The authors analysed the findings of discograms in the 1355 levels of 900 herniated lumbar disc cases during May 1984 to January 1987. Prior to intradiscal injection of Chymopapain in the treatment of lumbar disc herniation, Conray contrast medium was injected. The discographic patterns were devided in five types:I) contained, II) degenerative, III) annular bulging, IV) subligamentous leak, and V) epidural leak type. Among the 5 types, annular bulging type was most common(38.7%). Discography was useful in the determination of a needle placement, intradiscal pathology, and Chymopapain injection or not.
Chymopapain ; Needles ; Pathology

The authors analysed the relationship of the discographic finding to the chemonucleolysis results of herniated lumbar disc during May 1984 to January 1987. Among 900 herniated lumbar disc cases, 882 patients were treated with the chymopapain injections. Overall success rate was 87.2%. Discographic findings were devided in five types:I) contained, II) degenerative, III) annular bugling, IV) subligamentous leak, and V) epidural leak type. In 546 one level chemenucleolysis cases the successful rates were different in the discogram types as followings:type V 92.9%, type III 89.1%, type IV 87.5%, type II 85.0% and type I 62.5%. The discography is considered to be useful not only in predicting the chemonucleolysis result, but also in determination of chymopapain injection or not.
Chymopapain ; Humans ; Intervertebral Disc Chemolysis*

Chymopapain was discovered by Jensen in 1941, and in 1963 Smith demonstrated the chondrolytic properties of chymopapain. Since then, many patients have been injected with this agent. Although there are evidences of neurotoxicity to chymopapain in animals, adverse effects in humans have rarely been reported. We present a case delayed onset of paraplegia after chymopapain chemonucleolysis and review the neurotoxicities to chymopapain.
Animals ; Chymopapain ; Humans ; Intervertebral Disc Chemolysis* ; Paraplegia*

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

Hereditary ovarian cancer accounts for about 5% to 10% of the total ovarian cancer bnurden, The discase has been observed in context with three types of hereditary ovarian cancer prone syndrome : (1) site-specific ovarian cancer, (2) hereditary breast/ivarian cancer syndrome, (3) hereditary nonpolyposis colorectal cancer(Lynch syndrome II). Each of these syndmmcs is chracterized by autosomal dominant transmission of cancer, sigrdficant early age of onset, and exeess of multiple Iprimary cancers. Auuthor expxeriencecl six families with hereditaty ovarian cancer, two families with a site-spxific. ovarian cancer and four with a breast/ovarian cancer syndrome, and report these families.
Age of Onset ; Chymopapain ; Humans ; Ovarian Neoplasms*

The purpose of this study was to identify the determinants of nutrition service utilization in health centers. Utilization of nutrition services for chronic discase were also investigated. Interview survey using questionnaire was conducted to collect the data required for analysis. The study subjects were 300 residents over 40 years of age, and 15 health workers representing health center service personnel in Kypnggi province. A wilcoxon 2-sample test and Kruskal-Wallis test were used to compare the distribution of health centers by health center characteristics and nutrition services. A chi-square test was used to test the association between service utilization and personal variables of the population. A multiple logistic regression analysis was used to measure the relative importance between the variables on service utilization. The results showed that only 10.0% of the study subjects used nutrition services provided by the health centers. Pilot project implementation and location of health centers, as well as educational level of the residents were significant factors influencing the utilization of the nutrition services provided by the health centers. Among the variables, pilot project implementation was the most important factor that influenced the nutrition service utilization in health centers.
Chronic Disease ; Chymopapain ; Humans ; Logistic Models ; Pilot Projects ; Surveys and Questionnaires

The purpose of this study is to evaluate the effect of Disken(R)(chymopapain) on the intervertebral discs of Mongolian Dogs. Three healthy Mongolian dogs at same age(9 months) were underwent laparotomy, and the intradiscal injections of Disken(R) were made from the anterior. After sequential roentgenographic examination, the dogs were sacrificed at 1 month, and the gross and histological examination were performed. The results were as follows: 1) The discolytic effects of Disken(R) were evidently observed through the roentgenographic and histological examination. 2) The maximal changes of intervertebral disc space narrowing developed within 1 week after injection. 3) The reduction percentage of disc spaces was ranged between 45% to 50%, compared to the pre-injections stage. 4) The nucleus pulposus was evidently affected, but the annulus fibrosus and epiphyseal cartilage were not affected. 5) The adverse reactions were not observed in this study.
Animals ; Chymopapain ; Dogs ; Growth Plate ; Intervertebral Disc ; Laparotomy

We had experienced 60 cases of chemonucleolysis with Discase(R)(chymopapain for injection) under careful patient selection of herniated lumbar discs and had followed up thereafter at least 3 months since July, 1984. Therapeutic results were generally favorable, with 90% of patients achieving either excellent or good(satisfactory) results. Three patients only had poor or failure results. There was no major anaphylatic reaction and no serious neurologic complications. Back spasm and stiffness/soreness were the most frequently encountered complications.
Chymopapain ; Humans ; Intervertebral Disc Chemolysis* ; Patient Selection ; Spasm

For many years chemonucleolysis has been proven effective in the curative treatment of lumbar disc herniation. However, this technique is seldom popular in the herniated cervical disc. For several years microsurgery of the cervical disc has been effective in the treatment of refractory cervicobrachial neuralgia. To compete with this method which has been familiar to neurosurgeons, cervical nucleolysis using chymopapain for 1 year. Twenty two pateints(75%) had excellent outcomes, 5 pateints(15%) considered good while 3 sustained their symptom, but showed decreased intensity. The decision to intervene is made when the radiculagia is recurrent or resistant to medical treatment of several weeks duration, without myelopathy or bony abnormalities such as spondylosis or canal stenosis. The principal advantages of this method are : short stay in the hospital(3 days to 5 days on average), absence of general anesthesia, prompt resumption of previous activities, and long-term preservation of an intervertebral space. As a result, cervical nucleolysis has been shown to be an effective alternative to surgery for cervical soft disc herniations with refractory radicualgia.
Anesthesia, General ; Brachial Plexus Neuritis ; Chymopapain ; Constriction, Pathologic ; Intervertebral Disc Chemolysis* ; Microsurgery ; Spinal Cord Diseases ; Spondylosis

BACKGROUND/AIMS: Common bile duct stones are the most common among bile duct diseases. In the past, common bile duct stones were considered a surgically operable disease, but is now considered a medical disease due to the advancement of endoscopy and endoscopic techniques. The aim of this study was to determine the results of endoscopic treatment of common bile duct stones. METHODS: Removal of primary or secondary common bile duct stones were attempted by peroral or percutaneous endoscopy. The common bile duct stones were diagnosed by ultrasonography or cholangiography. As a primary approach route, the peroral transpapillary endoscopic approach was tried. On the other hand, percutaneous common bile duct stone removal was attempted if the patient already had a percutaneous route, peroral transpapillary approaches failed, or if conditions for endoscopy were unfavorable. RESULTS: The study subjects consisted of 196 patients; 96 males and 100 females. The mean age was 61.8 years. A total of 272 endoscopic stone removal were attempted in 196 patients. Of the 272, peroral approaches were conducted 241 times for 183 patients, and percutaneous approaches were performed 31 times for 12 patients. The success rate of the first treatment modality to remove the common bile duct stones was 90.3% (176/195). The overall success rate of endoscopic common bile duct stones removal was 100%. CONCLUSIONS: In all patients, the common bile duct stones were removed successfully by endoscopy, and thus supporting the shift of recognizing common bile duct stones as a medical rather than surgical discase.
Bile Duct Diseases ; Cholangiography ; Chymopapain ; Common Bile Duct* ; Endoscopy ; Female ; Hand ; Humans ; Male ; Ultrasonography