Mucoid Secretions Research Articles

Ethmoidal Sinus Mucocele as a Cause of Acquired Brown Syndrome

Dear Editor, A mucocele is composed of a respiratory epithelial lined mucus-containing lesion with accumulation of mucoid secretion. Sometimes, it produces remodeling of the bony structure and influences the adjacent tissues [1]. In this case, extension of the ethmoid sinus mucocele and remodeling of the orbital structure were major causes of acquired Brown syndrome. Although various causes of acquired Brown syndrome have been described, this is the first reported case of acquired Brown syndrome due to ethmoidal sinus mucocele in Korea. A 69-year-old male presented to our institution with a newly-developed diplopia. There was no history of trauma or any medical illness. At initial examination, visual acuity was 20 / 30 in both eyes. The intraocular pressure was 17 mmHg in the right and 20 mmHg in the left eye. There was no relative afferent pupillary defect and color vision was normal. A soft compressible tender mass measuring 2 × 2 mm on the superonasal aspect of the left upper lid extending from the trochlea to the medial canthal tendon was noted. A motility examination showed an underelevation in adduction of the left eye mimicking Brown syndrome (Fig. 1A). A left hypotropia of 2 prism diopters (PD) to 4 PD in primary gaze, which increased to 6 PD in right and upgaze, was present. Forced duction testing indicated a restriction of elevation in adduction of the left eye. Computed tomography (Fig. 1B) revealed an expansile nonenhancing 30 × 25 mm mass of the left ethmoidal sinus having an intraorbital extension consistent with a mucocele. The mass appeared to be pressing on the globe causing effacement of the left medial rectus and superior oblique tendon with anterolateral displacement of the trochlea. The patient underwent endoscopic ethmoidectomy and evacuation of the mucocele by an otolaryngologist. Postoperatively at two months, there was complete resolution of the diplopia and the patient was asymptomatic. A forced duction test revealed no restrictions. Fig. 1 (A) Preoperative versions of subject in nine diagnostic positions of gaze, demonstrating underelevation in adduction of the left eye. (B) Orbital computed tomography scan showing the nonenhancing 30 × 25 mm mass (arrow) of the left ethmoidal sinus ... Brown syndrome is characterized by limited elevation in adduction with positive forced duction testing [2]. The mechanism of acquired Brown syndrome in this case was thought to be the ethmoidal sinus mass preventing anterior tendon movement through the trochlea or the spread of inflammation from an adjacent sinus disease [3]. Complete resolution of symptoms after surgery suggests that mechanical effects were the main cause in this case. Although acquired Brown syndrome is rare, ethmoidal sinus mucocele should be considered in differential diagnosis of acquired Brown syndrome.

Management of Grade I Vaginal Prolapse in a Friesian Cross: A case report

A 350kg Friesian cross was presented to the Veterinary Teaching Hospital, University Putra Malaysia with a complaint of a bulging vagina one month after paturition. On physical examination, there was evidence of a grade I vaginal prolapse with presence of a yellowish mucoid secretion from the vulva. All the vital parameters were normal. Blood workout showed leucocytosis accompanied by neutrophilia with left shift, lymphocytosis and monocytosis. Creatine kinase was elevated ten folds, while serum globulin was only slightly elevated. There was a slight decline in calcium level in the blood. The prolapse was corrected surgically by applying Buhner's suture. Systemic analgesic, antibiotic, multivitamin and calcium infusion were administered to minimize pain, prevent bacterial complication and normalize the calcium level in the blood, respectively. The prognosis was good and the prolapse regressed completely after a week. Prompt and timely management of vaginal prolapse is necessary in order to avoid serious complications that may predispose to uterine infections, infertility and death due to septicemia. Keywords: Vaginal prolapse; Diary cow; Buhner's suture; Calcium

ECCRINE CARCINOMA IN THE FOOT OF AN ASIAN ELEPHANT (ELEPHAS MAXIMUS)

A case of eccrine carcinoma of the interdigital foot glands in a 39-yr-old female Asian elephant (Elephas maximus) from Zagreb Zoo is described. The tumor between the toenails of the right forefoot was surgically removed 3 yr before postmortem examination (2003), and the histopathologic diagnosis was compound eccrine carcinoma characterized with glandular tubular and papillary proliferations, mild cellular pleomorphism, proliferation of the myoepithelial cells with mucoid secretions, and necrosis. Immunohistochemistry revealed strong immunoreactivity to S-100 protein, estrogen, and high-molecular weight cytokeratin. This elephant also had chronic renal fibrosis with uremia.

RadIologIcal aspect of fungus ball wIthIn a mucocele of the sphenoId sInus

Paranasal sinus fungus ball is within the non-invasive forms and is characterized by the presence of aggregated hyphae that do not invade the sinus mucosa. Mucoceles are benign, expansile, cyst-like lesions of the paranasal sinuses. The mucoid secretions of mucoceles are usually sterile. However, secondary infections, mostly bacterial, may lead to the development of pyocoeles. Although an association between a fungus ball and a mucocele is rare in the paranasal sinuses, this disease entity should be considered in the differential diagnosis of expansile, cystic sinus lesions. In this article, clinical and radiological findings of a 61-year-old male patient with isolated sphenoid sinus fungus ball within a mucocele presented with headache and periorbital pain were discussed with recent literature.

Transport of mucoid mucus in healthy individuals and patients with chronic obstructive pulmonary disease and bronchiectasis

ObjectiveTo characterize and compare the in vitro transport properties of respiratory mucoid secretion in individuals with no lung disease and in stable patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. MethodologySamples of mucus were collected from 21 volunteers presenting no lung disease who had undergone surgery, from 10 patients presenting chronic COPD, and from 16 patients with bronchiectasis. Mucociliary transport (MCT), transport by cough (SCM), and contact angle (CAM) were evaluated. ResultsMCT was found to be greater in healthy individuals (1.0±0.19) than in COPD (0.91±0.17) and bronchiectasis (0.76±0.23) patients (p<0.05), whereas SCM was greater in COPD patients (16.31±7.35cm) than in patients with bronchiectasis (12.16±6.64cm) and healthy individuals (10.50±25.8cm) (p<0.05). No significant differences were observed between the groups regarding CAM. ConclusionMucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms.

Atrial Natriuretic Peptides in Patients with OME: Serous Otitis Media and Mucoid Otitis Media

Objectives: Atrial natriuretic peptides (ANPs) are located within extracardiac tissues known to play an important role in the maintenance of fluid/electrolyte homeostasis. It is not known whether ANPs are expressed in middle ear effusions (MEEs) and whether ANP is correlated in development of serous or mucoid effusion (OME). In order to determine whether secretion of ANP is affected in chronic disease condition, we compared the ANP concentration in the mucoid effusions with that in the serous effusions. Methods: MEE concentrations of ANP were measured in 21 patients (12 mucoid, 9 serous) with OME. The patients underwent myringotomy and/or insertion of a ventilation tube for treatment of OME and collected MEEs. The samples were divided into serous or mucoid types based on observation by the naked eye. ANP immunoreactive cells and ANP levels were measured in the tissues and effusions of the patients with OME, using IHC and radioimmunoassay. Results: In human MEE samples, ANP levels showed a significant increase with the mucoid effusions when compared with the serous effusions and control plasma. ANP concentration was increased in mucoid effusion but was decreased in patients with serous effusion and in control plasma. ANP-immunoreactive (ANP-IR) cells are showed in the tall columnar cells of the middle ear mucosa. Conclusions: Our results suggest that a high concentration of ANP in mucoid secretions promotes chronicity of mucoid otitis media and hypothesize that ANP may also play a role in the pathogenesis of OME through changes in the transport of water and ions across the middle ear epithelium.

A simple method to prevent the obstruction of post-tympanoplasty ventilation tubes

The simultaneous insertion of a ventilation tube or grommet during tympanoplasty is a well-recognised practice among otologists. It is used to reverse atelectasis and to repneumatise the middle ear. A troublesome problem which can occur is post-operative, intraluminal grommet obstruction by blood or viscous mucoid secretions. Routine post-operative use of eardrops may help prevent grommet obstruction but cannot be administered after tympanoplasty when the ear canal is packed with dressings for up to three weeks post-operatively. In this article, we describe a simple method to prevent post-tympanoplasty grommet obstruction.

A 74-year-old soybean allergy woman with anaphylaxis after propofol injection

Methods A previously healthy 74-year-old woman visited our hospital to undergo esophagogastroduodenoscopy for a checkup. She had an allergy to soybean. Approximately 1 min following administration of intravenous propofol, stridor was heard and oxygen saturation fell to 56% on pulse oximetry. We decided to stop the exam, and tried to remove the endoscope. But, the endoscope has stuck in her throat and it was not pulled out. We removed the endoscope by compulsion. After 10 seconds endoscope removal, severe wheezing was heard and her oxygen saturation fell to 56%. The larynx was observed using a laryngoscope for endotracheal intubation. At that time marked swelling and severe edema of the epiglottis and heavy mucoid secretion in the epiglottis extending to the arytenoids cartilage was detected. Immediately 1mg epinephrine was administered subcutaneously, together with 150 mg intravenous methylprednisolone was infused. Because the patient was not improved in symptom after 1 minute, 1mg epinephrine was administered intravenously. After 1minute, her oxygen saturation recovered to 98% and the wheezing was subsided.

Transporte de secreções mucóides de indivíduos saudáveis e pacientes com doença pulmonar obstrutiva crónica e bronquiectasias

ObjectiveTo characterise and compare the in vitro transport properties of respiratory mucoid secretion in individuals with no lung disease and in stable patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. MethodologySamples of mucus were collected, from 21 volunteers presenting no lung disease who had undergone surgery, from 10 patients presenting chronic COPD, and from 16 patients with bronchiectasis. Mucociliary transport (MCT), transport by cough (SCM), and contact angle (CAM) were evaluated. ResultsMCT was found to be greater in healthy individuals (1.0±0.19) than in COPD (0.91±0.17) and bronchiectasis (0.76±0.23) patients (p<0.05), whereas SCM was greater in COPD patients (16.31±7.35cm) than in patients with bronchiectasis (12.16±6.64cm) and healthy individuals (10.50±25.8cm) (p<0.05). No significant differences were observed between the groups regarding CAM. ConclusionMucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms.

Frontal sinus mucocele with orbital complications: Management by varied surgical approaches

A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach.

Safety of recombinant human deoxyribonuclease as a rescue treatment for persistent atelectasis in newborns

BACKGROUND AND OBJECTIVEPulmonary problems are vitally important in newborns. Increased intense and mucoid secretions may lead to atelectasis, pulmonary infections, respiratory distress, prolonged mechanical ventilation or even death. The aim of this study was to evaluate the safety of recombinant human deoxyribonuclease (rhDNase) in the management of persistent atelectasis in term and preterm newborns, unresponsive to the conventional treatment.DESIGN AND SETTINGProspective study of patients admitted to a general community setting of a neonatal intensive care unit between December 2007 and December 2009.PATIENTS AND METHODSThe study included 22 patients (12 premature and 10 term) who were admitted to the neonatal intensive care unit because of respiratory distress and developed atelectasis, and were unresponsive to conventional treatment. Nebulized rhDNase was administered to all patients at a dose of 1 mg/m2 twice daily for 3 days. In patients who did not respond to 3 days of treatment, endotracheal rhDNase was administered at a dose of 1 mg/m2. We assessed the clinical (respiratory rate and oxygen requirement) and radiologic responses (chest radiographic score), recurrence of atelectasis, the need for a repetitive treatment, and mortality rate.RESULTSA clinical and radiologic improvement of atelectasis was observed in 18 of 22 patients following 3 days of nebulized rhDNase treatment. Atelectasis relapsed in 4 patients. Following the administration of combined endotracheal and nebulized rhDNase treatment, an improvement of atelectasis was noted in all four recurrent cases. No adverse events were observed in patients because of the rhDNase treatment.CONCLUSIONSrhDNase treatment is a safe option and may be used as an effective method for the management of persistent atelectasis in newborns, which is resistant to other conventional treatment methods.

Histology and Mucous Histochemistry of the Integument and Body Wall of a Marine Polychaete Worm,Ophryotrochan. sp. (Annelida: Dorvilleidae) Associated with Steelhead Trout Cage Sites on the South Coast of Newfoundland

Histology and mucous histochemistry of the integument and body wall of a marine polychaete worm,Ophryotrochan. sp. (Annelida: Dorvilleidae) associated with Steelhead trout cage sites on the south coast of Newfoundland. A new species of polychaete (Ophryotrochan. sp. (Annelida: Dorvilleidae)) was identified from sediment below Steelhead trout cages on the south coast of Newfoundland, Canada. The organisms were observed to produce a network of mucus in which groups of individuals would reside. Questions regarding the nature and cellular source of the mucus were addressed in this study. Samples of worms were taken from below cages and transported to the laboratory where individuals were fixed for histological study of the cuticle and associated mucus histochemistry. The body wall was organized into segments with an outer cuticle that stained strongly for acid mucopolysaccharides. The epidermis was thin and supported by loose fibrous connective tissue layers. Channels separating individual segments were lined with cells staining positive for Alcian blue. Mucoid cellular secretions appeared thick and viscous, strongly staining with Alcian blue and Periodic Acid Schiff Reagent. It was noted that lateral channels were connected via a second channel running through the anterior/posterior axis. The role of mucus secretion is discussed.

Potentially Lethal Complications of Tracheostomy

Tracheostomy is widely used to facilitate respiration by protecting the airways. It may be performed to relieve upper airway obstruction from congenital stenoses or from acquired conditions such as foreign body impaction, swelling from neck trauma or anaphylaxis, benign or malignant tumors, and infection. Tracheostomy may also be performed in individuals with respiratory impairment who require suctioning for accumulated mucoid secretions and in those with obstructive sleep apnea. Review of autopsy files and the literature was undertaken to demonstrate the range of lethal circumstances that may involve tracheostomy. Unexpected death may result from incorrect positioning of an endotracheal tube with failure of oxygenation, tracheal perforation with pneumothorax, mucus plugging, accidental extubation, and hemorrhage from tracheovascular fistulas. Lethal tracheovascular fistulas usually involve the innominate artery and result from mural perforation by the tip of a tracheostomy tube, mural necrosis from a high-pressure cuff, prolonged intubation, radiotherapy, and low tracheal incisions. Increased movement of tubes in patients with impaired consciousness and excessive head movements may also increase the chances of hemorrhage, as may infiltrating tumors. Given the wide range of potential fatal mechanisms that may be found in such cases, careful autopsy evaluation and dissection will be required to demonstrate the exact nature and site of the lethal lesion in individuals who underwent tracheostomy and die unexpectedly.

Use of flexible bronchoscopy in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support

Critically ill children treated with extracorporeal membrane oxygenation (ECMO) support frequently have respiratory complications amenable to evaluation by flexible bronchoscopy (FB). The safety and efficacy of FB in this setting has not been well described in children. Retrospective analysis of 153 FBs in 79 children treated with ECMO at a single institution from 2000 to 2008. Demographic data, clinical findings, and complications were obtained. Chest radiographs reports were evaluated prior to and following FB. Physiologic variables were compared prior to and following FB. Seventy-nine patients underwent FB on ECMO [58 veno-venous (VV) and 21 veno-arterial (VA) ECMO], with 153 total FBs performed. Indications for FB included clearance of tenacious airway secretions (n = 118, 77%), or evaluation of suspected secondary infections with bronchoalveolar lavage (n = 26, 17%). Two patients also had surfactant instillation following secretion removal. FB was performed a median 5 days following cannulation for ECMO (range 2-14 days). Most common findings included thick secretions (n = 77, 50.3%), mucoid secretions (n = 15, 9.8%), and mucopurulent secretions (n = 28, 18.3%). No deterioration in radiographic lung findings was described post-FB. FB was not associated with any significant change in heart rate, systemic blood pressure, or temperature. No significant changes in ECMO pump flow rate or sweep gas flow was seen during or after FB. Cannula dislodgement, inadvertent extubation, fever, pneumothorax, or intraprocedural hypoxemia was not reported. Fifty-three FBs (35%) resulted in blood-tinged secretions from the endotracheal tube post-FB, which resolved spontaneously. Three patients received high frequency oscillatory ventilation (HFOV) following FB in association with mild hemorrhage. FB is a well-tolerated and safe procedure in critically ill pediatric patients on ECMO. FB may have a diagnostic as well as therapeutic benefit in such patients.

An innovative tracheostomy mask

Tracheostomies are widely used for maintaining the airway in patients undergoing surgeries for oral and oropharyngeal tumours. Adequate maintenance of optimal humidity is essential to sustain respiratory function postoperatively. Delivery of gas at optimal conditions prevents moisture exhaustion in the mucociliary transport system and facilitates clearance of mucoid secretions.

A Café Coronary Death due to a 'Banana'

Cafe Coronary syndrome which was first reported as sudden collapse at restaurants while dining was found to be due to fatal occlusion of upper airway by large pieces of food. Many of those individuals had consumed large amounts of alcohol prior to the incident. However, same condition has also been noticed among institutionalized elderly with dementia and psychiatric conditions. This is an un-witnessed death of a cafe coronary syndrome , where a 70 year old man after having dinner with his children previous night found dead next day morning in his bed. At autopsy a blob of mucoid secretions were found at right nostril and a piece of banana weighing 21g was found impacted within the laryngophrarynx, occluding the air way. He was edentulous. This case highlights the need of being aware of the condition especially in the elderly with mastication problems due to lack of teeth and other deglutition problems. DOI: 10.4038/sljfmsl.v1i1.2712 Sri Lanka Journal of Forensic Medicine, Science & Law 2010 Vol.1 No.1 pp.22-24

Atypical Presentation of Thyroglossal Duct Cyst in a Pediatric Patient

Atypical Presentation of Thyroglossal Duct Cyst in a Pediatric Patient

Airway inflammation in Michigan pleasure horses: prevalence and risk factors

Although subclinical airway inflammation is thought to be common in horses, there is little information on its prevalence and none on risk factors. To determine the prevalence and risk factors for an increased number of inflammatory cells and for mucus accumulation in the trachea of pleasure horses. Horses (n = 266) in stables (n = 21) in Michigan were examined endoscopically, once in winter and once in summer 2004. Visible tracheal mucoid secretions were graded 0-5 and inflammatory cell numbers counted in a tracheal lavage sample. Information collected about each horse included age, gender, presence of cough, percent time indoors and source of roughage. The repeated measures were analysed by generalised estimating equations and linear mixed models. Horses eating hay, especially from round bales, had the most neutrophils, whereas horses feeding from pasture had the fewest. Being female and being outdoors in winter were associated with increased numbers of inflammatory cells. Older horses had fewer macrophages than young horses. More than 70% of horses had >20% neutrophils in tracheal lavage. Twenty percent of horses had a mucus accumulation score >1; 17% had both a mucus score >1 and >20% neutrophils. The significant risk factors for mucus accumulation >1 were age >15 years, feeding on hay as compared to pasture, and being outdoors for more than 80% time in winter. Even though mucus accumulation score >1 was a risk factor for cough, only half of such horses coughed. Cough and mucus accumulation were associated with increased number of neutrophils. In comparison to pasture feeding, hay feeding, particularly from round bales, was associated with an increased number of neutrophils in the airway. Being outdoors in winter was associated with increased numbers of inflammatory cells and with mucus accumulation. Because 70% of horses have >20% neutrophils, this value should not be used as the sole indicator of airway inflammation. The study reinforces the importance of hay feeding and older age as risk factors for inflammatory airway disease. Horses that do not have 'heaves' may be best kept indoors when winters are cold.

An easy technique to prevent post-tympanoplasty ventilation tube blockage

No abtract. Concomitant placement of a ventilation tube (VT) during tympanoplasties performed for atelectatic ears is a common practice among otologists to reverse atelectasis and repneumatize the middle ear.1, 2 The aim of inserting the ventilation tube is to restore the aeration of the tympanic cavity and thus avoid reformation of the atelectatic changes. Intraluminal obstruction of the VT by mucoid secretions or blood can be a troublesome clinical problem postoperatively. Although routine administration of ear drops postoperatively is a common practice to prevent blockage of the VT,3, 4 the same method is not applicable after tympanoplasty as the ear canal is packed with dressings for 2 to 3 weeks routinely. In the literature, we could not find a published method to prevent VT blockage after tympanoplasty. Here we describe an easy and straightforward technique that can be employed for preventing blockage of VTs inserted during tympanoplasty. After inserting the VT tube at the end of the procedure, the sheath of a 20-G BD Venflon Pro (1.26IN 1.1 × 32 mm) (Becton, Dickinson and Co., Franklin Lakes, NJ) is cut to a suitable length to prevent it from falling into the tympanic cavity. Under the microscope, the sheath is inserted within the lumen of the VT so that it effectively blocks it (Figs. 1 and 2). Sheath of 20-G Venflon inserted within the lumen of a Shah grommet put in before the tympanic membrane perforation is grafted. Sheath of 20-G Venflon seen within the lumen of a Shah grommet after graft insertion by underlay technique with care taken not to obstruct the grommet medially. At the first postoperative visit (usually 2–3 weeks), the sheath can be easily pulled out after removal of the dressings. This technique can be used in patients that are cooperative with aural care in the postoperative period. No increase in pain has been seen with this technique. In our experience we have also not seen any of the sheaths getting stuck, or both the VT and sheath coming out together while pulling out the sheath at the first postoperative visit. We have been using this method in our department for many years. We have performed this technique on more than 100 patients and find it a very useful and convenient method to prevent blockage of VT in tympanoplasty.

Crystal content investigation in dried human bulbo-urethral gland (Cowper's) secretion.

The present study compiled the data furnished by 77 different specimens of human bulbo-urethral secretion obtained from 4 donors. It established that Cowper's fluid, allowed to dry at room temperature, gives rise to dendritic crystalline structures showing a remarkable pattern closely resembling fern leaves. In addition to the dendrites, which may develop in some other mucoid secretions and are known to be mainly composed of NaCl crystals, numberless tiny spherulites are also observed within interdendritic intervals, in the central part of the preparations. These spherulites consist of polycrystalline microstructures radiating from a central nucleus. It can be inferred from their structure and localization that they are composed of salts other than NaCl and do not crystallize in the cubic system. Far from being an occasional phenomenon, ferning crystallization is considered to be an unequivocal physical constant of dried human bulbo-urethral fluid. As for interdendritic crystalline spherulites that were described previously as occasional structures present only in ovulatory cervical mucus, both their abundance and range of size variation make them a constant and specific feature of dried Cowper's fluid.