In an attempt to understand the pathophysiology of the transurethral resection syndrome this prospective metabolic study was conducted on 100 consecutive patients undergoing transurethral resection of the prostate (TURP). The volume of glycine absorbed, intravenous fluid given and blood loss were calculated, and serum osmolality, sodium and glycine were measured before, during and after operation. The mean volume of glycine absorbed, fluid gain and blood loss were 0.6, 1.57 and 0.356 litres respectively. The mean weight of prostate resected was 30.8 g and resection time was 56.5 min. The mean serum osmolality dropped from 291 to 286 mOsm/l, sodium dropped from 138 to 132 mmol/l and glycine concentration increased from 293 to 3599 mumol/l post-operatively. Ten patients developed signs suggestive of the TURP syndrome. Multiple regression analysis showed that the most consistent statistically significant factors in relation to the syndrome were volumetric gain and hypo-osmolality. The latter proved to be the only significant factor later post-operatively. The increase in serum glycine and drop in serum sodium concentrations were the best serological markers, reaching significance only after excluding volumetric gain and osmolality from the analysis.

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Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling's law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling's law.

Introduction and objective: In 1886, Starling proposed a hypothesis for the capillary-interstitial fluid (ISF) transfer, in which the capillary was thought a tube of a uniform diameter that is impermeable to plasma proteins. The flow of fluid across its wall was thought dependent upon a balance between the hydrostatic pressure within its lumen causing 'filtration', and the osmotic pressure of plasma proteins causing 'absorption'. The physical basis on which LP of a capillary was thought positive and responsible for filtration was Poiseuille's work on long Brass tubes of uniform diameters. Later discoveries demonstrated that the capillary is a porous orifice tube with totally different hydrodynamics that is reported here. Material and methods:The hydrodynamics of an inlet tube was studied in order to demonstrate the negative side pressure (SP) gradient exerted on its wall. We then studied the porous orifice (G) tube akin to capillary and later enclosed it in a chamber (C), akin to interstitial fluid space, making the G-C apparatus demonstrating the G-C circulation phenomenon. The effect of proximal (arterial) pressure (PP), distal (venous) pressure (DP) and inlet diameter on the SP and CP of the G-C model are reported. Result:The PP induces the negative SP in the G tube which is responsible for absorption. The orifice has an inverted bell shaped effect on SP and CP. The DP augments filtration. The G tube enclosed it in a chamber (C), making the G-C apparatus demonstrating the G-C circulation phenomenon. Conclusion:Hydrodynamic studies on G tube, based on capillary ultrastructure, demonstrate results which differ from Poiseuille's in a strait tube, challenge the role attributed to arterial pressure as a filtration force in Starling's hypothesis. A perspective literature review shows that the oncotic pressure force has been previously cancelled and the Starling's hypothesis has failed to explain the capillary-ISF transfer in most parts of the body.A concept based on a new hydrodynamic of the G-C model phenomenon is proposed for the capillary-ISF circulation. An autonomous dynamic magnetic field-like G-C circulation occurs between fluid in the G tube's lumen and a surrounding fluid compartment C. Based on results of studies on a circulatory model incorporating the G-C apparatus, factors which initiate, regulate and affect the G-C circulation, its physiological and haemodynamic relevance and its clinical importance to the pathogenesis of oedema and shock are discussed.