Renal lymphatic function following venous pressure elevation.

The renal lymphatic system plays an important role in removing excess fluid from the kidneys. Unfortunately, the factors influencing lymphatic flow are difficult to measure. We used a simple model to represent renal lymphatics as a single pressure source (PL) pushing lymph through a single resistance (RL). In anesthetized dogs, we cannulated renal lymphatics and measured lymph flow rate (QL) as we varied pressure (PO) at the outflow end of the lymphatics. There was no significant change in QL as we increased PO from -5 to 0 cm H2O. In other words, there was a plateau in the QL vs. PO relationship. At higher PO's, QL decreased linearly with increases in PO. From this linear relationship, we calculated RL as -delta PO/ delta QL and we took PL as the PO at which QL = 0 microliter/min. At baseline, RL = 0.34 +/- 0.14 (SD) cm H2O.min/microliter and PL = 8.2 +/- 4.4 cm H2O. When we increased renal venous pressure (PV) from baseline (3.5 +/- 3.0 cm H2O), the plateau in the QL vs. PO relationship extended to higher PO's, RL decreased, and PL increased. Renal interstitial fluid volume and interstitial pressure increased following elevation of PV. The extension of the QL vs. PO plateau with increasing PV suggests that renal interstitial pressure may partially collapse intrarenal collecting lymphatics which may compromise lymph flow.

The effect of anesthesia and surgery on diaphragmatic lymph vessel flow after endotoxin in sheep.

Increases in diaphragmatic lymph vessel flow (Qdi) may be important in preventing ascites because diaphragmatic lymph vessels drain the peritoneal space. However, lymphatic vessel function may be depressed in anesthetized, open chested animals. To test this hypothesis, we cannulated diaphragmatic lymph vessels in five sheep which were anesthetized with 1-2% halothane. We performed a thoracotomy and cannulated a diaphragmatic lymph vessel in each sheep. Then we infused 0.75-1.0 micrograms/kg of E. coli endotoxin intravenously and we measured Qdi and the lymph protein concentration for 2-4 hrs. The data were compared to previously reported data for five unanesthetized sheep (J. Appl. Physiol. 62:706-710, 1987). At baseline Qdi = 0.8 +/- 0.7 (SD) in the anesthetized sheep and 1.0 +/- 0.8 ml/hr in the unanesthetized sheep. After endotoxin, Qdi increased to 4.5 +/- 3.1 ml/hr in the unanesthetized sheep (p less than 0.05) but Qdi did not change in the anesthetized sheep. However, the lymph protein concentration increased similarly in each group, indicating that endotoxin caused the same degree of injury in each group. Our results indicate that diaphragmatic lymph vessel function is depressed in anesthetized, open chested sheep.

Pressure within the thoracic duct modulates lymph composition.

The amount of lymph received by the thoracic duct depends on each contributing organ's ability to produce interstitial fluid and generate a pressure differential moving lymph into the central lymphatic circulation. It has been reported that varying the pressure within the thoracic duct could alter each organ's contribution to thoracic duct flow. The thoracic duct above the diaphragm was cannulated to obtain lymph from the liver, gut, and lower body. Pressure within the thoracic duct was elevated serially by increasing the lymphatic cannula outflow height. This caused lymph protein concentration to increase while chyle concentration (measured by absorbance) decreased. The data demonstrate that as thoracic duct pressure increases, the percentage contribution of gut lymph flow (as represented by chyle concentration) decreases while the contribution of lymph originating within the liver (as indicated by higher protein concentration) increases. We conclude that pressure variation within the central lymphatic system affects the amount of lymph or edema fluid leaving any given organ.

Loss of resistance technique for locating the epidural space: evaluation of glass and plastic syringes.

Location of the epidural space in epidural anaesthesia usually involves the measurement of loss of resistance using glass or plastic syringes. In the present study two varieties of glass syringe and one plastic type were evaluated to determine the resistive forces associated with plunger movement. The mean static (fs) and dynamic (fd) forces for polished glass syringes having a ground plunger only were fs = 0.47 X 10(-3) +/- 0.22 X 10(-3) N and fd = 0.37 X 10(-3) +/- 0.19 X 10(-3) N and for polished glass syringes having a ground barrel and plunger were fs = 0.43 X 10(-3) +/- 0.16 X 10(-3) N and fd = 0.38 X 10(-3) +/- 0.15 X 10(-3) N. Each of these values was significantly lower (P less than 0.5) than those for plastic syringes fs = 2.22 X 10(-3) +/- 0.48 X 10(-3) N and fd = 1.46 X 10(-3) +/- 0.37 X 10(-3) N. It is concluded that glass syringes are favoured over plastic for locating the epidural space because frictional forces developed with glass syringes were significantly lower than with plastic.

Intestinal lymphatic flow during portal venous hypertension.

We used a circuit-model technique to analyze the flow from intestinal lymphatics. Postnodal lymph vessels from the small intestine were cannulated in five halothane-anesthetized dogs. We measured the flow rate from the cannula (QL) as we held the outflow end of the cannula at several heights above the site of cannulation. At each cannula height we calculated the pressure at the outflow end of the lymphatic (Po) as Po = QL X cannula resistance + height of the outflow end of the cannula above the cannulation site. Then we determined a best-fit regression line for QL vs. Po. The effective lymphatic resistance (RL) was estimated from the regression line as -delta Po/delta RL and the effective pressure driving lymph flow (PL) was taken as the Po at which QL = 0. At base line, RL = 0.039 +/- 0.018 (SD) cmH2O.min.microliters-1 and PL = 5.2 +/- 2.4 cmH2O. When we raised the portal venous pressure from 11.4 +/- 4.0 cmH2O (base line) to 34.4 +/- 9.0 cmH2O, RL decreased by only 26 +/- 11%, but PL rose by 160% to 13.6 +/- 8.7 cmH2O (P less than 0.05). Thus our data indicate that increases in portal venous pressure to 34.4 +/- 9.0 cmH2O cause intestinal lymph flow to increase primarily because of increases in the effective PL.

Lymphatic function in the liver after hepatic venous pressure elevation.

The liver lymphatic system plays an important role in removing excess fluid from the hepatic tissue. A complete analysis of the liver lymphatic system would be difficult. However, we used a simple circuit-analysis technique to represent the intrahepatic portion of the lymph system as a single pressure source (PL) pushing lymph through a single resistance (RL). Liver lymphatic vessels were cannulated in nine halothane-anesthetized dogs. The lymphatic vessel outflow pressure (PO) was varied by raising the outflow end of the cannula. Lymph flow from the cannula (QL) decreased linearly with PO, and we calculated RL as -delta PO/delta QL and PL as the extrapolated PO at which QL = 0. At base line, PL = 8.5 +/- 2.9 cmH2O, and RL = 0.05 +/- 0.03 cmH2O.min/microliter. After we increased inferior vena caval pressure from 5.8 +/- 2.7 to 15.2 +/- 2.5 cmH2O, PL increased significantly to 13.7 +/- 3.4 cmH2O, and RL decreased to 0.02 +/- 0.02 cmH2O.min/microliter (P less than 0.05). The results indicate that increases in QL occur because the effective pressure pushing lymph from the liver (PL) increases, and the effective resistance of the intrahepatic lymph vessels (RL) decreases.

Pulmonary edema following retrobulbar block.

We report a patient requiring keratoplasty who developed acute pulmonary edema following the administration of a retrobulbar block for anesthesia. A variety of factors that may have been implicated in the genesis of this complication are discussed.

Treatment of acute self-poisoning in a respiratory intensive care unit. A 5-year review.

A study of 103 cases of drug-related suicide attempts admitted to the Respiratory Intensive Care Unit, Groote Schuur Hospital, over a 5-year period (1980-1984) was carried out. This group constituted 4.8% of all patients admitted to this hospital with acute self-poisoning. The majority of patients made an uneventful recovery (survival rate 91.7%). No association was found between initial admission status and ultimate recovery. Haemoperfusion was useful in treating patients with severe barbiturate poisoning.