karl bernhof malnes

Dupuytren'scontracture (DC) is a fibromatous disease of the palmar fascia ofunknown etiology. The present study was undertaken in order to assesspathophysiological mechanisms and consequences.

In a cohort studyof 2,375 patients operated for DC at the Department of Hand Surgery,Uppsala there was a male: female ratio of 5.9:1. Women had a highermean age at first operation than men. One-third of the men andone-quarter of the women required repeated surgery. Early age at firstoperation was associated with recurrent disease.

The risk ofcancer was determined in 15,212 patients operated on for DC in Sweden.The overall relative risk was increased by 24%. There was asignificantly increased risk for buccal, oesophageal, gastric, lung andpancreatic cancers, which indicates that smoking and alcohol abuse areprobable risk factors for DC.

Furthermore, there was anincreased frequency of fibrosarcoma and malignant fibrous histiocytoma,the cause of which is unexplained

The causes of death wereevaluated in a national cohort of 16,517 patients operated for DC.There was an overall increased mortality (SMR=1.06), inversely relatedto age and significant for both sexes, in patients under 70 years. Therisk estimate was highest for endocrine-, gastrointestinal-, andrespiratory diseases, and accidents. There was also an increased SMRfor cardiovascular diseases in younger patients more than 10 yearsafter surgery. The most probable mechanism is related to smoking andother lifestyle factors.

Outcome after surgery was not related tothe immunohistochemical expression of connective tissue activationmarkers, such as collagen type IV, integrin α5, laminin, smooth muscleα-actin, procollagen type I, and desmin, in surgical specimens in aprospectively investigated group of patients. Furthermore, there wereno associations between gender, age at onset of DC, number ofoperations, heredity, diabetes mellitus, or medication forcardiovascular disease, and the expression of the different markers.The individual characteristics that place a person at high risk are,thus, not obviously related to ongoing connective tissue production attime of surgery or to connective tissue activity in its conventionallyused sense.