Clinical results of collagenase treatment for dupuytren's disease: a case series study with 2-years follow-up / Resultados clínicos do tratamento com colagenase para a doença de dupuytren: um estudo de série de casos com 2 anos de acompanhamento

ABSTRACT Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series.

RESUMO Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos.

Epidemiological aspects of dupuytren's disease in brazil / Aspectos epidemiológicos da doença de dupuytren no brasil

ABSTRACT Objectives: The purpose of this study is to describe associated factors and epidemiological aspects of Dupuytren's Disease in patients followed up in a Brazilian tertiary public hospital, at the Hand Surgery service. Methods: A cross-sectional study was performed from 2014 to 2019. Data collected included: age, gender, ancestry, associated comorbidity presence, phenobarbital, tobacco, and alcohol use, family history of Dupuytren's Disease and associated fibrotic diseases. Then, the patients underwent a clinical examination to identify and characterize the involvement of the fingers. The patients were also assessed in regard to whether they presented Dupuytren's Disease severity factors. Results: 140 patients were included, 70.7% men and 29.3% women. Only 42.3% reported being of European ancestry; 20% had first-degree relatives with the disease; 59.3% presented comorbidities, including hypertension, diabetes, chronic heart disease, dyslipidemia, epilepsy, and HIV infection; 15.8% had Ledderhose disease, 7.1% had Peyronie's disease. 31% were smokers, 16.6% were alcoholic, and 37.1% were phenobarbital users; 40% presented with a severe form of DD. Conclusion: The population studied was composed of Brazilians, most of whom did not report European ancestry; still, they presented several characteristics similar to those described in literature worldwide. Level of Evidence II; Prognostic Studies; Investigating the effect of a patient characteristic on the outcome of a disease .

RESUMO Obejtivo: Descrever fatores associados e aspectos epidemiológicos da Doença de Dupuytren em uma população de pacientes acompanhados em serviço de Cirurgia de Mão de hospital público terciário brasileiro. Métodos: Realizou-se um estudo transversal entre os anos de 2014 e 2019. Coletamos dados como idade, gênero, ascendência, comorbidades associadas, doenças fibróticas associadas, uso de fenobarbital, uso de tabaco e álcool e histórico familiar de Doença de Dupuytren. Em seguida, realizamos exame clínico, caracterizando o acometimento dos dedos da mão. Também foi avaliado se os pacientes da amostra apresentavam fatores de gravidade da Doença de Dupuytren. Resultados: 140 pacientes foram incluídos, 70,7% eram homens e 29,3% mulheres. Apenas 42,3% dos pacientes relataram ascendência europeia; 20% apresentaram parentes de primeiro grau com a doença; 59,3% apresentaram comorbidades, incluindo hipertensão, diabetes, cardiopatia crônica, dislipidemia e infecção por HIV; 15,8% tinham doença de Ledderhose e 7,1% tinham doença de Peyronie. 31% eram fumantes, 16,6% declararam alcoolismo, 37,1% faziam uso de fenobarbital e 40% apresentaram a forma grave da DD. Conclusão: A população estudada foi composta por brasileiros que apesar de, em sua maioria, não relatarem ascendência europeia, apresentaram diversas características semelhantes às descritas na literatura mundial. Nível de Evidência II; Estudos Prognósticos; Investigação do efeito de característica de um paciente sobre o desfecho da doença.

Resultado de tratamiento de la enfermedad de Dupuytren / Treatment Outcome of Dupuytren's Disease

RESUMEN Introducción: La enfermedad de Dupuytren es una contractura de la fascia palmar debida a proliferación fibrosa, que provoca deformidades en flexión y pérdida de la función de los dedos de la mano. Puede también localizarse en las plantas de los pies, el pene y otras partes del cuerpo; un gran por ciento de los casos son de causa desconocida. Objetivos: Describir las variables sexo, enfermedades acompañantes, hábitos tóxicos y edad de los pacientes estudiados con la afección, e identificar las complicaciones relacionadas con la técnica quirúrgica aplicada. Métodos: Se realizó un estudio observacional descriptivo longitudinal en pacientes con enfermedad de Dupuytren, atendidos en el Hospital Carlos Manuel de Céspedes de Bayamo, en el período comprendido entre enero de 2018 y diciembre de 2019. La recolección de datos se realizó a través de las historias clínicas. La muestra fue de 67 pacientes atendidos en este periodo. Para la evaluación se utilizó el sistema de evaluación propuesto por Leuking Hung. Resultados: La enfermedad fue más frecuente en el sexo masculino y en el grupo de 51 a 60 años; se diagnostica más en fumadores, diabéticos y alcohólicos; los síntomas que más se presentaron fueron la presencia de cuerdas y nódulos; el tratamiento más utilizado fue la cirugía mediante zetaplastia; las infecciones en el sitio quirúrgico constituyeron la principal complicación. Conclusiones: En más del 73 por ciento de los pacientes tratados se obtuvieron resultados aceptables(AU)

ABSTRACT Introduction: Dupuytren's disease is a contracture of the palmar fascia due to fibrous proliferation, which causes flexion deformities and loss of function of the fingers of the hand. It can also be located on the soles of the feet, the penis and other parts of the body; a large percent of cases are of unknown cause. Objectives: To describe the variables sex, accompanying diseases, toxic habits and age of the patients studied with the condition, and to identify the complications related to the applied surgical technique. Methods: A longitudinal descriptive observational study was carried out in patients with Dupuytren's disease, treated at Carlos Manuel de Céspedes Hospital in Bayamo, from January 2018 to December 2019. Data collection was performed through the medical records. The sample consisted of 67 patients seen in this period. For the assessment, Leuking Hung´s evaluation system was used. Results: The disease was more frequent in males and in the group of 51 to 60 years. It is more diagnosed in smokers, diabetics and alcoholics; the most common symptoms were the presence of cords and nodules; zetaplasty surgery was the most used treatment. Surgical site infections were the main complication. Conclusions: In more than 73 percent of the treated patients, acceptable results were obtained(AU)

Randomized controlled trial of limited fasciectomy with injection of adipose graft for dupuytrens disease / Estudo comparativo randomizado de enxerto de gordura para a doença de dupuytren

ABSTRACT Objective: Dupuytren's disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciectomy. Methods: We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciectomy. In one group, fat graft was injected. Results: The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up. Conclusion: Fat grafting associated with limited fasciectomy promotes worse functional results compared to conventional limited fasciectomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.

RESUMO Objetivo: A moléstia de Dupuytren (MD) está associada a um distúrbio genético relacionado à proliferação de miofibroblastos. Acredita-se que a propriedade totipotente das células-tronco, presentes no tecido adiposo, seria capaz de inibir a formação dos miofibroblastos. O objetivo deste estudo foi avaliar o efeito do enxerto de gordura, rico em células-tronco, nos pacientes com MD, submetidos à fasciectomia parcial. Métodos: Estudamos 45 pacientes, em um ensaio clínico prospectivo, randomizado e cego. No grupo-controle, era realizada apenas a fasciectomia parcial. No grupo com gordura, era realizada a fasciectomia parcial e injetado o enxerto de gordura. Os desfechos foram avaliados pelo Déficit de Extensão Passiva Total (DEPT) e escore funcional Brief Michigan Hand Questionnaire (BMHQ). Resultados: Os resultados do déficit de extensão passiva total não apresentaram diferença significativa. O grupo com gordura apresentou pior escore funcional após 6 meses e 1 ano, como maiores taxas de complicações (43%) em comparação ao grupo controle (8%) e mais dor com 6 semanas de seguimento. Conclusão: O uso de enxerto de gordura associado à fasciectomia parcial promove piores resultados funcionais em comparação com a fasciectomia parcial convencional, a curto prazo. No entanto, a recidiva e os resultados a longo prazo devem ser avaliados. Nível de Evidência II, Estudo prospectivo comparativo.

Enfermedad de Dupuytren en múltiples sitios / Multiple Site Dupuytren Disease

RESUMEN Introducción: La enfermedad de Dupuytren es una contractura de la fascia palmar debido a una proliferación fibrosa que provoca deformidades en flexión y pérdida de la función de los dedos de la mano. Puede también localizarse en las plantas de los pies, en el pene y otras localizaciones. La causa es desconocida. Objetivo: Describir la enfermedad en dos pacientes con características peculiares en múltiples sitios. Conclusiones: La enfermedad es más frecuente en el sexo masculino y en el grupo de edad de mayores de 40 años. El tratamiento utilizado fue la cirugía mediante fasciectomia más zetaplastia y la amputación(AU)

ABSTRACT Introduction: Dupuytren's disease is a contracture of the palmar fascia due to a fibrous proliferation that causes flexion deformities and loss of function of fingers. It can also be located on the soles of the feet, on the penis or other locations. The cause is unknown. Objectives: To describe the disease in two patients with peculiar characteristics at multiple sites. Conclusions: The disease is more frequent in males and older than 40 years. The treatment used was fasciectomy surgery plus zetaplasty and amputation(AU)

Contractura de Dupuytren. Estudio de 33 casos en Colombia / Dupuytren's contracture. Study of SS cases in Colombia

RESUMEN Objetivo: Describir el comportamiento clínico y epidemiológico de la contractura de Dupuytren (CD) en la población colombiana y comparar nuestros resultados con otras series publicadas en la literatura. Materiales y métodos: Estudio descriptivo observacional de 33 casos de CD presentados en el hospital San Pedro y San Pablo de la Virginia, Risaralda, durante los últimos 6 arios. Los pacientes cumplieron con el diagnóstico de CD de acuerdo con el parámetro establecido. Se compararon los resultados con diferentes series de casos de CD publicadas en la literatura. Resultados: La edad promedio al momento del diagnóstico fue de 61,3 años con mayor prevalencia en hombres (64% de los casos). La forma de presentación más frecuente fue unilateral en mano derecha (73%), a diferencia de lo reportado en otras series, donde el compromiso usualmente fue bilateral. La diabetes mellitus fue la comorbilidad con mayor asociación a la CD (24,24%), hallazgo similar a lo publicado previamente. La mayoría de los pacientes requirió tratamiento quirúrgico. Conclusiones: La CD es una entidad de mayor ocurrencia en hombres de la sexta a la séptima década de la vida. La diabetes mellitus es la enfermedad que más se asocia a su aparición, sin encontrase diferencias entre los estudios realizados. En población colombiana no hay relación aparente con epilepsia. La presentación de la CD es variable, encontrándose en nuestra serie un mayor compromiso unilateral a diferencia de otras poblaciones donde la presentación usualmente es bilateral.

ABSTRACT Objective: To describe the clinical and epidemiological behavior of Dupuytren's contracture (DC) in the Colombian population, and to compare the results of this study with other series published in the literature. Materials and methods: A descriptive, observational study of 33 cases of DC presented at the Hospital San Pedro y San Pablo, La Virginia Risaralda, over the last 6 years. The patients were diagnosed with DC according to the established parameter. The results were compared against different series of DC cases published in the literature. Results: The mean age at diagnosis was 61.3 years, with a higher prevalence of men (64% of cases). The most frequent form of presentation was unilateral in the right hand (73%), unlike the reports from other series with usually bilateral involvement. Diabetes mellitus was the comorbidity most often associated with DC (24.24%), a finding similar to those of previous publications. Most patients required surgical treatment. Conclusions: DC is a condition that occurs more often in men in the sixth or seventh decade of life. Diabetes mellitus is the most frequently associated disease, with no differences being found among the various studies. In the Colombian population there is no apparent association with epilepsy. The presentation of DC is variable, but our series showed more unilateral involvement as compared to other populations where the presentation is usually bilateral.

Clinical Results of Subtotal Fasciectomy for Treatment of Dupuytren Contracture / 대한정형외과학회잡지

PURPOSE: In the treatment of Dupuytren's contracture, the aim of optical treatment is to lower the recurrence rate and reduce complications. This paper reports the results of subtotal fasciectomy in Dupuytren's contracture, extending the excision of palmar fascial structures from the diseased to normal appearing adjacent fascial structure. MATERIALS AND METHODS: From 2007 to 2017, 45 patients with Dupuytren's contracture treated by subtotal fasciectomy were reviewed retrospectively. The mean follow-up period was 45.9 months. Ninety-two digits were involved (index: 2, middle: 10, ring: 44, little: 36). The predisposing factors and affected joint were reviewed and the preoperative and postoperative contracture was measured. For clinical results, quick disabilities of the arm, shoulder, and hand (quick DASH) were used. Complications, including wound or skin problems, nerve injuries, hematoma, and complex regional pain syndrome, were assessed. RESULTS: Preoperative flexion contracture was 43.2° in the proximal interphalangeal joint and 32.9° in the metacarpophalangeal joint. In nine cases, patients had residual contracture of 9.7° (range, 5°–20°) on average and if the total number of cases were included, the mean residual contracture was 2.3° on average. The quick DASH score at the 12 months follow-up was 12.4. The overall complication rate was 26.6%. CONCLUSION: Subtotal fasciectomy can be a good surgical treatment option for Dupuytren's contracture with a low recurrence and low complication rate compared to other open procedures.

Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: 2-Year Follow-up

BACKGROUND: Dupuytren disease is characterized by the development of palmar fibrous tissue that can lead to fixed flexion contracture (FFC) and contribute to functional loss of the involved digits. Our goal was to investigate rates of contracture resolution and recurrence in patients who underwent enzymatic fasciotomy for Dupuytren contracture consisting of collagenase clostridium histolyticum (CCH) injection followed by passive manipulation combined with splinting and home-based therapy. METHODS: We prospectively enrolled 34 patients (44 metacarpophalangeal [MCP] and 33 proximal interphalangeal [PIP] joints) treated by one orthopaedic hand surgeon between November 2010 and November 2014. On day 1, CCH was injected into a palpable fibrous cord of the involved fingers. The next day, the finger was passively extended to its maximal corrective position. FFC was measured for each joint before injection and immediately after manipulation. Patients were instructed to wear an extension splint at night and perform stretching exercises at home and were re-evaluated at 6 weeks, 4 months, 1 year, and 2 years. Resolution was defined as improvement of contracture to ≤ 5° of neutral. Recurrence was defined as an increase in FCC of ≥ 20° after treatment. RESULTS: Immediate contracture resolution occurred in 42 of 44 MCP joints (p < 0.001), improving from 50° to 1.5°, and in 14 of 33 PIP joints (p = 0.182), improving from 44° to 16°. Four joints had recurrence within 6 weeks. Of the 48 joints with minimum 4-month follow-up (mean, 26 months), 12 had recurrence at 2-year follow-up (MCP, 6; PIP, 6). At 2-year follow-up, MCP and PIP contractures measured 17° and 35.5°, respectively. Older age and multiple digit involvement were associated with higher recurrence rates. CONCLUSIONS: CCH offers a safe, nonoperative option to correct FCC in Dupuytren disease with greater success for MCP joints compared to PIP joints. There is a tendency of reoccurrence within 2 years of treatment. Further investigation is needed to determine optimal timing of repeat CCH injection to improve upon or extend the period of contracture resolution.

Resultados a tres años de seguimiento de Fasciotomía percutánea con aguja en enfermedad de Dupuytren / Results after three years of follow-up of percutaneous fasciotomy with needle in Dupuytren's disease

Dupuytren's disease is the abnormal and progressive proliferation of the palmar fascia, its etiology remains unknown. Percutaneous needle fasciotomy is a minimally invasive procedure, where hypodermic needles are used as a scalpel blade to break the pathological cord in Dupuytren's disease. OBJECTIVE: To evaluate the results of percutaneous needle fasciotomy in patients with 3-year follow-up METHODS: Percutaneous needle fasciotomy was performed in patients from the regional hospital of Talca from January 2014 to January 2017, pre and post-procedure contracture measurement was performed, followed up at 6 weeks, 3 months and annually up to three years. there was a registry of complications, recurrence and functional results with the QuickDASH scale. RESULTS: Of the 17 patients chosen, 13 completed the follow-up. 15 fingers (5 little fingers, 9 ring fingers, 1 middle) and 23 joints. The metacarpophalangeal joints achieved an immediate correction of 89%, maintaining a correction of 48% at three years. The proximal interphalangeal joint achieved a correction of 62%, maintaining 32% at the end of the follow-up. The QuickDash managed to descend from 39.4 to 21.5 points. There was recurrence of 35.7% in the metacarpophalangeal joints and 42.8% in proximal interphalangeal joints. We found that percutaneous fasciotomy is a treatment option.

Minimally invasive treatment of Dupuytren's contracture by Pi needle percutaneous multi-segmental fasciotomy / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of Pi needle percutaneous multi-segmental fasciotomy as a minimally invasive treatment for Dupuytren's contracture.</p><p><b>METHODS</b>Sixteen patients(25 fingers: 4 middle fingers, 12 ring fingers, 9 little fingers) were involved in the study, including 11 males and 5 females. There were 2 cases on both hands and 14 cases of single hand disease, including 8 cases of left hand and 6 cases of right hand. The age ranged from 48 to 79 years old, with a mean age of 58.5 years old. The duration of the disease ranged from 1 to 15 years, with a mean time of 5.5 years. There were 12 cases of physical labor, 4 cases of non physical labor, with no family history of palmar fascial contracture. There were 9 cases of tobacco and alcohol addicts, 6 cases with hypertension history, and 3 cases of diabetes mellitus. According to Meyerding classification, 1 case was stage 0, 1 case was stage I, 10 cases were stage II, 4 cases were stage III and 0 case was stage IV. The postoperative function of Dupuytren's contracture patients was evaluated according to Adam efficacy evaluation criteria.</p><p><b>RESULTS</b>The time of incision healing time ranged from 7 to 14 days, 10 days on average. The 3 fingers incision skin cracked 3 to 4 mm during the loosening process, and 14 days after dressing changed, no skin necrosis and wound infection complication occurred. After treatment, fascia contracture of 24 fingers completely or almost disappeared. Limited extension of metacarpophalangeal joint and interphalangeal joint ranged from 0 to 10 degrees, 22 fingers showed normal function of finger extension, 2 fingers had more than 75% elongation function, and 1 finger recurred. According to the evaluation of Adam evaluable standard of curative effect on the postoperative function of Dupuytrens's contracture: 22 fingers got an excellent result, 2 fingers good and 1 finger recurred. The patients were satisfied with the results of the treatment.</p><p><b>CONCLUSIONS</b>Pi needle percutaneous multi-segmental fasciotomy for the treatment of Dupuytren's contracture is a simple, minimally invasive and effective method.</p>

3-Dimensional fasciectomy: A highly efficacious common ground approach to Dupuytren's surgery

BACKGROUND: Numerous Dupuytren’s fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren’s disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential contributors to the high recurrence rate of Dupuytren’s disease and unite current limited fasciectomy practice that varies considerably between surgeons. METHODS: We describe the 3DF principles; raising thin skin flaps (addressing dermal involvement), excising diseased palmar fascia with a 3−5 mm clearance margin (treating highly locally recurrent conditions) and excising the vertical septae of Legueu and Juvara (providing deep clearance, hence addressing all potentially involved pathological tissue). The surgical outcomes between traditional limited fasciectomy (LF) and 3DF are compared. RESULTS: From the 786 operations included (n=585), postoperative recurrence rates were significantly lower for the 3DF group (2/145, 1.4%) than the LF group (72/641, 11.2%) (P=0.001), and the time to recurrence was significantly longer (5.0±0 years vs. 4.0±0.2 years; P < 0.0001). With recurrence excluded, there were no differences between the postoperative complication rates for 3DF (5/145, 3.5%) and LF (41/641, 6.4%) (P=0.4). CONCLUSIONS: Our results suggest that 3DF leads to lower recurrence rates and a longer disease-free period for patients, without increasing complications. 3DF provides a safe, efficacious, common ground surgical approach in the treatment of Dupuytren’s flexion deformity.

Surgical treatment results for dupuytren's disease / Resultados do tratamento cirúrgico na doença de dupuytren

ABSTRACT OBJECTIVE: To present the results of our cases of Dupuytren's disease treated with regional selective fasciectomy in light of the literature. METHODS: Patients diagnosed with Dupuytren's contracture and surgically treated with regional selective fasciectomy at our institution with adequate follow-up data were included in the study. All patients were routinely followed after surgery to assess results and complications. QuickDASH scoring was used to evaluate the patients and recurrences and complications were recorded. RESULTS: Twenty-one hands of 19 patients (13 males, 6 females) who underwent surgery and received adequate follow-up were retrospectively evaluated. Mean patient age was 65.8 (range: 41 to 86) and the mean follow-up period was 48.2 months (range: 24 to 86). Fourteen (66.6%) hands had excellent results, five (23%) hands had good results and two (9.4%) had fair results. The mean QuickDASH score for the patients at the final follow-up was 6.58 (range: 0 to 20.4). CONCLUSION: Our study results demonstrated that regional selective fasciectomy is a reliable and efficient method to treat Dupuytren's disease with low rates of complications and recurrence and the technique can be considered the gold standard. Level of Evidence IV, Case Series.

RESUMO OBJETIVO: Apresentar os resultados de nossos casos de doença de Dupuytren tratados com fasciotomia seletiva regional, à luz da literatura. MÉTODOS: Os pacientes diagnosticados com contratura de Dupuytren e tratados cirurgicamente com fasciotomia seletiva regional em nossa instituição que tinham dados de acompanhamento adequados foram incluídos no estudo. Todos os pacientes foram rotineiramente acompanhados após a cirurgia para avaliação dos resultados e das complicações. Foi utilizada a pontuação QuickDASH na avaliação dos pacientes e as recorrências e complicações foram registradas. RESULTADOS: Foram avaliadas retrospectivamente vinte e uma mãos de 19 pacientes (13 homens, 6 mulheres) submetidos à cirurgia e acompanhados adequadamente. A média de idade dos pacientes foi de 65,8 (intervalo: 41 a 86) e o período médio de seguimento foi 48,2 meses (intervalo: 24 a 86). Quatorze (66,6%) mãos tiveram excelentes resultados, enquanto cinco (23%) mãos tiveram bons e duas (9,4%) tiveram resultados moderados. A pontuação média no QuickDASH dos pacientes no seguimento final foi de 6,58 (intervalo: 0 a 20,4). CONCLUSÃO: Os resultados do nosso estudo demonstraram que a fasciotomia seletiva regional é um método confiável e eficiente, com baixas taxas de complicação e recorrência no tratamento da doença de Dupuytren e a técnica pode ser considerada o padrão-ouro. Nível de Evidência IV, Série de Casos.

Radiotherapy, a New Treatment Option for Non-malignant Disorders: Radiobiological Mechanisms, Clinical Applications, and Radiation Risk

Radiotherapy is used to treat not only malignant tumors but also benign inflammatory and hypertrophic diseases. Because of concerns about the potential hazards of irradiation, physicians in many countries, especially in North America, ruled radiotherapy out of medical practice for non-malignant diseases. Low-dose radiotherapy modulates the inflammatory response, providing an anti-inflammatory effect. Many researchers have reported low-dose radiotherapy efficacious for degenerative and inflammatory diseases. There are broad potential clinical indications for radiotherapy of non-malignant diseases. The general indications for radiotherapy for non-malignant disorders are acute/chronic painful degenerative diseases, such as chronic or acute painful osteoarthritic diseases of various joints; hypertrophic (hyperproliferative) disorders of soft tissues, such as early stages of Morbus Dupuytren and Ledderhose, keloids and pterygium; functional diseases, such as dysthyroid ophthalmopathy and arteriovenous malformations; and others, such as prophylaxis of heterotopic ossification. Radiotherapy for non-malignant disorders may be safely and effectively used, especially in older patients who suffered from these disorders and those who are reluctant to use other treatment options.

Radiotherapy, a New Treatment Option for Non-malignant Disorders: Radiobiological Mechanisms, Clinical Applications, and Radiation Risk

Radiotherapy is used to treat not only malignant tumors but also benign inflammatory and hypertrophic diseases. Because of concerns about the potential hazards of irradiation, physicians in many countries, especially in North America, ruled radiotherapy out of medical practice for non-malignant diseases. Low-dose radiotherapy modulates the inflammatory response, providing an anti-inflammatory effect. Many researchers have reported low-dose radiotherapy efficacious for degenerative and inflammatory diseases. There are broad potential clinical indications for radiotherapy of non-malignant diseases. The general indications for radiotherapy for non-malignant disorders are acute/chronic painful degenerative diseases, such as chronic or acute painful osteoarthritic diseases of various joints; hypertrophic (hyperproliferative) disorders of soft tissues, such as early stages of Morbus Dupuytren and Ledderhose, keloids and pterygium; functional diseases, such as dysthyroid ophthalmopathy and arteriovenous malformations; and others, such as prophylaxis of heterotopic ossification. Radiotherapy for non-malignant disorders may be safely and effectively used, especially in older patients who suffered from these disorders and those who are reluctant to use other treatment options.

A Case of Palmar Fibromatosis / 대한피부과학회지

No abstract available.

Glicosaminoglicanos e proteoglicanos na fáscia palmar de pacientes com dupuytren / Glycosaminoglycans and proteoglycans in palmar fascia of patients with dupuytren

Objetivo: Avaliar e comparar o comportamento dos glicosaminoglicanos(GAGs) na Doença de Dupuytren (DD). Métodos: Trata-se deum estudo experimental com 23 pacientes diagnosticados com DD.Tecidos coletados através de fasciectomia com incisão tipo Brunnerou McCash, foram avaliados por eletroforese para identificação dosGAGs. A quantificação foi realizada por imunofluorescência e dosagemdas proteínas para os diferentes tipos de glicosaminoglicanos.Os resultados coletados foram expressos em porcentagem e avaliadosestatisticamente. Resultados: Foi observado, na corrida eletroforética,aumento significativo dos GAGs em relação ao controle(p<0,05). Na imunofluorescência houve redução (23 vezes) do ácidohialurônico quando comparado ao controle (p<0,0001). Conclusão:Ficou evidenciado pelos resultados o aumento dos GAGs sulfatadosna doença de Dupuytren, principalmente do dermatam sulfato, egrande diminuição do ácido hialurônico na aponeurose palmar dosmesmos pacientes. Nível de Evidência III, Estudo Caso Controle.

Objective: To evaluate and compare the behavior of glycosaminoglycans(GAGs) in Dupuytren disease (DD). Methods: Thisis an experimental study with 23 patients diagnosed with DD.Tissue collected through fasciectomy with incision type Brunneror McCash were evaluated by electrophoresis for identificationof GAGs. The quantification was carried out by immunofluorescenceand dosage of proteins for different types of glycosaminoglycans.The results were expressed in percentage and statisticallyevaluated. Results: A significant increase was observed througheletrophoresis in GAGs, as compared to the control (p<0.05). Immunofluorescenceof hyaluronic acid was reduced (23 times) whencompared to the control (p<0.0001). Conclusion: An increase ofsulfated GAGs in Dupuytren’s disease, mainly dermatan sulfate,was evident from our results, as well as a pronounced decrease ofhyaluronic acid in the palmar aponeurosis from the same patients.Level of Evidence III, Case-Control Study.

Síndrome de la mano diabética, a propósito de tres casos con limitación de la movilidad articular y lesiones complicadas del pie / A propos of three cases of diabetic hand syndrome with limited joint mobility and complicated foot injures

Introducción: La diabetes mellitus está asociada a una gran variedad de alteraciones músculo esqueléticas en las manos. El término síndrome de la mano diabética aparece con frecuencia en la literatura médica, aunque no existe una definición precisa, y hasta la fecha no se ha reconocido como una complicación específica de la enfermedad. El examen físico para la identificación temprana de estas alteraciones podría evitar la discapacidad de las formas severas.Objetivos: describir las alteraciones músculo esqueléticas más frecuentes en las manos de las personas con diabetes, a propósito de 3 pacientes con limitación de la movilidad articular, hospitalizados por lesiones complicadas del pie.Desarrollo: entre las alteraciones más frecuentes de la mano en las personas con diabetes está la limitación de la movilidad articular, la contractura de Dupuytren, el dedo en gatillo, la neuropatía ulnar y el túnel carpiano. Cada una tiene sus particularidades y pueden ser fácilmente diagnosticadas con el examen físico. Se asocian con la duración de la enfermedad, el pobre control metabólico y la presencia de complicaciones microvasculares, como en los casos que se presentan, con limitación de la movilidad articular severa. Estas deformidades afectan las actividades de la vida diaria, y por tanto, la calidad de vida de los pacientes, además, orientan al médico en la búsqueda de complicaciones microvasculares no diagnosticadas, de ahí la importancia de detectarlas.Conclusiones: se establece que la identificación temprana de las alteraciones en las manos de los diabéticos tiene importantes implicaciones individuales y sanitarias, por lo que su examen periódico debe ser realizado a todos los pacientes(AU)

Introduction: Diabetes mellitus is associated to a variety of musculoskeletal alterations in hands. The term diabetic hand syndrome frequently occurs in medical literature, although there is no exact definition and to date, it has not been recognized as specific disease complication. The physical exam for early detection of these alterations might prevent severe disability.Objectives: to describe the most common musculoskeletal alterations in diabetic persons’ hands using 3 patients with limited joint mobility who were hospitalized because of complicated foot injures.Development: among the most common hand alterations observed in diabetic persons are limited joint mobility, Dupuytren’s contracture, ulnar neuropathy and Carpal tunnel syndrome. Each of them has its own particularities and may be easily diagnosed through physical exam. They are related to length of disease, poor metabolic control and microvascular complications as it happens in the present cases with severe limited joint mobility. These deformities affect daily life activities and the quality of life of patients. Additionally, they guide the physicians in searching undiagnosed microvascular complications, hence the importance of detecting them.Conclusions: the early detection of hand alterations in diabetics has significant personal and health implications, so a systematic exam is required to be performed in all the patients(AU)

Extranodal natural killer/T-cell lymphoma of the tenosynovium of the hand

No abstract available.

Bilateral Dupuytren’s Contracture.

Dupuytren’s contracture (DC) is painless flexion contracture of ulnar side of palm where fingers bend towards palm and cannot be straightened. It is a fibrosing disorder that results in slowly progressive thickening and shortening of the palmar fascia, leading to the debilitating digital contractures. The prevalence of DC is found to be higher in patients with cirrhotic or noncirrhotic alcoholic liver disease. We report the case of a 56-year-old male chronic alcoholic who presented with distention of abdomen, yellow discoloration of sclera since 1 month and altered sensorium since 1 day. He had bilateral contractures on ulnar side of hands, suggestive of DC.

Contribuicao das moleculas de antigeno de histocompatibilidade leucocitaria (HLA) para a contratura de Dupuytren em uma populacao do Sudeste do Brasil / The contribution of HLA molecules to Dupuytren's contracture in a Southeast Brazilian population

Objetivo: O objetivo deste estudo foi investigar o fenótipo do HLA em pacientes com contratura de Dupuytren (CD) para verificar a correlação desses alelos com os fatores de risco para o desenvolvimento da CD na população brasileira. Métodos: Este foi um estudo de caso-controle de 25 pacientes com CD e 443 indivíduos saudáveis sem histórico de doenças associadas ao HLA. As tipagens classe I e classe II do HLA foram feitas utilizando o método iniciador de sequências específicas da reação em cadeia da polimerase. Resultados: O fenótipo HLA-B*18 foi observado em 32% dos pacientes e 10,5% do grupo controle. Contudo, os valores de p não permaneceram significativos após correção. Discussão: Apesar de termos observado um aumento na tendência de os pacientes com CD terem o alelo HLA-B*18, os resultados não foram estatisticamente significativos após correção. Esse alelo foi maior em pacientes de etnia italiana e/ou espanhola, locais com frequências superiores a 18% e 14%, respectivamente. São necessárias investigações adicionais com uma coorte maior de pacientes com CD para confirmar o possível papel do HLA nessa doença. .

Purpose: The aim of the present study was to investigate the HLA phenotype in Dupuytren's contracture (DC) patients in order to verify the correlation of these alleles with risk factors for development of DC in the Brazilian population. Methods: This was a case-controlled study of 25 DC patients and 443 healthy individuals with no history of HLA-associated diseases. HLA class I and class II typing was performed using the polymerase chain reaction sequence-specific primer method. Results: The HLAB*18 phenotype was observed in 32% of the patients and 10.5% of controls. However, P values did not remain significant after correction. Discussion: Although we observed an increased tendency of DC patients to possess the HLA-B*18 allele, the results were not statistically significant after correction. This allele was higher in patients of Italian and/or Spanish ethnicity, localities with frequencies higher than 18.0% and 14.0% respectively. Further investigation with a larger cohort of DC patients is required to confirm the potential role of HLA in this disease. .