karl bernhof malnes

http://www.dupuytren-online.info/

Dupuytren'scontracture (DC) is a fibromatousdisease of the palmar fascia ofunknown etiology. The present study wasundertaken in order to assesspathophysiological mechanisms andconsequences.

In a cohort studyof 2,375 patients operated for DCat the Department of Hand Surgery,Uppsala there was a male: femaleratio 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 repeatedsurgery. Early age at firstoperation was associated with recurrentdisease.

The risk ofcancer was determined in 15,212 patientsoperated on for DC in Sweden.The overall relative risk was increased by24%. There was asignificantly increased risk for buccal, oesophageal,gastric, lung andpancreatic cancers, which indicates that smoking andalcohol abuse areprobable risk factors for DC.

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

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

Outcome after surgery was not relatedtothe immunohistochemical expression of connective tissueactivationmarkers, such as collagen type IV, integrin α5, laminin,smooth muscleα-actin, procollagen type I, and desmin, in surgicalspecimens in aprospectively investigated group of patients.Furthermore, there wereno associations between gender, age at onset ofDC, number ofoperations, heredity, diabetes mellitus, or medicationforcardiovascular disease, and the expression of the differentmarkers.The individual characteristics that place a person at high riskare,thus, not obviously related to ongoing connective tissue productionattime of surgery or to connective tissue activity in itsconventionallyused sense.