Reproducibility of the so-called "
mucolytic effect" of the 2%-10%
dextrose-water
solution is questioned. To test the
mucolytic effect of 5% and 10%
dextrose-water solutions and to determine what could be a true
mucolytic agent, in vitro and in vivo studies were undertaken in two proven
pseudomyxoma peritonei cases. In vitro study: Immediately after the
mucin jelly was taken out of the peritoneal cavity, the jelly was immersed in various 40 cc solutions including: 1) 5%
dextrose-water; 2) 10%
dextrose-water; 3)
normal saline; 4) lactated Ringer; 5) distilled water. The
mucolytic effects of these solutions were observed once every hour after vigorous mixing. In vivo study: After completion of the operation, the peritoneal cavity was repeatedly irrigated with massive warm 5%
dextrose-water and
normal saline solutions in an attempt to dissolve the residual
mucin cake and jelly. Neither 5% and 10%
dextrose-water
solution nor control solutions of
normal saline, lactated Ringer, and distilled water could dissolve the
mucin jelly in test tubes at 0, 1, 2, and 3 hours. The "claimed"
mucolytic agent, 5%
dextrose-water
solution could not facilitate the removal of both
mucin jelly and cake in the peritoneal cavity. The 5%
dextrose-water
solution was not superior to the
normal saline solution in terms of
mucolytic effect. In the present study, a true
mucolytic agent does not exist. Currently, multiple
laparotomy for aggressive cytoreduction remains the treatment of choice for
pseudomyxoma peritonei.