Range of motion, postoperative rehabilitation and patient satisfaction in MCP and PIP joints affected by Dupuytren Tubiana stage 1-3: collagenase enzymatic fasciotomy or limited fasciectomy? A clinical study in 52 patients.

INTRODUCTION: In Switzerland, collagenase Clostridium histolyticum therapy (CCH) for Dupuytren's disease was introduced in 2011. This study analyzes possible differences between CCH and limited fasciectomy (LF) in terms of range of motion, patient satisfaction and postoperative rehabilitation. MATERIALS AND METHODS: This retrospective study included 52 patients with Dupuytren's disease stage 1-3 according to Tubiana, treated with CCH or LF between January 2012 and December 2013. Complications were analyzed for each patient. The contracture of each treated joint measured on average at the 3 months and up to 2 years follow-up was compared with the preoperative values. The Michigan Hand score was evaluated at 2 years and the patients were asked to subjectively evaluate the outcome of the treatment and whether they would repeat it if necessary. Postoperative rehabilitation was also precisely quantified. RESULTS: 11 minor complications were reported for a complication rate of 29% in the CCH group. No major complications were reported in both groups. In the CCH group, mean MCP joint contracture was, respectively, 44° ± 20°, 9° ± 2° (gain of mobility compared to the preoperative situation 35°, P < 0.001), and 10° ± 3° (gain 34°, P < 0.001), respectively, before, at the 3 months' control and at the 2-year clinical control. In the LF group, mean MCP joint contracture was, respectively, 30° ± 21°, 2° ± 0.5° (gain 28°, P < 0.001), and 1° ± 0.5° (gain 29°, P < 0.001) for the same control periods. In the CCH group, mean PIP joint contracture was, respectively, 51° ± 21°, 18° ± 3° (gain of mobility compared to the preoperative situation 33°, P < 0.001), and 32° ± 4° (gain 19°, P < 0.001), respectively, before, at the 3 months' control and at the 2-year clinical control. In the LF group, mean PIP joint contracture was, respectively, 30° ± 20°, 2° ± 0.5° (gain of mobility compared to the preoperative situation 28°, P < 0.001), and 11° ± 4° (gain 19°, P < 0.001) for the same control periods. Outcomes were compared across the LF and CCH groups: surgery performed better than collagenase for PIP joint treatment at early (P < 0.001) and 2-year follow-up (P = 0.004) controls. However, patient satisfaction was higher in the CCH group: 92% were satisfied or very satisfied of the treatment compared to 71% in the LF group. All patients would reiterate the treatment in the CCH group if necessary compared to only 71% in the LF group. Rehabilitation was highly reduced in the CCH group compared to the LF group. CONCLUSION: In this study, surgery performed better than collagenase at early and 2-year follow-up in PIP joints and similar in MCP joints. While surgery seems to achieve better results, collagenase is considered in Switzerland as an off-the-shelf therapy that provides consistent results without scars, with shorter rehabilitation time, minor hand therapy, shorter splinting time, and applicability. LEVEL OF EVIDENCE AND STUDY TYPE: Level III.

Homogeneous catalysis of valeronitrile hydrolysis under supercritical conditions.

Supercritical nitrile hydrolysis can be used for both, amide and acid production as well as waste water treatment, as the hydrolysis products show good biodegradability. The conventional process at ambient conditions requires large amounts of mineral acid or base. Approaches that use supercritical water as a green solvent without a catalyst have been investigated over recent years. Findings for valeronitrile hydrolysis presented recently showed promising reaction rates and valeric acid yields. In an attempt to further maximize product yield and to better understand the impact of the pH, reactions in dilute sulfuric acid (0.01 mol L(-1)) were performed in a continuous high-pressure laboratory-scale apparatus at 400-500 °C, 30 MPa, and a maximum residence time of 100 s. Results from both reaction media were compared with regard to productivity and sustainability.

Valeronitrile hydrolysis in supercritical water.

Nitriles act as important intermediates for the chemical industry and are accessible on a large scale through hydrocyanation or ammonoxidation. Nitrile hydrolysis yields amides and acids used in various applications. The conventional nitrile hydrolysis process relies on stoichiometric amounts of mineral acid or base which inherently deliver great amounts of waste brine. Improving this process towards green chemistry would require reaction conditions which can provide technically significant results without the use of catalysts. Under these conditions, the hydrolysis of valeronitrile in pure supercritical water was investigated. The experiments were performed in a continuous high pressure laboratory-scale apparatus at a temperature between 400 and 500 degrees C, 30 MPa pressure and maximal residence time of 100 s. Nitrile conversion and valeric acid selectivity greater than 90% were achieved.