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)

We report results from 108 consecutive patients followed up for one year after chymopapain injection. The patients were selected on strict clinical and radiological criteria. In nine patients (8%) the result was poor, and they were surgically treated within one year after the injection. 99 (92%) patients improved and after one year 87 of these (81% of the total material) had returned full time to their previous occupation. The only serious complication was one case of septicemia and possible discitis. The patient made a full recovery after antibiotic treatment. On the basis of these results, we shall continue to use chymopapain injection to treat selected patients with sciatica caused by herniated lumbar discs.
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PMID:[Lumbar disk prolapse treated with chymopapain]. 141 32

Sciatica caused by intervertebral disc herniation can be treated with intradiscal injection of chymopapain. A search for a cheaper and less allergizing product led to triamcinolone hexacetonide, this procedure being known as "nucleorthesis". The first results at 6 months were encouraging. In 3 centres where triamcinolone hexacetonide was tested with a more than 2 years' follow-up 92 patients could be evaluated. The results obtained were considered satisfactory in 34 patients (36.9 percent), but they were poor in 19 patients (20.6 percent), and 39 patients (42 percent) had to be operated upon within 2 years. Return to surgery took place within the 6 months following nucleorthesis in 18 patients (19.56 percent) and beyond this period in 17 patients (22.8 percent) with degradation of the results. Moreover, calcifications were found in 19 out of 38 patients; they were of varying size, sometimes detected only at computerized tomography, and some of them appeared to produce symptoms. All considered, the failure rates, the number of patients who required surgery and the occurrence of large and sometimes symptomatic calcifications make triamcinolone nucleorthesis unacceptable compared with the recognized percentages of success with papain nucleolysis and surgical operations. For these reasons, we consider that this treatment should be abandoned.
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PMID:[Unsatisfactory results of intradiscal injection of triamcinolone hexacetonide in the treatment of sciatica caused by intervertebral disk herniation]. 841 78

Changes in the intervertebral disc after chemonucleolysis in 26 patients were observed by magnetic resonance imaging for 1 year, and from the results a mechanism for chemonucleolysis was considered. A reduction in size of the herniation was not recognized 2 weeks after treatment, when chymopapain had caused necrosis of the disc, but began after 4 weeks, when regeneration of the disc had occurred. The herniation was further reduced after 3 months, and the disc had become fibrocartilaginous in a cicatricial process. Marked decrease in disc signal was observed after 2 weeks, and never recovered. From these facts, it is considered that chymopapain might never cause primary diminution of disc herniation, and any reduction of herniation that occurs is due to the effects of a secondary cicatricial contraction.
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PMID:Serial changes observed by magnetic resonance imaging in the intervertebral disc after chemonucleolysis. A consideration of the mechanism of chemonucleolysis. 152 95

The treatment of sciatica due to lumbar disc herniation must be conservative, except if there is severe paralysis or a cauda equina syndrome. First of all, treatment needs bed rest during 15 days, non steroid antiinflammatory drugs and analgesics. In case of failure we propose 2 to 3 epidural injections of corticosteroids. Lumbar brace is often necessary. After 6 weeks of treatment including complete bed rest, radical treatment is proposed, either surgical or percutaneous. If the disc herniation is sequestered or if there is lumbar stenosis, surgery is indicated. In the other cases the choice between chemonucleolysis with chymopapain or percutaneous nucleotomy must be made with the patient informed of the results and complications of the different techniques and according to the results of CT scan or magnetic resonance imaging. Surgery remains efficacious after failure of percutaneous treatment.
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PMID:[Non surgical treatment of disk-related sciatica]. 153 29

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

Thirty patients with persistent sciatica due to a single disc protrusion were injected with 0.5 ml (2.0 mg) or 2.0 ml (8.0 mg) of chymopapain. Serial 24-hour urine samples were collected 1 day preinjection and for 5 days postinjection for glycosaminoglycan analysis. There was a significant increase in urinary glycosaminoglycan in both groups following chemonucleolysis, but no significant difference was found between the two groups in the total excretion of glycosaminoglycan during the 5-day period. Low-dose, low-volume chemonucleolysis may be as effective as standard doses in releasing glycosaminoglycan from intervertebral discs.
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PMID:Low-dose, low-volume chemonucleolysis. A biochemical study. 153 16

To clarify the pathogenesis of allergic pulmonary diseases by analysis of the reactivity of human lung mast cells, we established a method of dispersion and purification of mast cells from human lung tissue. This method consisted of 4 steps; 1) mincing by scissors, 2) enzymatic treatment by a pronase-chymopapain and collagenase-elastase mixture, 3) percoll centrifugation and 4) exclusion of adherent cells. Using this method, dispersed human lung mast cells were obtained with 38.8% purity and more than 95% viability. These mast cells contained 4.1 pg of histamine per cell, which showed these cells had mild spontaneous histamine release after treatment. The mast cells released histamine in a dose-dependent manner after treatment with calcium ionophore A 23187 and anti-IgE, and these phenomena were dependent on extracellular calcium ions. However, the cells did not release histamine with less than 100 micrograms/ml of compound 48/80. These results indicate that the human lung mast cells obtained by this method are useful to make immunological and pharmacological analyses in allergic lung diseases.
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PMID:[Purification and reactivity of human lung mast cells]. 157 35

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

Stenosis of the nerve root canal caused by isolated resorption of a lumbar disc is a frequently observed pathology, but one about which the orthopaedist still knows relatively little. Henry Crock was the first to reveal its principal pathogenetic factor, disc resorption, and to accurately describe the syndrome and its surgical treatment. A total of 22 patients operated according to Henry Crock's indications and followed-up after 2 years were reviewed. In 20 cases decompression alone was performed, while in 2 cases anterior fusion and MOSS instrumentation were associated. Of the 22 patients submitted to decompression 17 revealed complete regression of pain. Three cases failed: 1 patient had previously been treated with chymopapain, while 3 are awaiting anterior fusion to treat persistent lumbar pain. Follow-up is not sufficient for the two patients submitted to anterior fusion.
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PMID:Stenosis of the nerve root canal caused by disc resorption. 158 62

Studies were carried out to demonstrate residual chymopapain activity in intervertebral discs after chemonucleolysis; protease assay, enzyme-linked immunosorbent assay, and immunohistochemical localization of the chymopapain in the disc tissue were done. Chymopapain, one milligram per level, was injected into the normal lumbar intervertebral discs of adult mongrel dogs and the discs were excised after two weeks. Proteolytically active chymopapain was still present in the extract of intervertebral disc at this time. The proteolytic activity was decreased by sulfhydryl inhibitors but not by inhibitors of metalloproteases or serine proteases. Protease and enzyme-linked immunosorbent assays showed that 0.60 +/- 0.48 per cent and 0.49 +/- 0.38 per cent of the original dose was present two weeks after the injection. Chymopapain was shown by immunohistochemical staining to be diffusely located throughout the extracellular matrix of the anulus fibrosus and the nucleus pulposus. Some cells, located mainly in the inner portion of the anulus, contained vacuoles filled with immunoreactive product.
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PMID:Residual chymopapain activity after chemonucleolysis in normal intervertebral discs in dogs. 831 35


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