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)

Painful symptomatology in the lower limbs coming on with walking must not systematically be attributed to arteritis of the lower limbs. Among the characteristics which may suggest that this "claudication" is due to a narrowed lumbar canal, is the presence of paresthesia and above all the clear improvement when the patient is seated or adopts a lumbar kyphotic position. It is therefore extremely important to keep in mind the radicular topography of pain and neurological deficit. The congenitally narrow lumbar canals rarely produce problems unless there is further narrowing of the lumbar or radicular canal by a disco-osteophytic projection anteriorly, a posterior articular osteophytic projection posteriorly, thickening of the ligamentum flavum, an abnormal widening of the dural sheath, or excess peridural fat. Among the complementary investigations, CAT scan is useful to analyse the structures involved, but this examination is carried out in decubitus, i.e., without lordosis, while narrowing principally appears on lumbar extension, i.e., in the upright position. Saccoradiculography therefore remains the investigation of choice, performed in the seated and upright position. It can objectively assess the degree of narrowing and analyse the proportion due to the anterior discal or posterior articular component. This investigation should only be requested after failure of medical treatment based above all on analgesics, physiotherapy in lumbar kyphosis, and an abdomino-lumbar corset support. In the event of failure of medical treatment and if the patient is very handicapped, one most often resorts to decompressive surgery, however when narrowing is principally due to a discal projection, one may attempt discolysis with chymopapain.
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PMID:[Radicular claudication with a narrowed lumbar canal]. 252 41

Fifty consecutive patients undergoing chemonucleolysis with chymopapain at William Beaumont Hospital were analyzed with special reference to the following factors: the physical examination, the dye pattern noted on discogram, and the size of the preoperative myelographic defect. Discogram pattern was divided in four types: normal disc, degenerative pattern, degenerative pattern with extravasation, and annular injection. The myelograms were graded into a mild defect, a moderate defect, or a severe defect. Follow-up averaged 20 months. Conclusions of this study were Chymopapain can be considered as an alternative to lumbar laminectomy for relief of sciatica secondary to herniated disc. Statistically significant improved postinjection results were noted when patients presented with three out of four objective physical findings consisting of positive straight leg raising, reflex change, dermatomal paresthesia pattern, and/or mild motor weakness. Placement of the needle within the nucleus leads to a statistically significant improved result over placement of the needle into the annulus. A severe myelographic defect greater than 50% dura sac compression is a relative contraindication to the injection of chymopapain.
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PMID:Chemonucleolysis. The relationship of the physical findings, discography, and myelography to the clinical result. 375 74