Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An experimental model of disc herniation in tail discs of rats is described. Constant result on nucleus hernia and intervertebral narrowing were obtained by an easy manipulation on numerous rats. Intradiscal injection of aprotinin produced a widening of the disc height. Trypsin, collagenase, chymopapain, and hyaluronidase induced a narrowing of disc height; trypsin induced macroscopic necrosis of the soft surrounding tissues; and collagenase had a destructive effect on nucleus pulposus, annulus fibrosus, and even on end-plates. Chymopapain and hyaluronidase acted mainly on nucleus pulposus. Hyaluronidase could be of interest as a nucleolytic drug and needs further studies on optimal dosage and lack of side effects in the surrounding tissues before injecting it into human discs.
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PMID:Experimental model of disc herniations in rats for study of nucleolytic drugs. 244 86

Between 1% and 13% of lumbar disk hernias lie in a very lateral position outside the canal. Diagnosis of the disease is based mainly on CT scan with x-ray. Once conservative therapy has failed, surgery has hitherto been the only treatment proposed, but this generally requires sacrifice of an articular mass. The authors report their experience with chemonucleolysis with chymopapain in five patients presenting this type of hernia. Cure was obtained in four cases. The main advantage of the technique is that osteo-articular structures are preserved.
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PMID:[Chemonucleolysis. A therapeutic alternative in extra-canalicular lumbar disk hernias]. 251 Apr 52

Intradiscal injection of chymopapain for the treatment of sciatica due to disc herniation has been used for more than 25 years, but is still under debate. We review the indications, complications, and clinical results, and discuss the tissue effects of chymopapain. The results following surgical disc removal versus chymopapain injection indicate that surgery with removal of the disc hernia through a small laminotomy remains the documented treatment of choice for patients with proven disc herniation and sciatica in whom conservative treatment has failed.
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PMID:Chemonucleolysis for sciatica. A critical review. 272 95

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

The results of removal of a disc hernia at the L4/L5 level were compared with those obtained by the injection of 4000 IU (2 ml) of chymopapain (Discase) in 29 consecutive patients randomly selected for either treatment. All exhibited severe incapacitating sciatica, and all had a myelogram demonstrating a definite disc hernia. The two groups of patients did not differ significantly with regard to age, sex, or length of history. The total time of general anesthesia was significantly shorter for the injected patients by 20 minutes (p less than 0.01), as was the length of hospitalization, by three days (p less than 0.05). Within five months, eight of the patients receiving chymopapain injections had to be operated on because of unrelieved symptoms. All had definite disc herniae, and in four, a free fragment was found. All patients were seen at the time of dismissal from the hospital and at six and 12 months after operation by an independent observer. Comparisons made at these intervals, following either surgery or chymopapain injection with or without subsequent surgery, did not reveal any significant differences, but the short-term results following either treatment alone significantly (p less than 0.01) favored the surgical approach.
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PMID:Surgery versus chemonucleolysis for herniated lumbar discs. A prospective study with random assignment. 633 37

Nine hundred and eighteen patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels (150 of whom were treated at two levels): 185 patients were treated with Onik's automate discectomy. Chemonucleolysis was carried out on 733 patients (79.8%) and automated discectomy in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy was an effective method of management in 74.6% of the cases. The availability of several therapeutic methods has allowed us to respond in a more appropriate way to the patient's requirements and, in the case of failure, offer a more flexible therapeutic spectrum, and to consider surgery as the last resort. As regards the relation between enzymatic nucleolysis with chymopapain and disc nucleoaspiration, we feel that the two should not be in competition, for the indications are precise for both methods: in the enzymatic treatment, the hernia can be medium-large sized, in a sub- or extra-ligamentous position. The treatment of patients with moderately severe symptoms is preferable. In disc nucleoaspiration, the hernia must be small-sized.
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PMID:Percutaneous treatment of lumbar disc herniation. 835 35

The combination of percutaneous manual and endoscopic Ho:YAG laser discectomy (PELD) is a new minimal intervention technique in treating patients with herniated lumbar discs that do not penetrate the posterior longitudinal ligament. The results in 100 patients treated with PELD were compared randomly with those in 100 patients treated by chemonucleolysis with chymopapain (CN) and 100 patients treated by automated percutaneous lumbar discectomy (APLD) at the same hospital. We followed the 300 patients postoperatively for 1 year, with physical examination, postoperative plain lumbosacral radiography, CT, MRI and a self-assessment questionnaire. Some 68% of the patients in the PELD group considered the outcome as excellent or good and 23% as fair; the corresponding figures were 55% and 27% in the CN group, and 48% and 32% in the APLD group. Nine percent of the patients in the PELD group underwent open microdiscectomy or were suffering from back pain with sciatica, compared with 18% in the CN group and 20% in the APLD group. PELD showed better extraction of the hernia mass than APLD and a lower rate of low back pain and less decrease in disc height than CN.
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PMID:[Comparison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy]. 862 46