| 1. |
- Menzies, Scott W, et al.
(författare)
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Dermoscopic Evaluation of Nodular Melanoma.
- 2013
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Ingår i: JAMA dermatology (Chicago, Ill.). - : American Medical Association (AMA). - 2168-6084 .- 2168-6068. ; 149:6, s. 699-709
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical. OBJECTIVE To determine the dermoscopy features of NM. DESIGN Eighty-three cases of NM, 134 of invasive non-NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/hypomelanotic or pigmented to assess outcomes. SETTING Predominantly hospital-based clinics from 5 continents. MAIN OUTCOME MEASURES Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma. RESULTS Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, blue-white veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (>98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/hypomelanotic NM (84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM. CONCLUSIONS AND RELEVANCE When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.
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| 2. |
- Holland, Grainne, et al.
(författare)
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Artificial Cornea : Past, Current, and Future Directions
- 2021
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Ingår i: Frontiers in Medicine. - : Frontiers Media SA. - 2296-858X. ; 8
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Forskningsöversikt (refereegranskat)abstract
- Corneal diseases are a leading cause of blindness with an estimated 10 million patients diagnosed with bilateral corneal blindness worldwide. Corneal transplantation is highly successful in low-risk patients with corneal blindness but often fails those with high-risk indications such as recurrent or chronic inflammatory disorders, history of glaucoma and herpetic infections, and those with neovascularisation of the host bed. Moreover, the need for donor corneas greatly exceeds the supply, especially in disadvantaged countries. Therefore, artificial and bio-mimetic corneas have been investigated for patients with indications that result in keratoplasty failure. Two long-lasting keratoprostheses with different indications, the Boston type-1 keratoprostheses and osteo-odonto-keratoprostheses have been adapted to minimise complications that have arisen over time. However, both utilise either autologous tissue or an allograft cornea to increase biointegration. To step away from the need for donor material, synthetic keratoprostheses with soft skirts have been introduced to increase biointegration between the device and native tissue. The AlphaCor (TM), a synthetic polymer (PHEMA) hydrogel, addressed certain complications of the previous versions of keratoprostheses but resulted in stromal melting and optic deposition. Efforts are being made towards creating synthetic keratoprostheses that emulate native corneas by the inclusion of biomolecules that support enhanced biointegration of the implant while reducing stromal melting and optic deposition. The field continues to shift towards more advanced bioengineering approaches to form replacement corneas. Certain biomolecules such as collagen are being investigated to create corneal substitutes, which can be used as the basis for bio-inks in 3D corneal bioprinting. Alternatively, decellularised corneas from mammalian sources have shown potential in replicating both the corneal composition and fibril architecture. This review will discuss the limitations of keratoplasty, milestones in the history of artificial corneal development, advancements in current artificial corneas, and future possibilities in this field.
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| 3. |
- Moloney, Maria, et al.
(författare)
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20-Year outcome of TFCC repairs
- 2018
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : TAYLOR & FRANCIS LTD. - 2000-656X .- 2000-6764. ; 52:3, s. 193-197
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to investigate the functional result and rate of osteoarthritis 15-25 years after a TFCC-repair. Forty-seven patients completed the questionnaire Patient Rated Wrist Evaluation (PRWE), and 43 had new X-rays. Fifty-seven percent had a simultaneous arthroscopy. Sixteen patients had later additional surgery to the wrist, of these eight had a reoperation of the TFCC-injury due to recurrent instability. Radiographs showed that 17.5% had developed radiocarpal osteoarthritis and 34% osteoarthritis in the distal radioulnar joint. The median PRWE result was 22.5. Patients with radiocarpal osteoarthritis and patients who had additional surgery had significantly worse scores. Patients who had undergone arthroscopy significantly less often had developed radiocarpal osteoarthritis. The result is acceptable but not impressive and efforts should be made to diagnose these injuries early and also diagnose associated injuries, advisably by arthroscopy.
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| 4. |
- Moloney, Maria, et al.
(författare)
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Distal ulna fractures in adults - subcapitular, transverse fractures did not benefit from surgical treatment
- 2023
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Ingår i: Archives of Orthopaedic and Trauma Surgery. - : Springer. - 0936-8051 .- 1434-3916. ; 143:1, s. 381-387
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome. Materials and methods Patients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5-7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists. Results Ninety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result. Conclusions Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.
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| 5. |
- Moloney, Maria, et al.
(författare)
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Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively
- 2020
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Ingår i: Acta Orthopaedica. - : TAYLOR & FRANCIS LTD. - 1745-3674 .- 1745-3682. ; 91:1, s. 104-108
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Fractures of the distal ulna can occur in isolation or in conjunction with a distal radius fracture. They may result in incongruence and instability of the distal radioulnar joint. We investigated the incidence of distal ulna fractures, whether any fracture types were more common, and the methods of treatment used. Patients and methods - Data were collected from patients 18 years or older, treated for a fracture of the distal ulna in ostergotland, Sweden, during 2010-2012. Patients were identified in the patient registry. The fractures were classified according to the AO comprehensive classification of fractures. Results - The incidence of distal ulna fractures was 74/100,000 person-years. The most common fracture type was that of the ulnar styloid Q1 (79%), followed by the ulnar neck Q2 (11%). Rarest was ulna head fracture, type Q4 (1%). Incidental findings were a mean age of 63 years (SD 18), a concomitant distal radius fracture in 92% of the patients and that 79% were caused by falling from standing height. Internal fixation was performed in 30% of the Q2-Q6 fractures. This indicates that most were considered stable without internal fixation or stable after fixation of a concomitant radius fracture. Interpretation - Our results show that fractures of the distal ulna are not very common, and some fracture types are even rare. There seem to be no consensus on treatment.
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| 6. |
- Moloney, Maria, et al.
(författare)
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Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures
- 2022
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Ingår i: Acta Orthopaedica. - : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 93, s. 438-443
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Classification of fractures can be valuable for research purposes but also in clinical work. Especially with rare fractures, such as distal ulna fractures, a treatment algorithm based on a classification can be helpful. We compared 3 different classification systems of distal ulna fractures and investigated their reliability and reproducibility. Patients and methods - patients with 97 fractures of the distal ulna, excluding the ulnar styloid, were included. All fractures were independently classified by 3 observers according to the classification by Biyani, AO/OTA 2007, and AO/OTA 2018. The classification process was repeated after a minimum of 3 weeks. We used Kappa value analysis to determine inter- and intra-rater agreement.Results - The inter-rater agreement of the AO/OTA 2007 classification was judged as fair,. 0.40, whereas the agreement of AO/OTA 2018 and Biyani was moderate at. 0.42 and 0.43 respectively. The intra-rater agreement was judged as moderate for all classifications. Interpretation - The differences between the classifications were small and the overall impression was that neither of them was good enough to be of substantial clinical value. The Biyani classification, being developed specifically for distal ulna fractures, was the easiest and most fitting for the fracture patterns seen in our material, but lacking options for fractures of the distal diaphysis. Standard radiographs were considered insufficient for an accurate classification. A better radiographic method combined with a revised classification might improve accuracy, reliability, and reproducibility.
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| 7. |
- Moloney, Maria
(författare)
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Ulnar fractures and ligament injuries of the wrist
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falling over on an outstretched hand with the wrist extended is a common accident that can cause a multitude of injuries in the wrist. Research has mainly focused on distal radius fractures while injuries of the distal ulna and adjacent ligaments have taken a back seat. If not treated adequately, these injuries may result in ulnar-sided wrist pain, sometimes referred to as the “black box” of hand surgery. The distal radio-ulnar joint (DRUJ) enables forearm rotation where the radio-carpal unit rotates around the fixed ulna, stabilised most importantly by the triangular fibrocartilage complex (TFCC). Painless rotation and stability of the forearm under load is important for upper limb function. If full function is to be restored after wrist injury, it is important to treat not only injury to the radius but also those to the ulna and TFCC.The aims of this thesis were to evaluate the long-term results of TFCC injury repair, and contribute to our knowledge on fractures of the distal ulna, their epidemiology, radiographic classification and results of treatment.The long-term outcome of 47 patients with a foveal TFCC tear was evaluated by patient-rated wrist evaluation (PRWE) and radiography 20 years after open repair. The median PRWE score was 22.6 (7-48.5), and 34 % had had further surgery after the initial repair, half of these due to recurrence of DRUJ instability. Signs of osteoarthritis were seen in the radiocarpal joint in 17.5 % and in the DRUJ in 34 %. Higher PRWE scores were seen in patients with osteoarthritis or those who had undergone further surgery. Radio-carpal osteoarthritis was less frequently seen in patients who had undergone initial arthroscopy. This study highlights the importance of arthroscopy in identifying associated injuries. Twenty years after foveal TFCC tear repair patient reported outcomes were similar to those of distal radius fractures.Apart from fractures of the styloid process, distal ulna fractures are rare. All distal ulna fractures in the county of Östergötland 2010-2012 were identified. A total of 766 fractures were found (incidence 74/100 000 person-years), the majority of which were fractures of the ulnar styloid process(79%) usually caused by a fall from standing height. Most patients were female (76%), mean age at the time of injury was 63 years and 92 % had a concomitant distal radius fracture. Second after styloid fractures were fractures of the ulnar neck. A retrospective study of 96 patients with 97 fractures of the distal ulna (excluding the styloid) showed that 40 % were treated by internal fixation. The median PRWE score was 15, with significantly worse scores in patients with an internally fixed distal ulna fracture compared to patients not operated. When classifying these fractures according to AO/OTA 2018, transverse extra-articular fractures (2U3A2.3) had a significantly better outcome when not treated surgically, and these probably do not require internal fixation if the distal radius provides stability and alignment. All 97 fractures were classified by three independent observers according to three classification systems: Biyani, AO/OTA 2007, and AO/OTA 2018. Classification was repeated after a minimum of 3 weeks. Reliability and reproducibility were calculated. The reliability was judged as fair for AO/OTA 2007, and moderate for Biyani and AO/OTA 2018. The reproducibility was moderate for all three systems. These results together with the observers´ opinion that Biyani is an easier system to use, leads us to conclude that a slightly modified Biyani-system together with improved radiological techniques that provide more information about the fracture pattern, may well improve accuracy, reliability and reproducibility.A better classification of distal ulna fractures could help us in the evaluation of new and existing treatments as well as providing the information necessary for designing treatment algorithm. After careful consideration, internal fixation is probably the treatment of choice for certain types of fracture, but this needs further investigation.
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