Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.22.6 (chymopapain)
 407 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study of 480 patients who underwent enzymatic dissolution of the nucleus pulposus with chymopapain is reported. Seventy per cent of patients with the clincial criteria for a disc herniation had a favourable response to chemonucleolysis. The commonest cause of failure was persistent back pain. In patients with sequestered discs or lateral recess stenosis surgical intervention was not made more difficult by chemonucleolysis. Those with a previous operation, spinal stenosis or psychogenic components to the disability had very poor results. Complications were few and easily managed.
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PMID:Chemonucleolysis. 13 12

To help clarify the comparative effects of chemonucleolysis and discectomy, the author studied 178 consecutive patients with sciatica who did not respond to conservative treatment. None had previously undergone laminectomy or chemonucleolysis or had spinal stenosis. All received postmyelography computerized tomography (CT) and, if the radiological interpretation was that of an extruded migrated disc, a laminectomy was performed; otherwise, the patient was given a choice of the two procedures. Of the 178 patients, 106 underwent chemonucleolysis and 72 laminectomy. Workers' compensation was being paid to 21.6% of the chemonucleolysis patients and 20.8% of the laminectomy patients. Postoperatively, substantial improvement was noted in 82.7% of the chemonucleolysis patients and 92.5% of the laminectomy patients at 6 weeks and in 92.8% of the chemonucleolysis patients and 89.7% of the laminectomy patients at 6 months. The majority of patients in both groups had improved neurological signs. Follow-up questionnaires at 1 to 4 years postoperatively revealed an overall success rate of 86.5% for chemonucleolysis patients and 83.8% for laminectomy patients. In patients not receiving workers' compensation, 90.1% of the chemonucleolysis patients and 88.6% of the laminectomy patients had a successful outcome; in those receiving workers' compensation, 69.6% of the chemonucleolysis patients and 60.0% of the laminectomy patients had a successful outcome. No statistically significant differences in improvement rate in neurological symptoms or signs were identified between the two procedures. Overall, 85.1% of the chemonucleolysis patients and 78.5% of the laminectomy patients were employed at follow-up review. To achieve optimum results and eliminate noncandidates for chemonucleolysis, routine use of postmyelography CT is recommended. When properly used, chymopapain chemonucleolysis is an acceptable alternative to surgical discectomy.
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PMID:A 1- to 4-year follow-up review of treatment of sciatica using chemonucleolysis or laminectomy. 173 Sep 46

A follow-up of 1289 chemonucleolyses performed on 1141 patients and a questionnaire answered by 80% of these patients shows that some conditions hitherto held to be contraindications can be questioned: chemonucleolysis performed in cases of disk herniations with spinal stenosis can produce very good results. A second chemonucleolysis with chymopapain at a later date is possible. In patients who have previously undergone surgery on the same disk, chemonucleolysis offers good chances of improvement in the event of a reherniation.
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PMID:[Chemonucleolysis--with extended indications. 4 years clinical experience]. 324 82

739 patients treated eight to 13 years previously with chymopapain injection are evaluated by questionnaire. The results were 76% satisfactory and 24% unsatisfactory. When those with prior surgery, midline discs, and spondylolisthesis were eliminated, there is a satisfactory result in 82% with 60% excellent, reinforcing the importance of patient selection for the procedure. Thirty-one percent of patients had preoperative myelograms, and all had discograms and were done under general anesthesia with the single needle technique. Of the excellent and good results, 50% had a two-level injection, while one-level injections produced only 23% and 20%, respectively. Results in midline discs are comparable to lateral displacement and the 13 patients with spondylolisthesis had 85% satisfactory outcome. In ten patients younger than 19 years of age, only one was a failure. Sixteen percent of patients had prior surgery and they reported a successful outcome of injection in 55%. Of the 179 unsatisfactory results in the series, subsequent treatment reduced the rate of failed end results to 14%. The study verifies the persistence of early satisfactory results and shows no late complications such as symptomatic iatrogenic spinal stenosis.
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PMID:Eight- to 13-year follow-up evaluation of chemonucleolysis patients. 370 73

The effect of chymopapain injection was investigated in myelographically confirmed intervertebral disc herniation in 268 patients after ten years. Mean age is 39.4 years, 178 males and 90 females. Sixty-two patients had compensation or litigation and 12 had prior lumbar spine surgery. Discography was performed in 223 patients, resulting in 134 one-level injections, 124 two-level injections, and ten three-level injections. Forty percent of the patients experienced postoperative muscle spasm for several days. No complications were seen in 241 patients (92%) who were available for follow-up examination at ten years; 86% had less leg pain, 82% were employed at a capacity equal to or greater than before injection, 9% were at a less strenuous job, 1% were disabled, and 8% had retired. In 22 patients treated surgically within one year of chemonucleolysis, disc-related pathology was present in 14 cases and spondylosis or spinal stenosis was present in seven cases. One had a negative exploration and continued to be disabled. Eight patients came to surgical intervention after one year because of persisting symptoms: four patients had disc protrusion, three had laminectomy and spinal fusion, and one had a decompressive laminectomy secondary to spondylotic change. Chemonucleolysis did not prejudice the outcome of subsequent surgical treatment with good results following this intervention. One tumor, a neurofibroma, was found in this study. Chemonucleolysis with chymopapain was a safe and effective treatment of radicular complaints caused by well-documented intervertebral disc herniation.
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PMID:The long-term results of chymopapain. Ten-year follow-up of 268 patients after chemonucleolysis. 370 90

One hundred and twenty patients suffering some sciatica due to disc herniation have been treated by chemonucleolysis. All the patients had received conservative treatment for at least four months. The minimum followup after nucleolysis was six months. In 114 patients, radiculography was positive and in 6, radiculography was negative but phlebography was positive. Patients with symptoms of spinal stenosis, or with signs of sequestrated disc or who had been previously operated on by laminectomy were excluded from the study. By a lateral extradural approach, 4000 units of chymopapain were injected into the disc under general anaesthesia after discography. All patients except 3 had only disc injected. Results were good in 92 patients. 21 of the 28 failures were operated on. In 18 cases, a mechanical cause was found at operation with 16 good results. Complications were rare and benign. No neurological complication was noted. It is concluded that chemonucleolysis should be the last step in the conservative management of sciatica.
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PMID:[Treatment of disk sciatica by chemonucleolysis. 120 cases]. 621 15

Chemonucleolysis is a safe, relatively minor procedure which can be done with the patient under local anesthesia. If the procedure is confined to patients with sciatica resulting from a herniated intervertebral disk, and patients with non-organic spinal pain, spinal stenosis and poor response to previous surgery are excluded, good results can be anticipated. It is important that the technique include proper placement of the needle and injection of adequate amounts of chymopapain into a disk space which is free of other materials. Chemonucleolysis is a good procedure to bridge the wide gulf between standard conservative treatment and surgery.
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PMID:Chemonucleolysis: experience with 2000 cases. 698 36

Chemonucleolysis is the nonoperative chemical removal of displaced lumbar disc material. The enzyme chymopapain, which has a wide margin of safety between its effective therapeutic and toxic doses, is effective in the management of sciatica due to a herniated intervertebral disc. The patient will have leg pain as the dominant symptom and a 50% reduction in straight-leg raising with or without bowstring discomfort and crossover pain. Neurologic symptoms and signs are usual, as are abnormal results of contrast studies, which will verify the level of involvement. In 220 randomly selected patients who met criteria for the diagnosis of sciatica due to a herniated intervertebral disc and did not have psychogenic or nonorganic spinal pain, a spinal stenosis or a history of a previous, unsuccessful operation to relieve the sciatica, chemonucleolysis had a success rate of 80%. The only complications were a severe anaphylactic reaction in two patients and lesser, delayed reactions in five others. All of the reactions were successfully treated. Of the 45 patients in whom chemonucleolysis was unsuccessful, 38 underwent a laminectomy. In 3 of the 38 the results of chemonucleolysis were initially good, but later the disc herniation recurred; thus, the long-term treatment failure rate was 1.4%.
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PMID:Chemonucleolysis for relief of sciatica due to a herniated intervertebral disc. 701 30

This is a retrospective analysis of 118 patients who underwent 132 operations in a city compensation setting for the treatment of lumbar disk disease from January 1976 to December 1987. Each of these patients had a work-related injury. There was a minimum 2-year follow up with an average follow up of 6.9 years. No patients were lost to follow up. The purpose was to determine what percentage of patients treated in a work-related setting could be expected to return to a sustained, pre-injury employment state following a carefully executed lumbar spine surgical procedure. Satisfactory surgical results were considered achieved only by those patients who returned to full-duty work status. Only 31 of the 118 patients (26%) returned to full duty and were considered satisfactory. Regarding the number of surgical procedures, 31 of 132 operations (23%) were successful. Sixteen reoperations in 13 patients all resulted in failure. Only 16 of the 64 patients (25%) treated with laminectomy and diskectomy alone had a satisfactory result. When a two-level, posterior lateral spinal fusion was added the success rate was increased to 44%, with 12 of 27 patients returning to work. Six patients with spinal stenosis underwent decompression laminectomy and entry level foraminotomies, and all had unsatisfactory results. Five patients with isthmic spondylisthesis underwent a Gill procedure and fusion. Only one of these patients (25%) returned to work. For a 2-year period chymopapain injection was given to 14 patients. Only two returned to work, with a 14% success rate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of lumbar disk surgery in a city compensation population. 760 19