Sample records for chymopapain

  1. Chymopapain chemonucleolysis: CT changes after treatment

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    Lee, Min Jeong; Lee, Kyung Yun; Lee, Shin Hyung; Lee, Chang Jun [National Medical Center, Seoul (Korea, Republic of)


    The herniated nucleus pulposus (HNP) is a very common disorder. In those patient, who do not respond, more direct therapeutic measures, may be necessary. The chymopapain cheomonuclelysis, after two decades of development, has provided a variable alternative to surgical diskectomy for treatment of HNP. The changes of CT scan follow-up 1 month and 3 month that occur in the disks of those patient who respond to chymopapain chemonucleolysis must be defined and evaluation of temporal radiographic changes may also help clarity mechanism by which chemonucleolysis relieves sciatic pain caused by HNP. The results were as follows: 1. Our data indicates that chymopapain chemonucleolysis was effective in 70% and 90% of patients at both 1 M. and 3 M. follow-up. (average 80%) 2. At 1 M. follow-up, a successful response was noted in 70% of patients, with all significant intervertebral disc space narrowing (average 2.7 mm) and 30% of them showing an observable diminution in the herniated disc fragment (average 0.8 mm). At 3 M. follow-up, a successful response was noted in 90% of patients, with 70% of them showing significant narrowing (average 1.2 mm) and observable diminution in the herniated disc fragment (average 1.5 mm). The refor, with 3 M. follow-up, the CT changes did become more pronounced with greater number of patients exhibiting a diminution of the disk herniation and interspace narrowing, and associated with more progressive improvement of clinical outcome. 3. New vaccum phenomenon and extradiskal effects of chymopapain appear to be absent. 4. At 1 M. follow-up, Housefield Unit (HU) of disk is generally increased (average 8.8 HU) and at 3 M. follow-up, it is decreased (average 6 HU)

  2. Correlation between hypersensitivity to parenteral chymopapain and the presence of IgE anti-chymopapain antibody

    International Nuclear Information System (INIS)

    A solid phase radioimmunoassay, similar to the RAST, was developed in an attempt to predict anaphylactic reactions in patients injected with the proteolytic enzyme chymopapain, used in therapy for prolapsed intervertebral disc. The test measured the serum content of anti-chymopapain antibodies of the IgE class. Of 1263 patients tested, twelve gave anaphylactic reactions. The test was predictive for seven of them (58%), while sixty were false positives. Measurements were also made of anti-chymopapain IgE or other classes of antibodies which developed in the sera of patients after chymopapain injection. The presence of antibodies to chymopapain in individuals who had not been injected was also demonstrated. (author)

  3. Experimental chemonucleolysis with chymopapain in canine intervertebral disks

    International Nuclear Information System (INIS)

    The present study describes the radiological and histological changes in the canine intervertebral disk after the experimental injection of chymopapain as the chemical reagent, and determines the appropriate dose of the enzyme for treatment of herniated disks. By radiography, narrowing of the disk space was observed within 2 weeks after the injection of chymopapain, and recovered to 74.1% in the 0.1 mg group, 61.1% in the 1.0 mg group and 71.7% in the 10.0 mg group at 12 weeks. The disk space recovery showed a tendency to delay with aging. Microscopically, proteoglycan positive matrix appeared and the nuclear space was reduced in each disk at 2 weeks after chymopapain injection. The nucleus pulposus contained an irregularly-defined mass consisting of clusters of degenerated notochordal cells surrounded by proliferated chondrocytes and collagen matrix. In each disk at 12 weeks after chymopapain injection, the center of the nucleus pulposus was replaced by fibrocartilage tissue. In the disk into which 10.0 mg chymopapain was injected, the nuclear space filled with dense fibrocartilage tissue without a regenerated matrix component and narrowing of the disk were maintained. It is suggested that canine chemonucleolysis with 10.0 mg of chymopapain reduces the interdiskal pressure. This treatment may therefore relieve the signs and symptoms of herniation of the nucleus pulposus, and may effect chemical disk decompression

  4. Post-chymopapain (chemonucleolysis) - clinical and computed tomography correlation

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    Mall, J.C.; Kaiser, J.C.


    Chymopapain was first used for treatment of lumbar disc herniation in 1964 and has been used extensively in Canada and Europe for the last decade, but was recently released for general use in the United States. The enzyme is thought to cause decrease in intradiscal pressure and in disc volume; however, little in vivo evidence exists to support this concept. High resolution computed tomography (CT) scans were performed for diagnosis and at a variable period following chemonucleolysis on 17 randomly selected patients. The results of the study were: (1) disc space narrowing occurred almost invariably; (2) retraction of the prolapsed or extruded disc occurred in many patients; (3) clinical improvement was closely related to retraction of the prolapsed or extruded disc; (4) the best clinical results were obtained in patients who were injected at a single level with a clearly demonstrable disc prolapse or herniation.

  5. Surface Plasmon Resonance Imaging biosensor for cystatin determination based on the application of bromelain, ficin and chymopapain


    Anna Sankiewicz; Joanna Breczko; Ewa Gorodkiewicz


    A Surface Plasmon Resonance Imaging (SPRI) sensor based on bromelain or chymopapain or ficin has been developed for specific cystatin determination. Cystatin was captured from a solution by immobilized bromelain or chymopapain or ficin due to the formation of an enzyme-inhibitor complex on the biosensor surface. The influence of bromelain, chymopapain or ficin concentration, as well as the pH of the interaction on the SPRI signal, was investigated and optimized. Sensor dynamic response range ...

  6. Surface Plasmon Resonance Imaging biosensor for cystatin determination based on the application of bromelain, ficin and chymopapain

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    Anna Sankiewicz


    Full Text Available A Surface Plasmon Resonance Imaging (SPRI sensor based on bromelain or chymopapain or ficin has been developed for specific cystatin determination. Cystatin was captured from a solution by immobilized bromelain or chymopapain or ficin due to the formation of an enzyme-inhibitor complex on the biosensor surface. The influence of bromelain, chymopapain or ficin concentration, as well as the pH of the interaction on the SPRI signal, was investigated and optimized. Sensor dynamic response range is between 0–0.6 μg/ml and the detection limit is equal to 0.1 μg/ml. In order to demonstrate the sensor potential, cystatin was determined in blood plasma, urine and saliva, showing good agreement with the data reported in the literature.

  7. 1-Anilino-8-naphthalene sulfonate (ANS is not a desirable probe for determining the molten globule state of chymopapain.

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    Atiyatul Qadeer

    Full Text Available The molten globule (MG state of proteins is widely detected through binding with 1-anilino-8-naphthalene sulphonate (ANS, a fluorescent dye. This strategy is based upon the assumption that when in molten globule state, the exposed hydrophobic clusters of protein are readily bound by the nonpolar anilino-naphthalene moiety of ANS molecules which then produce brilliant fluorescence. In this work, we explored the acid-induced unfolding pathway of chymopapain, a cysteine proteases from Carica papaya, by monitoring the conformational changes over a pH range 1.0-7.4 by circular dichroism, intrinsic fluorescence, ANS binding, acrylamide quenching, isothermal titration calorimetry (ITC and dynamic light scattering (DLS. The spectroscopic measurements showed that although maximum ANS fluorescence intensity was observed at pH 1.0, however protein exhibited ∼80% loss of secondary structure which does not comply with the characteristics of a typical MG-state. In contrast at pH 1.5, chymopapain retains substantial amount of secondary structure, disrupted side chain interactions, increased hydrodynamic radii and nearly 30-fold increase in ANS fluorescence with respect to the native state, indicating that MG-state exists at pH 1.5 and not at pH 1.0. ITC measurements revealed that ANS molecules bound to chymopapain via hydrophobic interaction were more at pH 1.5 than at pH 1.0. However, a large number of ANS molecules were also involved in electrostatic interaction with protein at pH 1.0 which, together with hydrophobically interacted molecules, may be responsible for maximum ANS fluorescence. We conclude that maximum ANS-fluorescence alone may not be the criteria for determining the MG of chymopapain. Hence a comprehensive structural analysis of the intermediate is essentially required.

  8. AcEST: DK953330 [AcEST

    Lifescience Database Archive (English)

    Full Text Available Arabidopsis ... 167 5e-41 sp|P14080|PAPA2_CARPA Chymopapain OS=Carica papaya PE=1 SV=2 158 2e-38 sp|Q94B08|GCP1_ARATH Germination...VSVSEEELVTCSSES-GCDGG 606 TGNL+ +SE+ELV C S GC GG Sbjct: 175 VTGNLLELSEQELVDCDKHSYGCKGG 200 >sp|Q94B08|GCP1_ARATH Germination

  9. Lumbar disc ultrasonography for evaluation of chemonucleolysis: a preliminary report

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    Chung, Tae Sub; Kim, Young Soo; Park, Hyung Chun; Suh, Jung Ho; Kim, Dong Ik; Oh, Seong Hoon [College of Medicine, Yonsei University, Seoul (Korea, Republic of)


    There has been no reported change of ultrasonographic findings of nucleus pulposus in chemonucleolysis. We have found that the particle of herniated nucleus pulposus are highly echogenic and change to low echogenic after chemonucleolysis. On an in vitro experimental study, ultrasonography of the surgical specimen of the herniated nucleus pulposus was highly echogenic. After soaking the chymopapain into the surgical specimen of the herniated nucleus pulposus, the echogenicity was progressively lowered as time passed from 3 minutes to 12 hours. Our preliminary results are divided as two folds; 1. High echogenic shadows of outside of annulus fibrosus on ultrasonography of herniated lumbar disc will be important indicator of selection of patients for good therapeutic results of chemonucleolysis. 2. Progressively lowered echogenicity of high echogenic shadow after chemouncleolysis suggests good reaction of chymopapain with herniated nucleus pulposus.

  10. Percutaneous treatment of lumbar disc herniation

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    Leonardi, M.; Resta, F.; Bettinelli, A. [Ospedale Maggiore di Milano (Italy); Lavaroni, A.; Fabris, G. [Ospedale Civile di Udine (Italy); Abelli, F. [Fondazione Clinica del Lavorno, Pavia (Italy)


    918 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. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author). 7 refs, 6 figs, 1 tab.

  11. Effect of spondylosis on the outcome of chemonucleolysis

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    Tehranzadeh, J.; Kaufman, H.H.; Davis, C.M.; Radin, E.L.


    In an attempt to understand the relation between the outcome of chemonucleolysis treatment of lumbar discs and the presence of spondylosis (degenerative process) of the lumbar spine, 40 cases of disc herniation with subsequent intradiscal chymopapain injection (chemonucleolysis) were reviewed. Thirty-eight patients had plain radiographs, 25 had myelography, 28 had computed tomography (CT), and 15 had both myelography and CT. A review of these examinations revealed that 24 patients had minimal or mild spondylosis (group 1) and 13 patients had moderate spondylosis (group 2). Only one patient had a severe spondylosis (group 3). Chemonucleolysis failed in 8/24 (33%) patients from the first group and 2/13 (15%) cases from the second group. Therefore, the presence or absence of even moderate spondylosis did not affect the treatment success rate. A review of the 11 failed cases revealed spinal canal stenosis in three cases and a large disc herniation in two (one case with a myelographic block). Another case had a sequestered disc fragment. In two further cases, the disc herniation was far lateral with complete occlusion of the lateral foramen; another case exhibited severe degenerative changes of facet joints. In two other cases, treatment failure could not be explained by any radiographic finding. Of three patients with large disc herniation, only one responded successfully to intradiscal injection of chymopapain. Chemonucleolysis, however, failed in the only patient in the third group who had severe spondylosis of the facet joint.

  12. Modic changes, possible causes and relation to low back pain

    DEFF Research Database (Denmark)

    Albert, Hanne B; Kjær, Per; Jensen, Tue Secher;


    spondylitis and spondylarthritis. In the vertebrae, MC is seen in relation to vertebral fractures, spondylodiscitis, disc herniation, severe disc degeneration, injections with chymopapain, and acute Schmorl's impressions. The aim of this paper is to propose two possible pathogenetic mechanisms causing Modic...... subsequent inflammation, or a result of an inflammatory process from a toxic stimulus from the nucleus pulposus that seeps through the fractures. A bacterial cause: Following a tear in the outer fibres of the annulus e.g. disc herniation, new capilarisation and inflammation develop around the extruded...... changes. These are: A mechanical cause: Degeneration of the disc causes loss of soft nuclear material, reduced disc height and hydrostatic pressure, which increases the shear forces on the endplates and micro fractures may occur. The observed MC could represent oedema secondary to the fracture and...

  13. Insight to structural subsite recognition in plant thiol protease-inhibitor complexes : Understanding the basis of differential inhibition and the role of water

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    Mukhopadhayay Bishnu P


    Full Text Available Abstract Background This work represents an extensive MD simulation / water-dynamics studies on a series of complexes of inhibitors (leupeptin, E-64, E-64-C, ZPACK and plant cysteine proteases (actinidin, caricain, chymopapain, calotropin DI of papain family to understand the various interactions, water binding mode, factors influencing it and the structural basis of differential inhibition. Results The tertiary structure of the enzyme-inhibitor complexes were built by visual interactive modeling and energy minimization followed by dynamic simulation of 120 ps in water environment. DASA study with and without the inhibitor revealed the potential subsite residues involved in inhibition. Though the interaction involving main chain atoms are similar, critical inspection of the complexes reveal significant differences in the side chain interactions in S2-P2 and S3-P3 pairs due to sequence differences in the equivalent positions of respective subsites leading to differential inhibition. Conclusion The key finding of the study is a conserved site of a water molecule near oxyanion hole of the enzyme active site, which is found in all the modeled complexes and in most crystal structures of papain family either native or complexed. Conserved water molecules at the ligand binding sites of these homologous proteins suggest the structural importance of the water, which changes the conventional definition of chemical geometry of inhibitor binding domain, its shape and complimentarity. The water mediated recognition of inhibitor to enzyme subsites (Pn...H2O....Sn of leupeptin acetyl oxygen to caricain, chymopapain and calotropinDI is an additional information and offer valuable insight to potent inhibitor design.

  14. Chemonucleolysis in lumbar disc herniation: a meta-analysis Quimonucleólise em hernia de disco lombar: metanálise

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    José Mauro Cardoso Couto


    Full Text Available PURPOSE: To carry out a systematic review and meta-analysis of the efficacy of chemonucleolysis in the treatment of lumbar disc herniation. METHODS: Clinical trials were selected from 3 electronic databases (The Cochrane Controlled Trials Register, MEDLINE, and EMBASE. Data were analyzed with the software STATA, using the meta command. RESULTS: Twenty-two clinical trials were eligible. For chemonucleolysis versus placebo, the summary risk ratio estimate for pain relief as outcome was 1.51 (95% CI: 1.27-1.80. The summary estimate was 1.07 (95% CI: 0.95-1.20 for the comparison between chymopapain and collagenase. Regarding chemonucleolysis with chymopapain versus surgery, the fixed-effect summary estimate of effect for pain relief was 0.93 (95% CI: 0.88-0.98 with surgery as the reference group. In this case, heterogeneity was statistically significant. CONCLUSIONS: Chemonucleolysis with chymopapain was superior to placebo and was as effective as collagenase in the treatment of lumbar disc prolapse. Results for studies comparing chemonucleolysis with surgery were heterogeneous, making it difficult to interpret the summary measure of effect.OBJETIVO: Avaliar a eficácia da quimonucleólise no tratamento da hérnia de disco lombar por meio de uma metanálise de ensaios clínicos. MÉTODOS: Os ensaios clínicos foram selecionados de três bases de dados eletrônicas( Cochrane, MEDLINE, e EMBASE. Os dados foram analisados por intermédio do aplicativo STATA, com o comando meta. RESULTADOS: trabalhamos com 22 ensaios clínicos. Para a comparação entre quimonucleólise e placebo, a estimativa da razão de riscos, tendo melhora da dor como desfecho, foi de 1,51 (I 95% C: 1,27-1,80. Aquela medida foi de 1,07 (I 95% C: 0,95-1,20 para a comparação entre quimopapaína e colagenase. Em um modelo de efeitos fixos, a razão de risco, para melhora da dor, foi 0,93 (I 95% C: 0,88-0,98, tendo a discectomia como grupo de referência. Nesse caso, um teste de

  15. Correlations between quantitative T2 and T1ρ MRI, mechanical properties and biochemical composition in a rabbit lumbar intervertebral disc degeneration model. (United States)

    Gullbrand, Sarah E; Ashinsky, Beth G; Martin, John T; Pickup, Stephen; Smith, Lachlan J; Mauck, Robert L; Smith, Harvey E


    Improved diagnostic measures for intervertebral disc degeneration are necessary to facilitate early detection and treatment. The aim of this study was to correlate changes in mechanical and biochemical properties with the quantitative MRI parameters T2 and T1ρ in rabbit lumbar discs using an ex vivo chymopapain digestion model. Rabbit lumbar spinal motion segments from animals less than 6 months of age were injected with 100 μl of saline (control) or chymopapain at 3, 15, or 100 U/ml (n = 5 per group). T2 and T1ρ MRI series were obtained at 4.7T. Specimens were mechanically tested in tension-compression and creep. Normalized nucleus pulposus (NP) water and GAG contents were quantified. Stepwise multiple linear regression was performed to determine which parameters contributed significantly to changes in NP T2 and T1ρ. When all groups were included, multiple regression yielded a model with GAG, compressive modulus, and the creep time constants as variables significantly impacting T2 (multiple r(2)  = 0.64, p = 0.006). GAG and neutral zone (NZ) modulus were identified as variables contributing to T1ρ (multiple r(2)  = 0.28, p = 0.08). When specimens with advanced degeneration were excluded from the multiple regression analysis, T2 was significantly predicted by compressive modulus, τ1, and water content (multiple r(2)  = 0.71, p = 0.009), while no variables were significant predictors in the model for T1ρ. These results indicate that quantitative MRI can detect changes in the mechanical and biochemical properties of the degenerated disc. T2 may be more sensitive to early stage degenerative changes than T1ρ, while both quantitative MRI parameters are sensitive to advanced degeneration. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1382-1388, 2016. PMID:27105019

  16. Label-free quantitative proteomics reveals differentially regulated proteins in the latex of sticky diseased Carica papaya L. plants. (United States)

    Rodrigues, Silas P; Ventura, José A; Aguilar, Clemente; Nakayasu, Ernesto S; Choi, HyungWon; Sobreira, Tiago J P; Nohara, Lilian L; Wermelinger, Luciana S; Almeida, Igor C; Zingali, Russolina B; Fernandes, Patricia M B


    Papaya meleira virus (PMeV) is so far the only described laticifer-infecting virus, the causal agent of papaya (Carica papaya L.) sticky disease. The effects of PMeV on the laticifers' regulatory network were addressed here through the proteomic analysis of papaya latex. Using both 1-DE- and 1D-LC-ESI-MS/MS, 160 unique papaya latex proteins were identified, representing 122 new proteins in the latex of this plant. Quantitative analysis by normalized spectral counting revealed 10 down-regulated proteins in the latex of diseased plants, 9 cysteine proteases (chymopapain) and 1 latex serine proteinase inhibitor. A repression of papaya latex proteolytic activity during PMeV infection was hypothesized. This was further confirmed by enzymatic assays that showed a reduction of cysteine-protease-associated proteolytic activity in the diseased papaya latex. These findings are discussed in the context of plant responses against pathogens and may greatly contribute to understand the roles of laticifers in plant stress responses. PMID:22465191

  17. The treatment of paediatric burns using topical papaya. (United States)

    Starley, I F; Mohammed, P; Schneider, G; Bickler, S W


    Due to the limited resources for the management of burns in most regions of Africa there is a significant role for many aspects of traditional African medicine. The active component of many traditional preparations is often of plant origin and more than 25 plants have been described as useful in relations to burns and wound healing. Carica papaya is currently used in The Gambia at the Royal Victoria Hospital, Banjul in the Paediatric Unit as the major component of burns dressings, where it is well tolerated by the children. Cheap and widely available, the pulp of the papaya fruit is mashed and applied daily to full thickness and infected burns. It appears to be effective in desloughing necrotic tissue, preventing burn wound infection, and providing a granulating wound suitable for the application of a split thickness skin graft. Possible mechanisms of action include the activity of proteolytic enzymes chymopapain and papain, as well as an antimicrobial activity, although further studies are required. PMID:10563690

  18. Treatment with proteolytic enzymes decreases glomerular immune complex deposits in passive serum sickness in rats and mice

    International Nuclear Information System (INIS)

    This study assessed the effect of protease treatment on glomerular immune complex (IC) deposition in passive serum sickness. IC containing 2.2 mg of specific rabbit antibovine gammaglobulin (Ab) and cationic bovine gammaglobulin (CBGG) at 5-fold antigen excess were given via tail vein to 140 g Sprague-Dawley rats; some rats received IC containing 125I-Ab. After maximal glomerular IC deposition (1h) a single intravenous dose of either 4 mg chymopapain plus 2 mg subtilisin (T), or saline (C) was given. By immunofluorescence (IF) 1 h later, 1/13 T rats had bright capillary wall deposits of CBGG vs 10/11 C rats (x2 = 13.4, p 2 = 4.05, p 125I-IC had 25% less Ab (3267 +/- 293 cpm/mg glomerular protein) than C rats (4327 +/- 530, p 2 = 11.7, p 2 = 10.8, p < .001). The authors conclude that protease treatment can remove glomerular IC deposits

  19. Papain Induced Occupational Asthma with Kiwi and Fig Allergy. (United States)

    Jiang, Nannan; Yin, Jia; Wen, Liping


    Papain is a proteolytic enzyme which is widely used in food industry, pharmaceuticals, and cosmetics. Occupational and non-occupational papain allergies have previously been documented; however, there are limited publications about papain allergy with its relative fruit allergy. Here, we present a case of occupational, IgE-mediated papain allergy with kiwi fruit and fig fruit allergy. A 53-year-old man suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant where papain is often used as a meat tenderizer. He began to experience symptoms of chest tightness, shortness of breath and wheezing shortly after starting work 5 years ago. Furthermore, he experienced several episodes of oral itching, and tongue and oropharyngeal angioedema after injestion of kiwi fruit and fig fruit. The patient had a lifelong history of allergic conjunctivitis, allergic rhinitis, and childhood asthma. Specific IgE was positive to kiwi fruit, papain and chymopapain (2.95 kUA/L, >100 kUA/L, and 95.0 kUA/L, respectively). Similar bands at 10-15 kDa in blotting with papain and kiwi fruit extracts were found. This patient showed a potential association between papain allergy and sensitization to kiwi fruit. We also reviewed 13 patients with papain allergy published in the literature, with 85% (11/13) of the patients sensitized through the respiratory tract, and 40% (4/11) having atopy. Further studies should focus on the determination of cross-reactive allergens between papain and its fruit relatives, and the prevalence of food allergy in patients with papain allergy should be investigated in a relatively large cohort. PMID:26739411

  20. Chemonucleolysis and intradiscal electrothermal therapy: What is the current evidence?; Chemonukleolyse und intradiskale Elektrotherapie: Was ist die gegenwaertige Evidenz?

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    Relder-Puig, Rosemarie; Gyimesi, M.; Mittermayr, T.; Geiger-Gritsch, S. [Ludwig Boltzmann Inst. fuer Health Technology Assessment, Wien (Austria)


    We evaluated the efficacy and safety of chemonucleolysis and intradiscal electrothermal therapy (IDET) on the basis of the data presented in recently published papers with respect to pain relief, function, and complication rates. Detailed searches for English and German articles published between 2003 and 2008 were performed in a number of electronic databases. Further publications were identified by manual search. For summarizing the evidence, we considered only systematic reviews and controlled studies. The internal validity of reviews and studies was judged by two authors independently. Data extraction was performed by one author, and the extracted data was checked for completeness and correctness by a second author. The evidence of the efficacy of chemonucleolysis using chymopapain or collagenase is summarized in two recent, high-quality systematic reviews. We found 5 controlled studies evaluating nucleolysis using an oxygen-ozone mixture (O{sub 2}O{sub 3}-nucleolysis). Some of those studies were of limited methodological quality, but all showed the efficacy of O{sub 2}O{sub 3}-nucleolysis in comparison to microdiscectomy or the use of alternative substances. There is hardly any data regarding O{sub 2}O{sub 3}-nucleolysis complications. Regarding IDET, the authors of the 6 identified systematic reviews come to different conclusions about the efficacy of the procedure. The results of the 3 included controlled IDET studies, of which 2 are of high methodological quality, are also conflicting. The complication rates range from 0 to 15%. In summary, the evidence of efficacy is presently more compelling for chemonucleolysis than for IDET. This may also be because indications for chemonucleolysis are more firmly established. However, safety aspects should be better evaluated and presented in the literature. (orig.)

  1. Articular chondrocyte metabolism and osteoarthritis

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    Leipold, H.R.


    The three main objectives of this study were: (1) to determine if depletion of proteoglycans from the cartilage matrix that occurs during osteoarthritis causes a measurable increase of cartilage proteoglycan components in the synovial fluid and sera, (2) to observe what effect intracellular cAMP has on the expression of matrix components by chondrocytes, and (3) to determine if freshly isolated chondrocytes contain detectable levels of mRNA for fibronectin. Canine serum keratan sulfate and hyaluronate were measured to determine if there was an elevation of these serum glycosaminoglycans in a canine model of osteoarthritis. A single intra-articular injection of chymopapain into a shoulder joint increased serum keratan sulfate 10 fold and hyaluronate less than 2 fold in 24 hours. Keratan sulfate concentrations in synovial fluids of dogs about one year old were unrelated to the presence of spontaneous cartilage degeneration in the joints. High keratan sulfate in synovial fluids correlated with higher keratan sulfate in serum. The mean keratan sulfate concentration in sera of older dogs with osteoarthritis was 37% higher than disease-free controls, but the difference between the groups was not statistically significant. Treatment of chondrocytes with 0.5 millimolar (mM) dibutyryl cAMP (DBcAMP) caused the cells to adopt a more rounded morphology. There was no difference between the amount of proteins synthesized by cultures treated with DBcAMP and controls. The amount of fibronectin (FN) in the media of DBcAMP treated cultures detected by an ELISA was specifically reduced, and the amount of {sup 35}S-FN purified by gelatin affinity chromatography decreased. Moreover, the percentage of FN containing the extra domain. A sequence was reduced. Concomitant with the decrease in FN there was an increase in the concentration of keratan sulfate.

  2. A history of lumbar disc herniation from Hippocrates to the 1990s. (United States)

    Truumees, Eeric


    In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with