Volume 19 - Issue 2

Commentary Biomedical Science and Research Biomedical Science and Research CC by Creative Commons, CC-BY

Scientific Discoveries of the 21st Century : Authorised Nobel Award Nominators Take Notice, Please!

*Corresponding author: Dr Ahmed N M Ghanem, MD (Urology), FRCSE Ed, NHS The UK and Mansoura University, Faculty of Medicine Egypt.

Received: June 10, 2023; Published: June 16, 2023

DOI: 10.34297/AJBSR.2023.19.002564


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 advanced 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.

Keywords: Shock, Hyponatraemia, Fluid therapy, Capillary physiology, Starling’s law, The TURP syndrome, ARDS, LPHS, Bladder cancer

Abbreviations: HN: Hyponatraemia; ARDS: Acute Respiratory Distress Syndrome; TURP: The Transurethral Resection of the Prostate; LPHS: Loin Pain Haematuria Syndrome; IVU 7: Intravenous Urography 7sign; G tube: Porous Orifice Tube; TBL: Tree Branching Law.


Here I summarise the new scientific discoveries of the 21st century in physics, Physiology, biochemistry, medicine, and surgery. A total of 13 discoveries have been reported in articles and books by a single author, Researcher, and Scientist. Each one of these achievements is worthy and deserves a Nobel award when the authori sed nominators should take notice, please. However, I am not that greedy and certainly I do not want to break Nobel’s bank. Certainly, I would be delighted to receive one Nobel Award for all my achievements reported here.

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 provides the correct replacement of the magnetic field-like fluid hydrodynamics of the G tube [1-4].

2. The TBL Corrects two misconceptions about capillary physiology [5-8] namely:

a. The cross-section areas of all the capillaries are 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

1. Resolving the puzzle of acute dilutional hyponatraemia identifying its path-aetiology and finding a successful curative lifesaving therapy for it: The Hypertonic Sodium Therapy (HST) of 5% NaCl and/or 8.4% NaCo3 [9-12].

2. Revealing the effects of volume kinetics on the cardiovascular system pressure [13,14].

Medical Discoveries

1. Discovering two new types of cardiovascular shocks: the volume kinetic shocks or the volumetric overload shocks (VOS) of type one induced by sodium-free fluid and type 2 induced by sodium-based fluid retention [13-15].

2. Resolving the puzzle of the acute respiratory distress syndrome (ARDS) by identifying its exact patho-aetiology being caused by VOS and successful therapy of HST [15,16].

3. Resolving the puzzle of the transurethral resection of the prostate syndrome discovering its link with ARDS and finding a successful lifesaving therapy for it like that of acute hyponatraemia [9-12].

4. In discovering the above the bridge connecting physics, physiology, biochemistry, and medicine was constructed [15,16].

5. On a totally different subject, the patho aetiology of the loin pain haematuria syndrome (LPHS) was discovered revealing its link with SN, and 100% curative therapy surgery was devised [17,18].

6. A new surgical procedure for the therapy of cancer bladder with orthotopic bladder replacement was reported [19].

Despite multiple and powerful reporting in the literature on my multiple and important scientific discoveries the whole medical world 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, and 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.

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 recognize 2 new types of shocks and their treatmentprovees 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 resection of the prostate (TURP) syndrome and 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 syndromes were discovered but also successful treatments for it were found. The two new types of vascular shocks are volume kinetic shocks or VOS defined here Massive fluid infusions in a short time induce VO) of two types: Type one (VOS1) and Type two (VOS2). VOS1 is induced by sodium- free fluid of 3.5-5 litres in one hour known as the TURP syndrome [5] or hyponatraemic shock. VOS2 may complicate VOS1 or is induced by the massive infusion of sodium-based fluids. VOS2 also complicates fluid therapy in critically ill present 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 recognise VOS 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).

Biomedical Science &, Research

Table 1: Shows the multiple regression analysis of total per-operative fluid gain, drop in measured serum 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.

Biomedical Science &, Research

Figure 1: Shows the means and standard deviations of volumetric overload in 10 symptomatic patients presenting with shock and hyponatraemia among 100 consecutive patients during a prospective study on transurethral resection of the prostate. The fluids were of Glycine absorbed (Gly abs), intravenously infused 5% Dextrose (IVI Dext) Total IVI fluids, Total Sodium-free fluid gained (Na Free Gain) and total fluid gained in liters.

The second study was a case series of 23 case cases s of the TURP syndrome manifesting as VOS1. Volumetric overload quantity and type is shown in (Figure 2).

Three patients died and the 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 and bringing them back from the dead.

A study of the porous orifice (G) tube’s hydrodynamics compared 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 pressure of the G tube and chamber pressure, as 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 the C chamber (Figure 3) provides an adequate replacement for Starling’s law.

Biomedical Science &, Research

Figure 2: Shows volumetric overload (VO) quantity (in litres and as percent of 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 patients from the series who were correctly diagnosed as volumetric overload shock and treated with hypertonic sodium therapy (HST). Group 3 were 10 patients who were seen in the prospective study and subdivided into 2 groups; Group 3.1 of 5 patients treated with HST and Group 3.2 of 5 patients who were treated with guarded volume expansion using isotonic saline.

The physiological equivalent of this physics study was done on the hind limbs of sheep. It demonstrated that both saline and plasma induce oedema when run through the vein not the artery, and the arterial pressure causes suction not filtration due to effect of 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 osmotic pressure of plasma proteins, a call for reconsideration of Starling’s hypothesis was 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 [1-4] Figure 3 demonstrated that the proximal (arterial) pressure induces a 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 dynamic magnetic field-like fluid circulation between C and G tube lumen. Incorporating the G tube and C in a circulatory model driven by electric pump induced proximal pressure 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 capillary interstitial 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 puzzles of 3 clinical syndromes of TURP, hyponatraemia and ARDS.

Biomedical Science &, Research

Figure 3: 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 capillary ultra-structure of precapillary sphincter and wide inter cellular cleft pores, and the chamber C around it is another bigger plastic tube to form the G-C apparatus. 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 textbook, and added to chapters on hydrodynamics in physics textbooks. The numbers should read as follows:

1. The inflow pressure pushes fluid through the orifice

2. Creating fluid jet in the lumen of the G tube**.

3. The fluid jet creates a negative side pressure gradient causing suction maximal over the Proximal part of the G tube near the inlet that sucks fluid into lumen.

4. The side pressure gradient turns positive pushing fluid out of lumen over the distal part maximally near the outlet.

5. Thus, the fluid around G tube inside C moves in magnetic field-like circulation (5) taking an opposite direction to lumen flow of G tube.

6. The inflow pressure 1 and orifice 2 induce the negative side pressure creating the 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 again at 3,

7. Maintaining net negative energy pressure inside chamber C.

Note*: The shape of the fluid jet inside the G tube (Cone shaped), having a diameter of 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 leaves of fine and coarse sizes that run in the centre of G tube leaving the outer zone near the wall of G tube clear. This may explain the finding in real capillary of 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 amounts maintaining a higher concentration in the circulatory system than that in the C chamber- akin to plasma proteins.

The TBL is a fundamental law of nature that governs the ramifications of all trees of green and red of the Aorta-arterial trees. It corrects two important misconceptions on 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 adequate for the demands of cells at rest and increased demand during strenuous physical activity.

On another subject, this article [12] 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 causes vessel stenosis, ischaemia and neuropathy. Surgical treatment was used in 28 patients; 10 had simple nephropexy and 18 had Renal Sympathetic Denervation and Nephropexy Surgery (RSD&N) for severe LPHS. Four of the patients treated with simple nephropexy had a recurrence of LPHS while those who had RSD&N were all cured.

On another subject, I reported a surgical point of technique [13] for operable cancer bladder in which “capsule sparing” cystoprostadenectomy for orthotopic bladder replacement overcomes the problems of difficult urethral anastomosis, impotence, and incontinence.

Biomedical Science &, Research

Figure 4: 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.

Biomedical Science &, Research

Figure 5: Shows diagrammatic representation of the technique’s dissection plane (dotted line). Starting at retro-pubic (1) space, visico-prost-adenectomy including bladder containing tumour (2), prostate gland (3) and urethra (4) are excised in mass. The gland is enucleated and urethral divided within the spared capsule (5) protecting the external sphincter (6) and neurovascular bundle (7). Extra-peritoneal division ligature of vas (8), ureter (9), superior vesical vessels (10) and anterior prostatic veins are done at the start. Branches of inferior vesical vessels (11) and seminal vesicles (12) are divided at the line of capsule division. Excision of peritoneal bladder cover opens peritoneal cavity for constructing bowel bladder replacement. Pelvic ganglion (13) and rectum (14) lie within the concavity of sacrum (15).


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.

Conflict of Interest

The author declares none.


The author declares none.


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  • Ghanem KA, 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 1(1): 1-7.
  • Ghanem AN, Ghanem SA (2016) 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 7: 245-249.
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  • Ghanem AN (2021) The Tree Branching Law: Correcting Misconceptions on Capillary Cross-Section Areas and Blood Speed. IJSR 10(1).
  • Ghanem AN (2021) Capillary ultrastructure anatomy and physiology: what is known, what is unknown or missing, what is wrong, and what is new? INTERNATIONAL JOURNAL OF CURRENT MULTIDISCIPLINARY STUDIES, February 2021 issue.
  • Ghanem AN (2021) Final Affirmative Proof Starling’s Law Wrong and G Tube Hydrodynamic is the Correct Replacement: New Results and Critical Analytical Criticisms of Impactful Landmark Articles. Biomed J Sci & Tech Res 33(5).
  • Ghanem AN, Ward JP (1990) Osmotic and metabolic sequelae of volumetric overload in relation to the TURP syndrome. Br J Uro 66: 71-78.
  • Ghanem AN (2019) Post-Surgical Hyponatraemia: Problems of Management Resolved by Revealing its Relation to Volumetric Overload Shocks. EC Cardiology 6(8).
  • Ghanem AN (2019) Postoperative Dilution Hyponatraemia and the TURP Syndrome: Critical Analytical Review of Literature on Patho-Etiology and Therapy. EC Emergency Medicine and Critical Care 3(8): 507-514.
  • Ghanem AN (2018) Short Communication. Hyponatraemia: Nadirs and Paradoxes of the Missing Volumetric Overload. Open Access Journal of Surgery 10(2).
  • Ghanem AN (2018) Therapy of Hyponatremia: End of Era or Minority Report? Biomed J Sci & Tech Res 11(4).
  • Ghanem AN (2020) Volume Kinetic Shocks in Clinical Practice. Clin Surg J 3(S3): 1-5.
  • Ghanem (2020) Volumetric Overload Shocks (VOS) in Surgical Patients. Open Access J Surg 11(2): 555810.
  • Ghanem AN (2020) Volumetric Overload Shocks Cause the acute respiratory distress syndrome: Building the Bridge Between Physics, Physiology, Biochemistry, and Medicine. Biomed J Sci & Tech Res 29(1).
  • Ghanem (2020) Volumetric Overload Shocks Cause the acute respiratory distress syndrome: The Plenary Evidence on Patho-Aetiology and Therapy. Op Acc J Bio Sci & Res 1(4).
  • Ghanem AN (2016) Prospective Observational Study on Loin Pain Haematuria Syndrome Complicating Symptomatic Nephroptosis and the Results of Renal Sympathetic Denervation and Nephropexy Surgery. J J Nephro Urol 3(1): 024.
  • Ghanem SA, Ghanem KA, Pindoria N, Ghanem AN (2017) Loin Pain and Haematuria Syndrome (LPHS) Linked to Symptomatic Nephroptosis (SN) and Revealing Pedicle Stretch Causing Neuro-Ischaemia Using the New IVU 7 Sign. Exp Tech Urol Nephrol 1(1).
  • Ghanem AN (2022) Experience with “capsule sparing” cystoprostadenectomy for orthotopic bladder replacement: Overcoming the problems of impotence, incontinence, and urethral anastomosis.  BJU International 90: 617-620.

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