Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.22.25 (chymopapain)
 430 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 13,700 patients who received one or more lumbar disc injections of chymopapain, 401 complications, adverse reactions, and delayed untoward events were recorded, including eight deaths. The deaths were secondary to anaphylaxis, pulmonary embolism, discitis with subacute bacterial endocarditis, ruptured abdominal aortic aneurysms (two patients), encephalitis (of unknown etiology), and myocardial infarction. Of these, the deaths secondary to anaphylaxis and discitis with subacute bacterial endocarditis can be attributed directly to the procedure of chemonucleolysis.
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PMID:Complications of chemonucleolysis for lumbar disc disease. 61 47

Three hundred and nine patients having herniated nucleus pulposus syndrome were treated by chemonucleolysis with chymopapain. We analyzed the results of that treatment in the first 100 patients who had been followed up for two years. No significant allergic reactions, deaths, spinal cord injury or paralysis occurred. One patient had pulmonary embolus and another had a disk space infection. Diskitis did not occur. Of the 100 patients receiving chymopapain, 71% of the results were rated good to excellent; of those in a comparably followed-up group of 100 patients who underwent surgery, 63% of the results were rated good to excellent. The end result was achieved more quickly after chemonucleolysis and with less physiologic stress on the patient. The beneficial result was considered to be long lasting, and in our opinion, the quality of the end result was superior after chemonucleolysis.
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PMID:Chemonucleolysis vs laminectomy. 72 23

We report results from 108 consecutive patients followed up for one year after chymopapain injection. The patients were selected on strict clinical and radiological criteria. In nine patients (8%) the result was poor, and they were surgically treated within one year after the injection. 99 (92%) patients improved and after one year 87 of these (81% of the total material) had returned full time to their previous occupation. The only serious complication was one case of septicemia and possible discitis. The patient made a full recovery after antibiotic treatment. On the basis of these results, we shall continue to use chymopapain injection to treat selected patients with sciatica caused by herniated lumbar discs.
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PMID:[Lumbar disk prolapse treated with chymopapain]. 141 32

This study is based on 20 patients who underwent bone scanning before and after chemonucleolysis (CN) for a herniated lumbar disk. It shows that chymopapain, the proteolytic enzyme used for CN, does not induce early or late bone lesions of the adjacent vertebral plates. Abnormal uptake by one of the vertebral plates indicates a "chemical discitis." The pattern observed on the bone scan is different from the one presented by patients with bacterial spondylitis.
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PMID:Bone scan and chemonucleolysis. 227 34

The role of antibiotics in the treatment of iatrogenic discitis remains controversial. This study was carried out to assess the ability of cephazolin (a first-generation cephalosporin) to penetrate the intervertebral disc and to establish the role of intravenous antibiotics in the prevention and treatment of iatrogenic discitis. Six sheep had 1 g of intravenous antibiotic administered between 30 minutes and 120 minutes before being killed. Two adjacent lumbar intervertebral discs were harvested and assayed for antibiotic concentration. Cephazolin could only be detected in the animals killed at 30 minutes. Intravenous cephazolin was administered 30 minutes before bacterial inoculation in 46 discs of nine sheep. In five animals, the bacterial suspension contained radiographic contrast and, in four sheep, reconstituted chymopapain. No evidence of discitis was found at any level at death. Eight sheep were treated with intravenous cephazolin commencing 1, 2, or 3 weeks after bacterial intradiscal inoculation and for periods of up to 21 days. All discs developed discitis, and the lesions appeared to be similar, irrespective of time between inoculation and the commencement, duration, and dosage of antibiotic therapy. Our study supports the use of a suitable broad-spectrum antibiotic during any surgical procedure that invades the intervertebral disc. Antibiotics, however, are unable to arrest the progression of discitis once it is established
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PMID:Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. 278 8

Four patients who had received chymopapain injections for treatment of herniated lumbar disks were evaluated by computed tomography (CT) because of persistent low back pain and suspicion of infection. Irregularity of the vertebral end-plate and a mottled appearance of the vertebral bodies suggested the diagnosis of disk-space infection in all four cases. CT-guided biopsy of the disk space was performed in each case, and bacterial cultures demonstrated staphylococcal infections, which were treated accordingly. Diskitis secondary to chymopapain injection is rare because of the precautions that are usually taken. No antibiotics are used routinely with such injections, although systemic antibiotics have been used in diabetics for prophylaxis.
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PMID:Intervertebral disk-space infection after chymopapain injection. 315 70

A prospective, multiinstitutional, double-blind trial comparing the effect of chymopapain (Discase) vs. placebo (cysteine-edetate-iothalamate: CEI) for lumbar intervertebral disc rupture with sciatica was carried out on 173 patients, the largest such study reported to date. Patients were matched with respect to age, sex, physical habitus, and level of injection. The procedure was carried out under local anaesthesia. The success rate was superior in the chymopapain group regardless of the method used to assess outcome or the time over the first 6 months at which the two groups were compared: 71% vs. 45% if code breaks were analyzed at 6 months, and 67% vs. 44% if code breaks were defined as lost to follow-up. A single case of anaphylaxis and one case of septic discitis were the only serious complications noted. This study supports the role of chymopapain in the treatment of lumbar disc rupture with sciatica.
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PMID:Safety and efficacy of chymopapain (Discase) in the treatment of sciatica due to a herniated nucleus pulposus. Results of a randomized, double-blind study. 318 1

Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.
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PMID:Intervertebral disc infection after lumbar chemonucleolysis: report of a case. 371 10

Magnetic resonance imaging (MRI) of the spine produces images which reflect the chemical composition of the intervertebral disc. We have conducted a prospective study of the serial changes in the MRI appearance of the intervertebral disc after chemonucleolysis with the enzyme chymopapain. Fourteen patients were studied after single-level chemonucleolysis and the results compared with a control group of 17 discs in six patients who had diagnostic discography without enzyme insertion. A consistent pattern of gradual loss of signal from the nucleus pulposus culminating in complete loss of nuclear signal was seen in all cases after chemonucleolysis. Chymopapain therefore produced MRI changes analogous with premature gross disc degeneration. The rate at which this occurred varied; complete loss of signal took at least six weeks. Transitory minor end-plate changes were present in five patients, probably representing a mild chemical discitis. No similar changes were seen in the discography group.
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PMID:The changes in the intervertebral disc after chemonucleolysis demonstrated by magnetic resonance imaging. 378 31

Although infection following intradiscal injections has been recognized as a distinct entity, discitis following chemonucleolysis has been often attributed to a chemical reaction from chymopapain. In the first part of this study the effect of chymopapain and Conray 280 on a wide range of bacteria was measured in vitro. Chymopapain was found to have a bactericidal effect on all bacteria tested, which was more pronounced with gram positive organisms, whereas Conray 280 showed very little if any antibacterial effect after 48 hours. The aim of the second part of the study was to test the hypothesis that discitis following intradiscal chymopapain injection is due to infection and not to a chemical reaction. Multiple level lumbar intradiscal injections were carried out in eight mature sheep. Sixteen discs in four sheep were injected with a mixture of reconstituted chymopapain and a Staphylococcus epidermidis suspension. Sixteen discs in another four sheep were injected with reconstituted chymopapain only. All sheep were sacrificed at 6 weeks and the discs and end-plates were examined radiologically, and by histopathology and nuclear material was cultured for bacteria. None of the controls showed any evidence of discitis, whereas all sheep injected with bacteria had typical radiologic and histopathologic changes of discitis. However, in most cases in which end-plate lesions were well established there was no evidence of bacteria at sacrifice. These findings support the opinion that discitis following intradiscal injection is always due to infection introduced by the needle tip.
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PMID:Discitis following chemonucleolysis. An experimental study. 378 39


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