Abstract
Introduction and Objective: To report the new scientific discoveries in physics, physiology and medicine by one author.
Material and Methods: Results of my research are summarized. It is based on 2 clinical studies one prospective and the second case series on hyponatraemia (HN) of the transurethral resection of the prostate (TURP) syndrome. A physics study on porous orifice (G) tube proves Starling’s law is wrong. I reported prospective study on nephroptosis revealing its link with the loin pain haematuria syndrome (LPHS) and curative surgery for it.
Results: Two physics and two physiological discoveries are reported. Acute HN presents as shock during surgery. It is induced by massive gain of sodium-free fluid recognized as volumetric overload shock (VOS). Features of the multiple organ dysfunction syndrome occur, include ARDS, Acute renal failure (ARF) and Coma. The prospective study demonstrated volumetric overload is the most significant in patho-aetiology. The case series demonstrated mistaking VOS for a known shock and treating it with further volume expansion cause death. Correct diagnoses as VOS and treating it with hypertonic sodium is lifesaving. The physics study on the G tube demonstrated that proximal, akin to arterial, pressure induces suction not filtration producing the hydrodynamic phenomenon that replaces Starling’s law. The link of LPHS with nephroptosis is demonstrated by the IVU 7 sign. The curative surgery for LPHS is renal sympathetic denervation and nephropexy.
Conclusion: Dilution HN presents as shock that is mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium. Starling s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved.
Keywords: Shock; Hyponatraemia; Fluid therapy; The TURP syndrome; ARDS; LPHS; Bladder cancer
Abbreviations:HN: Hyponatraemia; ARDS: Acute Respiratory Distress Syndrome; TURP: The Transurethral Resection of the Prostate; LPHS: Loin Pain Haematuria Syndrome; IVU 7: Intravenous Urography 7 sign; POT: Porous Orifice Tube
Introduction
This article summarizes the full list of recent scientific
discoveries in physics, physiology and medicine made by a single
scientific medical investigator and independent researcher who
was fully self-financed supported by a full list of reported articles in
reputable open access journals.
The discoveries are:
Physics Discoveries
1. The hydrodynamics of the porous orifice (G) tube [1-4]
2. The Tree Branching Law (TBL) [5-8].
Physiological Discoveries
1. Proving Starling’s law for the capillary-interstitial (ISF)
fluid is wrong and providing the correct replacement of the
magnetic field like fluid hydrodynamics of the G tube.
2. The TBL Corrects two misconceptions on capillary
physiology namely:
a. The cross-section areas of all the capillaries is larger than
the aorta
b. The red blood cells (RBCs) speed in a capillary is thought
“very slow” to allow for the slow perfusion of the capillary-ISF
transfer as based on Starling’s forces.
Biochemical Discoveries
1. Resolving the puzzle of acute dilutional hyponatraemia
identifying its path-aetiology and finding a successful curative
lifesaving therapy for it: The Hypertonic Sodium Therapy (HST)
of 5%NaCl and/or 8.4%NaCo3 [9-13].
2. Revealing the effects of volume kinetics on the
cardiovascular system
Medical Discoveries
1. Discovering two new types of cardiovascular shocks: the
volume kinetic shocks or the volumetric overload shocks (VOS)
of type one induced by sodium-free fluid and type 2 induced by
sodium-based fluid retention [14,15].
2. Resolving the puzzle of the acute respiratory distress
syndrome (ARDS) by identifying its exact patho-aetiology being
caused by VOS and a successful therapy of HST.
3. Resolving the puzzle of the transurethral resection of the
prostate syndrome discovering its link with ARDS and finding
the successful lifesaving therapy for it similar to that of acute
hyponatraemia.
4. In discovering the above the bridge connecting the physics,
physiology, biochemistry, and medicine was constructed.
5. On a totally different subject, the patho aetiology of the
loin pain haematuria syndrome was discovered revealing its
link with SN, and 100% curative therapy surgery was devised.
6. A new surgical procedure for the therapy of cancer
bladded with orthotopic bladder replacement was reported.
Despite multiple and powerful reporting in the literature on
my multiple and important scientific discoveries the whole medical
world is not responding. It seems to be in a deep coma. Even the top
Medical, surgical and scientific journals including Nature, Nature
Medicine, Science, Lancet, British Medical Journal, New England
Journal of Medicine. Journal of The American Medical Association,
The Surgeon- The Journal of the Royal College of Surgeons of
Edinburgh, Physiology and Urology journals have repeatedly done
serious mistakes rejecting the many articles I sent to them. They
may ignore my person, but they cannot wrong any of my new
discoveries. Here is a summary of my new discoveries to show you
how wrong they all are [16-19].
My scientific discoveries are many and most important made
over the last 32 years of my career life spent in investigating and
reporting these articles. The articles recognize 2 new types of
shocks and its treatment, proves that Starling’s law for the capillary
interstitial fluid transfer is wrong and provides an alternative
mechanism: The hydrodynamics of a porous orifice (G) Tube These discoveries resolve the puzzles of 3 syndromes discovering
its patho-aetiology and new successful treatments; namely the
transurethral resection of the prostate (TURP) syndrome and
acute dilution hyponatraemia (HN), the acute respiratory distress
syndrome (ARDS) and the loin pain haematuria syndrome (LPHS).
Not only the exact patho-aetiologies of these syndromes were
discovered but also successful treatments for it were found. The
two new types of vascular shocks are volume kinetic shocks or VOS
defined here.
Massive fluid infusions in a short time induce VO) of two types:
Type one (VOS1) and Type two (VOS2). VOS1 is induced by sodiumfree
fluid of 3.5-5 liters in one hour known as the TURP syndrome5
or hyponatraemic shock. VOS2 may complicate VOS1 or is induced
by massive infusion of sodium-based fluids. VOS2 also complicates
fluid therapy in critically ill and presents with ARDS.6 Volumetric
gain of 12-14 litres of sodium-based fluids reported in ARDS.
Two clinical studies to understand the TURP syndrome and
recognise VOS were conducted. A prospective study on 100
consecutive TURP patients of whom ten suffered TURP syndrome
[5]. Volumetric overload was the only significant factor in causing
the condition (Table 1 & Figure 1). The second study was case
series of 23 case cases s of the TURP syndrome manifesting as
VOS1. Volumetric overload quantity and type is shown in (Figure
2). Three patients died and remaining 20 patients were correctly
diagnosed as VOS1 and treated with hypertonic sodium therapy
(HST). Each patient passed 4-5 litres of urine followed by recovery
from shock and coma. This treatment was successful in curing all
patients bringing them back from dead [19,20].
A study of the hydrodynamics of the porous orifice (G) tube
comparing it to that of Poiseuille’s tube was done. Measurements
of pressures at various parts of a circulatory system incorporating
the G tube in a chamber to mimic the capillary-interstitial fluid
compartment were done. The effect of changing the proximal
(arterial), the distal (venous) pressures and the diameter of the
inlet on side pressure of the G tube and chamber pressure as well as
the dynamic magnetic field like fluid circulation around the G tube
was evaluated. The dynamic magnetic field like fluid circulation
around the G tube and surrounding it in C chamber (Figure 3)
provides adequate replacement for Starling’s law. The physiological
equivalent of this physics study was done on the hind limbs of sheep.
It demonstrated that both saline and plasma induces oedema when
run through the vein not the artery, and the arterial pressure causes
suction not filtration due to effect of pre- capillary sphincter.
Starling’s hypothesis was based on Poiseuille work on strait
uniform brass tubes. Eight decades latter evidence demonstrated
that the capillary is a porous narrow orifice (G) tube as it has a precapillary
sphincter [8] and pores that allow the passage of plasma
proteins [9]. As the capillary pores allow the passage of plasma
molecules, nullifying the osmotic pressure of plasma proteins, a call
for reconsideration of Starling’s hypothesis was previously made
[10] but there was no alternative then. The replacement came to
light when the hydrodynamics of the G tube were discovered and
reported in 2001.
The hydrodynamics of the G tube [1,11] (Figure 3) demonstrated
that the proximal (arterial) pressure induces a negative side
pressure gradient on the wall of the G tube causing suction most
prominent over the proximal half and turns into positive pressure
over the distal half. Incorporating the G tube in a chamber (C),
representing the ISF space surrounding a capillary, demonstrated
a rapid dynamic magnetic field-like fluid circulation between C and
G tube lumen. Incorporating the G tube and C in a circulatory model
driven by electric pump induced proximal pressure similar to
arterial pressure, causing suction from C into the lumen of G tube.
This proves that the arterial pressure causes suction not filtration
at the capillary interstitial fluid circulation, and hence Starling’s law
is wrong on both forces and equations. The hydrodynamics of the G
tube provide adequate correct replacement for Starling’s law. This
illustrates how 2 new types of vascular shocks and a replacement
of Starling’s law were discovered that have resolved the puzzles of 3
clinical syndromes of TURP, hyponatraemia and ARDS [21,22].
1. The inflow pressure pushes fluid through the orifice
2. Creating fluid jet in the lumen of the G tube**.
3. The fluid jet creates negative side pressure gradient causing suction maximal over the proximal part of the G tube near
the inlet that sucks fluid into lumen.
4. The side pressure gradient turns positive pushing fluid out of lumen over the distal part maximally near the outlet.
5. Thus, the fluid around G tube inside C moves in magnetic field-like circulation [5] taking an opposite direction to lumen
flow of G tube.
6. The inflow pressure 1 and orifice 2 induce the negative side pressure creating the dynamic G-C circulation phenomenon
that is rapid, autonomous, and efficient in moving fluid and particles out from the G tube lumen at 4, irrigating C at 5, then
sucking it back again at 3,
7. Maintaining net negative energy pressure inside chamber C.
**Note the shape of the fluid jet inside the G tube (Cone shaped), having a diameter of the inlet on right hand side and the
diameter of the exit at left hand side (G tube diameter). I lost the photo on which the fluid jet was drawn, using tea leaves of
fine and coarse sizes that runs in the centre of G tube leaving the outer zone near the wall of G tube clear. This may explain the
finding in real capillary of the protein-free (and erythrocyte-free) sub-endothelial zone in the Glycocalyx paradigm (Woodcock
and Woodcock 2012) [3]. It was also noted that fine tea leaves exit the distal pores in small amount maintaining a higher
concentration in the circulatory system than that in the C chamber- akin to plasma proteins.
The TBL is a fundamental law of nature that govern the ramifications of all tress of green and red of the Aorta-arterial trees. It corrects two important misconceptions on the capillary physiology. This evidence sums up to demonstrate that the capillary-ISF transfer occurs according to a precise fast circulation of the magnetic field like fluid not the slow perfusion. That provides adequately for the demands of cells at rest and increased demand during strenuous physical activity. On another subject, this article12 reports the overlooked link of Loin Pain Haematuria Syndrome with Symptomatic Nephroptosis and the Results of a new curative surgery; Renal Sympathetic Denervation and Nephropexy Surgery. Two new signs namely; the IVU 7 sign (Figure 4) and tube stretch hypothesis were reported demonstrating that renal pedicle stretch causing vessel stenosis, ischaemia and neuropathy. Surgical treatment was used in 28 patients; 10 had simple nephropexy and 18 had Renal Sympathetic Denervation and Nephropexy Surgery (RSD&N) for severe LPHS. Four of patients treated with simple nephropexy had recurrence of LPHS while those who had RSD&N were all cured.
On another subject I reported a surgical point of technique [13] for operable cancer bladder in which “capsule sparing” cystoprostadenectomy for orthotopic bladder replacement that overcomes the problems of difficult urethral anastomosis, impotence and incontinence.
Conclusion
Two new physics discoveries of the G tube hydrodynamics and tree branching law with two related physiological discoveries of proving Starling’s law wrong and correcting two misconceptions on capillary physiology, and 6 new medical discoveries are reported. These resolved the puzzles of dilution HN of the TURP syndrome that presents as shock mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium therapy. Starling’s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved. A new point of technique for bladder replacement was reported.
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