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)

The role of antibiotics in the treatment of iatrogenic discitis remains controversial. This study was carried out to assess the ability of cephazolin (a first-generation cephalosporin) to penetrate the intervertebral disc and to establish the role of intravenous antibiotics in the prevention and treatment of iatrogenic discitis. Six sheep had 1 g of intravenous antibiotic administered between 30 minutes and 120 minutes before being killed. Two adjacent lumbar intervertebral discs were harvested and assayed for antibiotic concentration. Cephazolin could only be detected in the animals killed at 30 minutes. Intravenous cephazolin was administered 30 minutes before bacterial inoculation in 46 discs of nine sheep. In five animals, the bacterial suspension contained radiographic contrast and, in four sheep, reconstituted chymopapain. No evidence of discitis was found at any level at death. Eight sheep were treated with intravenous cephazolin commencing 1, 2, or 3 weeks after bacterial intradiscal inoculation and for periods of up to 21 days. All discs developed discitis, and the lesions appeared to be similar, irrespective of time between inoculation and the commencement, duration, and dosage of antibiotic therapy. Our study supports the use of a suitable broad-spectrum antibiotic during any surgical procedure that invades the intervertebral disc. Antibiotics, however, are unable to arrest the progression of discitis once it is established
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PMID:Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. 278 8

Chymopapain is a proteolytic enzyme used in the chemonucleolysis of the herniated nucleus pulposus of lumbar intervertebral discs. It causes rapid hydrolysis of the noncollagenous polypeptides that maintain the tertiary structure of the chondromucoprotein of the nucleus pulposus. We report here an anaphylactoid reaction after the intervertebral injection of chymopapain.
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PMID:Anaphylactoid reaction to chymopapain. 239 12

Short and long-term effects of chymopapain on nervous transmission were studied in rats. The drug was injected into the lumbar spinal canal. Action potentials evoked by electrical stimulation of the sciatic nerve were recorded at the dorsal root entry zone of the lumbar cord. One group of rats was pre-treated with dexamethasone. Chymopapain prolongs impulse latency compared to that of control rats treated with isotonic saline. The effect is dose dependent and can last for several weeks. Rats pre-treated with dexamethasone showed milder impairment of nervous transmission after chymopapain injection compared to the rats treated only with papain.
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PMID:[Animal experiment studies of the diagnosis and therapy of chymopapain-induced spinal complications]. 282 93

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

Using magnetic resonance imaging, conventional histology, and spinal evoked potentials, the authors studied the short-term effects of chymopapain on nerve tissue in the lumbar vertebral canal region in rats. Chymopapain in different concentrations was injected into the subarachnoid space in 31 rats. As early as 20 minutes later latency changes in the evoked potentials were observed; the histologic examinations after two hours showed bleeding, swelling of the myelin, and vascular changes. Magnetic resonance imaging of the lumbar spine, performed after six hours, showed a markedly stronger signal, indicative of an intraspinal edema, as compared to the control group. The authors' studies are clear proof that changes in nerve tissue following contact with chymopapain occur considerably faster than hitherto assumed in the literature.
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PMID:[Early functional and structural changes in the nerve tissue following contact with chymopapain]. 285 34

The American experience concerning the epidemiology of anaphylactic reactions following chemonucleolysis with chymopapain (Chymodiactin) were presented. The first study involved 1,585 patients of whom 17% were premedicated with some drug with either an H1 or H2 antagonist or both. The rate of anaphylaxis was 0.82%. Following its clinical introduction, a postmarketing surveillance study was undertaken. During the first 30,000 cases of which 93% were premedicated with combined H1 and H2 antagonists, the frequency of anaphylactic reactions was 0.78%. Subsequently, following the introduction of an immunologic test to screen for circulating IgE, the reaction rate fell to 0.44% in 45,000 cases of which 92% were premedicated with combined H1 and H2 antagonists. Females were far more likely to experience an anaphylactic event. Overall mortality from anaphylaxis decreased from one in 800 to one in 25,000 administrations. The decreased number and severity of these reactions correspond to the development of an immunologic screening test and utilization of prophylactic antihistamines.
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PMID:Use of prophylactic combined H1 and H2 antagonists reduces mortality in chymopapain anaphylaxis. 286 Aug 28

A recognized side effect of chemonucleolysis is life-threatening anaphylaxis to chymopapain. In the clinical trials of chymopapain, 13 cases of anaphylaxis were reported in 1585 administrations (0.82%). Two patients died. Data from a postmarketing survey (48,239 questionnaires) were reviewed to identify factors influencing the incidence and severity of anaphylaxis. The results indicate the incidence of anaphylaxis decreased to 0.44% in the 1983-1984 period (126/23,736), a level significantly (P less than or equal to 0.001) below the incidence of 0.82% observed in initial clinical trials. Only three deaths from complications related to anaphylaxis occurred in approximately 75,000 administrations (producing 252 anaphylactic episodes) reported since December 1982. The prophylactic use of antihistamines and pretreatment with intravenous fluids coincide with the dramatic reduction in mortality due to anaphylaxis. However, overdiagnosis of anaphylaxis in the clinical trials and avoidance of chemonucleolysis in patients with IgE antibodies to chymopapain may account, in part, for the reduction in incidence.
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PMID:Decreased incidence and mortality of anaphylaxis to chymopapain. 286 10

Percutaneous diskectomy, particularly using Onik's nucleotome, has promise. It is too early, however, to decide if the percutaneous approach to reducing lumbar disk herniation will achieve a permanent place in the surgical armamentarium. Nevertheless, it is clear that patient selection is important. At the minimum, an adequate trial of conservative therapy must be followed by diagnostic imaging that documents a herniation that can be treated in this fashion and correlates with the patient's neurological signs and symptoms. If free fragments are found, a laminectomy of some sort will be required to remove the offending material. Patients who are at risk for general anesthesia or may be allergic to chymopapain were mentioned by the panel as special subpopulations for whom the procedure may be indicated despite the lack of wide experience with it. The rapidly rising popularity of automated percutaneous lumbar diskectomy via the nucleotome will hopefully be followed in the near future with larger studies with long-term follow-up.
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PMID:Diagnostic and therapeutic technology assessment. Percutaneous lumbar diskectomy for herniated disks. 277 12

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

Electrically evoked compound action potentials were used to quantify the neurophysiologic abnormalities caused by application of chymopapain into the lumbar spinal canal in rats. A branch of the sciatic nerve was stimulated with voltage impulses of constant amplitude (40 V) and duration (0.1 msec) at the right external malleolus. The responses were recorded at the dorsal root entry zone L1. The authors used different doses of chymopapain (low dose = 100 IU, middle dose = 250 IU, and high dose = 500 IU). The control rats were subjected to exactly the same stimulus and recording procedures, but the test solution was a corresponding volume of isotonic saline. The prolongation of the latency of the electrically evoked potential due to chymopapain is very clear at the doses of 250 IU and 500 IU, being about 10 to 15% relative to the mean latency before application of the drug. This study indicates that locally applied chymopapain has a dose-dependent effect on nerve conduction properties.
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PMID:The influence on spinal cord evoked potentials of chymopapain applied to the rat lumbar spine canal. 291 70


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