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Connective tissue activation markers in Dupuytren's contracture: Relationship to outcome after surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
In: Article in journal (Refereed) Submitted
Identifiers
URN: urn:nbn:se:uu:diva-89704OAI: oai:DiVA.org:uu-89704DiVA: diva2:161395
Available from: 2002-03-21 Created: 2002-03-21 Last updated: 2015-03-17Bibliographically approved
In thesis
1. Dupuytren´s Contracture: Features and Consequences
Open this publication in new window or tab >>Dupuytren´s Contracture: Features and Consequences
2002 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Dupuytren's contracture (DC) is a fibromatous disease of the palmar fascia of unknown etiology. The present study was undertaken in order to assess pathophysiological mechanisms and consequences.

In a cohort study of 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 higher mean age at first operation than men. One-third of the men and one-quarter of the women required repeated surgery. Early age at first operation was associated with recurrent disease.

The risk of cancer was determined in 15,212 patients operated on for DC in Sweden. The overall relative risk was increased by 24%. There was a significantly increased risk for buccal, oesophageal, gastric, lung and pancreatic cancers, which indicates that smoking and alcohol abuse are probable risk factors for DC.

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

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

Outcome after surgery was not related to the immunohistochemical expression of connective tissue activation markers, such as collagen type IV, integrin α5, laminin, smooth muscle α-actin, procollagen type I, and desmin, in surgical specimens in a prospectively investigated group of patients. Furthermore, there were no associations between gender, age at onset of DC, number of operations, heredity, diabetes mellitus, or medication for cardiovascular 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 at time of surgery or to connective tissue activity in its conventionally used sense.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2002. 53 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1130
Keyword
Surgery, Dupuytren´s contracture, epidemiology, outcome study, cohort, prognostic factors, immunohistochemistry, Kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-1794 (URN)91-554-5262-0 (ISBN)
Public defence
2002-04-19, Skoog salen. ingång 79, Akademiska sjukhuset, Uppsala, 13:15 (English)
Opponent
Available from: 2002-03-21 Created: 2002-03-21 Last updated: 2009-08-10Bibliographically approved

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