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 […]
Cortisone shots for Dupuytren’s nodules
Cortisone injections have been used for many years as an early treatment for Dupuytren’s in the nodular stage of involvement. This approach is based on clinical experience, but what is the actual biology? It may have to do with the finding that tissue matrix as well as the blood vessel cells in Dupuytren’s nodules have […]
Feedback Loops in Dupuytren’s
The best hope for finding a medical cure for Dupuytren’s and other fibrotic conditions is through a better understanding of abnormal cell signalling feedback loops regulating fibrosis. Cellular collagen metabolism regulation is not fully understood. Here are a few puzzle pieces. The protein transforming growth factor beta (TGF-ß), among other things, signals myofibroblasts to produce […]
The Dupuytren Symposium is coming!
As tomorrow’s deadline for abstract submission nears, internet connections are heating up at command central for the 2010 International Symposium on Dupuytren’s Disease. The symposium syllabus looks very exciting, with some amazing new reports. Session topics have solidified as: The Myofibroblast; Genetics and Demographics; Disease Concepts; Collagen and Collagenase; Surgical Treatments; Energy Based Treatments; Manual […]
Needle Release of Dupuytren’s: 2010 Manual of Technique
Percutaneous fasciotomy for Dupuytren’s contracture is an old procedure, but was reinvented by Dr. Lermusiaux in Paris in the 1980s, who used a small needle rather than a scalpel. This modification allows the procedure to be performed using almost no anesthesia, which gives an unprecedented safety margin: the patient can easily confirm whether nerves or […]
Management strategies for Dupuytren’s
The management options for people with Dupuytren’s can appear as confusing as the biology. This review provides a nice overview of Dupuytren’s disease and a practical decision tree approach to manage hands affected by Dupuytren’s. It’s worth a read: http://www.dupuytrenfoundation.org/DupPDFs/2006_Bayat_1586.pdf
Homeopathy for Dupuytren’s
HH Reckeweg (1905-1985) in Germany developed the Disease Evolution Table of homeopathic medicine. In this system, Dupuytren’s contracture is classified as a mesenchymal-connective tissue cellular-degeneration phase disease. This should be the starting point for homeopathic physicians to begin developing a homeopathic cure for Dupuytren’s. See where Dupuytren’s fits on the Disease Evolution Table: http://www.dupuytrenfoundation.org/DupPDFs/1985_Reckeweg.pdf
Machines to Stretch Dupuytren’s Cords
There is not yet a perfect solution for PIP contractures from Dupuytren’s Disease, or for PIP contractures in general. One approach has been to use temporary skeletal fixation devices to slowly lengthen Dupuytren’s cords and scar tissue. The collagen bundles in Dupuytren’s cords don’t actually stretch: they remodel, disconnecting crosslinks between adjacent strands, sliding adjacent […]
Dupuytren’s, epilepsy, barbiturates and genes: a chemical love …triangle.
Dupuytren’s has been associated with epilepsy. The type or cause of epilepsy doesn’t seem to matter. What does matter is the specific medication phenobarbitone. Dupuytren’s was not common in epileptics prior to the common use of this medicine, but is very common in people on long term treatment with it: Dupuytren’s will be found in […]
