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)

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 long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.
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PMID:The long-term results of chymopapain chemonucleolysis for lumbar disc disease. Ten-year follow-up results in 268 patients injected at the Mayo Clinic. 371 15

Out of a total of 435 cases of nucleolysis, 400 case-reports of which could be used, secondary surgery was performed in 48 cases or 12% of the total. Surgery was most frequently required following L4/L5 than L5/S1 nucleolysis. The most frequent causes of failure of nucleolysis were lateral osseous stenosis (19 cases) and sub-ligamentous hernia (17 cases), apparently due to the ineffectiveness of the enzyme. Excluded hernia was rare (4 cases). Hernias at another level (4 cases) required surgery since it was not possible to repeat the injection of chymopapain. Three of these explorations were of the linea alba and one failure was due to spondylolisthesis due to isthmic lysis. Some failures occurred after some delay. The sciatic relapses after a period of complete clinical cure. In some cases, the relapse was in fact at another level or involved sub-ligamentous or excluded hernia. Surgery following nucleolysis is the same as that of an uninjected hernia; there are no adherences. The results are generally the same as those obtained by primitive surgery (two thirds favorable outcome). However, this depends mainly on what has been detected. The results are very good for hernias at another level and for excluded hernias. Fair results are obtained for stenosis and for sub-ligamentous hernias but only poor results in explorations of the linea alba.
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PMID:[Cause of failure of nucleolysis and results of surgery]. 376 25