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.
Allergens ; Angioedema ; Asthma ; Asthma, Occupational* ; Chymopapain ; Cohort Studies ; Conjunctivitis, Allergic ; Dyspnea ; Food Hypersensitivity ; Food Industry ; Fruit ; Humans ; Hypersensitivity* ; Immunoglobulin E ; Meat ; Middle Aged ; Papain* ; Plants ; Prevalence ; Pruritus ; Respiratory Sounds ; Respiratory System ; Rhinitis ; Thorax ; Tongue

OBJECTIVE: This study is aimed to evaluate the chemonucleolytic effect of medical ozone by investigating the change of the signal intensity on magnetic resonance imaging (MRI) scan after injection of medical ozone into the lumbar intervertebral disc of the rabbit. METHODS: A series of 21 intradiscal injections of 1ml of medical ozone(30microgram of ozone per ml of oxygen) was performed in 7 young adult rabbits. Two control series, which 20 intradiscal injections of 0.1ml of iodine contrast medium in 7 young adult rabbits and 21 intradiscal injections of 0.05ml of chymopapain in 7 young adult rabbits, were performed. T2 weighted MRI scan was performed pre-operatively and at 4 weeks after injection. RESULTS: T2-weighted MRI scan of intervertebral disc spaces demonstrated significantly decreased signal intensities in the series (n=21) of intradiscal injections of medical ozone at 4 weeks after injection, as compared with the control series of intradiscal injections of 0.1ml of iodine contrast medium. T2-weighted MRI scan of intervertebral disc spaces demonstrated significantly decreased signal intensities in the series(n=21) of intradiscal injections of chymopapain at 4 weeks after injection. Any neurologic deficit or complication was not found in all groups. CONCLUSION: Intradiscal injections of medical ozone into the lumbar intervertebral disc of the rabbits are proven to have chemonucleolytic effects.
Chymopapain ; Humans ; Intervertebral Disc Chemolysis* ; Intervertebral Disc* ; Iodine ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Ozone* ; Rabbits ; Young Adult

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

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

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

BACKGROUND: Surgical resection offers the potential care in patients with carcinoma of the lung whose tumors are amenable to resection, those with infections destroyed lung discase or congenital lung disease prediction of risk factors to influencing outcome after thoracic operations offers important benefits. Physicians anticipating those patients most prone to complications can provide special attention aimed at reducing morbidity and mortality. MATERIAL AND METHOD: We have retrospectively reviewed hospital records of 153 patients undergoing pulmonary resection for neoplastic and inflammatory destroyed lung disease between 1994 and 1998 to identify predictors of outcome. The mean age was 54.3+/-10.6years. Ninety-six patients(62%) had malignant lung disease and 47 patients(30%) had destroyed lung desease and 10(7%) had congenital or other lung desease. RESULT: Of the 153 resections performed 118 were lobectomies, 29 were pneumonectomies, 6 were segmentectomies, Seven of the 153 patients died during their hospital stay(4.5%). The most significant predietors of in-hospital mortality were presence of concomittent medical disease (P<0.001) and patients age 70 years or over(P<0.003). There were 67 postoperative complication occurring in 57 patients. Operation related complications were in 50 patients (32%), respiration related were in 14(9.1%) and cardiovascular related were in 1(0.6%) and other complications were in 2 patients(1.3%). The most significant predictors of postoperative morbidity was patients age 70 years or over(P<0.004). CONCLUSION: concomitant medical disease and patients age 70 years or over were very predictive value of postoperative mortality, also the patients age 70 years or over was significant preoperative value of postoperative morbidity.
Chymopapain ; Hospital Mortality ; Hospital Records ; Humans ; Lung ; Lung Diseases ; Mastectomy, Segmental ; Mortality* ; Pneumonectomy ; Postoperative Complications ; Respiration ; Retrospective Studies ; Risk Factors*

The diagnostic efficacy and comparability of digital infrared thermographic imaging(DITI), computerized tomographic(CT) scan and magnetic resonance imaging(MRI) in the assessment of outcome of chemonucleolysis for herniated soft cervical disc patients with ce rvicobrachial neuralgia were evaluated. Forty seven patients of herniated cervical discs who were treated with nucleolysis using chymopapain for last 2 years were assessed by each studying modality and clinical examinations. All the cases received DITI, CT scan and/ or MRI, and the thermal difference of each patient between symptomatic and asymptomatic limb was analyzed pre- and post-operatively. The diagnostic efficacy of each technology was similar, and inter-rater comparability did not differ significantly. DITI showed significantly good correlation with clinical outcome although there existed a considerable inaccuracy in assessing individual subjects. Digital infrared thermographic imaging was shown to be very useful method in the outcome evaluation of cervical chemonucleolysis.
Chymopapain ; Extremities ; Humans ; Intervertebral Disc Chemolysis* ; Magnetic Resonance Imaging ; Neuralgia ; Retrospective Studies* ; Tomography, X-Ray Computed

In this retrospective study, we assessed the clinical usefulness of postoperative decline of serum CA 125 level after initial surgery to predict the size of residual disease in patients with advanced epithelial ovarian cancer. Between June 1989 and December 1995, sixty-three patients with advanced epithelial ovarian cancer (FIGO stage II-IV) were evaluated, who were managed at Asan Medical Center by cytoreductive surgery followed by chemotherapy. All patients had elevated preoperative serum CA 125(>35U/ml) and had another serum CA 125 assay 7~10 days after surgery. Preoperative CA 125 levels were similar in patients with residual disease below 2 cm and in those with larger residuum. The postoperative decline of serum CA 125 was significantly higher in patients with smaller residual disease only if preoperative serum CA 125 value was over 400U/ml. By taking 70% as the cutoff of CA 125 decline for discriminating patients with residual disease above 2 cm, the specificity and positive predictive value of this parameter improved when we considered patients with increasing preoperative serum levels. Hence, in the subset of patients with preoperative serum CA 125 level over 400U/ml, 95.2% (20/21) of patients with residual disease below 2 cm showed postoperative decline of serum CA 125 level over 70%, and 91.7%(11/12) of patients with postoperative decline of serum CA 125 level below 70% had residual disease over 2 cm. In conclusion, postoperative decline of serum CA 125 level after initial surgery does not exactly reflect the size of residual disease, but shows limited clinical usefulness in subset of patients with preoperative serum CA 125 level over 400 U/ml.
Chungcheongnam-do ; Chymopapain* ; Drug Therapy ; Humans ; Ovarian Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity

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

Congenitally corrected transposition of the great arteries is a rate congenital heart disease. In this discase, there is discordance between both the atria and ventricles and the ventricles and great vessels. The anatomic left ventricle lies on the rightside and is connected to the pulmonic trunk, whereas the anatomic right ventricles lies on the left side and functions as the systemic ventricle. Most patients have associated another cardiac anomalies and conduction disturbance.Less commonly, ventricular extrasystoles, paroxismal supraventricular tachycardia, WPW preexitaion and atrial fibrillation may be obserced. We report an adult case of congenitally corrected transposition of great arteries associated with paroxysmal atrial fibrillation and heart failure.
Adult* ; Arteries* ; Atrial Fibrillation* ; Chymopapain ; Heart Defects, Congenital ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Tachycardia, Supraventricular ; Transposition of Great Vessels ; Ventricular Premature Complexes