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)

Symptoms arising from a herniated disk appear when the nucleus pulposus or soft inner portion of the disk bulges against a nerve root. When conservative treatment fails to help the patient, the enzyme chymopapain is currently being used in the treatment of such conditions. Injected directly into the disk, the chymopapain dissolves the nucleus by enzymatic action which selectively breaks certain bonds within the nucleus. The pressure within the center is decreased, hence the pressure against the nerve root is relieved, alleviating the symptoms. Because back care is particularly important following such treatment, physical therapy is valuable in promoting continued relief. The major emphasis of the therapy back care program is on abdominal strengthening exercises and postural training.
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PMID:Treatment of lumbar disks with chymopapain. 126 9

Sixty patients with sciatica from lumbar intervertebral disc herniation were entered into a double-blind study. Following a randomized schedule, 30 patients were treated with intradiscal chymopapain and 30 patients with intradiscal normal saline. At 10 years, with the patients still unaware of the treatment given, 80% of the chymopapain patients regarded the injection to be successful, compared with 34% for the saline group (P = 0.0006). Laminectomy was required in 20% of the chymopapain patients, compared with 47% of the saline patients (P = 0.028). Seventy-seven percent of the chymopapain group was assessed by a blinded independent observer to be at least moderately improved, compared with 38% for the saline group (P = 0.004). The results of this double-blind study at 10 years demonstrate a sustained therapeutic effect of chymopapain in the treatment of patients with sciatica from lumbar intervertebral disc prolapse.
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PMID:Chymopapain. A 10-year, double-blind study. 157 72

MR tomography can be used for the diagnosis of lumbar disc prolapse and provide information concerning the indications and the follow-up of injection treatment with chymopapain. It is able to distinguish various parts of the disc from their varying signal intensity. Examination of 26 patients showed the effect of chymopapain on intradiscal fluid shift based on shifts in signal intensity. The use of T2-weighted gradient echo sequences over a period of seven to ten minutes is sufficient to show significant changes in the disc following chemonucleolysis.
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PMID:[MR tomography in the control of chemonucleolytic therapy]. 282 90

16 patients suffering from a herniated disc with purely lumbalgic manifestations were treated with chymopapain nucleolysis. The results were very good in 5 cases, good in 6 cases and poor in 5 cases. These data, along with those scattered in the literature, led us to consider nucleolysis as a treatment, probably valid, of a herniated disc in its purely lumbalgic form.
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PMID:[Treatment by nucleolysis using chymopapain of disk hernias of purely lumbalgic form]. 305 7

Fifty consecutive patients treated with chymopapain injection for a clinical and radiographic diagnosis of herniated nucleus pulposus were evaluated prospectively. All patients had a prechymopapain computed tomography (CT) scan and a three-month postinjection CT scan. In addition, ten patients (20%) had a six-month postinjection CT scan. All scans were interpreted blindly. Only six patients (12%) had obvious changes in the size of the disc when preinjection and three-month postinjection CT scans were compared. By six months, however, seven of ten patients (70%) had obvious changes in their CT scan. Seven patients (14%) were considered chymopapain treatment failures and were later treated with surgical discectomy. Only two of these seven patients (30%) had obvious changes in their three-month CT scan. Chymopapain injection did not alter the size of the herniated portion of the disc during the first three months after chymopapain injection. A decision to operate for presumed chymopapain failure should therefore be based on clinical grounds, rather than on the three-month CT appearance of the herniated disc.
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PMID:Computed tomography scanning after chymopapain injection for herniated nucleus pulposus. A prospective study. 358 60

One hundred and one consecutive patients with lumbar disc prolapse were treated by chymopapain chemonucleolysis and their response and favourable pre-treatment criteria determined. Most improvement occurred within the first month, and one year after treatment outcome was judged satisfactory (excellent or good) in 71%. Individual patient characteristics associated with a satisfactory response were sciatica of greater severity than back pain (p = 0.005) and duration of symptoms less than 18 months (p = 0.03). Patients fulfilling 3 or 4 of four immediate pre-treatment clinical and radiographic criteria (sciatica more severe than back pain, reduced straight leg raising, neurological deficit, radiographic abnormality) had a satisfactory response more often than others (p less than 0.05). Reported success one year after surgery for disc prolapse is similar. Chemonucleolysis, however, requires less resources and does not preclude subsequent operation. Our results therefore suggest that it might be considered an alternative to surgery when conservative treatment has failed.
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PMID:Chemonucleolysis of lumbar intervertebral disc prolapse with chymopapain: outcome after 1 year. 358 97

Chemonucleolysis was performed in 103 patients for lumbar disc prolapse. Multiple (two) interspaces were injected in only seven patients. Radiographically, all patients had myelographic or computerized tomography evidence of disc prolapse. Eighty-seven of 100 patients who were available for follow-up review had improved. Ten of 13 patients with persistent symptoms required a laminectomy. Altered spinal alignment was evident in five of the 13 patients with persistent symptoms: retrolisthesis in three and myelographic disc defect on the convex aspect of the scoliosis in two. Review of radiographic studies was carried out in an attempt to establish guidelines for patient selection so as to decrease the rate of failure in chymopapain treatment.
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PMID:Correlation of radiological features to failure of lumbar intervertebral disc chemonucleolysis. 370 23

The "wink" sign of nerve root cut-off seen on metrizamide-enhanced computerized tomography correlates well with compression of a lumbar nerve by a herniated disk. Seven of 46 patients had normal or equivocal myelograms, but had definite nerve root cut-off on metrizamide-enhanced CT scan. All seven patients were found to have a herniated lumbar disk at operation or a diskogram positive for herniation at the time of chymopapain injection. The wink sign is an additional objective finding that can be used in assessing the patient with sciatica.
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PMID:Nerve root cut-off on metrizamide-enhanced computerized tomography. 370 20

Seventeen patients with intractable sciatica due to prolapse of a lumbar disc, treated by intradiscal injection of chymopapain (chemonucleolysis) were studied. Analysis of serial 24 hour urine collections showed a significant increase in urinary glycosaminoglycan after chemonucleolysis. This was not detected in four patients undergoing routine discography. Enzymic analysis of urinary glycosaminoglycan after chemonucleolysis suggested that the increase in levels was largely due to an increase in the amounts of chondroitin sulphate present, probably resulting from proteoglycan breakdown in the intervertebral disc. Eight of the patients treated by chemonucleolysis underwent serial computed tomography (CT). One month after the injection the only change seen was a loss of definition of the disc prolapse, which could be interpreted as a loss of turgidity in the disc as a result of proteoglycan breakdown by chymopapain. By six months the CT of those patients whose symptoms had improved showed that the degree of disc prolapse was usually less marked and the disc margin more clearly defined, suggesting that by this stage anatomical remodelling had occurred.
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PMID:Mechanism of action of intradiscal chymopapain in the treatment of sciatica: a clinical, biochemical, and radiological study. 372 72

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


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