTINGS AND DESIGN Prospective study in Neurosurgery and Radiology departments. MATERIALS AND METHODS Scan delay in 53 patients suffering an acute SAH was measured employing test bolus technique. Cerebral CTA was performed afterwards. STATISTICAL ANALYSIS USED SPSS for Windows v.10.1 software package was applied for dispersion analysis, including one-sample Kolmogorov-Smirnovs test and Levenes Test of Equality of Error Variances. RESULTS A statistical model for the prediction of scan delay in SAH was developed. Cerebral CTA scan delay was dependent upon age, neurological status and impact of the latter factors together (P< 0.05). The determined mean square error of prognosis of scan delay of the developed model equals 3.3 sec. CONCLUSION Using our proposed model it is possible to estimate an optimal delay time for CTA in most patients with SAH with a determined error.

Laser Doppler imaging as a tool in the burn wound treatment protocol

Introduction The main treatment of burns is early excision of injured tissues. Aim To compare two different methods of examination of burned patients: clinical burn depth examination (CDE) and laser Doppler imaging (LDI). Material and methods A prospective randomized study of 57 burn patients treated in 2009–2011 was carried out. The burned patients were randomized into a CDE group and an LDI group. The CDE and LDI scan were performed 72 h after injury, with the second and third CDE and LDI scan on the 7th and 14th day after the burn. Age, sex, length of inpatient stay, cost of burn treatment, burn depth, cause and localization of the burns were analyzed between the two groups. Results Fifty-seven patients were treated during 2 years. Thirty-two patients were in the CDE group and 25 patients were in the LDI group. Most of the patients were male (45 male vs. 12 female, p < 0.001). The age was similar between the males and the females (female: 46.4 ±16.9 years vs. male: 46.3 ±12.5 years; p = 0.11). The mean length of stay in hospital was significantly higher in the CDE group (47 ±34.4 day vs. 25 ±10.8 day; p = 0.005). The mean cost of treatment of burned patients was significantly higher in the CDE group. Conclusions The length of stay and cost of treatment of burn patients depends upon early diagnosis of the deep burns and well-timed surgical treatment of burn wounds.

Assessment of radiographers' competences from the perspectives of radiographers and radiologists: A cross-sectional survey in Lithuania

BackgroundAssessing radiographers’ clinical competence is of major importance in all medical imaging departments, and is a fundamental prerequisite for guaranteeing professional standards in both nursing care and radiography. Despite the fact that self-assessment has been reported to be the most common form of competence evaluation only several studies defining the radiographers’ self-assessment of clinical competencies were identified. The aim of the study was to evaluate radiographers’ professional competence from the perspectives of radiographers and radiologists by applying the Radiographers’ Competence Scale (RCS).MethodsThe study was conducted in university hospitals of Lithuania. We used the original instrument designed by Swedish researchers – the Radiographers’ Competence Scale (RCS) consisting of two domains: A “Nurse-initiated care” and B “Technical and radiographic processes”. The study involved in all 397 respondents; radiographers (250) and radiologists (147) working in departments of diagnostic radiology. Each competence was evaluated twice – the level on a 10-point scale, and the frequency of practical application on a 6-point scale.ResultsThe overall level of the radiographers’ competence and the frequency of its use in practice were evaluated high or very high by both respondent groups. The radiographers attributed the highest evaluations to such competences as “Encouraging and supporting the patient” and “Collaborating with other radiographers”, while the lowest evaluations were attributed to “Guiding the patient’s relatives” and “Empowering the patient by involving him/her in the examination and treatment” competences. The radiologists attributed the highest evaluations to such competences as “Collaborating with radiologists” and “Independent carrying out of the radiologist’s prescriptions”, while the lowest evaluations – to the same competences as the radiographers did. Irrespectively of the work experience and age, the radiographers gave significantly higher ratings to all competences that the radiologists did (p < 0.001).ConclusionsBoth groups of the respondents attributed high or very high evaluations to the competences in both the “Nurse-initiated care” and the “Technical and radiographic processes” domains.