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Kianian R, Regets KV, Mills JN, Eleswarapu SV. "Can we try to avoid surgery first?"-Real-world experience with surgery for Peyronie's disease in the post-intralesional collagenase setting. Int J Impot Res 2024; 36:171-172. [PMID: 37142832 DOI: 10.1038/s41443-023-00713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Reza Kianian
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Keith V Regets
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jesse N Mills
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sriram V Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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2
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Gundogdu K, Kılıc Erkek O, Gundogdu G, Sayin D, Abban Mete G. Anti-inflammatory effects of sericin and swimming exercise in treating experimental Achilles tendinopathy in rat. Appl Physiol Nutr Metab 2024; 49:501-513. [PMID: 38284362 DOI: 10.1139/apnm-2023-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
The aim of this study was to assess the effectiveness of combining sericin with swimming exercise as a treatment for type-I collagenase-induced Achilles tendinopathy (AT) in rats, with a focus on inflammatory cytokines. An experimental AT model was established using type-I collagenase in male Sprague-Dawley rats, categorized into five groups: Group 1 (Control + Saline), Group 2 (AT), Group 3 (AT + exercise), Group 4 (AT + sericin), and Group 5 (AT + sericin + exercise). Intratendinous sericin administration (0.8 g/kg/mL) took place from days 3 to 6, coupled with 30 min daily swimming exercise sessions (5 days/week, 4 weeks). Serum samples were analyzed using ELISA for tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-10 (IL-10), and total antioxidant-oxidant status (TAS-TOS), alongside histopathological and immunohistochemical assessments of Achilles tendon samples. Elevated TNF-α and IL-1β and decreased IL-10 levels were evident in Group 2; Of these, TNF-α and IL-1β were effectively reduced and IL-10 increased across all treatment groups, particularly groups 4 and 5. Serum TAS was notably lower in Group 2 and significantly increased in Group 5 compared to Group 2. Histopathologically, Group 2 displayed severe degeneration, irregular fibers, and round cell nuclei, while Group 5 exhibited decreased degeneration and spindle-shaped fibers. The Bonar score increased in Group 2 and decreased in groups 4 and 5. Collagen type-I alpha-1 (Col1A1) expression was notably lower in Group 2 (P = 0.001) and significantly increased in groups 4 and 5 compared to Group 2 (P = 0.011 and 0.028, respectively). This study underscores the potential of sericin and swimming exercises in mitigating inflammation and oxidative stress linked to AT pathogenesis, presenting a promising combined therapeutic strategy.
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Affiliation(s)
- Koksal Gundogdu
- Department of Orthopedics and Traumatology, Denizli State Hospital, Denizli, Turkey
| | - Ozgen Kılıc Erkek
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gulsah Gundogdu
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Dilek Sayin
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gulcin Abban Mete
- Department of Histology and Embryology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Räisänen MP, Leppänen OV, Soikkeli J, Reito A, Malmivaara A, Buchbinder R, Kautiainen H, Kaivorinne A, Stjernberg-Salmela S, Lappalainen M, Luokkala T, Pönkkö A, Taskinen HS, Pääkkönen M, Jaatinen K, Juurakko J, Karjalainen VL, Karjalainen T. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med 2024; 177:280-290. [PMID: 38346307 DOI: 10.7326/m23-1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase. OBJECTIVE To compare the effectiveness of surgery, needle fasciotomy, and collagenase injection at 3 months and 2 years (secondary time points of the trial). DESIGN A multicenter, randomized, outcome assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT03192020). SETTING 6 public hospitals in Finland. PARTICIPANTS 302 persons with treatment-naive Dupuytren contracture (contracture angle <135°). INTERVENTION Surgery (n = 101), needle fasciotomy (n = 101), or collagenase (n = 100). MEASUREMENTS The primary outcome was the success rate, defined as greater than 50% contracture release and patients reaching the patient acceptable symptom state. Secondary outcomes included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events. RESULTS A total of 292 (97%) and 284 (94%) participants completed the 3-month and 2-year follow-ups. Success rates were similar at 3 months: 71% (95% CI, 62% to 80%) for surgery, 73% (CI, 64% to 82%) for needle fasciotomy, and 73% (CI, 64% to 82%) for collagenase. At 2 years, surgery had superior success rates compared with both needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30 [CI, 0.17 to 0.43]) and collagenase (78% vs. 65%; aRD, 0.13 [CI, 0.01 to 0.26]). Secondary analyses paralleled with the primary analysis. LIMITATION Participants were not blinded. CONCLUSION Initial outcomes are similar between the treatments, but at 2 years success rates were maintained in the surgery group but were lower with both needle fasciotomy and collagenase despite retreatments. PRIMARY FUNDING SOURCE Research Council of Finland.
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Affiliation(s)
- Mikko Petteri Räisänen
- Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.)
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Janne Soikkeli
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Aleksi Reito
- Department of Orthopedics, Tampere University Hospital, Tampere, Finland (A.R.)
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare and Orton Orthopedic Hospital, Helsinki, Finland (A.M.)
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (R.B.)
| | | | - Antti Kaivorinne
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland (O.V.L., A.K.)
| | - Susanna Stjernberg-Salmela
- Department of Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland (S.S.)
| | | | - Toni Luokkala
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Annele Pönkkö
- Department of Hand Surgery and Orthopedics, Oulu University Hospital, Oulu, Finland (J.S., A.P.)
| | - Hanna-Stiina Taskinen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Markus Pääkkönen
- Department of Orthopedic and Traumatology, Turku University Hospital, Turku, Finland (H.-S.T., M.P.)
| | - Kati Jaatinen
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | - Joona Juurakko
- Department of Surgery, Wellbeing Services County of Central Finland/Hospital Nova of Central Finland, Jyväskylä, Finland (T.L., K.J., J.J.)
| | | | - Teemu Karjalainen
- Department of Hand Surgery and Microsurgery, Tampere University Hospital, Tampere, Finland, and Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (T.K.)
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Zhang D, Earp BE, Blazar P. Collagenase Treatment Versus Needle Fasciotomy for Single-Digit Dupuytren Contractures: A Meta-Analysis of Randomized Controlled Trials. J Hand Surg Am 2023; 48:1200-1209. [PMID: 37725027 DOI: 10.1016/j.jhsa.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The objective of this systematic review and meta-analysis was to synthesize the available randomized controlled trial data comparing needle fasciotomy and collagenase treatment for single-digit Dupuytren contractures with a minimum of 3-year follow-up and determine whether one treatment is superior regarding contracture correction and functional outcomes. METHODS A systematic review and meta-analysis was conducted by searching four databases for randomized controlled trials investigating the single-digit treatment outcomes for Dupuytren contracture comparing collagenase treatment and needle fasciotomy with a minimum of 3-year follow-up. The risk of bias of included studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis was performed using a random effects model in anticipation of unobserved heterogeneity. The primary outcome measure was contracture recurrence. Secondary outcome measures included final fixed flexion contracture (FFC), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores, and Unité Rhumatologique des Affections de la Main (URAM) scores. RESULTS After screening 264 articles, 4 randomized clinical trials were eligible for final inclusion. One trial had a high risk of bias, and two trials had some concern for bias. The final meta-analysis included 347 patients, 169 who underwent collagenase treatment and 178 who underwent needle fasciotomy. No significant differences were noted between the groups in contracture recurrence, FFC, and URAM scores. The pooled data showed a higher QuickDASH score in the collagenase treatment group compared with the needle fasciotomy group, but the observed difference was less than what would be expected to be clinically relevant. CONCLUSIONS Needle fasciotomy and collagenase treatment have similar outcomes with regards to contracture recurrence, final FFC, QuickDASH scores, and URAM scores for the single-digit treatment for Dupuytren contracture at a minimum of 3-year follow-up. Relevant factors that may be considered during the shared decision-making process for treatment selection include surgeon and patient preferences, costs of treatment, and the disparate complication profiles of these two treatments. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Green B, Flores A, Warner J, Kohler T, Helo S, Trost L. Comparison of Collagenase Clostridium histolyticum to Surgery for the Management of Peyronie's Disease: A Randomized Trial. J Urol 2023; 210:791-802. [PMID: 37811752 DOI: 10.1097/ju.0000000000003634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/13/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Since Food and Drug Administration approval of collagenase Clostridium histolyticum for Peyronie's disease, there has been significant debate regarding its role and comparable efficacy to surgery. MATERIALS AND METHODS A randomized, controlled trial was performed of Peyronie's disease men treated with either collagenase C histolyticum + RestoreX penile traction therapy + sildenafil or penile surgery + RestoreX penile traction therapy + sildenafil, with 3-month data presented. Primary objectives were overall satisfaction, subjective changes in erectile function, penile sensation, penile length, and changes in the International Index of Erectile Function-Erectile Function Domain score. Secondary outcomes included objective changes in length, curve, adverse events, and other standardized and nonstandardized questionnaires. RESULTS A total of 40 men were enrolled, with 38 (collagenase C histolyticum group = 19, surgery group = 19) completing treatment and having 3-month data available. All demographic and clinicopathological variables were similar between groups. Following treatment, 50% of men in the collagenase C histolyticum group reported being very satisfied (vs 21% in the surgery group, P = .08) and noted better subjective erectile function (100% vs 68%, P = .03) and penile length (88% vs 16%, P < .0001), lesser impacts on penile sensation (75% vs 11% no change, P < .001), and similar International Index of Erectile Function-Erectile Function Domain changes (+1.5 vs +2.5, P = .91). Objectively, men in the surgery group had greater curve improvements (84% vs 54%, P < .01) and higher rates of adverse events (50 vs 13 events, P < .001) but decreased penile length (-0.5 cm vs +1.0 cm, P < .01). CONCLUSIONS At 3 months posttreatment, collagenase C histolyticum + RestoreX penile traction therapy + sildenafil results in lesser curve improvements but greater penile length and fewer adverse events, including impacts on subjective erectile function and sensation, than men treated with surgery.
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Affiliation(s)
| | | | | | | | | | - Landon Trost
- Male Fertility and Peyronie's Clinic, Orem, Utah
- CURE PD, Orem, Utah
- Brigham Young University, Provo, Utah
- Mayo Clinic, Rochester, Minnesota
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McDonald L, Hoffman L, Chapas A. Degradation Therapy with Collagenase and Deoxycholate. Facial Plast Surg Clin North Am 2023; 31:525-533. [PMID: 37806686 DOI: 10.1016/j.fsc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Deoxycholate (deoxycholic acid) and collagenase are naturally occurring substances whose ability to degrade adipose tissue and collagen respectively has given rise to a variety of therapeutic applications. This article will discuss the indications for the use of deoxycholic acid, primarily its well-established role in the non-surgical reduction of submental fat, with a focus on patient assessment, procedural technique, risks, pitfalls, and key clinical tips. It will also review the indications for collagenase as a degradation therapy, its mechanism of action, and benefits in the management of wound healing, scarring, and adipose tissue modification.
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Affiliation(s)
- Louise McDonald
- Department of Dermatology, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, Northern Ireland BT16 1RH, UK.
| | - Lauren Hoffman
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, NY 10003, USA
| | - Anne Chapas
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, NY 10003, USA
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Zhao C, Ye L, Cao Z, Tan X, Cao Y, Pan J. Therapeutic effects of kartogenin on temporomandibular joint injury by activating the TGF-β/SMAD pathway in rats. Exp Biol Med (Maywood) 2023; 248:1500-1506. [PMID: 36941805 PMCID: PMC10666730 DOI: 10.1177/15353702231157945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/26/2023] [Indexed: 03/23/2023] Open
Abstract
Patients with temporomandibular dysfunction (TMD) usually suffer from pathology or malpositioning of the temporomandibular joint (TMJ) disk, leading to the degenerative lesion of condyles. Kartogenin can promote the repair of damaged cartilage. This study aimed to explore whether intra-articular injection of kartogenin could alleviate the TMJ injury induced by type II collagenase. We measured the head withdrawal threshold and found that kartogenin alleviated the pain around TMD induced by type II collagenase. We observed the morphology of the condylar surface and found that kartogenin protected the integration of the condylar surface. We analyzed the density of the subchondral bone and found that kartogenin minimized the damage of TMJ injury to the subchondral bone. We next explored the histological changes and found that kartogenin increased the thickness of the proliferative layer and more collagen formation in the superficial layer. Then, to further ensure whether kartogenin promotes cell proliferation in the condyle, we performed immunohistochemistry of proliferating cell nuclear antigen (PCNA). The ratio of PCNA-positive cells was significantly increased in the kartogenin group. Next, immunofluorescence of TGF-β1 and SMAD3 was performed to reveal that kartogenin activated the TGF-β/SMAD pathway in the proliferative layer. In conclusion, kartogenin may have a therapeutic effect on TMJ injury by promoting cell proliferation in cartilage and subchondral bone. Kartogenin may be promising as an intra-articular injection agent to treat TMD.
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Affiliation(s)
| | | | | | - Xing Tan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jian Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Yuan P, Shi X, Wei X, Wang Z, Mu J, Zhang H. Development process and clinical application of collagenase chemonucleolysis in the treatment of lumbar disc herniation: a narrative review in China. Postgrad Med J 2023; 99:529-534. [PMID: 37319161 DOI: 10.1136/postgradmedj-2021-141208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/20/2022] [Indexed: 11/04/2022]
Abstract
Lumbar disc herniation (LDH) is one of the most common causes of lumbocrural pain. In the past 20 years, the incidence of LDH has increased dramatically. There are many treatments for LDH, including conservative treatment (such as acupuncture and physiotherapy), minimally invasive interventional treatment (such as collagenase chemonucleolysis and radiofrequency ablation) and surgical treatment. The main purpose of this paper is to review the development process and application status of collagenase chemonucleolysis in the treatment of LDH at home and abroad and provide a reference for clinical treatment.
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Affiliation(s)
- Peng Yuan
- Interventional Radiology and Pain Treatment, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China
| | | | - Xuanjun Wei
- The 3rd clinical department of China Medical University, China Medical University, Shenyang, China
| | - Zijun Wang
- Battalion of the first Regiment of cadets of Basic Medicine, Air Force Military Medical University, Xi'an, China
| | - Jiao Mu
- Interventional Radiology and Pain Treatment, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China
- Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Hematology, Xi'an Central Hospital, Xi'an, China
| | - Hongxin Zhang
- Interventional Radiology and Pain Treatment, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China
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Winberg M, Turesson C. Patients' perspectives of collagenase injection or needle fasciotomy and rehabilitation for Dupuytren disease, including hand function and occupational performance. Disabil Rehabil 2023; 45:986-996. [PMID: 35261296 DOI: 10.1080/09638288.2022.2046188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe patients' perspectives of collagenase injection or needle fasciotomy for Dupuytren disease (DD) including hand therapy, and their view of hand function and occupational performance. MATERIALS AND METHODS Interviews were performed with twelve patients who had undergone non-surgical treatment and rehabilitation for DD. Data was analysed using a problem-driven content analysis using the model of Patient Evaluation Process as a theoretical framework. RESULTS The participants' previous experiences influenced their expectations of the upcoming treatment and they needed information to be prepared for treatment. Treatment and rehabilitation had a positive impact on daily life and were regarded as effective and simple with quick recovery. However, there could be remaining issues with tenderness or stiffness. The participants expressed their belief in rehabilitation and how their own efforts could contribute to an improved result. Despite concerns about future recurrence participants described increased knowledge and sense of control regarding future needs. CONCLUSION Undergoing a non-surgical treatment and rehabilitation process for DD was regarded as quick and easy and can meet the need for improved hand function and occupational performance. Taking responsibility for one's own rehabilitation was considered to influence the outcome positively. The theoretical framework optimally supported the exploration of participants' perspective.Implications for rehabilitationTreatment of Dupuytren Disease (DD) with needle/collagenase combined with hand therapy was experienced as giving fast improvement in hand function and occupational performance.An individualized care process which satisfies the need for knowledge about the disease, prognosis, treatment options and rehabilitation can give individuals suffering from DD a sense of security.The need for active participation in the DD care process can vary and it is crucial to listen to individuals' opinions and needs.Individuals can take considerable responsibility for rehabilitation after non-surgical treatment for DD and regard it as important for the outcome.
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Affiliation(s)
- Madeleine Winberg
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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10
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Li MK, Sigalos JT, Yoffe DA, Modiri N, Hu MY, Gaither TW, Santamaria A, Walker DT, Regets KV, Mills JN, Eleswarapu SV. Multiple courses of intralesional collagenase injections for Peyronie disease: a retrospective analysis. J Sex Med 2023; 20:200-204. [PMID: 36763912 DOI: 10.1093/jsxmed/qdac030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the original clinical trials evaluating intralesional collagenase Clostridium histolyticum for Peyronie disease (PD), treatment protocols were limited to 8 injections. AIM We sought to describe our single-center experience with the use of multiple rounds (>8 injections) of intralesional collagenase in patients with PD. METHODS We conducted a retrospective analysis of all patients with PD receiving intralesional collagenase injections at our institution from October 2015 through December 2020. Some patients who completed 1 round of treatment elected to undergo additional rounds (16 or 24 injections) based on persistent curvature and presence of penile plaque. Clinical improvement was defined as a 20% reduction in penile curvature from the start of a given round of treatment to the end of that round of treatment. We measured erect penile curvature before and after each round and collected demographics, medical and surgical history, curvature outcomes, and treatment-related adverse events. OUTCOME The primary outcome was the reduction in penile curvature after multiple rounds of treatment with intralesional collagenase injections in patients with PD. RESULTS A total of 330 patients underwent intralesional collagenase injections for PD, of whom 229 completed at least 8 injections and underwent pre- and posttreatment erect penile goniometry. An overall 42.8% (98/229), 38.6% (22/57), and 12.5% (1/8) of patients achieved clinical improvement after 1 round of therapy (8 injections), 2 rounds (16 injections), and 3 rounds (24 injections), respectively. Mean degree and mean percentage improvement of penile curvature for the start and end of each round of treatment were 8.3° and 16.4% (after 1 round), 7.2° and 16.8% (after 2 rounds), and 3.3° and 8.1% (after 3 rounds). Bruising was the most common complication, with an incidence of at least 50% in each round. CLINICAL IMPLICATIONS Knowledge of patient responses to multiple rounds of intralesional collagenase injections may help guide physicians in management and counseling of patients regarding PD treatment options. STRENGTHS AND LIMITATIONS This is the first study to evaluate multiple rounds (>8 injections) of intralesional collagenase for PD. Limitations include retrospective analysis and smaller sample size among patients undergoing 3 rounds (24 injections). CONCLUSION For patients who did not achieve clinical improvement after 1 round of treatment, an additional round may be beneficial. However, no real improvement was observed for patients undergoing a third round.
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Affiliation(s)
- Michelle K Li
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - John T Sigalos
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Dar A Yoffe
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Neilufar Modiri
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Ming-Yeah Hu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Thomas W Gaither
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Alvaro Santamaria
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Dyvon T Walker
- School of Medicine, University of Colorado, Aurora, CO 80045, United States
| | - Keith V Regets
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Jesse N Mills
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Sriram V Eleswarapu
- Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
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Abstract
This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren's disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.
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Affiliation(s)
| | | | | | | | | | - Leon Nesti
- Uniformed Services University of the
Health Sciences, Bethesda, MD, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, El
Paso, TX, USA
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Diehm YF, Marstaller K, Seckler AM, Berger MR, Zepp M, Gaida MM, Thomé J, Kotsougiani-Fischer D, Kneser U, Fischer S. The collagenase of the bacterium Clostridium histolyticum does not favor metastasis of breast cancer. Breast Cancer 2022; 29:599-609. [PMID: 35129812 DOI: 10.1007/s12282-022-01337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy among women worldwide. As survival rates increase, breast reconstruction and quality of life gain importance. Of all women undergoing breast reconstruction, approximately, 70% opt for silicone implants and 50% of those develop capsular contracture, the most prevalent long-term complication. The collagenase of the bacterium Clostridium histolyticum (CCH) showed promising results in the therapy of capsule contracture; however, its influence on residual cancer cells is unknown. The aim of this study was to investigate whether CCH-treatment negatively impacts breast cancer cells in vitro and in vivo. METHODS MDA-MB-231 and MCF-7 cells were used in this study. In vitro, we tested the influence of CCH on proliferation, wound healing, migration and cell cycle by MTT-assay, scratch-assay, transwell-migration-assay, and flow cytometry. In vivo, solid tumors were induced in immune-deficient mice. CCH was injected into the tumors and tumor growth and metastasis formation was monitored by caliper measurement, in vivo bioluminescence imaging and histology. Gene expression analysis was performed by microarray including 27,190 genes. RESULTS CCH-incubation led to a dose-dependent reduction in proliferation for both cell lines, while wound healing was reduced only in MDA-MB-231 cells. No morphological alterations were monitored in cell cycle or apoptosis. In vivo, bioluminescence imaging and histology did not show any evidence of metastasis. Although CCH led to changes in gene expression of breast cancer cells, no relevant alterations in metastasis-related genes were monitored. CONCLUSION CCH has no impact on tumor growth or metastasis formation in vitro and in vivo. This paves the way for first clinical trials.
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Affiliation(s)
- Yannick Fabian Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Katharina Marstaller
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Toxicology and Chemotherapy Unit, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Anna-Maria Seckler
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Toxicology and Chemotherapy Unit, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Martin Reinhold Berger
- Toxicology and Chemotherapy Unit, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Michael Zepp
- Toxicology and Chemotherapy Unit, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Matthias Martin Gaida
- Institute of Pathology, University Medical Center, Johannes-Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Julia Thomé
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Sebastian Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
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Wang J, Wu Q, Wang Y, Xiang L, Feng J, Zhou Z, Fu Q, Zhang L. Collagenase-loaded pH-sensitive nanocarriers efficiently remodeled tumor stroma matrixes and improved the enrichment of nanomedicines. Nanoscale 2021; 13:9402-9414. [PMID: 34002757 DOI: 10.1039/d1nr00950h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The dense extracellular matrix (ECM) in tumor tissue severely hinders the penetration and enrichment of antitumor nanomedicines, which could significantly affect their efficiency. In this study, we used pH-sensitive nanocarriers loaded with collagenase (Col) to remold the tumor microenvironment (TME). Furthermore, we combined the collagenase delivery system with a nanomedicine to improve its penetration and enrichment in the tumor, thereby improving efficacy. We synthesized acetalated dextran (Ace-DEX) with an ideal pH-sensitivity as the carrier material of collagenase. Under mild preparation conditions, collagenase was loaded into Ace-DEX nanoparticles (NPs) with a high loading capacity (>4%) and remained highly active (>90%). Col-carrying NPs (Col-NPs) significantly reduced the tumor collagen content by 15.1%. Pretreatment with Col-NPs increased the accumulation of doxorubicin (DOX)-loaded liposome (DOX-Lipo) in the tumor by 2.8-fold. There were no safety concerns as the Col-NP showed no significant toxicity and reduced Col-induced damage to healthy tissues. Additionally, the number of circulating tumor cells remained unchanged after Col-NP treatment, suggesting no increased risk of tumor metastasis. Because the Col-NP acts essentially independent of the subsequent treatment, it has considerable potential for enhancing many existing delivery systems and drugs for cancer treatment. It may also be used for treating other collagen-related diseases.
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Affiliation(s)
- Jiading Wang
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610041, China.
| | - Qingsi Wu
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Yuanfang Wang
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Ling Xiang
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Jiaxing Feng
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Zhaojie Zhou
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610041, China.
| | - Qiang Fu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610041, China.
| | - Ling Zhang
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610041, China.
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Cocci A, Di Maida F, Russo GI, Capogrosso P, Francesco L, Rizzo M, Di Mauro M, Salonia A, Cito G, Falcone M, Romano A, Polloni G, Martinez-Salamanca JI, Fernández-Pascual E, Minervini A, Mondaini N. Efficacy of Collagenase Clostridium histolyticum (Xiapex ®) in Patients with the Acute Phase of Peyronie's Disease. Clin Drug Investig 2020; 40:583-588. [PMID: 32342279 DOI: 10.1007/s40261-020-00916-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE: Plaque formation ordinarily takes place in the acute phase of Peyronie's disease. There is no unanimous consent regarding the management of the acute phase of Peyronie's disease. The objective of this study was to evaluate the advantages of using a single intralesional injection of collagenase Clostridium histolyticum in patients with the active phase of Peyronie's disease and to assess its effect on disease progression by reducing penile curvature and ameliorating pain during sexual intercourse. METHODS Sexually active men aged older than 18 years with the acute phase of Peyronie's disease were enrolled. All patients received treatment with a single intralesional injection of collagenase Clostridium histolyticum. The primary outcome of the study was the change in penile curvature after treatment while secondary outcomes were the change in sexual function (International Index of Erectile Function [IIEF-5]) and in the Peyronie Disease Questionnaire (PDQ) and its sub-scores, PDQ-PS (psychological symptoms), PDQ-PP (penile pain) and PDQ-BD (bother disease). RESULTS Overall, 74 patients were enrolled. Mean penile curvature at baseline was 41.1° ± 12.2°. The mean changes before and at the 3-month evaluation in terms of penile curvature, Visual Analog Scale score at rest, and Visual Analog Scale score during intercourse were - 19.3 ± 8.4 (p < 0.0001), - 0.8 ± 1.1 (p < 0.0001) and - 3.8 ± 0.9 (p < 0.0001) with the benefit persisting also after 6 months. Moreover, improvements of mean IIEF-5 score (1.1 ± 0.9, p = 0.03; 0.9 ± 0.5, p = 0.02), PDQ-PS (- 2.7 ± 2.2; - 2.5 ± 2.0, p = 0.01), PDQ-PP (- 1.2 ± 1.6; - 1.1 ± 1.2, p = 0.02) and PDQ-BD (- 3.8 ± 3.4; - 3.5 ± 3.1, p = 0.001) were observed 3 and 6 months after the end of treatment, respectively. At the multivariable regression analysis, the time since disease onset (modelled with non-linear terms) and baseline curvature were independently associated with the degree of curvature improvement (coefficient: 0.30; 95% confidence interval 0.16-0.44) after a single intralesional injection (all p < 0.03). CONCLUSIONS Although intralesional therapy with collagenase Clostridium histolyticum is not yet indicated for the acute phase of Peyronie's disease, these preliminary results suggest the effectiveness of this minimally invasive option by improving penile curvature and IIEF-5 and PDQ scores.
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Affiliation(s)
- Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy.
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lotti Francesco
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Rizzo
- Department of Urology, University of Trieste, Trieste, Italy
| | - Marina Di Mauro
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
| | - Marco Falcone
- Urology Clinic, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Romano
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
| | | | | | - Esaù Fernández-Pascual
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Viale S. Luca, 50134, Florence, FI, Italy
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Messana F, Faccio D, Sonda R, Scortecci L, Tiengo C, Bassetto F. Wide-awake anesthesia in Dupuytren's contracture treated with collagenase. Hand Surg Rehabil 2020; 40:93-96. [PMID: 32961287 DOI: 10.1016/j.hansur.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
The injection of collagenase followed by cord manipulation is one of the most popular treatments for Dupuytren's contracture. This is traditionally performed under local anesthesia or regional nerve block potentially with sedation. Neither the treatment with collagenase, nor the wide-awake anesthesia are novel techniques for hand surgeons. Nevertheless, we report the first experience of cord manipulation using the wide-awake approach. In this prospective study, we compared the pain perception of patients who underwent wide-awake anesthesia versus traditional local anesthesia. We recorded the pain sensation on a visual analog scale (VAS) (0 to 10) during anesthetic injection, during cord manipulation and before discharge. Wide-awake anesthesia significantly reduced pain levels during anesthetic injection (p=0.003) and cord manipulation (p=0.0009). Pain levels did not differ significantly right before discharge in the two groups (p=0.54). Wide-awake anesthesia can be successfully applied to cord manipulation after collagenase injection in Dupuytren's contracture. This way, it is possible to improve the patient's subjective perspective of the procedure.
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Affiliation(s)
- F Messana
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy.
| | - D Faccio
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - R Sonda
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - L Scortecci
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - C Tiengo
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
| | - F Bassetto
- Clinic of Plastic Surgery, University Hospital of Padua, Via Nicolò Giustiniani 2, Padua, PD 35128, Italy
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Karahan N, Ozdemir G, Kolukısa D, Duman S, Arslanoğlu F, Çetin M. Can Collagenase Be Used in the Treatment of Adhesive Capsulitis? Med Princ Pract 2020; 29:174-180. [PMID: 31480049 PMCID: PMC7098315 DOI: 10.1159/000503086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the efficacy of subacromial injections of collagenase and corticosteroid in rats with experimentally induced adhesive capsulitis. METHOD Thirty adult Wistar albino male rats were distributed into 3 groups of 10 rats each after stabilization of their shoulders for 3 weeks: the first group received a single dose of 0.002 mg (0.25 mL) subacromial collagenase; the second group received a single dose of 1.60 mg (0.25 mL) subacromial steroid, and the third group received a single dose of 0.25 mL subacromial saline solution. One week later, we investigated shoulder range of motions, collagen content of the shoulder, and joint cartilage structure. RESULTS There was no statistically significant difference in the cartilage damage between the groups (p > 0.05). Fibrosis measurements were significantly lower in the collagenase group than in the steroid and saline groups. There was no significant difference in fibrosis between the steroid and saline groups (p > 0.05). Abduction measurements were significantly higher in the collagenase group than in the steroid and saline groups (p < 0.001). No significant difference in the abduction measurements was observed between the saline and steroid groups (p > 0.05). CONCLUSION We observed that subacromial injections of collagenase Clostridium histolyticum effectively treated adhesive capsulitis. The results suggest that this treatment could be considered for use in patients with an intact rotator cuff.
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Affiliation(s)
- Nazım Karahan
- Department of Orthopaedics and Traumatology, Corlu State Hospital, Tekirdağ, Turkey,
| | - Güzelali Ozdemir
- Department of Orthopaedics and Traumatology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Duygu Kolukısa
- Department of Pathology, Mersin City Hospital, Mersin, Turkey
| | - Serda Duman
- Department of Orthopaedics and Traumatology, Diyarbakir Selahattin Eyyubi State Hospital, Diyarbakır, Turkey
| | - Fatih Arslanoğlu
- Department of Orthopaedics and Traumatology, Istanbul Medipol Universitesi, Istanbul, Turkey
| | - Mehmet Çetin
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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Nordenskjöld J, Lauritzson A, Waldén M, Kopylov P, Atroshi I. Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease: study protocol of a randomised controlled trial. BMJ Open 2019; 9:e024424. [PMID: 30808670 PMCID: PMC6398619 DOI: 10.1136/bmjopen-2018-024424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION There is no definitive cure for Dupuytren disease (DD), and recurrence of finger contractures after treatment is common. Surgical fasciectomy is considered the standard treatment method for recurrence, although associated with a high incidence of complications. Collagenase injection, a non-surgical treatment option, has been shown to be a safe and effective method; however, most studies regarding collagenase have involved first-time treatment. Collagenase efficacy in patients with recurrent DD beyond the immediate effect has not yet been determined. The aim of our study is to compare surgical fasciectomy and collagenase injection in treating recurrent DD. METHODS AND ANALYSIS The study is a single-centre randomised controlled trial. Inclusion criteria are recurrence of DD in one or more fingers after previous treatment with fasciectomy or collagenase injection, a passive extension deficit ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint, and a palpable cord causing the recurrent contracture. A total of 56 patients will be randomised to either surgical fasciectomy or collagenase injection. A hand therapist blinded to patients' group allocation will measure range of motion at baseline, 3 months, 12 months, 24 months and 60 months. The primary outcomes are the total active extension deficit (MCP plus PIP) at 3 months and the proportion of patients with contracture worsening ≥20° in the treated finger joint at 2 years compared with 3 months. The secondary outcomes include changes in total active motion, active and passive extension deficit from baseline up to 5 years, scores on patient-reported outcome measures, adverse events and costs of treatment. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Ethical Review Board, Lund University, Sweden(2017/623). The trial will be conducted according to the Helsinki Declaration of 1975, revised in 2000. The results of the trial will be disseminated as published articles in peer-reviewed journals. TRIAL REGISTRATION NCT03406338; Pre-results.
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Affiliation(s)
- Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| | - Anna Lauritzson
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
| | - Markus Waldén
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
| | - Philippe Kopylov
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Strömberg J. [Not Available]. Lakartidningen 2018; 115:E949. [PMID: 31192405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Joakim Strömberg
- Sahlgrenska universitetssjukhuset - Goteborg, Sweden - Avancerad rekonstruktion av extremiteter Mölndal, Sweden
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Boyar V, Galiczewski C. Efficacy of Dehydrated Human Amniotic Membrane Allograft for the Treatment of Severe Extravasation Injuries in Preterm Neonates. Wounds 2018; 30:224-228. [PMID: 30212365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION A peripheral intravenous (PIV) catheter is placed in 60% to 70% of neonatal intensive care unit (NICU) infants. Extravasation injuries occur in 18% to 33%, with 70% in neonates < 27 weeks of gestational age. Despite such frequent use of PIV therapy, evidence on best practice, injury prevention, management, and treatment of extravasations is lacking. OBJECTIVE This case series of 4 neonatal patients describes the experience and efficacy of using a dehydrated human amniotic membrane allograft (dHAMA) in the treatment of severe extravasation injuries. MATERIALS AND METHODS The 4 preterm, critically ill neonates, all with stage 4 extravasations, were treated with 1 to 2 applications of the dHAMA to facilitate the repair process. Prior to treatments, standard of care included either enzymatic (collagenase ointment) or autolytic debridement (active Leptospermum honey) followed by mechanical debridement prior to allograft placement. RESULTS The 4 full-thickness wounds exhibited recalcitrant healing. The dHAMA invigorated the wounds after standard management failed to induce repair. Application was easy and follow-up care was minimal. All wounds healed without contractures and with minimal soft scars and normal pigmentation at the 1- to 2-month follow-up visits. CONCLUSIONS The dHAMA proved to be an effective, safe, and easy-to-apply treatment in this case series, leading to regeneration and healing of deep neonatal wounds associated with extravasations.
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Affiliation(s)
- Vita Boyar
- Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY
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Räisänen MP, Karjalainen T, Göransson H, Reito A, Kautiainen H, Malmivaara A, Leppänen OV. DupuytrEn Treatment EffeCtiveness Trial (DETECT): a protocol for prospective, randomised, controlled, outcome assessor-blinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of collagenase clostridium histolyticum, percutaneous needle fasciotomy and limited fasciectomy as short-term and long-term treatment strategies in Dupuytren's contracture. BMJ Open 2018; 8:e019054. [PMID: 29599391 PMCID: PMC5875682 DOI: 10.1136/bmjopen-2017-019054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Dupuytren's contracture (DC) is a chronic fibroproliferative disorder of the palmar fascia which leads to flexion contracture in one or more fingers. There is no definitive cure for DC, and treatment aims at relieving symptoms by releasing the contracture using percutaneous or operative techniques. METHODS AND ANALYSIS We planned a prospective, randomised, controlled, outcome assessor-blinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of (1) collagenase clostridium histolyticum injection followed by limited fasciectomy in non-responsive cases, (2) percutaneous needle fasciotomy followed by limited fasciectomy in non-responsive cases and (3) primary limited fasciectomy during short-term and long-term follow-up for Tubiana I-III stages DC. We will recruit participants from seven national centres in Finland. Primary outcome is the rate of success in the treatment arm at 5 years after recruitment. Success is a composite outcome comprising (1) at least 50% contracture release from the date of recruitment and (2) participants in a patient-accepted symptom state (PASS). Secondary outcomes are (1) angle of contracture, (2) quick disabilities of the arm, a shoulder and hand outcome measure (QuickDASH), (3) perceived hand function, (4) EQ-5D-3L, (5) rate of major adverse events, (6) patient's trust of the treatment, (7) global rating, (8) rate of PASS, (9) rate of minimal clinically important improvement, (10) expenses, (11) progression of disease, (12) progression-free survival, (13) favoured treatment modality, (14) patients achieving full contracture release and >50% improvement and (15) patient satisfaction with the treatment effect. Predictive factors for achieving the PASS will also be analysed. ETHICS AND DISSEMINATION The protocol was approved by the Tampere University Hospital Institutional Review Board and Finnish Medicine Agency. The study will be performed according to the principles of good clinical practice. The results of the trial will be disseminated as published articles in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03192020; Pre-results.
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Affiliation(s)
- Mikko P Räisänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Teemu Karjalainen
- Department of Hand Surgery and Orthopaedics, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Harry Göransson
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
| | - Aleksi Reito
- Department of Hand Surgery and Orthopaedics, Central Hospital of Central Finland, Jyväskylä, Finland
| | | | - Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli V Leppänen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
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Abstract
PURPOSE To examine agreement on Dupuytren disease (DD) treatment recommendations in an international sample of hand surgeons. METHODS A survey was developed to determine expertise in needle aponeurotomy, surgery, and collagenase injection to treat DD and to examine treatment recommendations for 16 case scenarios. Case scenarios were predeveloped using expert input. Each case represented a unique combination of 4 dichotomous variables including cord thickness, contracture severity, patient age, and joint involvement. Interrater reliability statistics were calculated and multinomial logistic regression modeling and analysis of variance were used to examine the impact of surgeon- and case-related variables on treatment recommendations. RESULTS A total of 36 hand surgeons from 9 countries (mean experience, 17 years) participated. Average pairwise percent agreement and Krippendorff's alpha were 26% and .012, respectively. Predictors of a recommendation for surgery over multiple options were a total contracture of greater than 70°, a thick precentral cord, involvement of the metacarpophalangeal and proximal interphalangeal joints, and greater years in practice. A greater number of years in practice predicted recommendation for collagenase injection and the presence of a thick precentral cord predicted a recommendation for needle aponeurotomy. CONCLUSIONS Little agreement exists on treatment recommendations for common presentations of DD in this sample. CLINICAL RELEVANCE Further investigation into the sources of potential widespread discrepancies in the management of DD may improve the capacity to make evidence-based recommendations.
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Affiliation(s)
- Catherine McMillan
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Celine Yeung
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Paul Binhammer
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
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22
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Abstract
BACKGROUND Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and promote healing, and there are many options to choose from including alginate, hydrocolloid and protease-modulating dressings. Topical agents have also been used as alternatives to dressings in order to promote healing.A clear and current overview of all the evidence is required to facilitate decision-making regarding the use of dressings or topical agents for the treatment of pressure ulcers. Such a review would ideally help people with pressure ulcers and health professionals assess the best treatment options. This review is a network meta-analysis (NMA) which assesses the probability of complete ulcer healing associated with alternative dressings and topical agents. OBJECTIVES To assess the effects of dressings and topical agents for healing pressure ulcers in any care setting. We aimed to examine this evidence base as a whole, determining probabilities that each treatment is the best, with full assessment of uncertainty and evidence quality. SEARCH METHODS In July 2016 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, guidelines and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) comparing the effects of at least one of the following interventions with any other intervention in the treatment of pressure ulcers (Stage 2 or above): any dressing, or any topical agent applied directly to an open pressure ulcer and left in situ. We excluded from this review dressings attached to external devices such as negative pressure wound therapies, skin grafts, growth factor treatments, platelet gels and larval therapy. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. We conducted network meta-analysis using frequentist mega-regression methods for the efficacy outcome, probability of complete healing. We modelled the relative effectiveness of any two treatments as a function of each treatment relative to the reference treatment (saline gauze). We assumed that treatment effects were similar within dressings classes (e.g. hydrocolloid, foam). We present estimates of effect with their 95% confidence intervals for individual treatments compared with every other, and we report ranking probabilities for each intervention (probability of being the best, second best, etc treatment). We assessed the certainty (quality) of the body of evidence using GRADE for each network comparison and for the network as whole. MAIN RESULTS We included 51 studies (2947 participants) in this review and carried out NMA in a network of linked interventions for the sole outcome of probability of complete healing. The network included 21 different interventions (13 dressings, 6 topical agents and 2 supplementary linking interventions) and was informed by 39 studies in 2127 participants, of whom 783 had completely healed wounds.We judged the network to be sparse: overall, there were relatively few participants, with few events, both for the number of interventions and the number of mixed treatment contrasts; most studies were small or very small. The consequence of this sparseness is high imprecision in the evidence, and this, coupled with the (mainly) high risk of bias in the studies informing the network, means that we judged the vast majority of the evidence to be of low or very low certainty. We have no confidence in the findings regarding the rank order of interventions in this review (very low-certainty evidence), but we report here a summary of results for some comparisons of interventions compared with saline gauze. We present here only the findings from evidence which we did not consider to be very low certainty, but these reported results should still be interpreted in the context of the very low certainty of the network as a whole.It is not clear whether regimens involving protease-modulating dressings increase the probability of pressure ulcer healing compared with saline gauze (risk ratio (RR) 1.65, 95% confidence interval (CI) 0.92 to 2.94) (moderate-certainty evidence: low risk of bias, downgraded for imprecision). This risk ratio of 1.65 corresponds to an absolute difference of 102 more people healed with protease modulating dressings per 1000 people treated than with saline gauze alone (95% CI 13 fewer to 302 more). It is unclear whether the following interventions increase the probability of healing compared with saline gauze (low-certainty evidence): collagenase ointment (RR 2.12, 95% CI 1.06 to 4.22); foam dressings (RR 1.52, 95% CI 1.03 to 2.26); basic wound contact dressings (RR 1.30, 95% CI 0.65 to 2.58) and polyvinylpyrrolidone plus zinc oxide (RR 1.31, 95% CI 0.37 to 4.62); the latter two interventions both had confidence intervals consistent with both a clinically important benefit and a clinically important harm, and the former two interventions each had high risk of bias as well as imprecision. AUTHORS' CONCLUSIONS A network meta-analysis (NMA) of data from 39 studies (evaluating 21 dressings and topical agents for pressure ulcers) is sparse and the evidence is of low or very low certainty (due mainly to risk of bias and imprecision). Consequently we are unable to determine which dressings or topical agents are the most likely to heal pressure ulcers, and it is generally unclear whether the treatments examined are more effective than saline gauze.More research is needed to determine whether particular dressings or topical agents improve the probability of healing of pressure ulcers. The NMA is uninformative regarding which interventions might best be included in a large trial, and it may be that research is directed towards prevention, leaving clinicians to decide which treatment to use on the basis of wound symptoms, clinical experience, patient preference and cost.
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Affiliation(s)
- Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Marta O Soares
- University of YorkCentre for Health EconomicsAlcuin 'A' BlockHeslingtonYorkUKYO10 5DD
| | - Nikki Stubbs
- Leeds Community Healthcare NHS Trust, St Mary's HospitalWound Prevention and Management Service3 Greenhill RoadLeedsUKLS12 3QE
| | - Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
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23
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Abstract
OBJECTIVES To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. DESIGN Prospective cohort study. SETTING Orthopaedic Department in Sweden. PARTICIPANTS Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24-48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24-35 months (mean 26) after injection. Five of the patients had received a second injection in the same finger within 6 months of the first injection. OUTCOME MEASURES Primary outcome was proportion of treated joints with ≥20° worsening in AED from 5 weeks to 2 years. RESULTS Between the 5-week and the 2-year measurements, AED had worsened by ≥20° in seven MCP and seven PIP joints (28% of the treated hands; all had received a single injection). Mean AED for the MCP joints was 54° before injection, 6° at 5 weeks and 9° at 2 years and for the PIP joints 30°, 13° and 16°, respectively. For joints with ≥10° contracture at baseline, mean (95 % CI) baseline to 2 years AED improvement was for MCP 49° (41-54) and for PIP 25° (17-32). No treatment-related adverse events were observed at the 2-year follow-up evaluation. CONCLUSIONS Two years after collagenase injections for Dupuytren's disease, improvement was maintained in 72% of the treated hands. Complete contracture correction was seen in more than 80% of the MCP but in less than half of the PIP joints.
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Affiliation(s)
- Anna Lauritzson
- Department of Orthopedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
- Department of Rehabilitation, Hässleholm Hospital, Hässleholm, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
- Department of Clinical Sciences—Orthopedics, Lund University, Lund, Sweden
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Scalise A, Campitiello F, Della Corte A, Longobardi P, Di Salvo M, Tartaglione C, Santin C, Giordan N, Guarnera G. Enzymatic debridement: is HA-collagenase the right synergy? Randomized double-blind controlled clinical trial in venous leg ulcers. Eur Rev Med Pharmacol Sci 2017; 21:1421-1431. [PMID: 28387882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the efficacy and safety of a new ointment containing Hyaluronic Acid and collagenase from non-pathogenic Vibrio alginolyticus. PATIENTS AND METHODS Double blind, multicenter, controlled clinical trial (no. ISRCTN71239043) conducted to demonstrate the superiority of Hyaluronic Acid-Collagenase applied once a day over placebo in mean reduction of devitalized/fibrinous/slough tissue after 15 days of treatment. 113 patients with venous ulcers were enrolled and randomized to receive active treatment therapy or vehicle preparation. Both arms also received compression therapy. Subjects were assessed at baseline and at 4 different clinical study visits up to a maximum of 30 days. Outcome measures included mean percentage debridement evaluated by digital planimetry, pain during change of dressing measured on a visual analogue scale and adverse event assessment for tolerance. RESULTS After 15 days the debridement rate in the active group was 67.5% compared to 59% in the placebo group (p = 0.0436). A significantly higher number of patients in the treatment group achieved 100% debridement by day 15 (p = 0.0025) than in the control group, and a higher percentage also demonstrated complete debridement at every other time point. Pain perception was similar in both groups with low levels during medication. No differences in tolerance were observed between groups. CONCLUSIONS Chronic venous ulcers treated with this novel compound of Hyaluronic Acid and collagenase resulted in a significantly higher debridement rate at Day 15 vs. the control group. Hyaluronic Acid-Collagenase was well tolerated and a low degree of pain was perceived during dressing change. The preparation of 0.2% of Hyaluronic acid-collagenase shows significant benefits in the management of chronic ulcers.
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Affiliation(s)
- A Scalise
- Department of Clinical and Experimental Medicine, Clinic of Plastic and Reconstructive Surgery, Ancona United Hospitals, Marche Polytechnic University, Ancona, Italy.
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25
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Waters MJ, Belsky MR, Blazar PE, Leibman MI, Ruchelsman DE. Collagenase enzymatic fasciotomy for Dupuytren contracture in patients on chronic immunosuppression. Am J Orthop (Belle Mead NJ) 2015; 44:518-521. [PMID: 26566553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Collagenase enzymatic fasciotomy is an accepted nonsurgical treatment for disabling hand contractures caused by Dupuytren disease. We conducted a study to investigate use of collagenase in an immunosuppressed population. We retrospectively reviewed data from 2 academic hand surgical practices. Eight patients on chronic immunosuppressive therapies were treated with collagenase for digital contractures between 2010 and 2011. Thirteen collagenase enzymatic fasciotomies were performed in these 8 patients. Mean preinjection contracture was 53.0°. At mean follow-up of 6.7 months, mean magnitude of contracture improved to 12.9°. Mean metacarpophalangeal joint contracture improved from 42.0° to 4.2°. Mean proximal interphalangeal joint contracture improved from 65.8° to 21.7°. Three of the enzymatic fasciotomies were complicated by skin tears. There were no infections. As more patients seek nonsurgical treatment for Dupuytren disease, its safety and efficacy in select cohorts of patients should continue to be evaluated prospectively.
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26
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Abstract
BACKGROUND Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many different dressing options including hydrogel dressings. A clear and current overview of the current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. OBJECTIVES To assess the effects of hydrogel dressings on the healing of pressure ulcers in any care setting. SEARCH METHODS We searched the following databases: the Cochrane Wounds Group Specialised Register (searched 19 June 2014); The Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 5); Ovid MEDLINE (1946 to June Week 2 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 23 June 2014); Ovid EMBASE (1974 to 20 June 2014); and EBSCO CINAHL (1982 to 18 June 2014). There were no restrictions based on language or date of publication. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) comparing the effects of hydrogel dressings with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above). DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included eleven studies (523 participants) in this review. Ten studies had two arms and one had three arms that were all relevant to this review. Three studies compared a hydrogel dressing with a basic wound contact dressing; three studies compared a hydrogel dressing with a hydrocolloid dressing; three studies compared a hydrogel dressing with another hydrogel dressing; one study compared a hydrogel dressing with a foam dressing; one study compared a hydrogel dressing with a dextranomer paste dressing and one study compared a hydrogel dressing with a topical treatment (collagenase). Limited data were available for analyses in this review: we conducted no meta-analyses. Where data were available there was no evidence of a difference between hydrogel and alternative treatments in terms of complete wound healing or adverse events. One small study reported that using hydrogel dressings was, on average, less costly than hydrocolloid dressings, but this estimate was imprecise and its methodology was not clear. All included studies were small, had short follow-up times and were at unclear risk of bias. AUTHORS' CONCLUSIONS It is not clear if hydrogel dressings are more or less effective than other treatments in healing pressure ulcers or if different hydrogels have different effects, Most trials in this field are very small and poorly reported so that risk of bias is unclear.
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Affiliation(s)
- Jo C Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, UK.
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27
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Sanjuan-Cerveró R, Franco-Ferrando N, Carrera-Hueso FJ, Poquet-Jornet JE, Vazquez-Ferreiro P. Are Really Collagenase Clostriodium Hitolyticum Injections More Effective than Surgical Release? Hand Surg 2015; 20:333-334. [PMID: 26094486 DOI: 10.1142/s0218810415200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Rafael Sanjuan-Cerveró
- * Orthopedics and Traumatology Surgery, Spain
- ‡ Pharm D. Pharmacy Service, Hospital Dr Moliner, Porta Coeli s/n Serra, Valencia, Spain
| | | | - Francisco Javier Carrera-Hueso
- † Head of Orthopedics and Traumatology Surgery, Hospital de Denia Marina Salud, Partida Beniadlà, S/N, Dénia, Alicante, Spain
| | - Jaime Eduardo Poquet-Jornet
- ∥ Pharm D. Head of Pharmacy Service, Hospital de Denia Marina Salud, Partida Beniadlá, S/N, Dénia, Alicante, Spain
| | - Pedro Vazquez-Ferreiro
- ‡ Pharm D. Pharmacy Service, Hospital Dr Moliner, Porta Coeli s/n Serra, Valencia, Spain
- ¶ Ophtalmologic Department, Hospital Virxen da Xunqueira, Cee, A Coruña, Spain
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28
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McInerney NM, O'Shaughnessy M, Clover J. A hand flexion contracture with progression. BMJ 2014; 349:g6137. [PMID: 25358591 DOI: 10.1136/bmj.g6137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Niall M McInerney
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - Michael O'Shaughnessy
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - James Clover
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Republic of Ireland
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29
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Liu DY, Fischer R, Fraga G, Aires DJ. Collagenase ointment and topical timolol gel for treating idiopathic pyoderma gangrenosum. J Am Acad Dermatol 2014; 71:e225-6. [PMID: 25438005 DOI: 10.1016/j.jaad.2014.07.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/17/2014] [Accepted: 07/27/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Deede Y Liu
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas.
| | - Ryan Fischer
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Garth Fraga
- Department of Pathology, University of Kansas Medical Center, Kansas City, Kansas
| | - Daniel J Aires
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
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30
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Rizzo M, Stern PJ, Benhaim P, Hurst LC. Contemporary management of dupuytren contracture. Instr Course Lect 2014; 63:131-142. [PMID: 24720301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dupuytren contracture is a condition that affects the palmar fascia. It most commonly affects men of northern European ancestry and initially presents at middle age. The diseased fascia may form cords that extend into the digits, resulting in limited motion and function. Treatment is aimed at either releasing or removing the diseased cord so that the finger can extend fully. Common interventions include surgery, needle aponeurotomy, and collagenase injection. Surgery remains the gold standard in treatment and most commonly includes a limited fasciectomy. Although often successful, surgery carries inherent risks and may involve a lengthy recovery with extensive therapy. Needle aponeurotomy and collagenase injections are office-based alternatives that aim to weaken the cord and release the contracture. Needle aponeurotomy involves repeated needling along the cord in intervals and collagenase injections to dissolve a portion of the cord. Despite being less invasive, problems such as nerve and/or tendon injury, skin tears, and autoimmune reactions have been reported. Regardless of treatment, recurrence remains a concern.
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Affiliation(s)
- Marco Rizzo
- Associate Professor, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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31
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Tallis A, Motley TA, Wunderlich RP, Dickerson JE, Waycaster C, Slade HB. Clinical and economic assessment of diabetic foot ulcer debridement with collagenase: results of a randomized controlled study. Clin Ther 2013; 35:1805-20. [PMID: 24145042 DOI: 10.1016/j.clinthera.2013.09.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 08/27/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite significant advances, the treatment of diabetic foot ulcers (DFUs) remains a major therapeutic challenge for clinicians, surgeons, and other health care professionals. There is an urgent need for new strategies with clinically effective interventions to treat DFUs to reduce the burden of care in an efficient and cost-effective way. OBJECTIVE This randomized trial evaluated and compared the clinical effectiveness, tolerability, and costs of clostridial collagenase ointment (CCO) debridement to that of debridement using saline moistened gauze (SMG) and selective sharp debridement for the treatment of DFUs. METHODS Randomized, controlled, parallel group, multicenter, open-label, 12-week study of 48 patients with neuropathic DFUs randomized to 4 weeks of treatment with either CCO or SMG after baseline surgical debridement. The primary end point was the condition of the ulcer bed at the end of treatment as measured using a standardized wound assessment tool. Secondary end points were the percentage of reduction in wound area and therapeutic response rates. Adverse events were monitored for the tolerability analysis. In addition, a comparative cost-effectiveness analysis was performed from the perspective of the Centers for Medicare and Medicaid Services as a payer. RESULTS Both the CCO and SMG groups had significantly improved wound assessment scores after 4 weeks of treatment (CCO, -2.5, P = 0.007; SMG, -3.4, P = 0.006). Only CCO treatment resulted in a statistically significant decrease from baseline in the mean wound area at the end of treatment (P = 0.0164) and at the end of follow-up (P = 0.012). In addition, the CCO group exhibited a significantly better response rate at the end of follow-up compared with the SMG group (0.92 vs 0.75, P < 0.05). Reported adverse events were similar between the 2 treatment groups. None of the reported adverse events were considered to be related to treatment. The economic analysis indicated that the direct mean costs per responder in the physician office setting of care were $832 versus $1042 for the CCO group versus the SMG group, whereas the direct mean costs per responder in the hospital outpatient department setting were $1607 versus $1980. CONCLUSIONS CCO treatment provides equivalent debridement of DFUs similar to SMG while fostering better progress toward healing as measured by decreasing wound area over time and improved response rates at the end of follow-up. In addition, CCO yields a more favorable cost-effectiveness ratio in both the physician office and hospital outpatient department settings of care. ClinicalTrials.gov identifier: NCT01056198.
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Affiliation(s)
- Arthur Tallis
- Associated Foot & Ankle Specialists LLC, Phoenix, Arizona
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32
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Abstract
OBJECTIVE The purpose of this study was to determine the cost-effectiveness of enzymatic debridement using collagenase relative to autolytic debridement with a hydrogel dressing for the treatment of pressure ulcers. METHODS A 3-stage Markov model was used to determine the expected costs and outcomes of wound care for collagenase and hydrogel dressings. Outcome data used in the analysis were taken from a randomized clinical trial that directly compared collagenase and hydrogel dressings. The primary outcome in the clinical trial was the proportion of patients achieving a closed epithelialized wound. Transition probabilities for the Markov states were estimated from the clinical trial. A 1-year time horizon was used to determine the expected number of closed wound days and the expected costs for the two alternative debridement therapies. Resource utilization was based on the wound care treatment regimen used in the clinical trial. Resource costs were derived from standard cost references and medical supply wholesalers. The economic perspective taken was that of the long-term care facility. No cost discounting was performed due to the short time horizon of the analysis. A deterministic sensitivity analysis was conducted to analyze economic uncertainty. RESULTS The number of expected wound days for the collagenase and hydrogel cohorts are estimated at 48 and 147, respectively. The expected direct cost per patient for pressure ulcer care was $2003 for collagenase and $5480 for hydrogel debridement. The number of closed wound days was 1.5-times higher for collagenase (317 vs 218 days) than with the hydrogel. The estimated cost/closed wound day was 4-times higher for the hydrogel ($25) vs collagenase ($6). CONCLUSIONS In this Markov model based on a randomized trial of pressure ulcer care in a long-term care setting collagenase debridement was economically dominant over autolytic debridement, yielding better outcomes at a lower total cost. Since it was a single institution study with a small sample size, the results should be interpreted with caution. Specifically, the findings may not necessarily be generalized to other hydrogel dressings, healthcare settings, age groups, or to wounds of other etiologies.
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Skirven TM, Bachoura A, Jacoby SM, Culp RW, Osterman AL. The effect of a therapy protocol for increasing correction of severely contracted proximal interphalangeal joints caused by dupuytren disease and treated with collagenase injection. J Hand Surg Am 2013; 38:684-9. [PMID: 23474162 DOI: 10.1016/j.jhsa.2013.01.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of a specific orthotic intervention and therapy protocol on proximal interphalangeal (PIP) joint contractures of greater than 40° caused by Dupuytren disease and treated with collagenase injections. METHODS All patients with PIP joints contracted at least 40° by Dupuytren disease were prospectively invited to participate in the study. Following standard collagenase injection and cord rupture by a hand surgeon, a certified hand therapist evaluated and treated each patient based on a defined treatment protocol that consisted of orthotic intervention to address residual PIP joint contracture. In addition, exercises were initiated emphasizing reverse blocking for PIP joint extension and distal interphalangeal joint flexion exercises with the PIP joint held in extension to lengthen a frequently shortened oblique retinacular ligament. Patients were assessed before injection, immediately after injection, and 1 and 4 weeks later. There were 22 fingers in 21 patients. The mean age at treatment was 63 years (range, 37-80 y). RESULTS The mean baseline passive PIP joint contracture was 56° (range, 40° to 80°). At cord rupture, the mean PIP joint contracture became 22° (range, 0° to 55°). One week after cord rupture and therapy, the contracture decreased further to a mean of 12° (range, 0° to 36°). By 4 weeks, the mean contracture was 7° (range, 0° to 35°). The differences in PIP joint contracture were statistically significant at all time points except when comparing the means at 1 week and 4 weeks. The results represent an 88% improvement of the PIP joint contracture. CONCLUSIONS In the short term, it appears that severe PIP joint contractures benefit from specific, postinjection orthotic intervention and targeted exercises. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Terri M Skirven
- Philadelphia Hand Center, Thomas Jefferson Medical College, Philadelphia, PA 21218, USA
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van Dijk D, Finigan P, Gerber RA, Szczypa PP, Werker PMN. Recognition, diagnosis and referral of patients with Dupuytren's disease: a review of current concepts for general practitioners in Europe. Curr Med Res Opin 2013; 29:269-77. [PMID: 23320611 DOI: 10.1185/03007995.2013.766163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dupuytren's disease (DD) is a fairly prevalent yet under-recognised disorder of the palmar fascia, resulting in fixed-flexion contractures of joints in the hand. Numerous population-based studies have been conducted in countries around the world, and published prevalence estimates vary widely. Nevertheless, most studies have shown that the prevalence of DD increases with age. Because the global population is aging, the prevalence of DD will also continue to increase. SCOPE Patients with DD typically present to a variety of physicians, generalists and specialists alike. Thus, it is critical that providers have clear guidance on the early recognition of signs and symptoms, comprehensive evaluation of potential risk factors, differential diagnosis and when to refer a patient for treatment. Treatment options range from minimally invasive injections with collagenase to surgery. FINDINGS Results from a large-scale study of the surgical management of DD in Europe indicate that most DD diagnoses and referrals are made by general practitioners, but there is much inter-country variation. Different patient- and physician-based factors affect diagnosis rates and referral pathways. Different healthcare systems and regulations are also influential. A simple management algorithm is provided herein and explained. CONCLUSION It is important for generalists to understand the natural history of DD and the potential benefits of early referral and treatment. General practitioners should diagnose and/or refer patients with DD to a specialist as early as possible to optimise disease management and treatment outcomes.
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Torra i Bou JE, Paggi B. [Collagenase and devitalized tissue in the framework of the wound bed preparation]. Rev Enferm 2013; 36:37-42. [PMID: 23527439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We analyze the role of collagenase, as an indispensable resource for the management and control of the devitalized tissue in the framework of the the wound bed preparation. An analysis and discussion of the physiopathological aspects of collagenase has been performed through a bibliographic review.
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Yurttutan S, Ozdemir R, Erdeve O, Calisici E, Oncel MY, Oguz SS, Dilmen U. Intrauterine upper extremity thrombosis successfully treated with recombinant tissue plasminogen activator, enoxaparin and collagenase. Acta Haematol 2012; 127:189-92. [PMID: 22398687 DOI: 10.1159/000335619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intrauterine ischemia of the limbs is a rare condition involving thrombosis and ischemia of the extremities before birth. The clinical presentation depends on the extremity affected as well as the timing of thrombosis. Very few cases with extremity hypoperfusion and gangrene due to intrauterine thrombosis have been reported in the literature, and therefore there is no consensus on the optimal therapeutic strategy for such cases. Presented here is a case of a newborn with intrauterine brachial arterial thrombosis of the right upper extremity who was successfully treated by a combination of recombinant tissue plasminogen activator, enoxaparin and collagenase application followed by surgery.
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Affiliation(s)
- Sadik Yurttutan
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
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Collagenase Clostridium histolyticum. Short-term benefit in Dupuytren's contracture, unknown long-term risks. Prescrire Int 2011; 20:285-7. [PMID: 22216538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dupuytren's contracture is due to fibroblast overgrowth in the aponeuroses of the hand and fingers, leading to excessive collagen production. This can cause functional impairment due to retraction of one or several fingers.The standard treatment is surgery, but relapses are frequent. A product containing collagenolytic bacterial enzymes (collagenases) is now marketed for local treatment of these retractions. Two double-blind placebo-controlled trials in 308 and 66 patients show that 1 to 3 local injections at one-month intervals lead to near-total reduction in finger retraction in about 50% of cases, versus about 5% of cases after placebo injections. A non-comparative follow-up of 830 successfully treated patients, lasting an average of 7.4 months, showed a relapse rate of 4%. The Most patients experience local reactions such as swelling, bruising, bleeding and pain. These reactions were rarely severe in clinical trials (1% of patients), but cases of tendon rupture have been described. Nearly all treated patients develop anticollagenase antibodies. The only known consequence of this immune reaction is pruritus, reported by about 11% of patients participating in clinical trials. The possible impact of these antibodies on the efficacy of subsequent injections is not known. A certain antigenic kinship between the bacterial collagenases and certain human enzymes raises the possibility of long-term autoimmune reactions. In practice, the limitations of surgical management and the simplicity of local collagenase injections make it a valid option for the treatment of Dupuytren's contracture. Uncertainties concerning the long-term harm-benefit balance mean that this treatment should only be considered when surgery is not an option.
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Chen NC, Shauver MJ, Chung KC. Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. J Hand Surg Am 2011; 36:1826-1834.e32. [PMID: 21981831 DOI: 10.1016/j.jhsa.2011.08.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 08/08/2011] [Accepted: 08/08/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE We undertook a cost-utility analysis to compare traditional fasciectomy for Dupuytren with 2 new treatments, needle aponeurotomy and collagenase injection. METHODS We constructed an expected-value decision analysis model with an arm representing each treatment. A survey was administered to a cohort of 50 consecutive subjects to determine utilities of different interventions. We conducted multiple sensitivity analyses to assess the impact of varying the rate of disease recurrence in each arm of the analysis as well as the cost of the collagenase injection. The threshold for a cost-effective treatment is based on the traditional willingness-to-pay of $50,000 per quality-adjusted life years (QALY) gained. RESULTS The cost of open partial fasciectomy was $820,114 per QALY gained over no treatment. The cost of needle aponeurotomy was $96,474 per QALY gained versus no treatment. When we performed a sensitivity analysis and set the success rate at 100%, the cost of needle aponeurotomy was $49,631. When needle aponeurotomy was performed without surgical center or anesthesia costs and with reduced hand therapy, the cost was $36,570. When a complete collagenase injection series was priced at $250, the cost was $31,856 per QALY gained. When the injection series was priced at $945, the cost was $49,995 per QALY gained. At the market price of $5,400 per injection, the cost was $166,268 per QALY gained. CONCLUSIONS In the current model, open partial fasciectomy is not cost-effective. Needle aponeurotomy is cost-effective if the success rate is high. Collagenase injection is cost-effective when priced under $945. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analysis II.
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Affiliation(s)
- Neal C Chen
- Department of Orthopaedic Surgery and the Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
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Jia S, Zhao Y, Law M, Galiano RD, Mustoe TA. The effect of collagenase on ischemic wound healing: results of an in vivo study. Ostomy Wound Manage 2011; 57:20-26. [PMID: 21904016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many chronic wounds have a limited blood supply and contain necrotic tissue that must be debrided. The effect of collagenase, an enzymatic debriding agent, has been studied in acute but not in chronic wounds. The purpose of this in vivo study is to evaluate the effect of collagenase on wound healing in ischemic wounds. The ears of eight young New Zealand White rabbits were rendered ischemic by ligation of caudal and central arteries and dermal circulation circumferentially so both ears were perfused only by the rostral artery, preserving the caudal, central, and rostra veins. Three 6-mm, full-thickness dermal punches were made on the inner surface of both ears down to perichondrium. One ear on each rabbit was treated with either collagenase or petrolatum ointment covered with a semi-occlusive dressing; wounds on the other ear of the same rabbit were covered with a semi-occlusive dressing only (control). On post-wounding day 8, wound samples were collected and processed for histological analysis of reepithelialization (epithelial gap, percentage healed, epithelial height, and epidermal area) and granulation tissue formation (peak height, granulation tissue distance, and area). Within-animal comparison showed no significant differences between the petrolatum and control wounds but epithelial height, epidermal area, wound peak height, and granulation tissue distance and area were significantly different between the collagenase and control-treated wounds. Between-animal comparison of petrolatum- and collagenase-covered wounds showed statistically significant (P <0.05) differences for the following outcomes: epithelial gap, percenatge healed, epithelial height, epidermal area, wound peak height, and granulation tissue distance and area. In this ischemic wound model, outcomes for most of the variables associated with healing were significantly better in wounds covered with collagenase and a semi-occlusive dressing than in the control or petrolatum group. Additional in vivo studies are warranted to confirm these results.
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Affiliation(s)
- Shengxian Jia
- The Laboratory for Wound Repair and Regenerative Medicine, Division of Plastic Surgery, Department of Surgery, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611-3093, USA.
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Morrow T. Collegenase molecules provide relief for hand contracture disorder. Manag Care 2009; 18:55-56. [PMID: 20088151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Thomas Morrow
- National Association of Managed Care Physicians, USA.
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Ahmed AAR, García-Godoy F, Kunzelmann KH. Self-limiting caries therapy with proteolytic agents. Am J Dent 2008; 21:303-312. [PMID: 19024256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To determine the extent to which artificial carious dentin can be removed by agents that do not seem to attack sound dentin such as pepsin, trypsin, collagenase and NaOCl, and to evaluate the effect of the enzyme pepsin and a new enzymatic solution SFC-V (pepsin in mild acidic buffer) as a self-limiting caries therapy in deep dentin carious lesions using our new model for artificial dentin caries. METHODS Artificial dentin caries was used to investigate different proteolytic agents which have the potential to remove carious tissue. 408 slices of coronal dentin were subjected to a demineralization regime which produces dentin caries very similar to natural lesions: acetic acid (pH 5) or lactic acid (pH 4) were used (7 days). Subsequently, sodium hypochlorite, collagenase, trypsin and pepsin were dissolved each in a suitable buffer and the demineralized dentin was treated for 10 minutes or 24 hours with these solutions. To differentiate the influence of the acidic buffer in case of pepsin, a second experiment was performed. 192 slices were exposed to lactic acid for 1 week. Subsequently the demineralized dentin surfaces were treated with either the enzyme pepsin in its acidic buffer, the acidic buffer alone, and in addition a neutral buffer as a control. In addition a fourth group was added where a new enzyme-based solution SFC-V was used. This second experiment differentiated further the influence of "diffusion enhanced by agitation" versus "diffusion" alone. The application time of the solutions was 3 minutes with and without agitation using a stiff nylon brush. To obtain information on the morphology of the pre- and post-treatment dentin surfaces, high resolution FE-SEM was used. Descriptive statistics were used based on cross tabulation of the morphological criteria. RESULTS Lactic acid produced demineralized dentin covered with a surface layer removable by proteolytic enzymes while acetic acid produced only demineralized dentin. The amount of tissue removed with the current proteolytic agents ranked as follows: trypsin < pepsin < collagenase < NaOCl. The neutral and the acidic buffers did not affect the surface precipitates while the enzyme pepsin and the solution SFC-V were effective in removing the degraded organic matrix.
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Affiliation(s)
- Aya Abdulla Rashid Ahmed
- Department of Operative Dentistry and Periodontology, Ludwig Maximilians University, Goethestrasse 70, D-80336 Munich, Germany
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Aznabaev MT, Munirova LN. [To the prevention of recurrent dacryocystitis after surgical treatment]. Vestn Oftalmol 2008; 124:42-43. [PMID: 18589654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The efficacy of collagenase KK was evaluated in the treatment of 121 patients with lacrimal duct diseases. Collagenase KK used to prevent recurrent lacrimal duct disease contributed to a significant relief of an inflammatory process (by an average of 2.04+/-0.2 days as rapidly as in the controls), recovery of nasal lacrimation, shorter treatment (by an average of 1.8+/-0.11 bed/days), a reduction in the number of complications (by 2.1 times). The findings enable the authors to recommend the agent for wide clinical application in combination with other treatments.
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Glina S, Gelbard MK, Akkus E, Jordan GH, Levine LA. Classic Citations: The use of collagenase in the treatment of Peyronie's disease M.K. Gelbard, A. Lindner, and J.J. Kaufman. J Sex Med 2007; 4:1209-13. [PMID: 17727345 DOI: 10.1111/j.1743-6109.2007.00581.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sidney Glina
- Department of Urology, Instituto H. Ellis, São Paulo, Brazil.
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Abstract
OBJECTIVE Patients with oral submucous fibrosis (OSF) suffer from the limitation of the oral opening. The aim of this study was to develop a simple and rapid method to improve the opening of the oral cavity and determine its effect on the incidence of developing oral carcinoma. METHODS We first induced an OSF-like lesion in rabbits which histopathologically resembles OSF in betel nut chewers and evaluated the effects of exogenous collagenase on these lesions. We then applied the collagenase treatment regimen to patients with OSF. RESULTS Endogenous collagenase activities in normal oral mucosa of patients exhibited 3- to 5-fold higher levels than that of OSF tissues. The collagenase treatment not only resulted in a significant improvement of oral opening, but patients also experienced a striking reduction in hypersensitivity to spices, sour, cold, and heat which helped restore eating function. Sub-mucosal fibrous proliferation, persistently good vascularization, and a mild increase in thickness of the sub-mucosal fibrous tissues were noticed 10 months after collagenase treatment. Within the 2-year follow-up period none of the treated patients developed an oral squamous cell carcinoma. CONCLUSION A reduced content of functional collagenase observed in OSF mucosa of patients might be one mechanism responsible for collagen accumulation. Intervention of OSF by collagenase treatment at the early stage may reduce the incidence of developing oral carcinoma.
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Affiliation(s)
- H-J Lin
- Department of Pathology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Badalamente MA, Hurst LC. Efficacy and safety of injectable mixed collagenase subtypes in the treatment of Dupuytren's contracture. J Hand Surg Am 2007; 32:767-74. [PMID: 17606053 DOI: 10.1016/j.jhsa.2007.04.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 04/03/2007] [Accepted: 04/04/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To further evaluate the efficacy and safety of an injectable mixed subtype collagenase for the treatment of Dupuytren's contracture (DC). METHODS Patients with flexion deformities of the metacarpophalangeal (MCP) and/or the proximal interphalangeal (PIP) joints of 20 degrees or greater were randomized in a double-blind, placebo-controlled trial. Patients completing this phase could enter an open-label extension phase. The primary efficacy variable was clinical success: contracture correction to within 5 degrees of normal (normal, 0 degrees ). Additional efficacy variables included the time and number of injections required to achieve success in the primary joint. Recurrence of contracture to 20 degrees or greater in successfully treated joints and adverse events (AEs) were recorded. RESULTS Thirty-three of 35 patients (mean +/- SD, 61 +/- 9 y) entering the double-blind phase completed the study; 19 of them entered the open-label extension. In the double-blind phase, clinical success of the primary joint was achieved in 16 of 23 patients receiving 1 injection and in 21 of 23 patients receiving 3 injections. No placebo-treated patients achieved joint correction. In the open-label extension, 17 of 19 patients achieved clinical success in at least 1 joint. The mean number of injections for clinical success in the double-blind and extension phases was 1.5 and 1.4, respectively; the time to clinical success ranged between 1 and 29 days. Overall, of 62 joints (31 MCP, 31 PIP) treated in 35 patients, 54 joints achieved clinical success. Over the 24-month follow-up period after the last injection, 5 joints had a recurrence. The most frequent treatment-related AEs were local reactions to injections. AEs were mild and resolved over several weeks. There were no serious treatment-related AEs. CONCLUSIONS The collagenase injections safely and effectively corrected MCP and PIP contractures in patients with 1 or more DC-affected joints. Recurrence rates after treatment appear to be low. Data suggest that this collagenase appears to be a viable nonsurgical treatment option for DC.
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Affiliation(s)
- Marie A Badalamente
- Department of Orthopedics, State University of New York at Stony Brook, Health Science Center, Stony Brook, NY 11794-8181, USA.
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Abstract
PURPOSE To carry out a systematic review and meta-analysis of the efficacy of chemonucleolysis in the treatment of lumbar disc herniation. METHODS Clinical trials were selected from 3 electronic databases (The Cochrane Controlled Trials Register, MEDLINE, and EMBASE). Data were analyzed with the software STATA, using the meta command. RESULTS Twenty-two clinical trials were eligible. For chemonucleolysis versus placebo, the summary risk ratio estimate for pain relief as outcome was 1.51 (95% CI: 1.27-1.80). The summary estimate was 1.07 (95% CI: 0.95-1.20) for the comparison between chymopapain and collagenase. Regarding chemonucleolysis with chymopapain versus surgery, the fixed-effect summary estimate of effect for pain relief was 0.93 (95% CI: 0.88-0.98) with surgery as the reference group. In this case, heterogeneity was statistically significant. CONCLUSIONS Chemonucleolysis with chymopapain was superior to placebo and was as effective as collagenase in the treatment of lumbar disc prolapse. Results for studies comparing chemonucleolysis with surgery were heterogeneous, making it difficult to interpret the summary measure of effect.
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Paramonov BA, Turkovskiĭ II, Bondarev SV. [Application of enzymes for treatment of patients with hypertrophic cicatrices]. Vestn Khir Im I I Grek 2007; 166:84-85. [PMID: 17966664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Treatment of 27 patients by electrophoresis with preparation "Polycollagenase K" was analyzed and it was shown that it gave positive results according to complex assessment by the scale developed by the authors.
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Abstract
Franz diffusion cells containing uniformly dehydrated equine blood clots to simulate fibrinous eschar were used to measure the rate of debridement of fibrin by novel and traditional wound dressings, under standardised conditions of temperature, pH and humidity. Significant increases in protein breakdown occurred within 24 hours with all the dressings, but not thereafter. In general, dressings hydrated in normal saline were better as debriding agents than dressings hydrated in water. Autolytic debriding agents were 47 per cent more effective than chemical debriding agents; specifically, hydrofibre and gauze dressings hydrated in saline broke down more than 3500 microg/ml of protein whereas dressings impregnated with proteolytic enzymatic agents digested less than 1400 microg/ml.
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Affiliation(s)
- R Pain
- The Cottage, 75A Blackheath Road, London SE10 8PD
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Makarov IA. [Densitometric analysis of changes in the vitreous body after cataract extraction]. Vestn Oftalmol 2006; 122:38-40. [PMID: 16927784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Densitometric methods for analyzing the images obtained at biomicroscopy were used to study the transparency of the spatium retrolentalis, membrana hialoidea anterior, and pars retrolenticularis of the vitreous body of 45 eyes after cataract phacoemulsification. In half the patients, the optical density in these structures has shown to increase as compared with the normal values, which is mainly associated with the opacity of the vitreous body and the increased destruction of its tracts. The results of drug treatment and a role of additional therapy with plasmin and collagenase activators in the complete rehabilitation of patients after surgical cataract treatment are discussed.
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Marazzi M, Stefani A, Chiaratti A, Ordanini MN, Falcone L, Rapisarda V. Effect of enzymatic debridement with collagenase on acute and chronic hard-to-heal wounds. J Wound Care 2006; 15:222-7. [PMID: 16711179 DOI: 10.12968/jowc.2006.15.5.26910] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A large retrospective analysis was performed to assess the outcomes of burns and chronic ulcers treated with collagenase in an outpatient setting. No cost comparison was performed. METHOD Of 979 patients entered into the analysis, 647 had burns affecting < or = 15% body surface area (BSA) and 332 had chronic ulcers of various aetiologies. AII were treated with collagenase-based ointments once daily (Noruxol or Iruxol, Smith and Nephew). Treatment was continued until complete healing was achieved. RESULTS In burns patients the overall average healing time was 17.9 days in the paediatric population and 23.6 days in adults. Burn depth and presence of eschar were the main factors affecting healing probability. The chronic ulcers were predominantly of diabetic, venous and mixed aetiology. Average healing time was 15.4 weeks, with ulcers of mixed aetiology showing the shortest average healing time (9.2 weeks). There was a positive correlation between wound area and healing time. The topical application of collagenase-based ointments was well tolerated by patients and caregivers. CONCLUSION This large retrospective analysis shows that collagenase treatments in outpatient clinics are effective and well accepted in patients with burns affecting < or = 15% BSA or with chronic ulcers of various aetiologies. Implementation of collagenase treatments in outpatient clinics has the potential to improve wound healing and may also decrease the cost of wound care.
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Affiliation(s)
- M Marazzi
- Department of Tissue Therapy, Hard-To-Heal Ulcer Clinic, Niguarda Ca' Granda Hospital, Milan, Italy.
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