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1.
Comput Intell Neurosci ; 2022: 3574037, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35528327

RESUMO

Objective: To study the risk factors of Dupuytren's contracture (DC) and to provide a reference for the clinical prevention and treatment of DC. Methods: The clinical data of 21 DC patients treated with surgery in Qilu Hospital of Shandong University (Qingdao) from March 2014 to January 2022 were collected. During the same period, 31 subjects who were admitted to the hospital for treatment of finger numbness, difficulty in movement, and other reasons were selected as the control group, and the clinical data of the control group were collected. A case-control study was used to analyze the risk factors for DC. The receiver operating curve (ROC) was used to analyze the efficacy of blood biochemical indexes and coagulation-related indexes in predicting the occurrence of DC. Results: Multivariate logistic regression analysis showed that male and diabetes were independent risk factors for the occurrence of DC (HR = 19.69, 95%CI: 3.12-124.19, P = 0.002; HR = 7.61, 95%CI: 1.25-46.47, P = 0.03). The results of the ROC analysis showed that the area under the curve (AUC) for the DC predicted by cystatin C was 0.7565 (95%CI: 0.6203-0.8928, P = 0.0018), and the AUC for the DC predicted by blood chloride level was 0.8121 (95%CI: 0.6880-0.9362, P = 0.0002), the AUC for the DC predicted by fibrinogen was 0.7796 (95%CI: 0.6439-0.9152, P = 0.0007), the AUC for the DC predicted by D-dimer level was 0.8740 (95%CI: 0.7812-0.9669, P < 0.0001), and the AUC for the DC predicted by thrombin time was 0.7803 (95%CI: 0.6411-0.9196, P = 0.0007). The AUC for the DC predicted by the combined detection of cystatin C, blood chloride, fibrinogen, D-dimer, and thrombin time was 0.9441 (95%CI: 0.8926-0.9957, P < 0.001). Conclusion: Male and diabetes are independent risk factors for the occurrence of DC. Combined detection of cystatin C, blood chloride, fibrinogen, D-dimer, and thrombin time has a certain value in predicting the occurrence of DC.


Assuntos
Cistatina C , Contratura de Dupuytren , Estudos de Casos e Controles , Cloretos , Diabetes Mellitus , Contratura de Dupuytren/epidemiologia , Fibrinogênio , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Fatores de Risco
2.
J Hand Surg Asian Pac Vol ; 27(2): 242-247, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35404200

RESUMO

Background: The primary objective of this study was to assess patient preferences for collagenase Clostridium histolyticum (CCH) treatment versus limited surgical fasciectomy in a cohort that has undergone both treatments for Dupuytren contracture. Methods: We retrospectively identified 68 patients who have undergone both limited surgical fasciectomy and CCH treatment for digital flexion contractures from Dupuytren disease. Patients were contacted by telephone and asked whether they preferred surgery or CCH treatment for their Dupuytren contracture. Multivariable logistic regression was used to determine factors associated with preference for surgery versus CCH treatment. Results: Of the 68 patients who were treated with both CCH and surgery, 37 patients (54.4%) preferred CCH treatment over surgery, 26 (38.2%) preferred surgery over CCH treatment, and 5 (7.4%) were unable to decide. Patients expressed common themes of the perceived ease of recovery following CCH treatment versus the perceived durability of contracture correction with surgery. Preference for surgical fasciectomy over CCH treatment was associated with lower American Society of Anesthesiologists Physical Status Classification (ASA) [odds ratio (OR): 0.32, 95% confidence interval (CI): 0.14-0.75]. The order of treatment was also associated with the treatment preference; treatment with surgery after CCH compared to treatment with CCH after surgery was associated with a preference for surgery (OR: 6.51, 95% CI: 2.15-19.7). Conclusions: In a cohort of patients who have undergone both treatments, patients were divided in their preferences, with a slight majority preferring CCH treatment over surgery. Treatment recommendations should be individualised to each patient's long-term goals and expectations. Level of Evidence: Level III (Therapeutic).


Assuntos
Contratura de Dupuytren , Colagenases/uso terapêutico , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/cirurgia , Fasciotomia , Humanos , Colagenase Microbiana/uso terapêutico , Preferência do Paciente , Estudos Retrospectivos , Resultado do Tratamento
3.
J Hand Surg Asian Pac Vol ; 27(2): 320-325, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35404210

RESUMO

Background: Arthrofibrosis is a complication of total knee arthroplasty (TKA) that can lead to poor outcome. Idiopathic arthrofibrosis and Dupuytren disease (DD) have similar histological appearance. The aim of this study is to determine the influence of DD on the recovery of motion after TKAy. Methods: Patients older than 50 who underwent a TKA for primary osteoarthritis were examined 1 year later for the presence of DD. They were divided into two groups based on the presence or absence of DD. The groups were compared to each other with regard to arc of motion (AOM) of the operated knee at 6 weeks and 1 year; the need for additional measures to improve the AOM, and the effect of obesity [body mass index (BMI) > 30]. Results: The study included 61 patients of which 25 (41%) had DD. There was no difference in AOM at 6 weeks or 1 year between the two groups. Patients in the DD group required a greater number of additional measures to improve AOM. Also, non-obese patients (BMI < 30) in the DD group had lower AOM at 1 year. Conclusions: Patients in the DD group needed additional physiotherapy or manipulation under anaesthesia (MUA) to achieve the same AOM. This might indicate a possible connection between DD and post-operative stiffness of the knee. Identifying patients with DD in the pre-operative period may help recognise patients who may have difficulty in regaining AOM after TKA. Level of Evidence: Level III (Therapeutic).


Assuntos
Artroplastia do Joelho , Contratura de Dupuytren , Artropatias , Artroplastia do Joelho/efeitos adversos , Contratura de Dupuytren/complicações , Contratura de Dupuytren/cirurgia , Humanos , Artropatias/cirurgia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
4.
Handchir Mikrochir Plast Chir ; 54(2): 149-154, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35419784

RESUMO

BACKGROUND: The biological mechanism of Dupuytren's contracture needs to be further studied in order to minimize postoperative recurrence and provide a pathological basis for the development of new therapeutic targets. METHODS: HE staining, immunohistochemistry, PCR and western blotting were performed in pathological palmar aponeurosis specimens and normal palmar aponeurosis tissues for comparative study. RESULTS: (1) TNF-α expression was up-regulated: TNF-α mRNA was more highly expressed in the pathological tissues of DD patients than in the CT group, P < 0.05, and the difference between the two groups was statistically significant; (2) Dkk-1 expression was down-regulated: Dkk-1 mRNA was lower expressed in the pathological tissues of DD patients than in the CT group, P < 0.05, and the difference between the two groups was statistically significant; (3) TGF-ß1 expression was up-regulated: TGF-ß1 mRNA was higher expressed in the pathological tissues of DD patients than in the CT group, P < 0.05, and the difference between the two groups was statistically significant; (4) Pearson correlation analysis suggested that TNF-α expression was positively correlated with TGF-ß1 expression, TNF-α expression was negatively correlated with DKK-1 expression, and TGF-ß1 expression was negatively correlated with DKK-1 expression. CONCLUSION: TNF-α, DKK-1 and TGF-ß1 may play a role in the pathogenesis of palmar aponeurosis contracture, and there is a relationship between them. The study of the relationship between the three and their related signaling pathways provides a therapeutic target and a basis for the prevention and early treatment of palmar aponeurotic contracture.


Assuntos
Contratura de Dupuytren , Peptídeos e Proteínas de Sinalização Intercelular , Fator de Crescimento Transformador beta1 , Fator de Necrose Tumoral alfa , Contratura de Dupuytren/genética , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/genética , RNA Mensageiro/genética , Fator de Crescimento Transformador beta1/genética , Fator de Necrose Tumoral alfa/genética
5.
Proc Natl Acad Sci U S A ; 119(13): e2120336119, 2022 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-35320046

RESUMO

SignificanceTissue fibrotic diseases, for example of the liver and lung, represent a huge unmet medical need. In this study, using single-cell RNA sequencing, cytometry by time of flight (CyTOF), tissue imaging, and functional assays, we identify a complex vascular niche in Dupuytren's disease (DD), a common localized fibrotic condition of the palm, where early-disease-stage tissue can be accessed readily. We uncover a population of myofibroblast precursors within the pericyte compartment and demonstrate that the endothelium instructs the differentiation of functionally distinct stromal cells, thereby orchestrating discrete microenvironments in the fibrotic milieu. Together, these findings provide a basis for the concept of targeting blood vessel signaling to control the progression of human fibrosis.


Assuntos
Contratura de Dupuytren , Miofibroblastos , Contratura de Dupuytren/genética , Contratura de Dupuytren/patologia , Fibrose , Humanos , Miofibroblastos/patologia , Fenótipo , Células Estromais , Microambiente Tumoral
6.
Plast Reconstr Surg ; 149(5): 914e-920e, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35271531

RESUMO

BACKGROUND: There have been no formal studies of the use of collagenase clostridium histolyticum (Xiaflex; Endo Pharmaceuticals, Malvern, Pa.) in the anticoagulated patient. Previous study on its use excluded patients receiving anticoagulation therapy. This study reviewed the effects of anticoagulation use in patients undergoing collagenase clostridium histolyticum injection and cord rupture to determine safety and efficacy. METHODS: The authors retrospectively reviewed patients receiving collagenase clostridium histolyticum injections for Dupuytren contracture between 2010 and 2017. Outcomes included type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding. RESULTS: A total of 388 injections were performed in 197 patients. The average clinical follow-up was 311 days. Fifty-two percent of patients (n = 201) were anticoagulated. The vast majority were taking aspirin (acetylsalicylic acid) (n = 182), followed by warfarin (n = 27), clopidogrel (n = 9), apixaban (n = 8), rivaroxaban (n = 4), and dabigatran (n = 2). There were 42 skin tears, 21 in the anticoagulated group. One tendon rupture occurred in the anticoagulated group (acetylsalicylic acid) and none occurred in the nonanticoagulated group (p = 0.34). No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding. CONCLUSIONS: Anticoagulation is commonly encountered by hand surgeons treating Dupuytren contracture. There is no significant difference in complications in the anticoagulated patient versus the nonanticoagulated patient. It is safe to perform collagenase clostridium histolyticum injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Contratura de Dupuytren , Lacerações , Traumatismos dos Tendões , Anticoagulantes/efeitos adversos , Aspirina , Clostridium histolyticum , Contratura de Dupuytren/cirurgia , Hematoma/induzido quimicamente , Humanos , Injeções Intralesionais , Colagenase Microbiana , Estudos Retrospectivos , Resultado do Tratamento
7.
Oncologist ; 27(3): e294-e296, 2022 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-35274715

RESUMO

Palmar and plantar fibromatosis are benign proliferative processes which present as a diffuse thickening or nodules of the hands and/or feet and may lead to flexion contractures, pain, and functional impairment known as Dupuytren and Ledderhose diseases, respectively. Current treatments are noncurative and associated with significant morbidity. Here, we report on the outcomes of 5 patients with advanced disease, no longer surgical candidates, treated with sorafenib. Sorafenib exhibited an expected safety profile. All 5 patients demonstrated objective responses as evaluated by a decrease in tumor size and/or tumor cellularity from baseline and all 5 patients reported subjective pain relief and/or functional improvement. Mechanistically, immunohistochemistry revealed patchy positivity for PDGFRß, a known target of sorafenib. The outcomes of these 5 patients suggest the safety and efficacy of a relatively well-tolerated oral agent in the treatment of Dupuytren and Ledderhose diseases and suggest the need for future controlled studies.


Assuntos
Contratura de Dupuytren , Fibromatose Plantar , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/patologia , Contratura de Dupuytren/cirurgia , Fibromatose Plantar/complicações , Fibromatose Plantar/terapia , Humanos , Dor , Manejo da Dor , Sorafenibe/uso terapêutico
8.
Math Biosci Eng ; 19(3): 2876-2895, 2022 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-35240811

RESUMO

In this study we review the current state of the art for Dupuytren's disease (DD), while emphasising the need for a better integration of clinical, experimental and quantitative predictive approaches to understand the evolution of the disease and improve current treatments. We start with a brief review of the biology of this disease and current treatment approaches. Then, since certain aspects in the pathogenesis of this disorder have been compared to various biological aspects of wound healing and malignant processes, next we review some in silico (mathematical modelling and simulations) predictive approaches for complex multi-scale biological interactions occurring in wound healing and cancer. We also review the very few in silico approaches for DD, and emphasise the applicability of these approaches to address more biological questions related to this disease. We conclude by proposing new mathematical modelling and computational approaches for DD, which could be used in the absence of animal models to make qualitative and quantitative predictions about the evolution of this disease that could be further tested in vitro.


Assuntos
Contratura de Dupuytren , Animais , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/etiologia , Contratura de Dupuytren/terapia , Projetos de Pesquisa , Cicatrização
9.
Pharm Dev Technol ; 27(2): 242-250, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35129055

RESUMO

Dupuytren's disease is a progressive fibrotic condition of the hand that causes contracture of fingers in later stages. Our previous in vitro studies suggest that the transformation of fibroblasts to myofibroblasts induced by transforming growth factor-beta can be inhibited by the addition of the antifibrotic drug, pirfenidone (PFD). We hypothesize that the local delivery of PFD directly to nodules can potentially prevent the progression to cords and, furthermore, that injection of PFD after the resection of cords can limit the recurrence of the disease. The purpose of this research was to develop a PFD injectable solution and to assess its safety in mice. Based on preformulation observations, a sterile solution containing up to 8 mg/0.4 mL of PFD was prepared in a phosphate buffer with and without 15%v/v N-methyl-2-pyrrolidone. Accelerated stability studies suggested that the product should be kept at refrigerated temperature (2-8 °C) for long-term storage. Safety studies involving subcutaneous administration to mice showed that 2-4 mg of PFD in 0.4 mL aqueous buffer did not elicit a significant inflammatory reaction. However, 4 mg PFD in 0.4 mL (FB) of buffer: NMP cosolvent system led to a significant increase in the influx of inflammatory cells and 8 mg PFD (FA) in the cosolvent system was lethal to the animals.


Assuntos
Contratura de Dupuytren , Animais , Contratura de Dupuytren/tratamento farmacológico , Fibroblastos , Camundongos , Piridonas/farmacologia
10.
Plast Reconstr Surg ; 149(4): 913-917, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35157618

RESUMO

BACKGROUND: Collagenase injection is a relatively new, minimally invasive treatment option for Dupuytren disease. Most literature focusses on quantitative outcome measures, such as degree of residual contracture and recurrence. The patient experience of the treatment has rarely been explored. This study sought to explore patients' experiences of the treatment process, including their reasons for seeking and choosing the treatment. METHODS: A qualitative descriptive design was used to explore patients' experiences. Seven patients (aged 57 to 81 years) who had received collagenase treatment for Dupuytren disease engaged in individual, semistructured interviews. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Thematic analysis revealed that Dupuytren disease was an obstacle to doing things, but not a barrier. Patients "went with the flow" of treatment, often taking a passive approach to their health care decisions. Patients found the collagenase injections to be extremely painful, but worth it. They had a varied knowledge of the disease and treatment. CONCLUSIONS: Patients were pleased with the results of the collagenase treatment, even if the finger was not completely straight or there was recurrence. The quick recovery and minimal complications were positive factors; however, the injections were extremely painful and could deter patients from future treatment. This research highlighted that a number of patients had low health literacy regarding their condition, and this affected their expectations of treatment outcomes and future treatment seeking. There are opportunities for health professionals to improve health literacy for people with Dupuytren disease, possibly in a group setting.


Assuntos
Contratura de Dupuytren , Idoso , Idoso de 80 Anos ou mais , Colagenases/uso terapêutico , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/cirurgia , Seguimentos , Humanos , Injeções Intralesionais , Colagenase Microbiana/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
11.
J Hand Surg Asian Pac Vol ; 27(1): 141-147, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35135420

RESUMO

Background: Collagenase clostridium histolyticum has become a widely used treatment in the management of Dupuytren disease. The aims of this study are to assess the immediate success of treatment of Dupuytren contracture with collagenase injection, to measure long-term patient-rated outcomes, to determine whether the risk factors for the disease impacted outcomes and to report complications of collagenase treatment. Methods: A prospective study was performed in a tertiary referral centre. Measurements were recorded pre-treatment, day 1 and day 90. Patient-rated outcome scores were measured using Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Michigan Hand Questionnaire (MHQ) at minimum 36 months post-injection. Results: The study included 45 patients with 53 hands with a mean age of 65.7 years. The treatment was successful in 62% of patients with the greatest improvement in the metacarpal-phalangeal joint of the little finger. Diabetes, epilepsy, gender, alcohol intake and positive family history had no statistically significant predictive value on successful outcomes. Patient satisfaction at 41 months was high with mean MHQ score of 97.3. Conclusions: Collagenase is effective in the treatment of Dupuytren contracture, with disease involving the little finger showing the greatest benefit. Risk factors for development of Dupuytren disease had no effect on successful outcome and long-term satisfaction rates are high. Level of Evidence: Level III (Therapeutic).


Assuntos
Contratura de Dupuytren , Idoso , Colagenases/uso terapêutico , Contratura de Dupuytren/tratamento farmacológico , Humanos , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento
12.
J Hand Surg Asian Pac Vol ; 27(1): 187-190, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35135428

RESUMO

Pulley injuries and Dupuytren disease are quite common in rock climbing. We report a rock climber who was treated for a Dupuytren contracture with collagenase injection therapy. Two months later, he developed a traumatic pulley injury during climbing and was treated with a ring orthosis. However, the finger contracture deteriorated and both a recurrent pulley rupture and a second pulley rupture were diagnosed. We were unable to find any reports on the use of collagenase in rock climbers with Dupuytren disease. We report a case of pulley rupture in a rock climber, treated for Dupuytren contracture in the treated and an adjacent finger, 2 months after the injection of collagenase. Level of Evidence: Level V (Therapeutic).


Assuntos
Contratura de Dupuytren , Traumatismos dos Dedos , Montanhismo , Traumatismos dos Tendões , Colagenases , Contratura de Dupuytren/tratamento farmacológico , Traumatismos dos Dedos/diagnóstico , Humanos , Masculino , Montanhismo/lesões , Traumatismos dos Tendões/diagnóstico
13.
J Hand Surg Asian Pac Vol ; 27(1): 62-67, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35037575

RESUMO

Background: Percutaneous needle fasciotomy (PNF) has been successfully used for the treatment of contracture bands in the hand in patients with Dupuytren disease. The aim of this study is to determine aesthetic and functional outcomes at 2 weeks following PNF in patients with Dupuytren contracture. Methods: Seventy-five patients undergoing PNF for Dupuytren disease during a 4-month period were included. Patients completed the Visual Analogue Appearance Score (VAAS), Derriford Appearance Score (DAS), and the quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH) preoperatively and at 2 weeks after surgery. In addition, VAAS was done in the immediate postoperative period as well. Results: Seventy-four (99%) patients completed the immediate postoperative VAAS scores and 51 (68%) completed the VAAS, DAS, and QuickDASH at 2 weeks. Preoperative VAAS fell from 6.01 to 1.53 (p < 0.0001) immediately post operation. Two weeks later, VAAS increased to 2.91 but was still significantly lower than preoperatively (p < 0.0001). DAS was unchanged. QuickDASH decreased from 22.4 preoperatively to 12.1 2 weeks later (p = 0.001). Conclusion: PNF for Dupuytren contracture resulted in improvement in both aesthetic and functional outcomes at 2 weeks. Longer term follow-up is required to determine whether these improvements are sustained. Level of Evidence: Level IV (Therapeutic).


Assuntos
Contratura de Dupuytren , Contratura de Dupuytren/cirurgia , Fasciotomia/métodos , Mãos/cirurgia , Humanos , Agulhas , Resultado do Tratamento
14.
JBJS Case Connect ; 12(1)2022 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-35050924

RESUMO

CASE: An exceptional event occurred during gradual extension with an external fixator for recurrent small finger Dupuytren flexion deformity. A massive proximal interphalangeal joint distraction arose, possibly because of the center of rotation misalignment and a hasty patient-controlled correction. The device was removed, and a plaster splint protected the finger for 5 days to prevent dislocation of the unstable joint. It relocated with an acceptable clinical result. CONCLUSION: Gradual extension of Dupuytren contractures with an external fixator may induce severe joint distraction by eccentric placement of the device. On the other hand, the good outcome of this case report may inspire further research on controlled joint distraction in hooked deformity.


Assuntos
Contratura de Dupuytren , Artroplastia , Contratura de Dupuytren/cirurgia , Articulações dos Dedos/cirurgia , Humanos , Amplitude de Movimento Articular , Resultado do Tratamento
15.
J Hand Surg Am ; 47(3): 211-217, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35074248

RESUMO

PURPOSE: Over the past decade, collagenase treatment and needle fasciotomy (NF) have gained widespread popularity in the treatment of Dupuytren contracture. This prospective study was designed to compare the results of these treatments in terms of clinical and patient-reported outcomes. METHODS: A prospective, randomized, controlled trial included patients with a contracture of 20° or more in a single metacarpophalangeal joint. Patients were allocated to treatment with either NF or collagenase Clostridium histolyticum. The primary outcome was a reduction in the metacarpophalangeal joint contracture to less than 5°. Secondary outcomes included recurrence, the presence of Dupuytren cords, and changes in patient-reported outcomes. The participants were examined 5 years after the intervention. RESULTS: The study cohort comprised 156 patients divided into 2 equally sized groups. After 5 years, data were collected from 143 (92 %) of the initially enrolled participants. The mean time for the clinical follow-up was 5.1 years. In the remaining cohort without a second procedure, 51% (23 patients) in the collagenase Clostridium histolyticum group and 47% (27 patients) in the NF group still had extension deficits of less than 5°. Among the participants with a successful initial procedure, the recurrence rate was 56% (36 patients) in the collagenase Clostridium histolyticum group and 45% (30 patients) in the NF group. There were no differences between the 2 treatments in regard to passive joint extension, reduction of contracture, range of motion, or patient-reported outcomes. CONCLUSIONS: The 5-year outcomes for NF are similar to those for collagenase in terms of sustained correction, recurrence, presence of Dupuytren cords, and patient-reported outcomes for the treatment of metacarpophalangeal joint contractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.


Assuntos
Contratura de Dupuytren , Colagenases/uso terapêutico , Contratura de Dupuytren/tratamento farmacológico , Contratura de Dupuytren/cirurgia , Fasciotomia , Seguimentos , Humanos , Injeções Intralesionais , Colagenase Microbiana/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento
16.
J Hand Surg Eur Vol ; 47(3): 280-287, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34617826

RESUMO

This study aimed to determine the association between the echogenicity of Dupuytren's disease nodules and myofibroblast load, and between echogenicity and nodule hardness. Thirty-eight nodules were assessed sonographically. The echogenicity of nodules was measured objectively with Image J (grey-value) and subjectively by visual inspection (hypo-, mixed and hyper-echogenicity). These findings were compared with myofibroblast load measured by histopathological analysis. In a different cohort, 97 nodules were assessed for grey-value and nodule hardness using a tonometer. There was a moderate, significant, negative association between grey-value and myofibroblast load and the subjective visual measurements corresponded to this finding. There was also a moderate, significant, negative association between grey-value and nodule hardness. Ultrasound and tonometry may be useful in the selection of patients for possible future preventive treatments.


Assuntos
Contratura de Dupuytren , Miofibroblastos , Contratura de Dupuytren/diagnóstico por imagem , Contratura de Dupuytren/patologia , Dureza , Humanos , Miofibroblastos/patologia , Ultrassonografia
17.
J Plast Surg Hand Surg ; 56(1): 23-29, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33840343

RESUMO

The objective of this study was to compare the effectiveness of ultrasound-guided injection of collagenase Clostridium histolyticum (CCH) in patients with Dupuytren's contracture (DC), with the standard injection. We hypothesised that the ultrasound-guided Injection of CCH is more effective than the standard injection. A prospective cohorts study in patients with DC was done. We treated consecutively 47 fingers with the standard injection and 43 with the ultrasound-guided. Patients in both groups had the same inclusion criteria. The degrees of contracture of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were measured before treatment and after three months. We compared the effectiveness of each type of injection in respect to obtaining a complete finger extension and to the percentage of improvement in each finger and in each joint. With ultrasound-guided injection, complete finger extension was obtained in 54% of cases and an 81% mean percentage of correction of the finger contracture; with standard injection 49% and 77%, respectively. In the MCP joint, the mean percentage of correction was 92.5 % in the ultrasound-guided Injection group and 84% in the standard injection group. In the PIP joint, it was 75.1% in the ultrasound-guided injection group and 65.3% in the standard injection group. These results showed no statistical significance. Hand surgeons must balance the possible benefits of the ultrasound-guided injection with the complexity and resources needed to perform the technique.


Assuntos
Contratura de Dupuytren , Colagenases , Contratura de Dupuytren/diagnóstico por imagem , Contratura de Dupuytren/tratamento farmacológico , Humanos , Colagenase Microbiana , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção
18.
J Orthop Res ; 40(3): 738-749, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-33913534

RESUMO

Dupuytren's disease is a benign fibroproliferative disorder of the hand that results in disabling digital contractures that impair function and diminish the quality of life. The incidence of this disease has been correlated with chronic inflammatory states, but any direct association between inflammatory cytokines and Dupuytren's disease is not known. We hypothesized that advanced fibroproliferation is associated with increased levels of circulating inflammatory cytokines. Blood and fibrotic cord tissue were collected preoperatively from patients with severe contracture and control patients. Blood plasma concentrations of known inflammatory cytokines were evaluated using a multiplex immunoassay. Proteins from the cord tissue were analyzed by RNA sequencing and immunohistochemistry. Moreover, collagen-rich cords were analyzed using Fourier-transform infrared spectroscopy. The results indicate that patients exhibited significantly elevated circulating inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin (IL)-2, and IL-12p70, as compared with controls. Similarly, IL-4 and IL-13 were detected significantly more frequently in Dupuytren's disease as compared with control. RNA sequencing revealed 5311 differentially expressed genes and distinct clustering between diseased and control samples. In addition to increased expression of genes associated with fibroproliferation, we also observed upregulation of transcripts activated by inflammatory cytokines, including prolactin inducible protein and keratin intermediate filaments. IL-2, but not TNF-α, was detected in fibrotic cord tissue by immunohistochemistry. Finally, spectroscopic assays revealed a significant reduction of the collagen content and alterations of collagen cross-linking within the Dupuytren's disease tissues. In total, our results illustrate that patients with severe Dupuytren's disease exhibit substantially elevated circulating inflammatory cytokines that may drive fibroproliferation. Clinical Significance: The results from this study establish the basis for a specific cytokine profile that may be useful for diagnostic testing and therapeutic intervention in Dupuytren's disease.


Assuntos
Contratura de Dupuytren , Colágeno , Citocinas , Contratura de Dupuytren/etiologia , Contratura de Dupuytren/patologia , Fibrose , Mãos , Humanos , Qualidade de Vida , Fator de Necrose Tumoral alfa
19.
Lasers Med Sci ; 37(1): 323-333, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33483776

RESUMO

Dupuytren's disease is a progressive fibroproliferative disorder of the hand. In the nodular stage of Dupuytren's disease, pain might limit daily hand activities and progress to finger contractures. Focused electromagnetic high-energetic extracorporeal shockwave therapy (ESWT) may reduce pain in Dupuytren's nodules (Tubiana N). In this prospective, randomized, blinded, placebo-controlled single center trial, we enrolled 52 patients (mean age, 58.2 ± 9.2) with painful nodular Dupuytren disease Tubiana N. Randomization was done to either (group A) 3 treatments with focused electromagnetic high-energetic ESWT (2000 shots, 3 Hz, 0.35 mmJ/mm2/hand, Storz Duolith SD1, n = 27) or (group B) placebo ESWT (2000 shots, 3 Hz, 0.01 mJ/mm2/hand, n = 25) in a weekly interval. Primary outcome was the level of pain on a visual analogue scale (VAS 0-10) at 3/6/12/18 months, secondary outcomes were patient-related outcome measures (DASH score, MHQ score, URAM scale), grip strength, patient's satisfaction, and Dupuytren's disease progression over 18 months follow-up. Focused ESWT significantly improved outcomes. Pain was reduced from 3.6 ± 1.8 to 1.9 ± 1.2 at three, to 1.4 ± 0.7 at six, to 1.7 ± 1.6 after 12 months and 1.9 ± 0.8 after 18 months in the intervention group (47% reduction, p < 0.05). In the placebo group, pain on VAS increased from 2.2 ± 1.4 to 3.4 ± 1.7 at three, to 3.4 ± 1.8 at six, to 3.4 ± 1.4 at 12 and 3.1 ± 1.1 at 18 months (35% increase, p < 0.05). Quality-of-life score tended to improve in the intervention group (MHQ, 77 ± 19 to 83 ± 12; DASH, 12 ± 18 to 10 ± 9) while it deteriorated in the placebo group as Dupuytren's disease was progressing (MHQ, 79 ± 15 to 73 ± 17; DASH, 6 ± 10 to 14 ± 13). The strength of the affected hand and fingers did not change significantly in either of the groups. Patients' satisfaction was higher in the intervention group for symptom improvement (56% vs. 12%) and reduction of disease progression (59% vs. 24%). Any Dupuytren-related intervention was performed in 26% in the intervention group and in 36% in the placebo group within 18 months of follow-up (n.s.). Focused electromagnetic high-energetic ESWT can significantly reduce pain in painful nodules in Dupuytren's disease in an 18-month perspective. ( ClinicalTrials.gov Identifier: NCT01184586).


Assuntos
Contratura de Dupuytren , Ondas de Choque de Alta Energia , Idoso , Contratura de Dupuytren/terapia , Fenômenos Eletromagnéticos , Ondas de Choque de Alta Energia/uso terapêutico , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos
20.
J Hand Surg Eur Vol ; 47(1): 80-88, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34496664

RESUMO

In this article we take an international perspective on the use of needles, either percutaneous needle fasciotomy (PNF) or Clostridial Collagenase Histiolyticum (CCH), in treating Dupuytren's Disease (DD). Worldwide, PNF is now used more frequently. The CCH has been withdrawn from non-USA markets, which lessens its use. Different patients have different preferences, while different surgeons have different skills and opinions. The surgeon should fully consider the patient's preference and should also, in view of the scarcity of surgical resource and the potential hazard of surgery, reconsider and expand the use of a needle rather than an operation. In the future, a cheaper, yet equally safe and effective alternative to CCH, will provide a useful clinical tool for those cords, which, in the surgeon's personal Venn diagram, are too challenging for PNF, but the patient does not want to have surgery.


Assuntos
Contratura de Dupuytren , Contratura de Dupuytren/cirurgia , Fasciotomia/efeitos adversos , Humanos , Agulhas , Recidiva Local de Neoplasia/etiologia
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