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A sensitive method for recording lymph flow
A Sensitive Method for Recording Lymph Flow Observations on the Dynamics of Hepatosplanchnic Blood and Lymph FIKRI
ALICAN,
M . D . , U n i v e r s i t y of M i s s i s s i p p i M e d i c a l C e n t e r
Objective and accurate recording is essential for studies concerned with acute clmnges in the flow rate of lympll. T h e purpose of this report is to describe a sensitive metllod of recording the flow rate of lymph simultaneously with the recording of other vascular parameters, and to demonstrate its application as related to the dynamics of hepatosplanchnic blood and lymph. METHODS Tile techniques used in this laboratory for the cannulation of hepatic and intestinal lymphatics and the ttloracic duct need not be discussed here, because they are essentially based on those previously described by other workers, x.2,3 These techniques are illustrated in Figures 1 and 2 as we have applied them, with m i n o r modifications, in more than 200 such cannulations in tile dog for various experimental purposes. T h e method for recording lymph flow is illustrated schematically in Figure 8. Following satisfactory cannulation of the lymphatic duct, the catheter is secured to tlle table with adltesive tape in such a m a n n e r that the last two or three inches of it extend from the edge of the table. A beaker which is suspended from a Statham strain gauge transducer (G-1-8-350) is so adjusted under the tip of the catheter tlmt each drop of lymph will fall to its bottom. T h e catheter is not in contact with any part of the beaker. T h e transducer is connected to a Sanborn 150 series recorder. Each drop of lymph falling to the bottom of the beaker is recorded separately as a vertical mark by the recorder. T h e flow rate of lymph can be read botll as drops of lynlpll per unit time hnd grams of lymph per unit time from tile lymph line on tlm chart. T h e transducer and recorder system can be From the Department o[ Surgery, University o[ Mississippi Medical Center, Jackson, MississippL This work was supported by Army Contract No. DA49-007-MD-627. Submitted for publication August 10, 1961; accepted November 22, 1961. 104
calibrated in such a way that tile distance between two horizontal lines of the paper may represent a suitable weight of lymph (e.g., 2 gm. of lymph)~ A lymph line for the thoracic duct lymph is seen in Figure 4. T h e first part of the line is almost ltorizontal, and eacll vertical mark represents one drop of lymplt. W h e n massage to the abdominal wall was started, lymph flow increased abruptly as a result of increased intra-abdominal pressure. Tlte line sloped sltarply upward. At this unusual high rate of flow, individual drops are no longer countable. However, tlle rate of flow can still be estimated very accurately from the change in the slope of tlm line, the distance between two horizontal lines representing 2 gm. of lymph. T h e line at the bottom is the time scale. In about two minutes 10 gin. of lymph was collected in the beaker. T h e speed of the paper in tile Sanborn recorder may be adjusted so as to obtain a chart which will be convenient to read. For most studies, r u n n i n g the paper at a speed of 1 ram. per second is suitable. From Figure 4 it is obvious that the speed of the paper in this experiment was too slow for the high rate of lymph flow. T h e speed of the paper was not changed in this case, for the purpose of illustrating the slope of the lympll line in a short segment of the chart. If the paper were r u n n i n g at a speed of 5 mm. per second instead of 1 mm. per second, individual drops could be counted easily, bu't the slope of tile lymph line would not be so steep. It would reach tim same height in the same length of time, b u t the length of the paper would be five times longer. However, the distance on the time scale representing one second would also be five times longer. T h e speed of tile paper should be adjusted, therefore, in such a m a n n e r that a lympll line sllowing tile drops distinctly will be obtained. This speed llas no effect on the calibration. Wllen the lymph line reaches the top of the chart, which it will do in a short or long time depending on the rate of lymph flow and the JSR - Vol. II, No. 2 - March, 1962
JSR
-
~[ETIIOD FOR RECORDING LYMpII FLOW
V o l . I I , N o . 2 - M a r c h , 1962
Fig. 1. Anatomy and technique of cannulation of the prindpal lymphatic ducts of the liver and the intestine. Right subcostal incision. calibration of the transducer-recorder system (not on the speed of the paper), the beaker is emptied, and the lymph line starts from the bottom once more. Liver, intestinal and tlmracic duct
~~"
L
22>
~.
.
Fig. 2. Anatomy and tcdmlque of cannulation of the thoracic duct. Left lhoracotomy through the sixth intercostal space.
105
Fig. 3. Schematic representation of tim method for recording the flow rate of lymph. The catheter is in the thoracic duct, brought out through a stab wound. Lymph drips from the tip of the catheter into the beaker (B) wlficb is suspended from a Statham strain gauge transducer (,4). The Sanborn rccorder to which tlm transducer is connected makes a vertical mark for cach drop of lymph. lymI)h flows can be recorded at the same time as three different l y m p h lines on the same chart, by using three separate transducers. Several other vascular parameters, such as arterial blood pressure, venous pressures and blood flow, call be recorded simultaneonsly with tile lympl~ flow. In Figure 5 is seen the effects of transfusion and bleeding on the rate of thoracic duct l y m p h flow which was simuhaneously recorded with the blood pressure anti the portal vein pressnre. As only the representative parts of tim clmrt could be slmwn here, tim relative levels of the l y m p h line segments Imve no significance, and attention slmuld be paid only to tim relative frequency of the vertical marks (lylnph drops). T h e frequency increases with the increasing a m o u n t of transfnsion, and decreases with bleeding. Figure 6 is another such example in which the thoracic dnct lymph flow, portal vein pressure and systemic arterial pressure were recorded synchronously following acute ligation of the portal vein in tlm dog. W h e n tlte lylnph flow is being recorded, factors tlmt could affect this flow, other tlmn tlmse that are relevant for the particular investigation, should be carefully eliminated. T h e animal shottld be u n d e r a uniform level of anesthesia oi" sedation. Cltanges in the depth of respiration, muscle tonus or muscular activity affect the flow rate of l y m p h very substantially and invalidate tlm stttdy. For example, let its suppose tlmt the effect of acute anoxia or high carbon dioxide breathing on the flow rate of the thoracic duct
106
~'IKRI ALICAN
JSR
-
V o l . I I , N o . 2 - M a r c h , 1962 Gm.
: o
! O
I I
I 2
MINUTES Fig. 4. A 1)'mph line. At the horizontal part of the line a vertical mark for each drop of lymph is seen distinctly. At the point marked by the arrow the abdomen.was compressed, increasing the lymph flow greatly, and in two minutes about 10 gin. of lymph was coUected. (The transducer and recorder, system is so calibrated that the distance between two horizontal lines on the paper represents 2 gin. of lymph.) l y m p h is to be investigated. In b o t h instances the initial response will be vigorous respiratory activity, which by itself will increase the flow tremendously. T o obviate this incidental factor the dog should be curarized before the experiment, the uniformity of meclmnical respiration being instituted. LABORATORY
OBSERVATIONS
In this section some experimental observations ]glv'IVE~F131:'TR/~'USION ~
BLEEDI/IG
mm.
'~176 r 0t--
Fig. 5.
S y n d l r o n o u s recording of t h e thoracic duct
lymph flow, the blood pressure and the portal vein pressure during'blood transfusion and henaorrhage. The relative levels of the lymph line segments have no significance here, as only the representative parts of the chart are shown; attention should be paid only to the frequency of the drops.
associated with acute and short-lasting changes in lynaph flow will be discussed, and situations will be pointed out in which the application of a sensitive method of recording the flow rate of 1)'ml)la would be indispensable. E p i n e p h r i n e . T h e effect of epinephrine on the simultaneously recorded systemic arterial pressure, portal vein pressure and thoracic duct 1)anph flow was investigated in three dogs. Epinephrine was injected intravenously as a single large dose (15 to 25 #g. per kg.), and the injections were repeated several times on each dog with u n i f o r m results. During the first minute following the injection, while the systemic arterial pressure is rising, the portal vein pressure falls and the thoracic duct l y m p h flow decreases greatly (Fig. 7). However, this fall in portal vein pressure lasts only a b o u t 10 to 15 seconds. T h e n it starts to rise again, and by tlte end of the first m i n n t e it is usnally above the control level. A sltort time later, the blood pressure starts to decrease and the portal vein pressure follows it until they b o t h return to near normal in three to five minutes (Fig. 8), at which time the flow rate of l y m p h returns to normal or higher than normal. T h i s characteristic response might be explained as follows: tile first effect of epinephrine is vasoconstriction of the arterial tree supplying the hepatosplanchnic area. As long as this effect is p r e d o m i n a n t (10 to 15 seconds), blood flow to the splanchnic organs is less tlmn normal and tile portal vein pressure falls. Tlte rise of the portal vein pressure a few seconds later seems to reflect the slightly delayed (or initially masked) vasoconstrictive action of epinephrine on the portal venous vasculature. T h e same type of response was observed on a dog with patent total Eck fistula. T h e decrease of the thoracic
]SR
-
MET~[OD FOR RECORDING LYAIPII FLOW
V o l . I I , N o . 2 - M a r c h , 1962
THORACIC DUCT LY~LPlI FLOW, BP & pVP FOLLOWIHG LIGATION OF PORTAL VEIN
107
DOG - "92
mm.
Hg
150
oL
4O
oE
Fig. 6. Ligation of the portal vein. T h e thoracic duct lymph flow gradually increased, reached a peak of about ten times the control value, and then gradually decreased tmtil the death of the dog. T h e mean blood pressure and portal vein pressure approached each other.
mt
H, 200
I00 0
I0 0 I
0
I
I MINUTES
I
2
Fig. 7. Effect of epinephrine on lymph flow. A large dose of epinephrine was injected at the time indicated by the arrow. Thoracic duct lymph flow decreased greatly (see text).
duct lymph flow (to approximately one-tenth that of the control) at a time wltich roughly corresponds to the height of the constrictive action of epinephrine on arterial and venous systems may well be explained by a direct constrictive effect of the drug on the stnooth muscle of tire lymphatic vessels. R a p i d Blood Transfusion. A paradoxic initial effect of very rapid blood transfusion on lymph flow deserves comment. While a very rapid blood transfi|sion is being given, the thoracic duct lymph flow declines and virtually stops during tlte procedure. This effect is observed regardless of tlte route of the transfusion (intra-arterial, intravenous), as long as it is rapid and ntassive. A few seconds after the transfusion is discontinued the lymph starts to flow again, and at a much higher speed than before (Fig. 9). A reflex tuecltanism is unlikely to be involved,
FIKRI ALICAN
108
JSR
. DOG :
i
-
Vol. I I , N o . 2 - M a r c h , 1962
suggests tlmt as the connective tissue fills with fluid and swells, the tension of the fibers attached to the lymphatic capillaries causes their walls to be drawn apart. This passive alteration in the caliber of the lymphatic capillaries could tlterefore produce a transient fall in the lymphatic pressure. T h e greatly slowed period of lymph flow may correspond to the time taken for the refilling of the suddenly dilated lymphatics of the abdominal organs.
47
J
I'nrt3.
SUMMARY AND CONCLUSIONS I00 C
_.-= ~ i : :!
'~
' r "' : ; ~ : 1 151
=--t ~ ' t ~ "
I
.:: t
~
;y~ : ' I : : ~ : ~ ; ~ - : 1 !-i;~:
, , I
;1~
-t z ~ : - ~ ' " ' t - ~
~ ! . 1 : : ~ i
-~1,, ! , ~ 1
t~:
:~ ; ! , ~ ~
.,!:t . L
l :--r~-§
I.
t
-
Fig. 8. Continuation of Figure 7. Four minutes after the injection of epinephrine. As the effect of epinephrine waned, manifested by the declining blood pressure, the lymph flow increased again (see text). since tiffs effect is observed even after the death of the clog (e.g., for one hour alter death). It can be explained plausibly on the basis of mechanical factors. Guyton et al. a ltave sltown that when very rapid transfusions are given, 65 per cent of the fluid in t h e i)lasma portion of the transfused blood is lost to the tissue spaces within two mintttes. Experimental evidence "z RAYID I I ~ - A ( Y ~ T I C
A sensitive method of recording the flow rate of lymph concomitantly with other vascular parameters is described. It involves the use of a Statltam strain gauge transducer connected to a Sanborn recorder. Since the lymph line on the chart can be read as drops of lymph per unit time and grams of lymph per unit time, this method is suitable for studying both instantaneous and gradnal changes in the rate of lymph flOIV.
T h e application of the method as related to the dynamics of Itepatosplanclmic blood and lymph is demonstrated. REFERENCES 1. C~ain, J. c., Grindlay, J. H., Bollman, J. L., Flock, E. V., and Mann, F. C.: Lymph from liver and thoracic duct. An experimental study. Surg. Gyncc. 8: Obst., 85:558, 19t7. 2. Grindlay, J. H., Cain, J. C., Bollman, J. L., and Flock, E. V.: Experimental studies of liver and thoracic duct lymph. Minnesota Med., 31:654, 1948.
T ~ S r J S X O M OF 500 c c BLOOD A F I ~ MIH~TI$ A ~
DBAT~
|
Fig. 9. Effect of rapid and massive blood transfusion (intra-aortic in this case) oil the thoracic duct lymph flow. The flow virtually ceased during the procedure (see text).
JSR
-
V o l . I I , N o . 2 - 2~farch, 1 9 6 2
3. Grindlay, J. H., Cain, J. C., Bollman, J, L., and Mann, F. C.: Lymph fistulas in trained dogs. An experimental technique. Surgery, 27:152, 1950. 4. Gu)'ton, A. C., Batson, H. M., and Smith, C. M.: Adjustments of the circulatory system following very
~IE'I'IIOD FOR RECORDING L',',xti'II FLOW rapid transfusion
109
or llemorrhage. Am. J. Physiol.,
164:351, 1951.
5. Yoffey, J. H., and Courtice, F. C.: Lymphatics, Lymph and L)mphold Tissue. 2rid. Ed. London, E. Arnold and Company, 1956.
ALICAN,
M . D . , U n i v e r s i t y of M i s s i s s i p p i M e d i c a l C e n t e r
Objective and accurate recording is essential for studies concerned with acute clmnges in the flow rate of lympll. T h e purpose of this report is to describe a sensitive metllod of recording the flow rate of lymph simultaneously with the recording of other vascular parameters, and to demonstrate its application as related to the dynamics of hepatosplanchnic blood and lymph. METHODS Tile techniques used in this laboratory for the cannulation of hepatic and intestinal lymphatics and the ttloracic duct need not be discussed here, because they are essentially based on those previously described by other workers, x.2,3 These techniques are illustrated in Figures 1 and 2 as we have applied them, with m i n o r modifications, in more than 200 such cannulations in tile dog for various experimental purposes. T h e method for recording lymph flow is illustrated schematically in Figure 8. Following satisfactory cannulation of the lymphatic duct, the catheter is secured to tlle table with adltesive tape in such a m a n n e r that the last two or three inches of it extend from the edge of the table. A beaker which is suspended from a Statham strain gauge transducer (G-1-8-350) is so adjusted under the tip of the catheter tlmt each drop of lymph will fall to its bottom. T h e catheter is not in contact with any part of the beaker. T h e transducer is connected to a Sanborn 150 series recorder. Each drop of lymph falling to the bottom of the beaker is recorded separately as a vertical mark by the recorder. T h e flow rate of lymph can be read botll as drops of lynlpll per unit time hnd grams of lymph per unit time from tile lymph line on tlm chart. T h e transducer and recorder system can be From the Department o[ Surgery, University o[ Mississippi Medical Center, Jackson, MississippL This work was supported by Army Contract No. DA49-007-MD-627. Submitted for publication August 10, 1961; accepted November 22, 1961. 104
calibrated in such a way that tile distance between two horizontal lines of the paper may represent a suitable weight of lymph (e.g., 2 gm. of lymph)~ A lymph line for the thoracic duct lymph is seen in Figure 4. T h e first part of the line is almost ltorizontal, and eacll vertical mark represents one drop of lymplt. W h e n massage to the abdominal wall was started, lymph flow increased abruptly as a result of increased intra-abdominal pressure. Tlte line sloped sltarply upward. At this unusual high rate of flow, individual drops are no longer countable. However, tlle rate of flow can still be estimated very accurately from the change in the slope of tlm line, the distance between two horizontal lines representing 2 gm. of lymph. T h e line at the bottom is the time scale. In about two minutes 10 gin. of lymph was collected in the beaker. T h e speed of the paper in tile Sanborn recorder may be adjusted so as to obtain a chart which will be convenient to read. For most studies, r u n n i n g the paper at a speed of 1 ram. per second is suitable. From Figure 4 it is obvious that the speed of the paper in this experiment was too slow for the high rate of lymph flow. T h e speed of the paper was not changed in this case, for the purpose of illustrating the slope of the lympll line in a short segment of the chart. If the paper were r u n n i n g at a speed of 5 mm. per second instead of 1 mm. per second, individual drops could be counted easily, bu't the slope of tile lymph line would not be so steep. It would reach tim same height in the same length of time, b u t the length of the paper would be five times longer. However, the distance on the time scale representing one second would also be five times longer. T h e speed of tile paper should be adjusted, therefore, in such a m a n n e r that a lympll line sllowing tile drops distinctly will be obtained. This speed llas no effect on the calibration. Wllen the lymph line reaches the top of the chart, which it will do in a short or long time depending on the rate of lymph flow and the JSR - Vol. II, No. 2 - March, 1962
JSR
-
~[ETIIOD FOR RECORDING LYMpII FLOW
V o l . I I , N o . 2 - M a r c h , 1962
Fig. 1. Anatomy and technique of cannulation of the prindpal lymphatic ducts of the liver and the intestine. Right subcostal incision. calibration of the transducer-recorder system (not on the speed of the paper), the beaker is emptied, and the lymph line starts from the bottom once more. Liver, intestinal and tlmracic duct
~~"
L
22>
~.
.
Fig. 2. Anatomy and tcdmlque of cannulation of the thoracic duct. Left lhoracotomy through the sixth intercostal space.
105
Fig. 3. Schematic representation of tim method for recording the flow rate of lymph. The catheter is in the thoracic duct, brought out through a stab wound. Lymph drips from the tip of the catheter into the beaker (B) wlficb is suspended from a Statham strain gauge transducer (,4). The Sanborn rccorder to which tlm transducer is connected makes a vertical mark for cach drop of lymph. lymI)h flows can be recorded at the same time as three different l y m p h lines on the same chart, by using three separate transducers. Several other vascular parameters, such as arterial blood pressure, venous pressures and blood flow, call be recorded simultaneonsly with tile lympl~ flow. In Figure 5 is seen the effects of transfusion and bleeding on the rate of thoracic duct l y m p h flow which was simuhaneously recorded with the blood pressure anti the portal vein pressnre. As only the representative parts of tim clmrt could be slmwn here, tim relative levels of the l y m p h line segments Imve no significance, and attention slmuld be paid only to tim relative frequency of the vertical marks (lylnph drops). T h e frequency increases with the increasing a m o u n t of transfnsion, and decreases with bleeding. Figure 6 is another such example in which the thoracic dnct lymph flow, portal vein pressure and systemic arterial pressure were recorded synchronously following acute ligation of the portal vein in tlm dog. W h e n tlte lylnph flow is being recorded, factors tlmt could affect this flow, other tlmn tlmse that are relevant for the particular investigation, should be carefully eliminated. T h e animal shottld be u n d e r a uniform level of anesthesia oi" sedation. Cltanges in the depth of respiration, muscle tonus or muscular activity affect the flow rate of l y m p h very substantially and invalidate tlm stttdy. For example, let its suppose tlmt the effect of acute anoxia or high carbon dioxide breathing on the flow rate of the thoracic duct
106
~'IKRI ALICAN
JSR
-
V o l . I I , N o . 2 - M a r c h , 1962 Gm.
: o
! O
I I
I 2
MINUTES Fig. 4. A 1)'mph line. At the horizontal part of the line a vertical mark for each drop of lymph is seen distinctly. At the point marked by the arrow the abdomen.was compressed, increasing the lymph flow greatly, and in two minutes about 10 gin. of lymph was coUected. (The transducer and recorder, system is so calibrated that the distance between two horizontal lines on the paper represents 2 gin. of lymph.) l y m p h is to be investigated. In b o t h instances the initial response will be vigorous respiratory activity, which by itself will increase the flow tremendously. T o obviate this incidental factor the dog should be curarized before the experiment, the uniformity of meclmnical respiration being instituted. LABORATORY
OBSERVATIONS
In this section some experimental observations ]glv'IVE~F131:'TR/~'USION ~
BLEEDI/IG
mm.
'~176 r 0t--
Fig. 5.
S y n d l r o n o u s recording of t h e thoracic duct
lymph flow, the blood pressure and the portal vein pressure during'blood transfusion and henaorrhage. The relative levels of the lymph line segments have no significance here, as only the representative parts of the chart are shown; attention should be paid only to the frequency of the drops.
associated with acute and short-lasting changes in lynaph flow will be discussed, and situations will be pointed out in which the application of a sensitive method of recording the flow rate of 1)'ml)la would be indispensable. E p i n e p h r i n e . T h e effect of epinephrine on the simultaneously recorded systemic arterial pressure, portal vein pressure and thoracic duct 1)anph flow was investigated in three dogs. Epinephrine was injected intravenously as a single large dose (15 to 25 #g. per kg.), and the injections were repeated several times on each dog with u n i f o r m results. During the first minute following the injection, while the systemic arterial pressure is rising, the portal vein pressure falls and the thoracic duct l y m p h flow decreases greatly (Fig. 7). However, this fall in portal vein pressure lasts only a b o u t 10 to 15 seconds. T h e n it starts to rise again, and by tlte end of the first m i n n t e it is usnally above the control level. A sltort time later, the blood pressure starts to decrease and the portal vein pressure follows it until they b o t h return to near normal in three to five minutes (Fig. 8), at which time the flow rate of l y m p h returns to normal or higher than normal. T h i s characteristic response might be explained as follows: tile first effect of epinephrine is vasoconstriction of the arterial tree supplying the hepatosplanchnic area. As long as this effect is p r e d o m i n a n t (10 to 15 seconds), blood flow to the splanchnic organs is less tlmn normal and tile portal vein pressure falls. Tlte rise of the portal vein pressure a few seconds later seems to reflect the slightly delayed (or initially masked) vasoconstrictive action of epinephrine on the portal venous vasculature. T h e same type of response was observed on a dog with patent total Eck fistula. T h e decrease of the thoracic
]SR
-
MET~[OD FOR RECORDING LYAIPII FLOW
V o l . I I , N o . 2 - M a r c h , 1962
THORACIC DUCT LY~LPlI FLOW, BP & pVP FOLLOWIHG LIGATION OF PORTAL VEIN
107
DOG - "92
mm.
Hg
150
oL
4O
oE
Fig. 6. Ligation of the portal vein. T h e thoracic duct lymph flow gradually increased, reached a peak of about ten times the control value, and then gradually decreased tmtil the death of the dog. T h e mean blood pressure and portal vein pressure approached each other.
mt
H, 200
I00 0
I0 0 I
0
I
I MINUTES
I
2
Fig. 7. Effect of epinephrine on lymph flow. A large dose of epinephrine was injected at the time indicated by the arrow. Thoracic duct lymph flow decreased greatly (see text).
duct lymph flow (to approximately one-tenth that of the control) at a time wltich roughly corresponds to the height of the constrictive action of epinephrine on arterial and venous systems may well be explained by a direct constrictive effect of the drug on the stnooth muscle of tire lymphatic vessels. R a p i d Blood Transfusion. A paradoxic initial effect of very rapid blood transfusion on lymph flow deserves comment. While a very rapid blood transfi|sion is being given, the thoracic duct lymph flow declines and virtually stops during tlte procedure. This effect is observed regardless of tlte route of the transfusion (intra-arterial, intravenous), as long as it is rapid and ntassive. A few seconds after the transfusion is discontinued the lymph starts to flow again, and at a much higher speed than before (Fig. 9). A reflex tuecltanism is unlikely to be involved,
FIKRI ALICAN
108
JSR
. DOG :
i
-
Vol. I I , N o . 2 - M a r c h , 1962
suggests tlmt as the connective tissue fills with fluid and swells, the tension of the fibers attached to the lymphatic capillaries causes their walls to be drawn apart. This passive alteration in the caliber of the lymphatic capillaries could tlterefore produce a transient fall in the lymphatic pressure. T h e greatly slowed period of lymph flow may correspond to the time taken for the refilling of the suddenly dilated lymphatics of the abdominal organs.
47
J
I'nrt3.
SUMMARY AND CONCLUSIONS I00 C
_.-= ~ i : :!
'~
' r "' : ; ~ : 1 151
=--t ~ ' t ~ "
I
.:: t
~
;y~ : ' I : : ~ : ~ ; ~ - : 1 !-i;~:
, , I
;1~
-t z ~ : - ~ ' " ' t - ~
~ ! . 1 : : ~ i
-~1,, ! , ~ 1
t~:
:~ ; ! , ~ ~
.,!:t . L
l :--r~-§
I.
t
-
Fig. 8. Continuation of Figure 7. Four minutes after the injection of epinephrine. As the effect of epinephrine waned, manifested by the declining blood pressure, the lymph flow increased again (see text). since tiffs effect is observed even after the death of the clog (e.g., for one hour alter death). It can be explained plausibly on the basis of mechanical factors. Guyton et al. a ltave sltown that when very rapid transfusions are given, 65 per cent of the fluid in t h e i)lasma portion of the transfused blood is lost to the tissue spaces within two mintttes. Experimental evidence "z RAYID I I ~ - A ( Y ~ T I C
A sensitive method of recording the flow rate of lymph concomitantly with other vascular parameters is described. It involves the use of a Statltam strain gauge transducer connected to a Sanborn recorder. Since the lymph line on the chart can be read as drops of lymph per unit time and grams of lymph per unit time, this method is suitable for studying both instantaneous and gradnal changes in the rate of lymph flOIV.
T h e application of the method as related to the dynamics of Itepatosplanclmic blood and lymph is demonstrated. REFERENCES 1. C~ain, J. c., Grindlay, J. H., Bollman, J. L., Flock, E. V., and Mann, F. C.: Lymph from liver and thoracic duct. An experimental study. Surg. Gyncc. 8: Obst., 85:558, 19t7. 2. Grindlay, J. H., Cain, J. C., Bollman, J. L., and Flock, E. V.: Experimental studies of liver and thoracic duct lymph. Minnesota Med., 31:654, 1948.
T ~ S r J S X O M OF 500 c c BLOOD A F I ~ MIH~TI$ A ~
DBAT~
|
Fig. 9. Effect of rapid and massive blood transfusion (intra-aortic in this case) oil the thoracic duct lymph flow. The flow virtually ceased during the procedure (see text).
JSR
-
V o l . I I , N o . 2 - 2~farch, 1 9 6 2
3. Grindlay, J. H., Cain, J. C., Bollman, J, L., and Mann, F. C.: Lymph fistulas in trained dogs. An experimental technique. Surgery, 27:152, 1950. 4. Gu)'ton, A. C., Batson, H. M., and Smith, C. M.: Adjustments of the circulatory system following very
~IE'I'IIOD FOR RECORDING L',',xti'II FLOW rapid transfusion
109
or llemorrhage. Am. J. Physiol.,
164:351, 1951.
5. Yoffey, J. H., and Courtice, F. C.: Lymphatics, Lymph and L)mphold Tissue. 2rid. Ed. London, E. Arnold and Company, 1956.