Dupuytren Foundation

A new Dupuytren's research project has launched!

noreply@blogger.com (eaton.md) — Sun, 09 Oct 2011 15:28:00 +0000

After much preparation, a collaborative effort is underway between Professor Paul Werker at Groningen University Medical Center in The Netherlands and Dr. Charles Eaton at The Hand Center in Jupiter, FL. This retrospective study will follow the long term outcomes of patients who have had Dupuytren's treated with Needle Aponeurotomy, and will take a fresh look at demographics, risk factors and patterns of involvement. Gronigen University medical student Alix Matton has traveled from the Netherlands to Jupiter to work on this project. After reviewing charts, she has begun the long process of contacting and interviewing patients for the study. This will take a while, but the plan is to reveal the results early next year. One more stepping stone in the path to find a cure.

Medical research: I have nodules but no contractures. What can I do?

noreply@blogger.com (eaton.md) — Sun, 25 Sep 2011 00:21:00 +0000

I have nodules but no contractures. What can I do?

The question "What can I do to keep my Dupuytren's from getting worse or from coming back after treatment?" is the holy grail for Dupuytren's. Dupuytren's is not cured by surgery, and there is not an effective medical treatment to stop or slow progression. This makes it easy for people to make unfounded claims, recommedations and sales pitches. However, there are some interesting leads which may be worth pursuing and which have some published scientific basis. Links listed will connect you to abstracts of the source publications through the National Library of Medicine.

Dupuytren's is probably aggravated by mechanical forces 19505772, particularly stretching or shearing forces on the palm. From this, it would be logical to try to reduce the amount of stretching and shearing forces on the palm if you have Dupuytren's. For example, when doing pushups or the downward dog position in Yoga, use pushup handles or hold on to light dumbells to bear weight and avoid stretching the wrist and fingers back. When possible, use gel padded gloves for heavy work or sports to reduce shearing forces on the palm. Increase the grip size of tennis racquet, golf club or other handles used in sports.
Dupuytren's may be helped by silicone rubber and by night time splinting 21935846. There is anecdotal evidence that Dupuytren's may be slowed or even improved by wearing a hand splint while sleeping. There are two points to this. The first is that many people hold their hands in a fist while sleeping, and that this may contribute to Dupuytren's contracture. The second is that silicone rubber may have a beneficial effect to soften, flatten and calm the biology of areas affected by Dupuytren's. From this, it would be logical to wear a simple hand splint while sleeping with a silicone rubber insert contacting the palm. This may be made as a do-it-yourself project by combining a drugstore hand splint with over the counter adhesive gel sheeting (such as Pedifix Visco-gel Moleskin® or similar products) or professionally by a hand therapist using a special silicone rubber moulded to the palm. The point of wearing a splint while sleeping is not to force the fingers backward, but to support the fingers comfortably straight so that you don't sleep with your hand in a fist.
Dietary changes may help. There is also a growing body of evidence to look at diet and dietary supplements as a way to slow progression of Dupuytren's. Biologically, Dupuytren's is a type of fibrosis, like scar tissue, and seems to be provoked by a protein called tumor growth factor beta (TGF beta). Studies have shown therapeutic effects of TGF-beta-related fibrosis by curcumin (in turmeric) (12890714, 15200418), ginsan (in ginseng) 20945375, fish oil 21370451, flaxseed oil 18981722, quercetin (flavonoid found in green tea and a number of fruits and vegetables) 15580028. It may be helpful to increase awareness and intake of these items. A recent laboratory cell biology study higlighted the possible benefit in Dupuytren's of increasing cyclic AMP levels in tissue 21612641. Caffeine (in coffee) and theobromide (in tea) are known to increase cyclic AMP levels. What is not known is how effective they might be out of the lab and in the body. Excessive caffeine may be harmful - this is not a recommendation to overdo it with coffee, tea, and energy drinks! Caffeine containing creams and lotions are sold as treatments for cellulite and bags under the eyes - might they be helpful used on a Dupuytren's palm? More research is needed.
Lifestyle changes may help. There is overlap in risk factors for Dupuytren's and for cardiovascular disease. This is not a surprise, because both involve the biology of fibrosis. TGF-beta-mediated fibrosis is aggravated both by excessive dietary salt 9843472 and dietary cholesterol 9214456. Smoking and chronic heavy drinking also increase the likelihood of Dupuytren's 15485739, and smoking increases the likelihood of recurrence after treatment for Dupuytren's. Here's your reason to quit!
What can my doctor do at this stage? Cortisone injections 11119679 or low dose radiation treatment 20127225 have benefit for burning, tender or itching Dupuytren nodules. These interventions are most effective when used before actual contractures develop - they have no effect on contractures themselves. They may help slow the progression from nodules to contractures, but are unpredictable.

All of these ideas need further research. If you have experience with these, good or bad, please share your story to help build a database for more work to be done! The ultimate goal of the Dupuytren Foundation is to push to find a cure.

Dupuytren Roundtable Discussions

noreply@blogger.com (eaton.md) — Sun, 20 Feb 2011 15:55:00 +0000

Here are links to two recently published roundtable discussions by experts in the field of Dupuytren's. Although these were discussions by surgeons for surgeons, they are really just conversations and quite readable. They highlight the current challenges both surgeons and their patients face with Dupuytren's disease and provide insight into future efforts to develop a biological cure.

American Association of Hand Surgeons (go to page 6): http://www.dupuytrenfoundation.org/DupPDFs/2010_AAHS.pdf

American Academy of Orthopaedic Surgeons: http://www.dupuytrenfoundation.org/DupPDFs/2011_AAOS.pdf

Coming up: What is known about Dupuytren's and Chondroitin/Glucosamine?

Dupuytren Foundation 2010 Report

noreply@blogger.com (eaton.md) — Fri, 31 Dec 2010 20:08:00 +0000

It's been a busy year behind the scenes for the Dupuytren Foundation - see what we've been up to at http://conta.cc/hV1lEy

2010 Dupuytren's Symposium Screensaver. Mysterious, like Dupuytren's

noreply@blogger.com (eaton.md) — Tue, 12 Oct 2010 21:59:00 +0000

Produced for the 2010 Miami Dupuytren Symposium with Electric Sheep and Wax Audio, this musical animation provides a background to contemplate new approaches to find a cure for Dupuytren's. http://www.youtube.com/watch?v=KOrWEYWl4fA

Miami Dupuytren Symposium spurs new research: Report from Dupuytren's Day at the Deutsche Gesellschaft für Handchirurgiethe (German Society for Surgery of the Hand - DGH)

noreply@blogger.com (eaton.md) — Mon, 11 Oct 2010 00:10:00 +0000

Dr Wolfgang Wach reports from the DGH, Oct 7 Dupuytren Program: "I attended the Dupuytren’s day at the Nuremberg conference of German hand surgeons and the Miami Dupuytren Symposium was pretty well covered there. Bernhard Lukas gave a review of the Miami conference and the current issue of the German hand surgeons journal which was distributed at the conference also contained a 3 page summary by Bernhard Lukas and Albrecht Meinel of the Miami conference. Lawrence Hurst presented collagenase. Albrecht Meinel presented an extended version of his Miami anatomy and his splinting papers, Bernhard Lukas presented his surgery paper, Holger Erne and Bernhard Lukas gave papers on NA, Ilse Degreef presented a summary of her papers, Hans Hennies presented an update on his genomics study and mentioned that, as result of the Miami Dupuytren Symposium, the UK, the Netherlands, and the German genomics study started cooperating and are exchanging samples. Great! I also gave a little patient talk.".
The full conference program can be downloaded at http://www.dgh-kongress.de/dgh2010/Hauptprogramm_DGH2010.pdf. The DGH web site is http://www.dg-h.de. This new joint effort of researchers is a realization of a goal of the Dupuytren Foundation: to spur global collaboration to develop better treatment options for Dupuytren's; to find a cure. It is happening.

Swimming the English Channel to Support Dupuytren's Research

noreply@blogger.com (eaton.md) — Sun, 10 Oct 2010 15:22:00 +0000

Surgeons and surgeons in training brave the English Channel to raise money to support hand surgery research: http://www.oxfordmail.co.uk/news/yourtown/oxford/8441861.Swimming_medics_show_surgical_spirit/ Cold! I mean ...How cool is that? Good work!

Video: I was a Teenage Myofibroblast (and I loved it!)

noreply@blogger.com (eaton.md) — Sat, 02 Oct 2010 12:13:00 +0000

Before becoming the villain in Dupuytren's, the myofibroblast was really not a bad cell. What happened? What caused the change? Could it happen to you? Professor Sem Phan, Department of Pathology, University of Michigan explains almost everything in this presentation of "Mechanisms of Myofibroblast Differentiation":
http://www.youtube.com/user/DupuytrenFoundation#p/u/0/dsPwSUDrz1Y

Funding for these and other Miami Dupuytren Symposium videos at http://dupuytrensymposium.com/program.html, is provided by the Dupuytren Foundation. Support the Dupuytren Foundation with an online donation: http://CureDup.com.

The Secret Life of Myofibroblasts: Dr. Boris Hinz reveals all!

noreply@blogger.com (eaton.md) — Sat, 25 Sep 2010 18:42:00 +0000

Boris Hinz PhD, University of Toronto, Ontario, CA presents "Fundamental aspects of myofibroblast contraction." and explains how the process is both simple and complex. How do these little cells do such big things? More importantly, what steps in the process go wrong to result in Dupuytren's and what can be done to safely and simply correct this? Watch the video and see: http://www.youtube.com/user/DupuytrenFoundation#p/u/0/fvmRS3OiWic

Funding for these and other Miami Dupuytren Symposium videos at http://dupuytrensymposium.com/program.html, is provided by the Dupuytren Foundation. Support the Dupuytren Foundation with an online donation: http://CureDup.com.

Dupuytren's vs. Burns! Video: Dr. Paul Zidel at the 2010 Miami Dupuytren Symposium

noreply@blogger.com (eaton.md) — Sun, 19 Sep 2010 19:35:00 +0000

Dr. Paul Zidel, Chief, Hand Surgery, Maricopa Medical Center, Phoenix, Arizona, presents a thought provoking comparison of two different yet similar conditions in "Dupuytren's versus burn scar contracture"
http://www.youtube.com/user/DupuytrenFoundation#p/u/0/uR5OcoIKfOI
Hypertrophic scars, Ledderhose disease, burn scars, keloid scars, desmoid tumors, pulmonary fibrosis, arteriosclerosis and other abnormal fibrosing conditions share some of the same complex biology as Dupuytren's. Answers found for one condition may apply to others - there are many stones yet unturned in the path to find a cure for Dupuytren's. Support the effort at http://CureDup.com

Video: Professor Millesi at the Miami Dupuytren's Symposium

noreply@blogger.com (eaton.md) — Thu, 16 Sep 2010 10:55:00 +0000

Professor Hanno Millesi of the Millesi Center in Vienna, chairman of the 1983 Dupuytren's Meeting in Vienna, presents "Changes of the visco-elastic properties of the palmar fascia as pathogenetic basis of Dupuytren's Disease": http://www.youtube.com/user/DupuytrenFoundation#p/u/0/vRc9XFBOVTk. The more one investigates, the deeper the mystery of Dupuytren's becomes. The legendary Dr. Millesi explores the chicken and egg aspect of the mechanics of Dupuytren's.
These and other videos are archived at http://dupuytrensymposium.com/program.html and are made possible through funding by the Dupuytren Foundation. Please support further research and education by giving to the Dupuytren Foundation at http://CureDup.com

Dr. Meinel presents a new concept of Dupuytren's at the Miami Dupuytren Symposium

noreply@blogger.com (eaton.md) — Mon, 13 Sep 2010 12:06:00 +0000

Dr. Albrecht Meinel, former chief of surgery for over 20 years at Tauberbischofsheim Hospital, Germany, shares his insights from a lifetime interest in Dupuytren's contracture with the paradigm-shifting presentation "The palmar fibromatosis or the loss of flexibility of the palmar finger tissue. A new insight into the disease process of Dupuytren’s contracture based on clinical and anatomical findings." We need both luck and lateral thinking to develop better treatments for Dupuyten's, and Dr. Meinel's concept of extension blocking as the basic mechanical biology of Dupuytren's turns conventional thinking on its head: http://www.youtube.com/user/DupuytrenFoundation#p/u/0/kq4hr06tOtY

Dr. Paul Werker presents at the 2010 Dupuytren Symposium

noreply@blogger.com (eaton.md) — Mon, 06 Sep 2010 13:58:00 +0000

Paul Werker MD PhD, Professor and Head of the Department of Plastic Surgery, Groningen University Medical Center Groningen, NL presents: Management of soft tissue contractures: a surgical perspective. See the video at http://www.youtube.com/user/DupuytrenFoundation#p/u/0/fHoOhGlsgDU. This and other video presentations from the 2010 International Symposium on Dupuytren's Disease, are being added to http://dupuytrensymposium.com/program.html. This symposium was made possible through funding from the Dupuytren Foundation. Join the effort to find a cure by making a donation to support research, education and global collaboration through the Dupuytren Foundation: http://CureDup.com.

The search for a cure

noreply@blogger.com (eaton.md) — Fri, 03 Sep 2010 12:15:00 +0000

http://www.youtube.com/user/DupuytrenFoundation#p/u/0/a5iYXAdZCYc

Video: Dr. Rayan at the 2010 Miami Dupuytren Symposium

noreply@blogger.com (eaton.md) — Sun, 29 Aug 2010 23:08:00 +0000

Dr. Ghazi Rayan, reviews Dupuytren's disease: anatomy, pathology, presentation at the 2010 Miami Dupuytren's Symposium: http://www.youtube.com/user/DupuytrenFoundation#p/u/0/HE6nBpteAAo. Dr Rayan is Program Director, Hand/Orthopaedic Surgery, INTEGRIS Baptist Medical Center, Oklahoma City, OK, and is a world expert on the problem of Dupuytren's disease. Dr. Rayan has authored a number of papers on this condition in addition to co-authoring the 2003 book "Dupuytren's Disease - a concept of surgical treatment", published by Springer Verlag. Additional videos from this symposium are available free through http://dupuytrensymposium.com/program.html, sponsored by the Dupuytren Foundation. Support more work like this by donating to the Dupuytren Foundation: http://CureDup.com.

Video: Dr. Osterman at the 2010 Miami Dupuytren Symposium

noreply@blogger.com (eaton.md) — Sun, 22 Aug 2010 16:21:00 +0000

The latest installment of video presentations archived from the Miami Dupuytren Symposium features Dr. Lee Osterman, Professor of Hand/Orthopedic Surgery at the Thomas Jefferson University in Philadelphia, PA. Dr. Osterman's entertaining presentation highlights the complex background of efforts to understand and treat Dupuytren's Disease. See "Cline’s contracture: Dupuytren was a thief. A history of surgery for Dupuytren’s contracture." at http://www.youtube.com/user/DupuytrenFoundation#p/u/0/iOd0iZNbM_w. If you missed or had audio difficulties with previously posted symposium videos, check http://dupuytrensymposium.com/program.html for updated versions and new releases.

Video: Dr. Wolfgang Wach at the 2010 Dupuytren Symposium

noreply@blogger.com (eaton.md) — Tue, 17 Aug 2010 12:14:00 +0000

Dr. Wolfgang Wach, founder of the Dupuytren Society (http://www.dupuytren-online.info/), discusses the development, value and future of the Dupuytren Society in this video from the 2010 International Symposium on Dupuytren's Disease. The Dupuytren Society is the largest, most visited patient oriented Dupuytren's resource on the internet. http://www.youtube.com/watch?v=F_8did7Pr78

Video Presentations of the 2010 Miami Dupuytren Symposium on YouTube

noreply@blogger.com (eaton.md) — Wed, 11 Aug 2010 23:52:00 +0000

The Miami Dupuytren Symposium was very exciting. Presentations were recorded on video, and are finally making their way through post processing to be available on line. Free. For you - courtesy of the Dupuytren Foundation. These will be released weekly. Each presentation is at least 15 minutes, and most will take some time to digest, so get comfortable, and get to know the people who are working around the world to find a cure for Dupuytren's and related conditions.

The first video is the introductory and welcoming remarks by Dr. Charles Eaton.
http://www.youtube.com/user/DupuytrenFoundation#p/u/0/E4qAoklf4sE

Enjoy!

Scientific breakthroughs at the Miami Dupuytren Symposium

noreply@blogger.com (eaton.md) — Sun, 08 Aug 2010 15:57:00 +0000

It's been a few months since the 2010 International Symposium on Dupuytren's Disease in Miami, FL. This was a huge undertaking - the the first meeting of this scope and magnitude in 20 years, and some incredible new developments were showcased. There was so much material presented it's taking a while to sort through things, but work is underway to publish a textbook based on the proceedings (Springer-Verlag) as well as publish on line videos of the presentations. We will be going through these presentations over the next few months on this site, but in the mean time, the entire book of presentation abstracts and speaker biographies is available at http://www.dupuytrenfoundation.org/DupPDFs/2010_DupuytrenSymposium.pdf

Enjoy!

Miami International Dupuytren Symposium Breaks New Ground

noreply@blogger.com (eaton.md) — Wed, 19 May 2010 20:26:00 +0000

Medical researchers and physicians from 15 countries converge May 22 and 23 at the Intercontinental Hotel in Miami for an intensive two day summit on Dupuytren's Disease: www.DupuytrenSymposium.com. Dupuytren's disease is a progressive condition which gradually curls the fingers permanently into the palm. It is estimated that 3 to 9 million Americans have bent fingers from Dupuytren's. Currently, there is no cure. The goals of this symposium are for experts to share new information and to organize for the first time an international coalition of doctors and scientists who will work together to develop better options for treating this crippling genetic disease. This is a major step toward finding a cure.

Dupuytren's Disease is a "silent" condition because it affects seniors, progresses slowly, and can escape notice by others until it is fairly advanced. It is common enough that many public figures have been afflicted, including Ronald Reagan, Margaret Thatcher, playwright Samuel Beckett, pianist Misha Dichter, actors Bill Nighy and David McCallum, as well as James Barrie, author of "Peter Pan", who is believed to have based Captain Hook's hand on his own. Progress in treating Dupuytren's has potential impact on the treatment of other life altering conditions such as pulmonary fibrosis, scleroderma, renal fibrosis and cirrhosis of the liver.

The 2010 International Symposium on Dupuytren's Disease is hosted by The Dupuytren Foundation, www.DupuytrenFoundation.org, a 501(c)(3) public charity established to promote research, education and global collaboration towards finding better treatment options for Dupuytren's and related conditions.

Stony Brook Dupuytren Symposium

noreply@blogger.com (eaton.md) — Sun, 18 Apr 2010 14:12:00 +0000

I had the opportunity to attend the Stony Brook Dupuytren Symposium April 17. This was a real treat, featuring a faculty of well known authorities on Dupuytren's. The volcanic ash European flight difficulties prevented attendance of only one speaker. The symposium covered a range of topics and in addition provided an in depth tour of the use of collagenase injection for Dupuytren's from the initial concept, through proof of concept in laboratory tests and then clinical trials, to clinical application, indications and issues. This is a monumental achievement for Drs. Hurst and Badalamente, and a testimony to their insight and persistence. Plans were also discussed to jointly present the materials from the Stony Brook and the upcoming Miami Dupuytren Symposium (http://www.DupuytrenSymposium.com) together as one book, to be published by the American Society for Surgery of the Hand (http://www.assh.org). What a promising year for Dupuytren's!

Stretching, Myofibroblasts and Dupuytren's

noreply@blogger.com (eaton.md) — Wed, 24 Mar 2010 03:17:00 +0000

How, and why, does Dupuytren's disease actually contract? What is the physical mechanism? What provokes it? There is a genetic risk, but genes don't provide the entire script, otherwise Dupuytren's contractures should be symmetric, the same problem developing at the same time in the same way in both hands, but that's not what happens: usually, contractures in one hand are different in time and space than the other hand. Why? One explanation is that Dupuytren's is both biological and mechanical, and that physical forces somewhat influence the process. One way to study the big picture is to look at the little picture: what happens inside Dupuytren cells in response to physical forces? This is an active and exciting area of research. Myofibroblasts are the contracting cells producing Dupuytren's and other fibrotic contractures. Myofibroblasts respond to stretching by first relaxing and then pulling against the line of pull. This process is the subject of ongoing studies. In "Stretch-activated force-shedding, force recovery, and cytoskeletal remodeling in contractile fibroblasts" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2008_Nekouzadeh.pdf), researchers used a laboratory model to demonstrate fibroblast reactions to stretch. Stretching cells initially tears the scaffolding inside cells, which is made of the protein actin. This releases tension, but also provokes the cells to pull back in two phases. The first phase starts within seconds ("Rapid Active Response"), the second after a few minutes ("Gradual Active Response"). These responses show the cell repairing the torn proteins. Other responses follow, modifying the collagen matrix outside the cells. The result? The more you pull, the more Dupuytren's pulls back. This is the type of data we need to move past what would seem to make sense, but is probably exactly wrong (pulling and stretching your fingers back to keep them from contracting) to an effective treatment, a cure.

Personal experiences with Xiaflex and Needle Aponeurotomy

noreply@blogger.com (eaton.md) — Wed, 17 Mar 2010 21:58:00 +0000

Xiaflex is now available, and is generating reports by both traditional writers and self published social media authors. There are now two minimally invasive treatments for contractures due to Dupuytren's disease - Xiaflex injection and needle aponeurotomy - with relative advantages and disadvantages of each. The following video was made by a Dupuytren's patient, documenting experience with needle aponeurotomy: http://www.youtube.com/watch?v=lGD9RjmFBzo. Another person's documentary experience with Xiaflex, also with videos, is posted here: http://bit.ly/9RhqQA. Their experiences were different, but both are satisfied with their results. Every hand is different and no one treatment works for everyone, but it's great that there are new options to choose from to buy time while researchers work for a cure. The Dupuytren Foundation is actively recruiting volunteers and fund raising options to develop better treatments - and eventually a cure. Support the effort. Make a difference. http://www.DupuytrenFoundation.org

Red wine and yellow curry to prevent Dupuytren's?

noreply@blogger.com (eaton.md) — Thu, 11 Mar 2010 13:13:00 +0000

Could a yellow curry dinner and a glass of red wine be good for Dupuytren's? Possibly. Dupuytren's is a fibrotic condition, something it shares with other disorders. There is a great deal of ongoing research into the biology of fibrosis and its possible treatment. Two studies suggest that diet may have an helpful influence on excessive fibrosis, at least in special circumstances. In "Protective Effects Of Curcumin Against Amiodarone-Induced Pulmonary Fibrosis In Rats" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2003_Punithavathi.pdf), researchers found a protective effect against lung fibrosis of curcumin, found in turmeric, the spice which gives the yellow color to curry and yellow rice. Another group reported in "Ochratoxin A–Induced Renal Cortex Fibrosis and Epithelial-to-Mesenchymal Transition: Molecular Mechanisms of Ochratoxin A-Injury and Potential Effects of Red Wine" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2005_Gagliano.pdf) a protective effect of red wine against kidney fibrosis. These studies were performed on rats, testing against drugs known to cause fibrosis, which is a bit of a stretch to to Dupuytren's, but it's a start, if you are a rat, and possibly if you are human. Simple options are often the best. Keep looking for a cure!

A personal look at Dupuytren's

noreply@blogger.com (eaton.md) — Wed, 10 Mar 2010 12:17:00 +0000

A family physician remembers his late father's Dupuytren's and muses on options for treatment: http://www.greatfallstribune.com/article/20100309/LIFESTYLE/3090307/Hands+become+claws+in+victims+of+Dupuytren+s. The observation "...in his final years he was wearied by the thought of 'another procedure' or treatment and decided to live with the condition" is a telling testimony for the need for better treatment options and the need to support efforts to find a cure for this common condition.