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*

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

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

The far lateral lumbar disc herniation occurs ten times less often than the classic posterolateral disc herniations. Its clinical presentation, the anatomy involved, and difficulty of surgical treatment are not well understood. The surgical approach and results also have not been clearly defined. Although there are limited number of reports and series in the literature, there is still no general consensus on the approach to surgical treatment. However, chymopapain, even with a history of controversy and troubling complications, has endured the test of time to show 30 years of clinical success in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and efficacy of treatment. Between 1984 and 1997, we treated with chymopapain injection in 69 patients with severe lumbar radiculopathy secondary to far lateral disc herniation. Average patient age was 38.5 years in the 47 male and 22 female patients involved. The L4-5 disc was the most commonly herniated level(44.9%) followed by L3-4(37.8%), L5-S1(13.0%), and L2-3(4.3%). They were assessed using standardized forms as well as the Mcnab classification and questioner. They were reviewed at an average of 5 years 8 months postoperatively. Relief of symptoms was obtained in 63 patients(91.3%) after injection. No one subsequently relapsed requiring operation. All 69 patients available for long-term follow-up had considerable and sustained relief from their symptoms. For ADL(activity of daily living), 50 patients(81.3%) answered that they had no limitation, and regarding the office or house work, 49 patients(71.0%) returned previous work without any difficulties. Based on these findings we recommend the chymopapain injection as the primary treatment for patients with severe radiculopathy secondary to far lateral herniation of a lumbar disc.
Chymopapain ; Classification ; Consensus ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Chemolysis* ; Male ; Radiculopathy

The herniated lumbar intervertebral disc, a common affliction in man, had been diagnosed with myelogram and treated with laminectomy. Recently, the application of CT scan and chemonucleolysis markedly changed the mode of management in lumbar disc diseases. High resolution CT scan of lumbar spine became the most popular diagnostic tool to detect herniations of lumbar discs and discolysis with chymopapain an alternative to surgery in a large number of patients. We performed CT scan and discography in 131 discs of 100 patients prior to chemonucleolysis and there were too many ruptured discs not found on CT scan but discography. Of the 5 patients who failed in chemonucleolysis severe dye leakage was seen in 4 cases. Extradural leakage of contrast medium was not a contraindication to the injection of chymopapain. However, when this occured the precaution was taken of injecting more quantity of chymopapain slowly. This report presents our experience with lumbar discography and comparative analysis of CT scan and discography. We think discography is very important diagnostic tool to detect rupture of discs prior to chemonucleolysis and may aid our gradually increasing understanding of the pathophysiology of the disc diseases.
Chymopapain ; Humans ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Laminectomy ; Rupture ; Spine ; Tomography, X-Ray Computed*