Dupuytren's Disease: An Outcomes-Focused Update

2021 ◽  
Author(s):  
Yasser H. Almadani ◽  
Joshua Vorstenbosch ◽  
Johnny Ionut Efanov ◽  
Liqin Xu
Keyword(s):  
Patient Education ◽  
Genetic Predisposition ◽  
Treatment Options ◽  
Clinical Treatment ◽  
Dupuytren’S Disease ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
Dupuytren's Disease ◽  
Associated Factor ◽  
Informed Decisions

AbstractDupuytren's disease (DD) remains a common fibroproliferative condition with significant sequelae and impact on patient's lives. The etiology of DD is poorly understood, and genetic predisposition is thought to be a strongly associated factor. Despite remarkable strides in improving our molecular understanding of DD, clinical treatment options have not yet overcome the frequently encountered challenge of recurrence. Recurrence rates continue to shape the prognosis of this fibrotic condition. In this outcomes-focused article, the various treatment modalities are reviewed. This further emphasizes the importance of patient education and providing them with the information to make informed decisions about their treatment.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

Dupuytren’s disease

2011 ◽  
Author(s):  
Peter Burge
Keyword(s):  
Surgical Treatment ◽  
Steroid Injection ◽  
Treatment Options ◽  
Genetic Component ◽  
Dupuytren’S Disease ◽  
Palmar Fascia ◽  
Dupuytren's Disease ◽  
Collagenase Injection ◽  
Operative Complications ◽  
Non Surgical Treatment

♦ Dupuytren’s disease is characterised by contracture of a finger resulting from thickening and shortening of the palmar fascia♦ A genetic component to the aetiology is apparent, smoking, alcohol and diabetes can increase the risk♦ The pathogenesis of Dupuytren’s disease remains elusive♦ Non-surgical treatment options include splintage, steroid injection and collagenase injection♦ Surgery cannot cure the disease but can straighten bent digits and minimize recurrence♦ Operative methods can be considered with regards to incision, management of the diseased fascia and closure techniques♦ Operative complications include injury of digital nerves and arteries

scholarly journals Dupuytren’s disease: where do we stand?

2019 ◽  
Vol 4 (2) ◽  
pp. 63-69 ◽  
Author(s):  
Rita Grazina ◽  
Sérgio Teixeira ◽  
Renato Ramos ◽  
Henrique Sousa ◽  
Andreia Ferreira ◽  
...  
Keyword(s):  
Alcohol Intake ◽  
State Of The Art ◽  
Treatment Options ◽  
Daily Activities ◽  
Dupuytren’S Disease ◽  
High Morbidity ◽  
Disease Treatment ◽  
Dupuytren's Disease ◽  
Current State ◽  
The World

Dupuytren’s disease is a fibroproliferative disease that involves collagen deposition, leading to hand contractures that ultimately affect hand mobility and grip strength. It is a benign disorder but can cause high morbidity by limiting daily activities. Many factors have been proposed for its aetiology: namely genetics, smoking, alcohol intake and diabetes. However, there is still controversy as to the main aetiological cause of the disease. Treatment is not yet uniform around the world and still varies with the surgeon’s experience and preference. In this review, the authors review the pathogenesis and treatment options for Dupuytren’s disease in an attempt to summarize the current state of the art. Cite this article: EFORT Open Rev 2019;4:63-69. DOI: 10.1302/2058-5241.4.180021.

scholarly journals Recent advances in the understanding of Dupuytren’s disease

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 231 ◽  
Author(s):  
Thomas Layton ◽  
Jagdeep Nanchahal
Keyword(s):  
Hand Function ◽  
Therapeutic Targets ◽  
Therapeutic Options ◽  
Dupuytren’S Disease ◽  
Treatment Modalities ◽  
Dupuytren's Disease ◽  
Recent Advances ◽  
Cellular Factors ◽  
Fibrotic Disorder ◽  
Novel Therapeutic

Dupuytren’s disease (DD) is a common fibrotic disorder of the hand and can significantly impair hand function. Although the exact pathogenesis of this disorder remains to be elucidated, immunological, genetic and cellular factors likely interact. In this review, we summarise recent advances in the understanding of DD pathogenesis and look to the future for potential novel therapeutic targets. In addition, we discuss the therapeutic options in DD with a focus on the need for more rigorous evidence to allow a meaningful comparison of different treatment modalities.

scholarly journals Treatment of Chronic Anal Fissure

2019 ◽  
Vol 19 (2) ◽  
pp. 67-71
Author(s):  
Abdullah Al Tarique ◽  
Md Manjur Alam
Keyword(s):  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Treatment Options ◽  
Dentate Line ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Healing Ulcer ◽  
Recurrence Rates ◽  
Support Device ◽  
Perineal Support

Chronic anal fissure is a non healing ulcer in the anoderm appearing as a painful tear below the dentate line. There are debates about the efficacy of different treatment options for chronic anal fissure. This review aims to evaluate existing and newer treatment modalities. Aspects of chronic anal fissure aetiology and pathogenesis are also reviewed. Glyceryl trinitrate (GTN) ointment, Diltiazem ointment can be used as first line and Botulinum toxin (BTX) injection as second line pharmacological treatment. The effects of these chemicals are not permanent with higher fissure recurrence rates. Lateral internal sphincterotomy is the operative treatment of choice for fissures with high anal tone. Flap anoplasty should be done for fissures with normal anal tone especially in female patients. Both surgical procedures can be used as primary treatment option. The newer treatment options like gonyautoxin, controlled balloon anal dilatation, closed anal spand fissurotomy need more research. Perineal support device can be used as an adjunct to other treatment modalities. Journal of Surgical Sciences (2015) Vol. 19 (2) : 67-71

scholarly journals Study protocol: A multi-centre, double blind, randomised, placebo-controlled, parallel group, phase II trial (RIDD) to determine the efficacy of intra-nodular injection of anti-TNF to control disease progression in early Dupuytren’s disease, with an embedded dose response study.

2017 ◽  
Vol 2 ◽  
pp. 37 ◽  
Author(s):  
Jagdeep Nanchahal ◽  
Catherine Ball ◽  
Jennifer Swettenham ◽  
Susan Dutton ◽  
Vicki Barber ◽  
...  
Keyword(s):  
Disease Progression ◽  
Early Stage ◽  
Dupuytren’S Disease ◽  
Recurrence Rates ◽  
Double Blind ◽  
Dupuytren's Disease ◽  
Early Stage Disease ◽  
Matrix Deposition ◽  
Stage Disease

Dupuytren’s disease is a common fibrotic condition of the hand affecting 4% of the population and causes the fingers to curl irreversibly into the palm. It has a strong familial tendency, there is no approved treatment for early stage disease, and patients with established digital contractures are most commonly treated by surgery. This is associated with prolonged recovery, and less invasive techniques have high recurrence rates. The myofibroblasts, the cells responsible for the excessive matrix deposition and contraction, are aggregated in nodules. Using excised diseased and control human tissue, we found that immune cells interspersed amongst the myofibroblasts secrete cytokines. Of these, only tumour necrosis factor (TNF) promoted the development of myofibroblasts. The clinically approved anti-TNF agents led to inhibition of the myofibroblast phenotype in vitro. This clinical trial is designed to assess the efficacy of the anti-TNF agent adalimumab on participants with early disease. The first part is a dose-ranging study where nodules of participants already scheduled for surgery will be injected with either placebo (saline) or varying doses of adalimumab. The excised tissue will then be analysed for markers of myofibroblast activity. The second part of the study will recruit participants with early stage disease. They will be randomised 1: 1 to receive either adalimumab or placebo at 3 month intervals over 1 year and will then be followed for a further 6 months. Outcome measures will include nodule hardness, size and disease progression. The trial will also determine the cost-effectiveness of adalimumb treatment for this group of participants.

Cost Comparison of Collagenase Clostridium Histolyticum and Fasciectomy for Treatment of Dupuytren’s Contracture in the Australian Health System

2018 ◽  
Vol 23 (03) ◽  
pp. 336-341 ◽  
Author(s):  
Andrew K. Sefton ◽  
Belinda J. Smith ◽  
David A. Stewart
Keyword(s):  
Treatment Options ◽  
Cost Comparison ◽  
Dupuytren’S Disease ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Health Care Environment ◽  
Dupuytren's Disease ◽  
Australian Health ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum

Background: Dupuytren’s disease results in contracted cords in the hand that lead to deformity and disability. Current treatment options include fasciectomy and an injectable, collagenase clostridium histolyticum. No cost comparison studies have been published within the Australian health care environment. Methods: A retrospective review of all patients treated for Dupuytren’s disease in a major teaching hospital was undertaken to compare the costs of treatment by fasciectomy or collagenase injection. Results: Eighteen patients underwent fasciectomy and 21 collagenase clostridium histolyticum injections were performed during the study period and were eligible for inclusion under the review criteria. Of the 39 patients, 36 were male and 3 were female with an average age 66.4 years (50–85). Twenty-five digits were treated by fasciectomy in 18 patients, and 23 digits were treated by collagenase in 21 patients. The fasciectomy group attended an average 9.2 visits (5–22), incurring an average costing of US$5738.12 per patient ($3181.18–$9618.10). The collagenase group attended an average 3.8 visits (3–8), incurring an average costing of US$2076.83 per patient ($1842.24–$3929.57). Conclusions: Collagenase treatment of Dupuytren’s contracture represents a significant reduction in cost relative to fasciectomy, with 64% savings, length of follow up and number of visits. This is a similar finding to studies in other countries.

scholarly journals The contribution of Australian research to Dupuytren’s disease

2020 ◽  
Vol 3 (1) ◽  
pp. 39-46
Author(s):  
Robert Phan ◽  
David Hunter-Smith ◽  
Warren Rozen
Keyword(s):  
Progressive Disease ◽  
English Literature ◽  
Dupuytren’S Disease ◽  
Treatment Modalities ◽  
Dupuytren's Disease ◽  
Library Search ◽  
Multiple Treatment ◽  
Conference Presentations ◽  
To Come ◽  
Royal Australasian College

Introduction: While the history and epidemiology of Dupuytren's disease (DD) is well documented, its aetiology and risk factors, pathogenesis and treatment to this day are still being studied. This paper explores and summarises the significant contributions Australian researchers have made to the understanding of DD and its treatment methodologies.  Methods: We performed a systematic search on EMBASE from 1947 until March 2019 to identify all English literature using keywords: ‘Dupuytren/Dupuytrens/Dupuytren’s disease’ and ‘Australia/Australian/Australasian’. Relevant articles were also identified through bibliographic links. A separate search was conducted using Google Scholar, Research Gate and PubMed using the same keywords. In total, 40 articles were identified. A library search was also conducted, with one book identified with an Australian author. The Royal Australasian College of Surgeons Journal of Surgery was also analysed for published abstracts pertaining to DD from conference presentations between 2014 to 2019. Results and discussion: We present a narrative discussion of Australian research that has contributed to the understanding of DD from its aetiology to treatment methodologies.  Conclusion: Numerous Australians have made significant contributions to the understanding of DD, its pathogenesis, development and multiple treatment modalities, both non-surgical and surgical. Dupuytren’s disease is a progressive disease that reoccurs despite our best efforts and will continue to be a topic of focus for some time to come.

scholarly journals Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review

2020 ◽  
Author(s):  
Danielle R. L. Brogden ◽  
Una Walsh ◽  
Gianluca Pellino ◽  
Christos Kontovounisios ◽  
Paris Tekkis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Hpv Vaccination ◽  
Intraepithelial Neoplasia ◽  
Surgical Excision ◽  
Anal Intraepithelial Neoplasia ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
Anal Squamous Cell Carcinoma

Abstract Purpose Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN. Methods MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included. Results Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison. Conclusions Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC.

Dorsal Dupuytren’s disease: a systematic review of published cases and treatment options

2019 ◽  
Vol 44 (9) ◽  
pp. 963-971 ◽  
Author(s):  
Raphael Carloni ◽  
Silvia Gandolfi ◽  
Benedicte Elbaz ◽  
Albane Bonmarchand ◽  
Roberto Beccari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Result ◽  
Treatment Options ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Female Ratio ◽  
Knuckle Pads ◽  
Male To Female

Dorsal lesions in Dupuytren’s disease are rare and data concerning their epidemiology and management are sparse. We conducted a systematic review to summarize reported cases of dorsal Dupuytren’s disease. Pubmed, Cochrane, and Embase databases were searched from 1893 to 2018, and 17 articles were selected (525 patients). The male to female ratio was 3.8:1. The dorsal disease was bilateral in 225 patients (50%). The index was the most commonly affected finger (48 patients). The proximal interphalangeal joint was the most commonly affected (484 cases). The most frequently reported lesions were knuckle pads (503 patients), dorsal nodules between interphalangeal joints (14 patients), boutonnière deformities (12 patients), and swan-neck deformities (2 patients). Nearly half of the included patients were treated surgically. Postoperative functional result depended on the treated lesion. Most of the included studies had a low level of evidence. Higher-quality studies are necessary to confirm our findings.

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