Randy, while I agree with everything you wrote about collagenase I believe your general statement about "French data" is just too strong. The French not only published papers describing the therapy (e.g. Lermusiaux et al., full text on http://www.dupuytren-online.info/NA_training_literature.html) but there are also papers with well documented statistics, two of them cited on http://www.dupuytren-online.info/NA_side_effects.html. There is always room for improvement and Charles Eaton's data will be important to publish. I am sure he will document them immaculately, present them in a way that the US surgeons accept (he himself being one), and will publish in the right journal. All this will provide more convincing evidence.

But Dr. Eaton will also face the common problem of such studies: his patients come from all over the US and only some of them will return when they facce a recurrence or extension. Those without recurrence will vanish in the dark, others with recurrence might consult other doctors at an increasing number of NA clinics in the US and Canada (http://www.dupuytren-online.info/NA_list_North_America.html). Getting feedback from former patients is difficult and elaborate. They wouldn't travel to FL just for an inspection and their selection might not be representative.

I am wondering whether the surgeons who treat Dupuytren's with classical surgery meet these demanding criteria. E. g. a double blind study wouldn't make any sense. The published data on surgical results vary so widely that you might get suspicious about their quality (at least some of them). Have e.g. a look at the overview of side effects that Keith Denkler presented at ASSH 2006 (http://www.dupuytren-online.info/surgery...s_denkler_2.htm). Nerve damage varies from 0.4 to 36 percent, sympathetic dystrophy from 0 to 19.4 percent. Another example: Surgeons typically report a very high success rate of surgery, yet a recent British audit of concludes "Surgery for Dupuytren's contracture achieved a high rate of full, or almost full, correction in 826 patients (75%) but had a high incidence of post-operative patient-reported complications of 46%." Did you ever see such a complication rate reported by surgeons themselves? Developing reliable statistics in this area is just very difficult.

Wolfgang

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Eaton told me that even he was surprised at how unscientific the record keeping is in France. It's tends to be very anecdotal and often not specific, such as "We did NA on patient X last week and he was happy with the results." Perhaps it's not *that* bad, but certainly not close to the standards of scrutiny we have in the US. For that reason none of the American CHS were impressed by the French study(s) of safety and effectiveness of NA. ...

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Randy, I believe that one of the obstacles, maybe even the biggest one, is that NA wasn't in the books when the surgeons went to university. Another confirmation of the statement that any new theory takes 25 years to get accepted because the old generation of scientists needs to move out of business first ... I believe that this was first stated for physical theories but it seems to hold for medicine as well. Fortunately some doctors and many patients are more flexible (and wiser) than that.

Wolfgang

Seven day check up following the second injection and "procedure" - delayed somewhat because of the Xmas holidays so it was more like a ten-day check up.

There's been considerable progress - the little finger PIP joint has gone from 60 degrees before starting the trial to 50 degrees after the first series of injections and procedure to 30 degrees now following the second set of injections and procedure. Still not there yet but the results are more encouraging now. I could probably live with the current extent of contracture even if there were no further improvement.

The finger was MUCH sorer and more tender following this set of injections than the first time and there's still some quite prominent swelling and discoloration including a particularly nasty looking red scabby thing on the outside of the PIP knuckle. And if I whack the thing just right, it's a definite "owie". The doctor seemed to think it no big deal however.

Third and final set of injections scheduled for the middle of next month. Hopefully there'll be some further improvement in the interim and the third time will be a charm. In the meantime, it's back to the exercises and the night time split.

Wow, it really sounds like you've had a tough go of it. I wonder how many others have had injections directly into the finger as opposed to the palm. Since my starting contraction (25%) was so much less I only needed the one injection to reach zero degrees. I still wear the hand splint most nights and have stiffness when I remove it in the morning. Generally within a few minutes it subsides. Good luck with your final injection. It will be interesting to hear what the doctor tries next.

I had the needle by Dr. Eaton three years ago. My finger is still straight. I had very little pain. I actually enjoyed chatting with Dr. Eaton while he worked on my little bent finger. I am concerned about the pain and trouble told by the Auxilium AA4500 patients. I am sure I would prefer the "French Neddle" should I have a bent finger again.

I add that I email a picture of my finger to Dr. Eaton every 3 months. I hope many of his patients do the same.