1
|
Reyntiens P, Vanhoenacker FM, Jager T. Tardigrade and Manifold Sign: Two New Signs in Dupuytren's Disease. Semin Musculoskelet Radiol 2023; 27:381-392. [PMID: 37230137 DOI: 10.1055/s-0043-1764287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Dupuytren's disease (DD) is a chronic benign fibroproliferative disorder of the palmar and digital fasciae. It is characterized by formation of nodules and fibrous cords that may eventually lead to contractures with permanent flexion of the finger joints. Correction of the flexion contractures in advanced disease is still performed by open limited fasciectomy; ultrasonography (US)-guided minimally invasive treatment is preferred for early disease.We provide an overview of the detailed anatomy of the palmar aponeurosis and the structures that may be involved in DD. Although magnetic resonance imaging is used as the gold standard, these small anatomical structures are often better visible on US. We describe two new morphological signs due to thickening of these small structures in patients with DD: the tardigrade sign and the manifold sign. Familiarity with detailed imaging anatomy and these new imaging signs of DD will help confirm a correct and early diagnosis and distinguish this disease from various other entities.
Collapse
Affiliation(s)
- Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, ASZ, Aalst, Belgium
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|
2
|
Nayar SK, Pfisterer D, Ingari JV. Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: 2-Year Follow-up. Clin Orthop Surg 2019; 11:332-336. [PMID: 31475055 PMCID: PMC6695332 DOI: 10.4055/cios.2019.11.3.332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 01/14/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Suresh K Nayar
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - John V Ingari
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
3
|
Factors predicting the 1-year outcome of collagenase treatment for Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:583-588. [PMID: 30673868 DOI: 10.1007/s00402-019-03120-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Several studies have investigated the clinical outcome after collagenase treatment for Dupuytren's disease in terms of range of motion of the affected finger. However, good objective clinical outcome defined by a small remaining flexion contracture does not necessarily translate into satisfactory patient-subjective hand function. The aim of the present study was to identify predictors of patient-reported as well as objective clinical outcome in patients 1 year after collagenase treatment for Dupuytren's disease. MATERIALS AND METHODS Socio-demographic and disease-related data of 92 Dupuytren patients were collected prior to the intervention. Flexion contracture of the most affected finger was measured at baseline and 1 year after treatment. Patients also completed the brief Michigan Hand Outcomes Questionnaire (brief MHQ) before the intervention and at 1-year follow-up. First, univariate correlations using Pearson's correlation coefficient of the baseline variables with the two target variables were investigated. All variables with r > 0.35 were selected for a multivariate linear stepwise backwards regression model. RESULTS The mean brief MHQ score increased between baseline (72 ± 14) and the 1-year follow-up (85 ± 15) (p ≤ 0.001) and baseline flexion contracture decreased from 76° (± 26) to 33° (± 31) (p ≤ 0.001). Higher hand function at baseline (R2 = 0.31) and less flexion contracture (R2 = 0.46) were identified as positive predictors for the outcome 1 year after collagenase treatment for Dupuytren's disease. Other variables such as age, gender, manual work and if the MCP or PIP joint was affected did not determine outcome in our patient series. CONCLUSIONS Collagenase treatment resulted in considerable improvement in flexion contracture as well as patient-reported hand function at the 1-year follow-up. Clinicians can expect better outcome after collagenase infiltration in patients with less flexion contracture and in patients showing good initial self-reported hand function.
Collapse
|
4
|
Kelenjian S, Mattjie RA, Franz R, Biedermann T, Brockow K. Klinische Merkmale und Management oberflächlicher Fibromatosen. J Dtsch Dermatol Ges 2019; 17:393-398. [DOI: 10.1111/ddg.13808_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shinorik Kelenjian
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Rebeca Assuncao Mattjie
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Regina Franz
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| | - Knut Brockow
- Klinik und Poliklinik für Dermatologie und Allergologie am BiedersteinTechnische Universität München München Deutschland
| |
Collapse
|
5
|
Kelenjian S, Mattjie RA, Franz R, Biedermann T, Brockow K. Clinical features and management of superficial fibromatoses. J Dtsch Dermatol Ges 2019; 17:393-397. [PMID: 30865379 DOI: 10.1111/ddg.13808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Fibromatoses are a group of benign connective tissue tumors characterized by the infiltrative, aggressive proliferation of well-differentiated fibroblasts, leading to frequent local recurrence. Within this heterogeneous disease group, superficial fibromatoses show slower growth and more benign infiltration of surrounding tissues than deep fibromatoses. Superficial fibromatoses relevant to dermatology include palmar, plantar, and penile fibromatosis, knuckle pads, pachydermodactyly and infantile digital fibromatosis. They present clinically with subcutaneous nodules or cords that lead to local infiltration and limited mobility of the affected areas. Treatment options vary from watchful waiting, non-invasive methods such as radiotherapy and intralesional corticosteroid/collagenase injections to radical surgical procedures. Early intervention may disrupt disease progression and may even restore functional ability. These disorders should therefore be recognized and treated early in the course of the disease.
Collapse
Affiliation(s)
- Shinorik Kelenjian
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Rebeca Assuncao Mattjie
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Regina Franz
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| |
Collapse
|
6
|
Rohit A, Peter A, Paul A, Anja B, Christian D, Renate D, Stefan G, Dietmar H, Johannes J, Peter K, Marco K, Martin L, Maximilian N, Christoph P, Gernot S, Gerald S, Tobias S, Matthias W, Armin Z, Markus G. Prospective observation of Clostridium histolyticum collagenase for the treatment of Dupuytren's disease in 788 patients: the Austrian register. Arch Orthop Trauma Surg 2019; 139:1315-1321. [PMID: 31317303 PMCID: PMC6689902 DOI: 10.1007/s00402-019-03226-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Since March 2011, the microbial collagenase of Clostridium histolyticum (Xiapex®, Swedish Orphan Biovitrum AB, Stockholm, Sweden) has become available in the European Union for treatment of Dupuytren's disease. The purpose of this study was to evaluate potential safety risks of Xiapex® and to contribute to a better understanding for its use. METHODS A prospective, non-interventional, observational study using Xiapex® for Dupuytren's disease named XIANIS was conducted between 1.10.2011 and 01.10.2017. Treatment was conducted in accordance to the manufacturer information. Patients were invited for follow-up after 1 week, 1 month, 3 months and 1 year. Demographic data, treatment data, pain levels, anaesthetic application during passive manipulation, subjective function improvement, subjective satisfaction and adverse events were recorded. RESULTS 788 patients with 814 treatments were included who suffered from Dupuytren's contracture for a mean of 64 months. The metacarpophalangeal joint was affected in 57% of cases and the PIP joint in 40.8% with a mean contracture of 39° and 56°, respectively. A change in the contracture down to 0°-5° was reported in 66.5% of cases, while 25.5% achieved a partial improvement. The pain during the injection was rated 4.5 and 3.3 during passive manipulation. Adverse events were reported in the majority of treated patients with skin tears being one main common event (26%). Further adverse outcomes were bleeding/hematoma, joint swelling, injection-site swelling, pressure sensitivity, erythema, injection-site pain, peripheral edema, blood blisters, blisters, painless lymphadenopathy, painful lymphadenopathy, axillary pain, arthralgia and sensory abnormality. There were no reported tendon ruptures, anaphylactic reactions or ligament injuries. On 1-year follow-up, 29% showed an increased contracture of a mean of 24° with the need for surgical treatment in 2% of patients. 74% of patients were very satisfied and 72% showed a high functional improvement. CONCLUSION The injectable collagenase Clostridium histolyticum (Xiapex®) proved to be effective and safe in patients with Dupuytren's disease. Minor adverse events disappeared within 30 days and the need for surgical treatment within 1 year was very low (2%). No major complications or rare side effects were seen in this prospective observational study.
Collapse
Affiliation(s)
- Arora Rohit
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Angermann Peter
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | - Binter Anja
- 0000 0000 9124 9231grid.415431.6Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Deml Christian
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria ,Sanatorium Kettenbrücke, Innsbruck, Austria
| | | | | | | | | | - Kaiser Peter
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Keller Marco
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria ,Kantonspital Baselland, Basel, Switzerland
| | | | - Neuwirth Maximilian
- 0000 0000 9124 9231grid.415431.6Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Pezzei Christoph
- 0000 0001 0723 5126grid.420022.6Lorenz Böhler Unfallkrankenhaus, AUVA, Wien, Austria
| | - Schmidle Gernot
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | | | | | | | - Gabl Markus
- 0000 0000 8853 2677grid.5361.1Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| |
Collapse
|
7
|
Nounou MI, Zaghloul TI, Ahmed NA, Eid AA, El-Khordagui LK. Skin permeability enhancement by Bacillus subtilis alkaline protease: Application to transdermal drug delivery. Int J Pharm 2017; 529:423-432. [PMID: 28711639 DOI: 10.1016/j.ijpharm.2017.06.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 01/19/2023]
Abstract
Enzymes may offer great potentials in topical pharmaceutical applications provided that treatment conditions are controlled for efficacy and safety. In this study, the effect of alkaline protease produced by recombinant Bacillus subtilis cells on the ex-vivo permeability of rabbit ear skin was investigated under different conditions of enzyme activity (5-60 units) and exposure time (15-60min). Data for transepidermal water loss (TEWL) and permeation of a hydrophilic dye, rhodamine B (Rb), indicated biphasic activity-dependent and exposure time-dependent skin permeability. Maximum effects were obtained at 20 proteolytic units and 30min exposure. Findings proved consistent with histopathological changes indicating progressive stratum corneum (SC) loss and disruption of the dermo-epidermal junction at 20 units and up to 30min exposure time followed by dermal hyalinization at longer exposure. This was associated with progressive loss of skin hair. Applying the identified pretreatment conditions to transdermal delivery of vardenafil in a gel base across dorsal rat skin indicated a significant increase in plasma levels at 30 and 60min with minimal histopathological changes 5days post enzyme treatment. Accordingly, the recombinant B. subtilis alkaline protease offers promise as a pharmaceutical enzyme for transdermal drug delivery bioenhancement and dermatological applications.
Collapse
Affiliation(s)
- Mohamed I Nounou
- Department of Pharmaceutical Sciences, School of Pharmacy, Joseph University of Saint (USJ), Hartford, CT 06103 USA; Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt.
| | - Taha I Zaghloul
- Department of Biotechnology, Institute of Graduate Studies and Research (IGSR), Alexandria University, Alexandria, 21526, Egypt
| | - Nehal A Ahmed
- Department of Biotechnology, Institute of Graduate Studies and Research (IGSR), Alexandria University, Alexandria, 21526, Egypt
| | - Amira A Eid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, 21521, Egypt
| | - Labiba K El-Khordagui
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt
| |
Collapse
|