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1.
J Pediatr Orthop B ; 28(1): 85-88, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30216209

RESUMO

We report the case of a 13-year-old girl who presented with a fibrous nodular lesion on the palm of her hand. After ultrasonographic examination, surgical resection of the skin (dermofasciectomy) was performed, and a nodular phase mass was recovered, characterized as fusocellular fibroblast proliferation in a dense collagenous stroma with a cell population consisting of parallel fascicles of densely packed fusiform cells of a fibroblast strain. No signs of encapsulation or malignant changes were observed, all of which was consistent with Dupuytren's disease. This lesion is exceptional in childhood. Sixteen years later, the patient has not relapsed, and retains full active and passive mobility. Dupuytren's disease in childhood must be considered in the differential diagnosis of any hard palmar lesion. Diagnostic uncertainty and the fact that a hard palmar lesion in children may be clinically indistinguishable from a malignant process mean that resection of the lesion and histological examination are required.


Assuntos
Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/cirurgia , Adolescente , Fasciotomia , Feminino , Humanos , Manipulações Musculoesqueléticas
2.
Oper Orthop Traumatol ; 28(1): 30-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26683416

RESUMO

OBJECTIVE: Nonsurgical treatment of Dupuytren's disease using collagenase Clostridium histolyticum (CCH). INDICATIONS: Metacarpophalangeal (MP) joint (20-100°) and proximal interphalangeal (PIP) joint (20-80°) contractures. CONTRAINDICATIONS: Pregnancy, previous hypersensitivity to collagenase or excipients, anticoagulant use within 7 days prior to treatment. INJECTION TECHNIQUE: CCH injected directly into the Dupuytren's cord weakening the contracted cord. After injection, the patient returns the following day to allow CCH to lyse the collagen within the cord. An extension force is then applied to the involved finger to disrupt the weakened cord. POSTMANIPULATION MANAGEMENT: Use of extension splint at night, movement instructions during the day. RESULTS: A total of 120 patients (107 men; 13 women; mean age 62 years, range 30-84 years) were treated. In 49% the little finger, in 44% the ring finger, in 4% the middle finger, and in 3% the index finger was treated. Full release was achieved in 71%, partial release in 26%, and no change in 3% of patients. The median pretreatment contracture for the MP joint was 37° (range 25-100°) and PIP joint 51° (range 30-97°). At 12 months, the mean contracture for the MP joint was 9° (range 0-25°) and for the PIP joint 21° (range 10-36°). Adverse events observed in 96% of patients for 3 months . No tendon ruptures, anaphylactic reactions, or nerve or ligament injuries observed.


Assuntos
Contratura de Dupuytren/terapia , Colagenase Microbiana/uso terapêutico , Manipulações Musculoesqueléticas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Contratura de Dupuytren/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 14: 293, 2013 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-24125161

RESUMO

BACKGROUND: Our purpose was to analyze and compare the use of direct health resources and costs generated in the treatment of Dupuytren's contracture using two different techniques: subtotal fasciectomy and infiltration with Collagenase Clostridium Histolyticum (CCH) in regular clinical practice at the Orthopedic and Traumatology Surgery (OTS) Department at the Hospital de Denia (Spain). METHODS: Observational, retrospective study based on data from the computerized clinical histories of two groups of patients- those treated surgically using a one or two digit subtotal fasciectomy technique (FSC) and those treated with CCH infiltration, monitored in regular clinical practice from February, 2009 to May, 2012. Demographic (age, sex), clinical (number of digits affected and which ones) and use of resources (hospitalizations, medical visits, tests and drugs) data were collected. Resource use and associated costs, according to the hospital's accounting department, were compared based on the type of treatment from Spain's National Health Service. RESULTS: 91 patients (48 (52.8%) in the FSC group) were identified. The average age and number of digits affected was 65.9 (9.2) years and 1.33 (0.48) digits affected in the FSC group, and 65.1 (9.7) years and 1.16 (0.4) digits in the CCH group.Overall, the costs of treating Dupuytren's disease with subtotal FSC amount to €1,814 for major ambulatory surgery and €1,961 with hospital stay including admission, surgical intervention (€904), examinations, dressings and physiotherapy. As to collagenase infiltration, costs amount to €952 (including minor surgery admission, vial with product, office examination and dressings). Finally, comparing total costs for treatments, a savings of €388 is estimated in favor of CCH treatment in the best-case scenario (patient under MAS system with no need for physiotherapy) and €1,008 in the worst-case scenario (patient admitted to hospital needing subsequent physiotherapy), implying a savings of 29% and 51%, respectively. CONCLUSIONS: This study demonstrates that treating patients with DC by injection with CCH at the OTS department of the Hospital de Denia generates a total savings of 29% and 51% (€388 and €1008) compared with fasciectomy at the time of treatment. Long term evolution of CCH treatment is uncertain and the recurrence rate unknown.


Assuntos
Clostridium histolyticum/enzimologia , Custos de Medicamentos , Contratura de Dupuytren/economia , Contratura de Dupuytren/terapia , Fasciotomia , Recursos em Saúde/economia , Custos Hospitalares , Unidades Hospitalares/economia , Colagenase Microbiana/economia , Colagenase Microbiana/uso terapêutico , Procedimentos Ortopédicos/economia , Ortopedia/economia , Centros de Traumatologia/economia , Idoso , Redução de Custos , Análise Custo-Benefício , Contratura de Dupuytren/diagnóstico , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Masculino , Colagenase Microbiana/isolamento & purificação , Pessoa de Meia-Idade , Modelos Econômicos , Programas Nacionais de Saúde/economia , Visita a Consultório Médico/economia , Modalidades de Fisioterapia/economia , Estudos Retrospectivos , Espanha , Fatores de Tempo , Resultado do Tratamento
5.
Rehabilitación (Madr., Ed. impr.) ; 37(5): 272-277, sept. 2003. ilus
Artigo em Es | IBECS | ID: ibc-26242

RESUMO

En este trabajo se ha revisado la bibliografía reciente sobre el tratamiento de la enfermedad de Dupuytren, seleccionando los aspectos de más interés relativos a la rehabilitación en el período postoperatorio. Se repasan la etiología, las manifestaciones clínicas, el tratamiento conservador, las diferentes intervenciones quirúrgicas y las posibles complicaciones que pueden derivarse de éstas. Se expone además el tratamiento postoperatorio, detallando el tipo de férulas que se pueden utilizar, el programa de ejercicios, la actuación sobre el edema y el tratamiento de la cicatriz. Después de la cirugía un tratamiento rehabilitador precoz puede mejorar los resultados y prevenir complicaciones (AU)


Assuntos
Adolescente , Adulto , Criança , Humanos , Contratura de Dupuytren/reabilitação , Ferula/classificação , Ferula/fisiologia , Complicações Pós-Operatórias/reabilitação , Complicações Pós-Operatórias/diagnóstico , Cicatriz/classificação , Cicatriz/reabilitação , Especialidade de Fisioterapia/métodos , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/etiologia , Contratura de Dupuytren/terapia
6.
J Nucl Med ; 18(5): 419-24, 1977 May.
Artigo em Inglês | MEDLINE | ID: mdl-870633

RESUMO

Supplemental hand scintigrams with abnormal features were obtained from 29% of patients (134 of 463) who were referred for routine minified bone imaging with 99mTc-Sn-polyphosphate. A wide spectrum of normal activity distribution ranging from well-defined to "wash-out" images is described in 329 cases (71%). In the abnormal images of the joints and individual bones, the changes--although not always characteristic of some particular disease--may often suggest a diagnosis and/or its pathophysiologic status. The joints with heavy uptake correlate well with the presence of active clinical findings, e.g., in the arthritides. The bone feature associated with metabolic disease, especially when full-blown, may be fairly characteristic. A potential application is in the assessment of digital circulation, particularly in obliterative vascular diseases such as scleroderma, Buerger's disease, chronic neuropathies, and possibly other collagen or vascular diseases that involve the hands. Interesting images, probably of somewhat limited usefulness, are observed in some congenital anomalies, fractures, camptodactyly, contracture deformities, unilateral lymphedema after mastectomy, etc.


Assuntos
Doenças Ósseas/diagnóstico , Mãos/diagnóstico por imagem , Cintilografia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Contratura de Dupuytren/diagnóstico , Displasia Fibrosa Óssea/diagnóstico , Gota/diagnóstico , Mãos/irrigação sanguínea , Deformidades Adquiridas da Mão/diagnóstico , Deformidades Congênitas da Mão , Traumatismos da Mão/diagnóstico , Hemiplegia/diagnóstico , Humanos , Hiperparatireoidismo/diagnóstico , Osteíte Deformante/diagnóstico , Osteoporose/diagnóstico , Radiografia
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