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PubMed2004

Wound healing-associated proteins Hsp47 and fibronectin are elevated in Dupuytren's contracture.

BACKGROUND: Dupuytren's contracture or disease (DD) affects hand function by causing irreversible contraction of the palmar fascia. Histological analysis has shown that DD and wound granulation tissue share many cellular and biochemical characteristics, suggesting that DD may be an exaggerated wound-healing response. The goal of the present study was to examine the possible involvement of two important wound-healing-associated proteins-heat shock protein 47 (Hsp47), fibronectin (Fn), and its oncofetal isoforms-in DD, using clinical tissue samples and primary cell cultures. MATERIALS AND METHODS: We examined the expression of Hsp47, Fn, and an oncofetal isoform of fibronectin (IIICS) in both normal and disease-matched surgical specimens and primary cell cultures using Western blot analysis, and immunocytochemistry (ICC). RESULTS: Our results indicate that Hsp47 and total fibronectin is elevated in DD lesional tissue. In addition, Western and ICC analysis of patient-matched (normal and disease) primary cultures show significantly elevated levels of oncofetal fibronectin (IIICS spliced variant) within disease primary cell cultures. CONCLUSIONS: The high levels of expression of Hsp47 and adult and oncofetal fibronectin in DD suggests that cell-mediated alterations in the extracellular environment may play an important role in the disease process. Furthermore, the involvement of these wound healing-associated proteins in DD supports the notion that this disease may be an exaggerated form of wound healing.

Blotting, Western↗
PubMed2005

Comprehensive study of bladder neck contracture after transurethral resection of prostate.

OBJECTIVES: To test the validity of transurethral resection of the prostate (TURP) plus transurethral incision (TUI) of bladder neck as an alternative to TUI of the prostate, a nonrandomized and retrospective study was done to review comprehensively the incidence of, severity of, and risk factors for bladder neck contracture (BNC) in patients with benign prostatic hyperplasia who underwent transurethral surgery. METHODS: The evaluation parameters included age, prostate-specific antigen level, urinalysis and uroflowmetry findings, voided volume, presence of vesical stones and urinary retention, surgical type, adenoma weight, and perioperative morbidities. RESULTS: Of the 1470 patients studied, 1135 (77.2%) were eligible for analysis. At a mean follow-up of 37.9 months, 110 patients (9.7%) had developed BNC. The adenoma weight, blood transfusion, and postoperative maximal and mean flow rate in patients with BNC were significantly less than in patients without BNC. The incidence of BNC in the TURP group was greater than that in the TURP plus TUI group (12.3% versus 6%, P = 0.000). BNC was completely prevented using TURP plus TUI if the adenoma weight was greater than 30 g. However, in the TURP group, 4% of patients developed BNC even with an adenoma weight greater than 50 g. Multivariate analyses showed that adenoma weight and surgical type were significant risk factors for BNC. Patients with associated vesical stones were less prone to develop BNC. CONCLUSIONS: TURP plus TUI provides a pathologic diagnosis, and with minimal morbidity, it can be an alternative to TUI of the prostate in selected patients. Personal diathesis may play a role in the pathogenesis of BNC.

Aged↗
PubMed2005

Cystoprostatectomy and orthotopic ileal neobladder reconstruction for management of bacille Calmette Guérin-induced bladder contractures.

OBJECTIVES: To evaluate the incidence of bacille Calmette-Guérin (BCG)-contracted bladders and attempt to ascertain the potential risk factors for this severe complication. BCG is the most effective intravesical agent for the treatment of high-grade, noninvasive transitional cell carcinoma (TCC) of the bladder. Widely used by urologists for the management of superficial TCC, adverse effects are not uncommon. These adverse effects are most commonly limited to irritative voiding symptoms, hematuria, and fever; however, severe adverse effects may occur. METHODS: We retrospectively reviewed two cystectomy databases (University of Southern California/Norris Cancer Center and University of Miami Miller School of Medicine) and identified patients who underwent cystectomy and orthotopic neobladder reconstruction for BCG-induced bladder contracture. RESULTS: We identified 1 case each in the two institutions' cystectomy databases of severely contracted bladders. The overall incidence of this complication leading to cystectomy was 0.05% and 0.3% at each institution. Both patients were salvaged with cystoprostatectomy and orthotopic reconstruction with an ileal neobladder. Neither patient had residual cancer at pathologic analysis of the cystectomy specimen, and both patients' severe lower urinary tract symptoms were alleviated postoperatively. CONCLUSIONS: A contracted bladder due to extravasation of BCG, although rare, is a serious complication. Cystoprostatectomy with orthotopic neobladder reconstruction may be the optimal solution to alleviate severe lower urinary tract symptoms and remove the risk of subsequent urothelial malignancy.

BCG Vaccine↗
PubMed1977

Occurrence of myofibroblasts in the different phases of morbus Dupuytren (Dupuytren's contracture).

Twenty-one surgically removed specimens of Morbus Dupuytren (M. D.) were studied by light and electron microscopy. The cell type observed in the proliferative phase shows the basic ultrastructural features of fibroblasts, while the majority of the cells in the involutional phase resemble myofibroblasts. Myofibroblasts exhibit ultrastructural characteristics of both smooth muscle cells and fibroblasts and are said to behave functionally like smooth muscle cells. In the residual phase, typical fibrocytes of connective tissue are found. These findings confirm the concept that fibroblasts are capable of converting into myofibroblasts and demonstrate the myofibroblasts represent an intermediate cell type of transitional cellular differentiation. The significance of myofibroblasts for the development of the contracture of M. D. is discussed.

Adult↗
PubMed1977

Intracellular "fibrous long spacing" collagen in morbus dupuytren (Dupuytren's contracture).

Fine structural analysis of 21 surgically removed specimens of Morbus Dupuytren (Dupuytren's contracture) in the cells of the proliferative phase revealed spindle-shaped or round, periodic banded structures of 1--1.5 micron size. These intracellular structures are surrounded by trilaminar membranes of 45 A continuous with membranes of the endoplasmic reticulum. The periodic banded structures display a light-dark pattern of 750--900 A and resemble with respect to periodicity and general morphology "fibrous long spacing" collagen. To date, "fibrous long spacing" collagen in human tissue has only been observed in the extracellular space, both in normal and pathologic conditions. Its formal pathogenesis is discussed.

Cell Division↗
PubMed1982

Identification of an inherited form of Peyronie's disease with autosomal dominant inheritance and association with Dupuytren's contracture and histocompatibility B7 cross-reacting antigens.

Peyronie's disease is an inflammatory disorder with no confirmed etiology. We have documented the familial transmission of the disease as an autosomal dominant trait in 3 pedigrees. The occurrence of Dupuytren's contracture in 7 of 9 (78 per cent) affected individuals, which is a significant increase over the average 0 per cent reported in sporadic cases, suggests that both of these fibrosing disorders are pleiotropic effects of the same gene in these families. Similarly, the histocompatibility B7 cross-reacting antigens were present in 90 per cent of the patients with Peyronie's disease. Additional studies, including careful family histories and histocompatibility antigen typing, are necessary to elucidate the role of histocompatibility antigens as a relative risk factor.

Adult↗
PubMed1977

Incidence of vesicle neck contracture complicating prostatic resection in hemodialysis patients.

Four hemodialysis patients with no or minimal urine output underwent transurethral resection of the prostate. Bladder neck contractures developed postoperatively in all 4 cases. A review of the literature demonstrated no emphasis on the relatively high incidence of this complication in hemodialysis patients. A discussion of the possible etiology, diagnosis and therapeutic modalities is presented.

Contracture↗
PubMed1997

Hypertrophic scars, keloids, and contractures. The cellular and molecular basis for therapy.

Keloids, hypertrophic scars, and contractures are a result of aberrations of the normal wound healing process. An understanding of the cellular and molecular events that are implicated in the development of these fibroproliferative disorders will allow for optimization of wound healing. In turn, treatment choices can be based on the most current scientific information available.

Adult↗
PubMed1983

Dupuytren's contracture--the role of fasciotomy.

This paper summarises the results obtained in 95 patients treated by fasciotomy, defines the indications for this procedure and describes the operative technique. During a period of seven years a total of 95 patients with 137 fingers affected by Dupuytren's Contracture have been treated by fasciotomy. The minimum follow-up is two years. The oldest patient was 79 years and no patient younger that 50 years was accepted for this form of treatment.

Aged↗
PubMed1987

Quadriceps contracture and fracture disease.

Fracture disease, which is a complication of fracture treatment and immobilization, is defined as atrophy of bone, soft tissues, nail, skin, and cartilage. This condition is most often seen in dogs with quadriceps contracture. Distal femoral fractures treated by extension splints often result in a stiffened stifle in immature dogs, which is a common and often irreversible postsurgical complication. The clinical signs, surgical anatomy, etiology, pathophysiology, and treatment of this syndrome are reviewed.

Animals↗
PubMed1991

Fracture disease and related contractures.

Fracture disease and the complications of immobilization are described. The pathogenesis of the disease is discussed. The clinical implications of immobilization are outlined, and physical therapy modalities are reviewed. Also included is a summary of quadriceps contracture management.

Animals↗
PubMed1996

The "S" Quattro in severe Dupuytren's contracture.

Postoperative traction, using the "S" Quattro external fixation device, improved the initial correction in 17 of 18 fingers treated by limited fasciectomy for severe proximal interphalangeal joint contracture in Dupuytren's disease. Unfortunately significant recurrence occurred in eight within 1 year and only five maintained improved function. Complications included infection, loosening, recurrence, stiffiness and amputation.

Aged↗
PubMed1998

Anatomy of the adductor pollicis muscle. A basis for release procedures for adduction contractures of the thumb.

Release of the origins of the adductor pollicis muscle is used to treat adduction contractures of the thumb. A knowledge of the anatomy of the adductor pollicis muscle is therefore the basis for this technique. A study of 20 specimens showed that the origins of the adductor pollicis are more extensive than generally described. This must be taken into account in release procedures in the first web space.

Cadaver↗
PubMed1984

Macroradiographic study of post-burn contracture of limbs.

Fifty patients with post-burn contracture involving various joints of the limbs were analysed. To study the minor skeletal changes the patients were subjected to macroradiography. In half of the patients various types of pathology were observed and their therapeutic and prognostic significance have been discussed.

Burns↗
PubMed1998

Correction of post burns contracture of wrist with Ilizarov method.

A case of severe post burns contracture of the wrist, of 43 years duration resulting in recurrent ulceration of the skin was successfully treated by gradual distraction using the Ilizarov method. This method is superior to plaster of Paris cast and is more versatile than other forms of external fixation.

Adult↗
PubMed2000

The axial bilobed flap for burn contractures of the axilla.

The axial bilobed flap, based on the transverse and descending branches of the circumflex scapular artery, was used to successfully reconstruct burn contractures of the axilla. The main advantages of this flap are that the donor site is closed primarily, it provides an adequate amount of healthy and pliable skin with an excellent blood supply and no chance of contraction, and it is an easy technique. In this paper, two cases are presented.

Adult↗
PubMed2003

Vasoprotective VEGF as a candidate for prevention of recurrence of fibrotic diseases such as Dupuytren's contracture.

Dupuytren's contracture is a disease caused by the proliferation of contractile, fibroblastic cells adjacent to the palmar fascia of the hand. Cellular proliferation is apparently related to similar 'fibroblast' proliferation in wound healing, but continues in the absence of wounding. I propose that this is a similar processes to that which happens in the vascular wall during vascular surgery, that the myofibroblasts are at least partially similar to smooth muscle cells in phenotype, and consequently that treatment with VEGF, either as protein or via gene therapy, which has proven successful in controlling aberrant, wounding-related cell proliferation in arterial grafting, may be valuable in preventing recurrence of Dupuytren's disease after surgery.

Dupuytren Contracture↗