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

Ten normal adult volunteers, 75 patients with low back pain and/or lumbar radiculopathy, 16 patients following chymopapain treatment, 14 patients with recurrent symptoms following disc surgery, and two patients with distal cord compression were scanned on Fonar 3000 permanent magnet scanner. Of all the patients 98 had additional computed tomography scans (CT) of the lumbar spine and 82 had myelography. Lumbar magnetic resonance imaging (MRI) and CT scans were both diagnostic in cases of herniated and extruded discs. MRI scan showed more information concerning the degenerative state of the intervertebral discs. It was relatively more accurate in detecting, small bulging and herniated discs without ruptured anulus and the relation of the migrated fragments of extruded discs to both the back of the vertebrae and the thecal sac. Moreover, lumbar MRI matched the clinical response of disc disease to chymopapain treatment more than lumbar CT scan. In addition, the MRI studies differentiated more accurately postoperative epidural fibrotic changes from recurrent herniated and/or extruded disc and detected distal spinal cord abnormalities. CT scan easily detected laterally herniated lumbar discs. Myelography was the diagnostic study in cases of arachnoiditis.
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PMID:Recognition of lumbar disc disease with magnetic resonance imaging. 299 99

Low back pain is the most common cause of disability under the age of 45. The annual incidence of back pain is estimated to be 5% and the lifetime prevalence is 80%. Majority of the patients with persistent symptoms are suffering from radiculopathy that is mainly caused by a herniated nucleus pulposus (HNP). HNP can heal spontaneously due to spontaneous resorption. Besides pressure nucleus pulposus, without any compression, may induce similar changes when applied epidurally to the nerve roots. Nevertheless, combination of chronic mechanical compression and application of nucleus pulposus causes a more pronounced nerve injury. When dual pathophysiology (pressure and inflammatory reaction), spontaneous resorption, and natural course of HNP are taken into account, any treatment modality that eliminates both the pressure and contact of the nucleus pulposus with the nerve root via creating extra time for healing to take place might prove beneficial. These requirements can be provided by spinal balloon nucleoplasty (SBN), which can be used in combination with other treatment modalities such as chymopapain injection. In this hypothetical method, epidural access to the subarachnoid space is established via epidural needles, thereafter a specially designed balloon tipped catheter is advanced. When the catheter is ideally placed with the help of CT or MRI, the balloon at the tip is inflated to relieve pressure and to prevent contact of the nerve root with HNP. The answer to the question, will SBN find a place in clinical practice? is obscure. But a homology can be established with uterine fibroid embolization, which has found clinical use in a period of 30 years approximately.
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PMID:Spinal balloon nucleoplasty: a hypothetical minimally invasive treatment for herniated nucleus pulposus. 1809 23

In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with lumbar disc herniation. In this era, use of discectomy surgery increased rapidly. Even patients with very early symptoms were offered surgery. Later work, especially by Weber and Hakelius, showed that many patients with lumbar disc herniation would improve without surgical intervention. In the ensuing decades, the debate over operative indications and timing continued, reaching another pivotal moment with the 2006 publication of the initial results of Spine Patient Outcomes Research Trial.
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PMID:A history of lumbar disc herniation from Hippocrates to the 1990s. 2475 13

Back pain is the second leading cause of disability among American adults and is currently treated either with conservative therapy or interventional pain procedures. However, the question that remains is whether we, as physicians, have adequate therapeutic options to offer to the patients who suffer from chronic low back pain but fail both conservative therapy and interventional pain procedures before they consider surgical options such as discectomy, disc arthroplasty, or spinal fusion. The purpose of this article is to review the potential novel therapies that are on the horizon for the treatment of chronic low back pain. We discuss medications that are currently in use through different phases of clinical trials (I-III) for the treatment of low back pain. In this review, we discuss revisiting the concept of chemonucleolysis using chymopapain, as the first drug in an intradiscal injection to reduce herniated disc size, and newer intradiscal therapies, including collagenase, chondroitinase, matrix metalloproteinases, and ethanol gel. We also review an intravenous glial cell-derived neurotrophic growth factor called artemin, which may repair sensory nerves compressed by herniated discs. Another new drug in development for low back pain without radiculopathy is a subcutaneous monoclonal antibody acting as nerve growth factor called tanezumab. Finally, we discuss how platelet-rich plasma and stem cells are being studied for the treatment of low back pain. We believe that with these new therapeutic options, we can bridge the current gap between conservative/interventional procedures and surgeries in patients with chronic back pain.
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PMID:Treatment of chronic low back pain - new approaches on the horizon. 2854 69