The complete evidence that Starling's law responsible for many errors and misconceptions on fluid therapy in shock is wrong: The correct replacement is the hydrodynamic phenomenon of the porous orifice (G) tube

2^nd World Congress on Heart

April 25-26, 2022 | Webinar

Ahmed Nasr Ghanem

Mansoura University, Egypt

Scientific Tracks Abstracts: J Cardiovasc Dis Diagn

Abstract :

To report the hydrodynamic of a porous orifice (G) tube as replacement for the wrong Starling’s law. Material and methods Hydrodynamics of the G tube, based on capillary ultra-structure, were studied. The effect of changing G tube orifice diameter, proximal pressure and distal pressure on the side pressure and chamber (C) pressure were evaluated. The physiological proof that the capillary works as G tube not Poiseuille’s tube is provided. Results Hydrodynamics of the G tube showed that proximal, akin to arterial, pressure induces a negative side pressure gradient on the G tube wall, which is negative causing suction maximum near the inlet and turn positive near the exit causing filtration. This created the rapid, autonomous magnetic field like fluid circulation phenomenon between G and C. The physiological evidence on the hind limb of sheep proves that the capillary works as G tube. Conclusion Hydrodynamic of the G tube challenges the role attributed to arterial pressure as a filtration force in Starling’s law. A literature review shows that oncotic pressure does not work, and the law has failed to explain the capillary–ISF transfer. A concept based on the new hydrodynamic phenomenon of the G tube is proposed to replace Starling’s law. A rapid autonomous dynamic magnetic fieldlike G–C circulation occurs. Factors which initiate, regulate, and affect the G–C circulation, its physiological proof and relevance to clinical importance are given. Physiological evidence on capillary working as G tube not Poiseuille’s tube is provided. Key words Capillary physiology, Starling’s law, Poiseuille’s tube, Hydrodynamics of the porous orifice (G) tube References 1. Ghanem AN and Ghanem, SA. Volumetric Overload Shocks: Why Is Starling’s Law for Capillary Interstitial Fluid Transfer Wrong? The Hydrodynamics of a Porous Orifice Tube as Alternative. Surgical Science 2016; 7: 245-249. http://dx.doi.org/10.4236/ ss.2016.76035 2. Ghanem SA, Ghanem KA, Ghanem A N. Volumetric Overload Shocks in the Patho-Etiology of the Transurethral Resection of the Prostate (TURP) Syndrome and Acute Dilution Hyponatraemia: The Clinical Evidence Based on Prospective Clinical Study of 100 Consecutive TURP Patients. Surg Med Open Access J. 2017: 1(1);1- 7 3. Ghanem KA and Ghanem AN. Volumetric overload shocks in the patho-etiology of the transurethral resection prostatectomy syndrome and acute dilution hyponatraemia: The clinical evidence based on 23 case series. Basic Research Journal of Medicine and Clinical Sciences 2017; Vol. 6(4): pp. 35-43 4. Ghanem KA and Ghanem AN. (2017) The proof and reasons that Starling’s law for the capillary-interstitial fluid transfer is wrong, advancing the hydrodynamics of a porous orifice (G) tube as the real mechanism. Blood, Heart and Circ, Volume 1(1): 1-7. doi: 10.15761/BHC.1000102 Available online. 5. Ghanem KA, Ghanem AN. The Physiological Proof that Starling’s Law for the Capillary-Interstitial Fluid Transfer is wrong: Advancing the Porous Orifice (G) Tube Phenomenon as Replacement. Open Acc Res Anatomy. 1(2). OARA.000508. 2017

Biography :

Dr, Ahmed Nasr Ghanem,. MD (Urol.), FRCSEd was educated in Egypt and qualified in 1968, Mansoura University, Egypt. He spent his internship at Mansoura University Hospitals. He gained all postgraduate experience in UK where he was promoted in posts up to the consultant level. He practiced as consultant Urologist in UK, Saudi Arabia, and Egypt. During his career life he attended many conferences and won the award of Princes Alexandra Memorial Award and reported over 100 articles of which he made important discoveries in medicine, physiology, urology, nephrology, cardiovascular and surgery. He discovered two new types of vascular shocks, proved that one physiological law is wrong and provided the correct replacement. He resolved the puzzles of 4 clinical syndromes: the transurethral of the prostate (TURP) syndrome, acute dilutional hyponatraemia, the adult respiratory distress syndrome (ARDS) and the loin pain haematuria syndrome (LPHS). Now he is happily retired in Egypt and UK dedicating his time to writing scientific medical articles and peer reviewing and editorial board member for many Journals. He is the Editor in Chief for Surgical Medicine Open Access Journal (SMOAJ).