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*Corresponding Author: Ahmed N Ghanem, General surgeon, University of Opole, Faculty of Medicine, Department of Family Medicine and Public Health.
Citation: Ahmed N Ghanem. (2023), Re-print: Update on Ghanem’s New Scientific Discoveries in physics, Physiology, and Medicine, J, Surgical Case Reports and Images 6(2); DOI:10.31579/2690-1897/142
Copyright: © 2023 Ahmed N Ghanem, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 23 January 2023 | Accepted: 30 January 2023 | Published: 18 February 2023
Keywords: shock; hyponatraemia; fluid therapy; The TURP syndrome; ARDS; LPHS; bladder cancer
Citation: Ahmed N Ghanem. Update on Ghanem’s New Scientific Discoveries in physics, Physiology, and Medicine. Biomed J Sci & Tech Res 31(3)-2020. BJSTR. MS.ID.005117.
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.
HN: Hyponatraemia; ARDS: Acute Respiratory Distress Syndrome; TURP: The Transurethral Resection of the Prostate; LPHS: Loin Pain
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
Medical Discoveries
Despite multiple and powerful reporting in the literature on my multiple and important scientific discoveries the whole medicalworld 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 recognize2 new types of shocksand 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 resectionof the prostate (TURP) syndromeand 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 syndromeswere discovered but also successful treatments for it were found. Thetwo new types of vascularshocks are volume kinetic shocks or VOS defined here.
Massive fluid infusions in a short time induceVO) of two types: Type one (VOS1)and Type two (VOS2). VOS1 is inducedby sodium- free fluid of 3.5-5 litersin 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 recogniseVOS 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 (Figure2). 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].
Figure 1: Shows volumetric overload(VO) quantity (in litres and as percentof body weight) and types of fluids.Group 1 was the 3 patients who died in the case series as they were misdiagnosed as one of the previously known shocks and treated with further volume expansion. Group 2 were 10 patientsfrom the series who were correctly diagnosedas volumetric overloadshock and treated with hypertonic sodiumtherapy (HST). Group 3 were 10 patientswho were seen in the prospective study and subdivided into 2 groups;Group 3.1 of 5 patientstreated with HST and Group3.2 of 5 patients who were treatedwith guarded volume expansion using isotonic saline.
Table 1: Shows the multiple regression analysis of total per- operative fluid gain, drop in measuredserum osmolality (OsmM), sodium, albumin, Hb and increase in serum glycine occurring immediately post-operatively in relation to signs of the TURP syndrome. Volumetric gain and hypoosmolality are the only significant factors.
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 pressureof the G tube and chamber pressureas 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 salineand plasma inducesoedema when run through the vein not the artery, and the arterial pressurecauses suction not filtration due to effectof 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 pre- capillary sphincter [8] and pores that allow the passage of plasma proteins [9]. As the capillary pores allow the passage of plasma molecules, nullifying the osmoticpressure of plasma proteins, a call for reconsideration of Starling’s hypothesiswas 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 inducesa 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 dynamicmagnetic field-like fluid circulation betweenC and G tube lumen. Incorporating the G tube and C in a circulatory modeldriven by electricpump induced proximalpressure 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 capillaryinterstitial 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 puzzlesof 3 clinical syndromes of TURP, hyponatraemia and ARDS [21,22].
Figure 2: Shows a diagrammatic representation of the hydrodynamic of G tube based on G tubes and chamber C. This 37-years old diagrammatic representation of the hydrodynamic of G tube in chamber C is based on several photographs. The G tube is the plastic tube with narrow inlet and pores in its wall built on a scale to capillaryultra-structure of precapillary sphincter and wide inter cellularcleft pores, and the chamber C around it is another bigger plastic tube to form the G-C apparatus. The chamber C represents the ISF space. The diagram represents a capillary-ISF unit that should replace Starling’s law in every future physiology, medical and surgical textbooks, and added to chapters on hydrodynamics in physics textbooks.
The numbers shouldread as follows:
1. The inflow pressure pushesfluid through the orifice
2. Creating fluid jet in the lumen of the G tube**.
3. The fluid jet createsnegative side pressuregradient causing suctionmaximal over the proximal part of the G tube near the inlet that sucks fluid into lumen.
4. The side pressure gradientturns positive pushingfluid out of lumen over the distalpart maximally near the outlet.
5. Thus, the fluid aroundG tube inside C movesin magnetic field-like circulation [5] takingan opposite direction to lumen flow of G tube.
6. The inflow pressure 1 and orifice2 induce the negative side pressure creatingthe 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
7. again at 3,
8. Maintaining net negative energypressure inside chamberC.
**Note the shape of the fluid jet inside the G tube (Cone shaped),having a diameterof 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 leavesof 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 capillaryof 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.
Figure 3: Shows renal pedicle mapped on a supine IVU film (Horizontal) and erect film (Vertical) limbs of 7 where the renal pedicle is stretched to 3 times its normal length, causing stenosis and ischemia.
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.
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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