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Hand Surgery & Rehabilitation Oct 2017The objective of this study was to review the incidence of complications associated with different treatment options for patients with Dupuytren's disease. In a...
The objective of this study was to review the incidence of complications associated with different treatment options for patients with Dupuytren's disease. In a systematic literature review, the PubMed, EMBASE, Cochrane and Scopus databases were searched for clinical studies reporting complications after collagenase treatment, percutaneous needle fasciotomy (PNF), fasciectomy and dermofasciectomy. The incidence of complications was extracted from each study and stratified by procedure. From a total of 2251 references, 113 studies were analyzed and included with complication incidences varying from 0% to 100%. The highest number of nerve and vessel lesions were reported after fasciectomy, whereas the highest rate of edema was after collagenase injection. Accidental skin tears were mostly associated with collagenase and PNF treatment. Pooled complication incidences were 17.4% (95% CI: 11.7-23.1) for fasciectomy, 78.0% (95% CI: 59.6-96.4) for collagenase treatment, 18.9% (95% CI: -5.5-43.3) for PNF and 11.6% (95% CI: 0.0-23.2) for dermofasciectomy. Due to inconsistencies in reporting complications as well as the lack of a standardized definition, the literature does not provide evidence in favor of a specific procedure for Dupuytren's disease. A standardized definition of complications is required to improve the comparability of published results.
Topics: Dupuytren Contracture; Fasciotomy; Humans; Microbial Collagenase; Needles; Orthopedic Procedures; Surgical Flaps
PubMed: 28917432
DOI: 10.1016/j.hansur.2017.07.002 -
The Journal of Hand Surgery Oct 2017To determine the role of night orthosis use after surgical correction of Dupuytren contracture. (Review)
Review
PURPOSE
To determine the role of night orthosis use after surgical correction of Dupuytren contracture.
METHODS
We searched MEDLINE, EMBASE, CINAHL, AMED, OTSeeker, and CENTRAL for articles published from inception of the databases to August 2015. Assessment was undertaken by 2 independent reviewers (O.A.S. and S.A.). Methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa instrument.
RESULTS
Seven studies met the standard for inclusion in this review. A total of 659 patients across these 7 studies were included in the analysis, with follow-up ranging from 3 to 72 months. None of the included studies assessed recurrence. The analysis revealed no significant improvement in range of motion of hand joints for patients who received a static night orthosis after Dupuytren surgery compared with patients without an orthosis. Similarly, no differences were found in patient-reported functional status across the 2 groups.
CONCLUSIONS
The current literature does not appear to support the use of static night orthosis in addition to hand therapy after surgical correction of Dupuytren contracture.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Dupuytren Contracture; Humans; Orthotic Devices
PubMed: 28867249
DOI: 10.1016/j.jhsa.2017.06.100 -
Archives of Physical Medicine and... Aug 2018To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain...
OBJECTIVES
To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.
DATA SOURCES
Cochrane Library, Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).
DATA SELECTION
Two reviewers independently applied the inclusion criteria to select potential studies.
DATA EXTRACTION
Two reviewers independently extracted the data and assessed the methodologic quality.
DATA SYNTHESIS
A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.
CONCLUSIONS
In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.
Topics: Conservative Treatment; De Quervain Disease; Dupuytren Contracture; Humans; Orthopedic Procedures; Physical Therapy Modalities; Postoperative Period; Treatment Outcome; Trigger Finger Disorder
PubMed: 28860097
DOI: 10.1016/j.apmr.2017.07.014 -
Journal of Oral Pathology & Medicine :... Apr 2018To integrate the available data published to date on ameloblastic fibromas (AF) and ameloblastic fibrosarcomas (AFS) into a comprehensive analysis of their...
PURPOSE
To integrate the available data published to date on ameloblastic fibromas (AF) and ameloblastic fibrosarcomas (AFS) into a comprehensive analysis of their clinical/radiological features.
METHODS
An electronic search was undertaken in July 2017. Eligibility criteria included publications having enough clinical, radiological and histological information to confirm a definite diagnosis.
RESULTS
A total of 244 publications (279 central AF tumours, 10 peripheral AF, 103 AFS) were included. AF and AFS differed significantly with regard to the occurrence of patients' mean age, bone expansion, cortical bone perforation and lesion size. Recurrence rates were as follows: central AF (19.2%), peripheral AF (12.5%), AFS (all lesions, 35%), primary (de novo) AFS (28.8%) and secondary AFS (occurring after an AF, 50%). Larger lesions and older patients were more often treated by surgical resections for central AF. Segmental resection resulted in the lowest rate of recurrence for most of the lesion types. AFS treated by segmental resection had a 70.5% lower probability to recur (OR 0.295; P = .049) than marginal resection; 21.3% of the AFS patients died due to complications related to the lesion.
CONCLUSIONS
Very long follow-up is recommended for AF lesions, due to the risk of recurrence and malignant change into AFS. Segmental resection is the most recommended therapy for AFS.
Topics: Humans; Jaw Neoplasms; Odontoma
PubMed: 28776760
DOI: 10.1111/jop.12622 -
The Journal of Hand Surgery, European... Sep 2017Radiotherapy has been advocated as an alternative treatment in early Dupuytren's disease. We have systematically reviewed the evidence on the use of radiotherapy in... (Review)
Review
UNLABELLED
Radiotherapy has been advocated as an alternative treatment in early Dupuytren's disease. We have systematically reviewed the evidence on the use of radiotherapy in Dupuytren's disease. Only six articles met a minimum set standard, five of which were retrospective cohort studies and one a randomized controlled study. A total of 770 Dupuytren's hands, nearly all with Tubiana stage 0-1 disease, were irradiated with an average 30 Gy. Disease regression ranged from 0%-56%, stability from 14%-98% and progression from 2%-86%. Salvage surgery was successful in all cases of disease progression post-radiotherapy. There were no reports of adverse wound healing problems associated with such surgery or radiotherapy-associated malignancy. On balance, radiotherapy should be considered an unproven treatment for early Dupuytren's disease due to a scarce evidence base and unknown long-term adverse effects. Well-designed randomized controlled studies are required to confirm the benefits of radiotherapy treatment.
LEVEL OF EVIDENCE
II.
Topics: Disease Progression; Dupuytren Contracture; Humans; Radiotherapy
PubMed: 28490266
DOI: 10.1177/1753193417695996 -
International Journal of Surgical... Sep 2017Ossifying fibromyxoid tumor (OFMT) is a mesenchymal neoplasm of uncertain lineage and intermediate biologic behavior. Involvement of the head and neck area is infrequent... (Review)
Review
Ossifying fibromyxoid tumor (OFMT) is a mesenchymal neoplasm of uncertain lineage and intermediate biologic behavior. Involvement of the head and neck area is infrequent (10% to 15%) and intraoral presentation is very rare. An OFMT developing in the retromolar trigone of a 13-year-old male is presented, along with a comprehensive review of oral OFMT cases. Among 12 oral OFMTs (including the present case), most patients were male (72.7%), with a mean age of 30.3 (13-67) years. The tumors generally appeared as painless masses of firm or hard consistency (mean diameter 27.7 mm), most commonly located in the soft tissues of the mandible (50%). Common microscopic features included ossification, lack of atypia or high mitotic activity, and immunohistochemical positivity for S100 (5/7), vimentin (6/6), GFAP (3/6), and SMA (2/6). Recurrence was reported only in one case. Further characterization of this rare entity is needed to increase our understanding of its distinct clinical and histopathologic features.
Topics: Adolescent; Fibroma, Ossifying; Humans; Male; Mouth Neoplasms
PubMed: 28436288
DOI: 10.1177/1066896917705197 -
Medicina Oral, Patologia Oral Y Cirugia... May 2017Retrospective studies to assess the distribution of oral diseases (ODs) are helpful in estimating the prevalence of oral diagnoses in the population, and thus help in... (Comparative Study)
Comparative Study Review
BACKGROUND
Retrospective studies to assess the distribution of oral diseases (ODs) are helpful in estimating the prevalence of oral diagnoses in the population, and thus help in preventive and curative services. Prevalence and frequency data for ODs are available from many countries, but information from Chile is scarce.
MATERIAL AND METHODS
This study investigated the frequency of OD in a Chilean population. For this, we included all patients treated at the University of Talca (UTALCA, Chile) between 2001 and 2014. Patient characteristics were retrieved from medical files. To contextualize our results, we conducted a systematic review (SystRev) using Publish or Perish software (PoP), Google Scholar and MEDLINE/PubMed.
RESULTS
One hundred sixty-six ODs were diagnosed, and the most prevalent groups were soft tissue tumours, epithelial pathology and salivary gland pathology. Individually, irritation fibroma, oral lichen planus (OLP) and mucocele were the most common diagnoses. ODs frequently affected unspecified parts of the mouth (including cheek, vestibule and retromolar area), gum, lips, tongue and palate. In the SystRev, the more studied diagnoses were leukoplakia, OLP and recurrent aphthous stomatitis; prevalent lesions included Fordyce's spots, recurrent aphthous stomatitis and fissured tongue. Chilean patients and SistRev shared almost all ODs.
CONCLUSIONS
The results reflect ODs diagnosed in a specialized service of oral pathology and medicine in Chile and will allow the establishment of preventive/curative policies, adequate health services and dentistry curriculum.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chile; Female; Humans; Infant; Male; Middle Aged; Mouth Diseases; Time Factors; Young Adult
PubMed: 28390130
DOI: 10.4317/medoral.21665 -
Der Orthopade Apr 2017The exact knowledge of the anatomy of the fibrous skeleton of the hand is an absolute prerequisite for any treatment of Dupuytren's disease. The fibrous skeleton does... (Review)
Review
The exact knowledge of the anatomy of the fibrous skeleton of the hand is an absolute prerequisite for any treatment of Dupuytren's disease. The fibrous skeleton does not only include the palmar aponeurosis, but also numerous retinacula cutis, which are not found in current anatomy books. Here, eponyms facilitate the otherwise difficult and over-pronounced names of the fiber systems. Skoog, Legueu and Juvara, Gosset, Grapow, Grayson, Cleland, Thomine, and Barton are the most important. This systematic review of the fibers and strands is designed to help reduce iatrogenic complications.
Topics: Aponeurosis; Dupuytren Contracture; Fascia; Hand; Humans; Ligaments; Models, Anatomic
PubMed: 28361190
DOI: 10.1007/s00132-017-3406-6 -
Journal of Clinical and Experimental... Feb 2017The oral examination is an essential part of the multidisciplinary medical care in elderly people. Oral mucosal lesions and normal variations of oral anatomy (OMLs) are...
BACKGROUND
The oral examination is an essential part of the multidisciplinary medical care in elderly people. Oral mucosal lesions and normal variations of oral anatomy (OMLs) are very common in this people, but few studies have examined the frequency and prevalence of these conditions worldwide and less in Chile. The aim of this research was to evaluate the frequency of OMLs in a Chilean elderly population.
MATERIAL AND METHODS
It was conducted a retrospective study (Talca, Chile). Two hundred seventy-seven OMLs were classified in groups and anatomical sites. In order to contextualize our numbers, we made a systematic review using Publish or Perish software, Google Scholar and InteractiVenn.
RESULTS
The most prevalent OMLs groups were soft tissue tumors, epithelial pathology, facial pain and neuromuscular diseases, and dermatologic diseases. The most frequent OMLs included irritation fibroma (30 patients, 10.8%), hemangioma (20, 7.2%), burning mouth syndrome (20 cases, 7.2%), oral lichen planus (12, 4.3%) and epulis fissuratum (12, 4.3%). In the systematic review, 75 OMLs were relevant and the more studied pathologies were traumatic ulcerations (11 of 15 articles), oral lichen planus (10/15), irritation fibroma, melanotic pigmentations, and recurrent aphthous stomatitis (9/10, respectively). Considering all included articles, most frequent OMLs in elderly people included denture-related stomatitis (13.3%), irritation fibroma (8.7%) and fissured tongue (6.3%).
CONCLUSIONS
The results reflect the frequency of OMLs diagnosed in a specialized service in south of Chile and many countries around the world. These numbers will allow the establishment of preventive politics and adequacy of the clinical services. Oral mucosal lesions, elderly people, Chilean population, frequency, systematic review.
PubMed: 28210449
DOI: 10.4317/jced.53427 -
BioDrugs : Clinical Immunotherapeutics,... Apr 2017Collagenase clostridium histolyticum (CCH) has proven to be both safe and effective in the treatment of Dupuytren disease (DD). The medium-term outcomes are similar to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Collagenase clostridium histolyticum (CCH) has proven to be both safe and effective in the treatment of Dupuytren disease (DD). The medium-term outcomes are similar to those achieved with surgery, and most adverse effects are self-limiting and considered to be mild or moderate.
OBJECTIVE
Our objective was to conduct a systematic review of the adverse effects of CCH in DD since the release of the drug to evaluate the incidence, severity, classification, and definitions of these effects.
METHODS
We analyzed the literature in terms of modifications to the original treatment protocol and grouped adverse effects according to their pathophysiological origin.
RESULTS
We included 28 clinical studies and five case reports or case series analyzing 4456 patients with a mean age of 63.6 years. Mean follow-up was 7.07 months (range 3-24); the mean number of patients per study was 148 (range 5-1082). The studies did not classify the adverse effects they reported into groups. The most common effects were peripheral edema (54.4%), bruising (42.9%), and upper limb pain (28.3%). Significant biases were observed for use of terminology, demarcation of sites of involvement, severity criteria, and assessment methods.
CONCLUSION
A simpler and clearer consensus-based classification system would enable better evaluation and comparison of the adverse effects of CCH in the treatment of DD. Consideration of inflammatory phenomena as part of the drug's mechanism of action would significantly reduce overall rates of adverse effects.
Topics: Dupuytren Contracture; Humans; Microbial Collagenase; Terminology as Topic
PubMed: 28181175
DOI: 10.1007/s40259-017-0211-z