Papain Induced Occupational Asthma with Kiwi and Fig Allergy

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.

Chemonucleolysis in lumbar disc herniation: a meta-analysis

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 percent CI: 1.27-1.80). The summary estimate was 1.07 (95 percent 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 percent 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 por cento C: 1,27-1,80). Aquela medida foi de 1,07 (I 95 por cento 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 por cento C: 0,88-0,98), tendo a discectomia como grupo de referência. Nesse caso, um teste de heterogeneidade foi considerado estatisticamente significante. CONCLUSÕES: a eficácia da quimonucleólise foi superior à do placebo e semelhante à da colagenase. Os resultados dos estudos referentes à comparação entre quimonucleólise e cirurgia foram heterogêneos, o que implica interpretação não-trivial da medida de efeito.

Ozone Chemonucleolysis on the Lumbar Intervertebral Disc of the Rabbit

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.

Determinants of Nutrition Service Utilization in Health Centers / 대한지역사회영양학회지

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.

Results of Endoscopic Treatment in Common Bile Duct Stones / 대한소화기내시경학회지

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.

Clinical Results of Chemonucleolysis for the Far Lateral Lumbar Disc Herniation

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.

The Risk Factors of Morbidity and Mortality after Pulmonary Resection / 대한흉부외과학회지

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.

Retrospective Outcome Evaluation of Cervical Chemonucleolysis with Digital Infrared Thermographic Imaging

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.

Prediction of Size of Residual Discase after Initial Surgery by Postoperative Decline of Serum CA 125 Levels in Patients with Advanced Epithelial Ovarian Cancer / 대한산부인과학회잡지

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.

A Clinical Study of Cervical Chemonucleolysis

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.

An Adult Case of Congenitally Corrected Transposition of the Great Arteries Associated with Paroxysmal Atrial Fibrillation and Heart Failure

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.

Hereditary Ovarian Cancer: Report of 6 Families / 대한부인종양콜포스코피학회잡지

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.

Hereditary Ovarian Cancer: Report of 6 Families / 대한부인종양콜포스코피학회잡지

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.

Chemonucleolysis using Chondroitinase ABC: An Expreimental Study / 대한정형외과학회잡지

Chymopapain and collagenase are well known chemonucleolytic agents for lumbar disc herniation. However, these enzymes have serious problems occasionally, such as severe neurotoxicity or anaphylaxis even fatal to patients. Chondroitinase ABC, a metabolic product of Proteus vulgaris, has a specific action on the proteoglycans of the nucleus pulposus, but rarely no effect on the intrathecal nerve tissues of vessels. Seventy eight rabbit lumbar discs were evaluated radiographically and histologically after injection of chondroitinase ABC 40U/ml per disc and compared with buffer injected group and nonigected control group. There was considerable disc space narrowing of the chondroitinase ABC injected group which was verified radiographically and histologically(p < 0.01). A zone of Safranin 0 depletion was present in the ventral anulus fibrosus adjacent to the nucleus pulposus in all treated discs, indicating proteoglycan loss. On electron microscopic findings there were collapse of chondrocytes and notochordal cells. All of these findings are corresponding to the evidence that chondroitinase ABC may be another chemonucleolytic agent by decreasing disc volume and thereby decompressing spinal cord or nerve roots. All histologic effects of chondroitinase ABC were confined to intervertebral disc tissues. Chondroitinase ABC deserves to be a study object for the alternative of chemonucleolysis.

The Clinical Study of Chemonucleolys in Herniated Nucleus Pulposus of Lumbar Spine

Chemonucleolysis with chymopapain has been shown to be an effective alternative to surgery for the treatment of Sciatica secondary to lumbar disc herniation after failure of conservative treatment. 92 lumbar herniated disc patients had been treated by chemonucleolysis in Eul Ji General Hospital during 3 years from March 1988 to 1991 and were evaluated clinically. 1) Of 92 patients, 60 patients(65%) were between 20 and 30 years old age group and male was predominent. 2) The lesion was the most common in L4-5space(52 patients, 56.6%). 3) The results were better in the younger group and the more limited straight leg raising group. 4) The excellent and good results were obtained in 82.6%. 5) In noncompensation cases, 69 patients(88.0%) had marked improvement, but in compensation cases, 7 patients(50%) had marked improvement. 6) In conclusion, above finding suggest that chemonucleolysis is a safe and effective nonsurgical method for treatment of herniated lumbar disc before surgical intervention.

Lumbar CT Findings and Results of Chemonucleolysis

The therapeutic response to treatment of lumbar disk heniation with chymopapain chemonucleolysis is significantly influenced by the criteria used for patient selection. In an attempt to identify objective pretreatment radiographic findings, especially spine CT scanning, that might refine selection criteria and further increase to success rate of chemonucleolysis, a retrospective correlation of pretreatment spine CT findings and clinical results easmade of 1000 consecutive patients from May 1984 to September 1987 at the Dept. of Neurosurgery, Yongdong Severance Hospital, Yonsei University College of Medicine. The data were obtained from a questionnare and clinical records. Overall success rate was 87.5%. The favorable CT parameters to define the higher successful rate of chemonucleolysis included:1) single level treatment;2) posterolateral directed herniation;3) mild to moderate degree protrusion;4) protruded type herniation;5) not combined facet hypertrophy or sipinal stenosis. The unfavorable CT parameters placed into lower successful rate of chemonucleolysis included:1) multiple levels treatment;2) degenerative bulging annulus;3) severe degree protrusion;4) sequestered type herniation;5) combined degenerative spondylosis or facet hypertrophy of spinal stenosis, bony spur or calcification of disc.

Discographic Findings in the Lumbar Disc Herniations

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.

The Relationship of the Discographic Finding to the Chemonucleolysis Results

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.

The Discolytic Effects of Disken(R)(Chymopapain, made in Korea): Experimental Study

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.

Ventricular Extrasystoles in Convalescent Phase of Acute Myocardial Infarction

Ventricular arrhythmia and left ventricular dysfunction after hospital discharge in acute myocardial infarction are powerful predictors of sudden death. We evaluated the ventricular extrasystoles with 24 hour ambulatory electrocardiography at convalescent phase in 34 patients of acute myocardial infarction. Ventricular extrasystoles were observed in 19 patients (56%) and classified by Lown's grading system as grade 1 for 8 cases, grade 2 for 3 cases, grade 3 for 3 cases, grade 4 for 3 cases, and grade 5 for 2 cases. There was no relation between the develoment of ventricular extrasytoles and the risk factors of ischemic heart discase such as smoking, hypertension, hyperlipidemia, diabetes mellitus, and male sex. Also, the development of ventricular extrasystoles was independent to infarct site, regional wall motion abnormalities, and clinical manifestations of left ventricular dysfunction such as congestive heart failure and cardiomegaly. In conclusion, ventricular arrhythmia might independently predict the prognosis in survivors of acute myocardial infarction.