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)

One hundred and fifteen patients underwent chymopapain treatment for acute disc protrusion between 1980 and 1988. Sixty-six patients who were treated with single-level injection were reviewed retrospectively with clinical follow-up from 2 to 10 years (mean, 4.6 years). All patients met modified McCulloch criteria (not all patients had leg pain greater than back pain). The presence of pre-existing chronic low back pain (LBP) was recorded in 33 patients and compared to their present low back symptomatology and functional limitations. Patients with pre-existing chronic LBP had a success rate of 52%, whereas patients meeting all the McCulloch criteria without chronic LBP had a success rate of 52%, whereas patients meeting all the McCulloch criteria without chronic LBP had a success rate of 85%. The overall effect of chemonucleolysis on LBP demonstrated no change in 18% and a mild increase in 45% of the patients (even though they had a successful outcome). The pre-existing disc space narrowing and the postoperative change of disc space height of 33 patients assessed on lateral roentgenograms showed no correlation to the clinical response. Temporal sequential computed tomography scan assessment of 56 patients following chemonucleolysis demonstrated little change of disc herniation in the first 3 months, with only a gradual and incomplete resolution in the ensuing 12 months.
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PMID:The effect of chymopapain on low back pain. 153 30

The prognostic significance of gravity-induced trunk list and cross leg pain was investigated in 113 patients who had root tension signs from a lumbar disc lesion. Cross leg pain, (a positive contralateral straight leg raising sign) and list was associated with poor prognosis for conservative management. There was a high incidence of disc sequestration and extrusion in the operated patients with cross leg pain. It was concluded that cross leg pain is probably a contraindication to chymopapain injections, and the surgeon should be aware of the possibility of a migrated disc fragment during operation on patients with cross leg pain.
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PMID:Cross leg pain and trunk list. 274 74

An automated technique for percutaneous lumbar discectomy applies the principle of suction cutting. The indications are leg pain greater than back pain (sciatica) and failure of all conservative therapy. The typical neurological and roentgenographic abnormalities of a contained herniated lumbar disc are mandatory. The procedure is performed with a Nucleotome (Surgical Dynamics, San Leandro, California) that is a specially designed, 2-mm blunt-tipped suction-cutting device inserted via a posterolateral approach into the affected disc using fluoroscopic control. The results that can be expected with the technique are similar to chymopapain and are in the 70% success range. Automated percutaneous discectomy has a demonstrably low morbidity and can be performed under local anesthesia on an outpatient basis.
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PMID:Percutaneous automated discectomy. A new approach to lumbar surgery. 291 Jun 19

Fifty patients underwent chemonucleolysis for the treatment of lumbar disk herniations unresponsive to conservative therapy. In patients treated with chymopapain, unrelieved sciatica was the most common cause of clinical treatment failure. Eight patients (16%) experienced no relief or only a transient reduction in their radicular symptoms following chymopapain injection. All eight patients were clinically reevaluated and underwent repeat neuroradiographic studies. Computed axial tomography and lumbar myelography demonstrated persistent nerve root compromise at the level of the injected disk space. Open diskectomy was performed in all eight cases. Postoperatively, seven patients noted complete resolution of their radicular symptoms; one patient had intermittent low back and leg pain following surgery.
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PMID:Evaluation and treatment of chemonucleolysis failures. 323 75

A follow-up evaluation of 357 patients injected with chymopapain ten to 20 years earlier included 97 females of mean age 42.2 years and 260 males of mean age 41.6 years. Pain distribution and physical findings were positive for discogenic involvement of long duration prior to chemonucleolysis. Eighteen patients were treated under worker's compensation. Postoperation, significant back pain persisted less than 24 hours in seven patients, less than six days in 133, less than 21 days in 178, from one to three months in nine, and between three and six months in two patients. Leg pain remained less than 24 hours in 32 patients, between one and five days in 212, between six and 21 days in 96, between one and three months in seven, and between six and 12 months in three patients. Similar improvement in extensor hallucis longus weakness and straight leg raising was also noted. Pain relief in the long term showed none persisting in the 158 patients or 44%, mild remaining pain in 107 or 30%, moderate pain in 71 or 20% and some pain in 21 or 6%. Thus the result was graded satisfactory in 74%. Complications included thrombophlebitis in two, pulmonary emboli in two, severe abdominal stress two days postoperation in one, severe anaphylatic reaction in one, and transient chest pain of undetermined etiology in one patient. All made good recovery from these complications.
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PMID:Clinical studies of chemonucleolysis patients with ten- to twenty-year follow-up evaluation. 370 68

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

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

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

Chemonucleolysis with chymopapain is a well-documented method of treating lumbar disc herniation. In spite of this, only few patients are treated in this way in Norway. We have offered selected patients chemonucleolysis at our hospital since 1985. This article reports the long-term outcomes as regards employment status, back pain and leg pain. We have treated 277 patients. 269 were still alive in October 1995 and were sent a follow-up questionnaire. 257 patients responded, of whom 36 (14%) had undergone surgery later, due to an unsatisfactory outcome of chemonucleolysis. 72% of the patients were fully employed at the time of follow-up. 61% had little or no back pain, while 69% never or only rarely suffered pain in the leg.
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PMID:[Chemonucleolysis of lumbar disk prolapse. Choice and complications]. 910 74

The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1-4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.
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PMID:Surgical treatments for lumbar disc disease in adolescent patients; chemonucleolysis / microsurgical discectomy/ PLIF with cages. 1574 15


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