Genes, enzymes and Dupuytren’s: the alphabet name game.
A proteinase is an enzyme which breaks down proteins. Metalloproteinases (MPs) are proteinases with a molecular structure and function involves a metal atom, usually zinc. Matrix Metalloproteinases (MMPs) are MPs which act outside of cells, in the tissue matrix. Human collagenases are MMPs which break down different types of collagen. Membrane-type MMPs (MT-MMPs) are MMPs […]
LSD as a treatment for Dupuytren’s?
There is one published report of Dupuytren’s being cured, fingers suddenly straightened, under the influence of the psychedelic drug LSD (full text: http://www.dupuytrenfoundation.org/DupPDFs/1966_Solursh_1417.pdf). Is this true? Probably not. LSD is a serotonin antagonist, and other serotonin antagonist drugs, such as methysergide, have been shown to cause retroperitoneal and cardiac valve fibrosis. Based on this information, […]
FDA approves Collagenase for Dupuytren’s
Collagenase (Xiaflex) has been approved by the FDA for treatment of Dupuytren’s contracture, after years of intensive laboratory and clinical trials. Collagenase enzymatic fasciotomy is more similar to needle fasciotomy than to either open fasciotomy or fasciectomy in terms of rapid recovery and low complication rate. Compared to needle release, collagenase enzymatic fasciotomy should eventually […]
Dupuytren’s Genes
The hunt is on for the genetic basis of Dupuytren’s. A interesting analysis of the chromosome patterns found in Dupuytren’s tissue found a variety of genetic abnormalities and the unexpected finding that these variations were not found in the skin but were seen in areas of palmar fascia not usually involved with Dupuytren’s. (full text: […]
Luck and Dupuytren’s
Needle aponeurotomy for Dupuytren’s is not that new. It’s a new twist on the very first operation described for Dupuytren’s, percutaneous fasciotomy, which was performed by Cooper years before Dupuytren’s famous presentation. Adams wrote extensively about his results with percutaneous fasciotomy for Dupuytren’s in the late 1800s. Before Lermusiaux began using a needle for percutaneous […]
ß Catenin, Transforming Factor ß and Dupuytren’s
The physical changes associated with Dupuytren’s are similar to the process which heals open wounds through contraction and collagen production. Thanks to sophisticated laboratory research, the molecular controls for this process are beginning to be understood. See http://multimedia.mcb.harvard.edu/anim_innerlife.html for an amazing animation of how molecular cellular controls act like tiny physical machines. In Dupuytren’s, two […]
A Sampling of Patient Information Brochures on Dupuytren’s
What do health care providers think you should know or want to know about Dupuytren’s? Here is a sampling of patient information materials from the government http://dupuytrens.org/DupPDFs/2010_NHS-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_OBS-ptinfo.pdf, organizations of hand surgeons http://dupuytrens.org/DupPDFs/2010_AAHS-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_ASSH-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_BSSH-ptinfo.pdf, individual physicians and hospitals http://dupuytrens.org/DupPDFs/2010_eHand-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_KWO-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2002_Hurst-ptinfo.pdf, http://dupuytrens.org/DupPDFs/2010_Lancashire-ptinfo.pdf and hand therapists http://dupuytrens.org/DupPDFs/2010_Kramer-ptinfo.pdf. Of course, a wide range of information is […]
Needle Aponeurotomy for Dupuytren’s
Needle aponeurotomy for Dupuytren’s contracture is a type of fasciotomy performed under local anesthesia. Compared to fasciectomy, it is less of an ordeal for the patient in terms of both procedure and recovery and has a lower complication rate. This report (full text: http://www.dupuytrenfoundation.org/DupPDFs/2008_Cheng_1610.pdf) reviews one group’s experience with needle aponeurotomy.
Dupuytren’s and Transforming Factor Beta Genetics
What is the initial abnormality which ultimately results in Dupuytren’s? Because biologic systems are guided by tiny triggers which start a cascading series of events, tiny differences can have large effects, and the hunt is sometimes for tiny differences early in the game. Transforming Factor Beta One (TGF-ß1) is one of the starting players in […]
Dermofasciectomy reconsidered
There are three mechanical approaches for Dupuytren’s. In order of both increasing problems and long term effectiveness, these are: fasciotomy (cut fascia); fasciectomy (remove fascia); dermofasciectomy (remove both skin and fascia). The popularity of dermofasciectomy and skin grafting has been limited by concerns regarding complications of wound healing and loss of flexion. Some of these […]
