| 1. |
- Atroshi, Isam, et al.
(författare)
-
Collagenase treatment of Dupuytrens contracture using a modified injection method
- 2015
-
Ingår i: Acta Orthopaedica. - : Informa Healthcare: Creative Commons Attribution Non-Commercial / Informa Healthcare. - 1745-3674 .- 1745-3682. ; 86:3, s. 310-315
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Treatment of Dupuytrens contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods - We studied 164 consecutive hands with DC, palpable cord, and extension deficit of greater than= 20 degrees in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7-34) days after finger extension. Results - A skin tear occurred in 66 hands (40%). The largest diameter of the tear was less than= 5 mm in 30 hands and greater than 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59 degrees (SD 26) as opposed to 32 degrees (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of greater than= 75 degrees. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55 degrees (SD 28). Interpretation - Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good.
|
|
| 2. |
- Eckerdal, David, et al.
(författare)
-
Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease : A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy
- 2022
-
Ingår i: Journal of Hand Surgery. - : Elsevier BV. - 0363-5023. ; 47:9, s. 834-842
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment. Methods: This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended follow-up evaluation performed by 2 independent examiners (participation rate 84% and 93%, respectively). We defined current contracture in a treated finger as an active extension deficit of ≥20° in the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint or a total (MCP + PIP) active extension deficit (TAED) of ≥30°. We used linear mixed models to analyze differences between the cohorts over time. Results: In the collagenase cohort, current contracture was present in 45 (25%) MCP and 60 (33%) PIP joints, and in the fasciectomy cohort, current contracture was present in 12 MCP (19%) and 30 PIP (48%) joints; a TAED of ≥30° was present in 79 (44%) of the collagenase-treated and 30 (48%) of the fasciectomy-treated fingers. In MCP and PIP joints with ≥20° pretreatment contracture, complete correction was observed in 82 (56%) MCP and 30 (30%) PIP joints in the collagenase cohort and 23 (70%) MCP and 5 (16%) PIP joints in the fasciectomy cohort. There was no statistically significant difference between the 2 cohorts in the TAED change over time. Conclusions: In patients with DD, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. Type of study/level of evidence: Therapeutic IV.
|
|
| 3. |
- Lindstrand, Anna, et al.
(författare)
-
From cytogenetics to cytogenomics : whole-genome sequencing as a first-line test comprehensively captures the diverse spectrum of disease-causing genetic variation underlying intellectual disability
- 2019
-
Ingår i: Genome Medicine. - : BMC. - 1756-994X. ; 11:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundSince different types of genetic variants, from single nucleotide variants (SNVs) to large chromosomal rearrangements, underlie intellectual disability, we evaluated the use of whole-genome sequencing (WGS) rather than chromosomal microarray analysis (CMA) as a first-line genetic diagnostic test.MethodsWe analyzed three cohorts with short-read WGS: (i) a retrospective cohort with validated copy number variants (CNVs) (cohort 1, n=68), (ii) individuals referred for monogenic multi-gene panels (cohort 2, n=156), and (iii) 100 prospective, consecutive cases referred to our center for CMA (cohort 3). Bioinformatic tools developed include FindSV, SVDB, Rhocall, Rhoviz, and vcf2cytosure.ResultsFirst, we validated our structural variant (SV)-calling pipeline on cohort 1, consisting of three trisomies and 79 deletions and duplications with a median size of 850kb (min 500bp, max 155Mb). All variants were detected. Second, we utilized the same pipeline in cohort 2 and analyzed with monogenic WGS panels, increasing the diagnostic yield to 8%. Next, cohort 3 was analyzed by both CMA and WGS. The WGS data was processed for large (>10kb) SVs genome-wide and for exonic SVs and SNVs in a panel of 887 genes linked to intellectual disability as well as genes matched to patient-specific Human Phenotype Ontology (HPO) phenotypes. This yielded a total of 25 pathogenic variants (SNVs or SVs), of which 12 were detected by CMA as well. We also applied short tandem repeat (STR) expansion detection and discovered one pathologic expansion in ATXN7. Finally, a case of Prader-Willi syndrome with uniparental disomy (UPD) was validated in the WGS data.Important positional information was obtained in all cohorts. Remarkably, 7% of the analyzed cases harbored complex structural variants, as exemplified by a ring chromosome and two duplications found to be an insertional translocation and part of a cryptic unbalanced translocation, respectively.ConclusionThe overall diagnostic rate of 27% was more than doubled compared to clinical microarray (12%). Using WGS, we detected a wide range of SVs with high accuracy. Since the WGS data also allowed for analysis of SNVs, UPD, and STRs, it represents a powerful comprehensive genetic test in a clinical diagnostic laboratory setting.
|
|
| 4. |
- Nordenskjöld, Jesper, et al.
(författare)
-
Benefit of Local Anesthesia in Reducing Pain during Collagenase Injection for Dupuytrens Contracture
- 2017
-
Ingår i: Plastic and reconstructive surgery (1963). - : Lippincott Williams & Wilkins. - 0032-1052 .- 1529-4242. ; 140:3, s. 565-569
-
Tidskriftsartikel (refereegranskat)abstract
- Collagenase injection for Dupuytrens contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received collagenase using the standard method (0.58 mg injected in one spot) without local anesthesia. Immediately after the first injection (collagenase or local anesthesia), the patients rated the severity of injection-related pain on a visual analogue scale from 0 (no pain) to 10 (worst pain). Before finger manipulation 1 or 2 days after injection, the patients rated the pain experienced since injection. Mean score +/- SD for pain experienced during modified collagenase injection was 4.3 +/- 2.5 without local anesthesia and 2.3 +/- 1.7 during injection of local anesthesia (before collagenase) (age-and sex-adjusted mean difference, 2.1; 95 percent CI, 1.5 to 2.7; p amp;lt; 0.001). Mean pain score +/- SD during standard collagenase injection without local anesthesia was 4.8 +/- 1.8. Mean pain score +/- SD during the injection-manipulation interval was 2.9 +/- 1.9 in the group without local anesthesia and 2.9 +/- 2.3 in the local anesthesia group (p = 0.79). This study shows that local anesthesia significantly reduces the patients overall pain experience during collagenase treatment for Dupuytrens contracture.
|
|
| 5. |
- Nordenskjöld, Jesper, et al.
(författare)
-
Collagenase injections for Dupuytren disease : 3-year treatment outcomes and predictors of recurrence in 89 hands
- 2019
-
Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 90:6, s. 517-522
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Few prospective studies have reported the long-term effect durability of collagenase injections for Dupuytren disease. We assessed the 3-year treatment outcome of collagenase injections and predictors of recurrence. Patients and methods — We conducted a single-center prospective cohort study. Indication for collagenase injection was palpable Dupuytren’s cord and active extension deficit (AED) ≥ 20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. From November 2012 through June 2013, we treated 86 consecutive patients (92 hands, 126 fingers). A hand therapist measured joint contracture before, 5 weeks, and 3 years after injection. The patients rated their treatment satisfaction. Primary outcome was proportion of treated joints with ≥ 20° AED worsening between the 5-week and 3-year measurements. We analyzed predictors of recurrence. Results — 3-year outcomes were available for 83 of the 86 patients (89 hands, 120 treated fingers). Between the 5-week and 3-year measurements, AED worsened by ≥ 20° in 17 MCP (14%) and 28 PIP (23%) joints. At 3 years, complete correction (passive extension deficit 0–5°) was present in 73% of MCP and 35% of PIP joints. Treatment of small finger PIP joint contracture, greater pretreatment contracture severity, and previous fasciectomy on the treated finger were statistically significant predictors of recurrence. Treatment satisfaction was rated as very satisfied or satisfied in 59 of 87 hands. No long-term treatment-related adverse events were observed. Interpretation — 3 years after collagenase injections for Dupuytren disease, improvement was maintained and treatment satisfaction reported in two-thirds of the treated hands, with no adverse events. Complete contracture correction was achieved in 3 of 4 MCP joints, but in only a third of the PIP joints.
|
|
| 6. |
- Nordenskjöld, Jesper, et al.
(författare)
-
Delayed vascular complication after collagenase injection for Dupuytren disease
- 2023
-
Ingår i: BMC Musculoskeletal Disorders. - 1471-2474. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Vascular adverse events after collagenase injection for Dupuytren disease are absent in large trials and systematic reviews. The aim of this study is to present a case series of delayed vascular complications after collagenase treatment. Methods: A prospective evaluation of 1181 consecutively treated patients at one orthopedic department identified three patients reporting symptoms of possible vascular complication. Baseline demographics and description of symptoms were collected, with a physical examination documenting extension deficit and neurovascular status. All patients completed the Cold Intolerance Symptom Severity (CISS) scale (range 4-100, lower is better) and underwent Doppler sonography examination of the digital arteries. Results: All patients were treated in the small finger and two had an isolated proximal interphalangeal joint contracture. All patients had a delayed presentation of a few months, with episodes of white discoloration of the treated finger relieved within 30 min and associated with variable pain, paresthesia, stiffness and weakness. Two of the patients reported cold exposure as an episode trigger and had a pathological CISS score (40 and 36, respectively). Doppler sonography identified a nonpatent ulnar digital artery in one patient. Conclusions: Delayed vascular complication after collagenase treatment is rare, but surgeons and patients should be aware of the risk, especially when treating the small finger.
|
|
| 7. |
- Nordenskjöld, Jesper
(författare)
-
Dupuytren disease: Prevalence, treatment and outcome
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Purpose To study the epidemiology of Dupuytren disease and evaluate treatment outcome of collagenase injections using a modified method.Patients and methods Paper I is a register-based study. From the general population of Skåne region (1.3 million) in southern Sweden, we identified all residents aged ≥20 years who had been diagnosed with Dupuytren disease during a 16-year period and identified treatments associated with the diagnosis. Papers II-V are prospective cohort studies assessing patients with Dupuytren disease treated with collagenase injections using a modified method. Treatment indication was a palpable cord and an active extension deficit (AED) ≥20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. In Paper II, 146 patients were evluated for skin tear occurrence and short-term treatment outcome. In Paper III, 187 patients were divided into 3 groups, comparing collagenase injection-related pain with or without prior local anesthesia (LA) using the the visual analog scale (VAS). In Paper IV, 86 patients were evaluated 3 years after treatment with the proportion of joints that demonstrated contracture recurrence (AED worsening ≥20°) as the primary outcome. In Paper V, 157 patients were examined by 3 hand therapists, investigating possible examiner-related difference between AED and passive extension deficit (PED) measurements. Paper VI is an ongoing randomized controlled trial of surgical fasciectomy versus collagenase injection for recurrent Dupuytren disease. Results The overall prevalence of doctor-diagnosed Dupuytren disease was 0.92%, peaking in men ≥70 years at 4.6%. 56% of diagnosed individuals underwent treatment. Skin tears, mostly minor, occurred in 40% of hands treated with collagenase injection. Greater severity of MCP joint contracture was a risk factor for skin tear. All skin tears healed with open-wound treatment, with no infections or surgical interventions required. Mean short-term contracture improvement in total AED was 55°. LA significantly reduced collagenase injection-related pain (mean VAS difference 2.1). At 3 years, complete correction (PED 0-5°) was observed in 3 of 4 MCP joints, but only in a third of PIP joints. Treatment of small finger PIP joint contractures, greater pretreatment contracture severity and previous surgical fasciectomy were significant predictors of recurrence. 70% of patients were satisfied with treatment and no adverse events were reported. The identity of the examiner was a significant determinant of the measured PED-AED difference.Conclusion Dupuytren disease is a common cause of medical consultation. Collagenase injection is a safe and effective minimally-invasive treatment method, especially for MCP joint contractures. Skin tears commonly occur during the finger manipulation procedure, but the healing prognosis is excellent. LA significantly reduces collagenase injection-related pain. Mesurement of PED may vary significantly between examiners. An ongoing randomized controlled trial will provide evidence regarding treatment of recurrent Dupuytren disease.
|
|
| 8. |
- Nordenskjöld, Jesper, et al.
(författare)
-
Examiners' influence on the measured active and passive extension deficit in finger joints affected by Dupuytren disease
- 2018
-
Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 18:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The most commonly reported outcome measure in Dupuytren disease is the extension deficit in finger joints. This study aimed to investigate the examiners' influence on the measured difference between active and passive extension deficit. Methods: A prospective cohort study was conducted on 157 consecutive patients (81% men, mean age 70 years) scheduled for collagenase treatment for Dupuytren disease. Before injection, one of three experienced hand therapists measured active extension deficit (AED) and passive extension deficit (PED) in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the affected fingers using a hand-held metal goniometer. We included joints with ≥10° AED, and calculated mean AED and PED in MCP and PIP joints measured by each examiner. For adjusted analysis we used a mixed effects model to determine the relationship between the examiner and the AED-PED difference. Results: For all 291 joints measured, mean AED was 46° (SD 21) and mean PED was 37° (SD 23). Mean difference between AED and PED measured by examiner 1 was 6° (SD 6), by examiner 2 was 9° (SD 9), and by examiner 3 was 12° (SD 9). The mixed effects model analysis showed that the identity of the examining therapist was a significant determinant of the AED-PED difference. Conclusions: In Dupuytren disease measurement of active and passive extension deficit in finger joint contractures may vary significantly between different examiners. This must be taken into consideration when designing clinical studies and comparing outcomes between studies.
|
|
| 9. |
- Nordenskjöld, Jesper, et al.
(författare)
-
Surgical fasciectomy versus collagenase injection in treating recurrent Dupuytren disease : Study protocol of a randomised controlled trial
- 2019
-
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:2
-
Tidskriftsartikel (refereegranskat)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.
|
|
