Document Detail

Starling pressures in the human arm and their alteration in postmastectomy oedema.
MedLine Citation:
PMID:  7932226     Owner:  NLM     Status:  MEDLINE    
1. Surgery and radiotherapy to axillary lymph nodes during breast cancer treatment is often followed, commonly years later, by chronic postmastectomy oedema (PMO). PMO is considered a 'high protein' oedema due to reduced axillary lymph drainage. Since oedema formation also depends on fluid input (capillary filtration), we studied the Starling pressures in the affected and contralateral arm. Colloid osmotic pressure was measured in patient serum (pi p) and interstitial fluid (pi i). Subcutis fluid was collected from PMO arms by both wick and aspiration methods, and from the control arm by the wick method only. Interstitial hydraulic pressure (P(i)) was measured by the wick-in-needle method. 2. Oedema pi i was 19.2 +/- 4.1 cmH2O (n = 13, wick) to 16.3 +/- 4.4 cmH2O (n = 41, aspirate; difference not significant; mean +/- S.D. throughout). This was significantly lower than pi i in the control arm (21.4 +/- 3.8 cmH2O, n = 14, P < 0.01, analysis of variance). Also, there was a negative correlation between oedema pi i and the percentage increase in arm volume (correlation coefficient r = -0.35, P < 0.05) in contrast to conventional expectation. 3. Oedema P(i) (1.9 +/- 2.0 cmH2O, n = 28) exceeded the subatmospheric control P(i) (-2.8 +/- 3.0 cmH2O; P < 0.01). Venous and arterial pressures were normal but pi p was subnormal (31.1 +/- 2.7 cmH2O, n = 47). 4. Net pressure opposing capillary blood pressure, P(o), was calculated as P(i) + sigma (pi p-pi i) for a reflection coefficient, sigma, of 0.90-0.99.(ABSTRACT TRUNCATED AT 250 WORDS)
D O Bates; J R Levick; P S Mortimer
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of physiology     Volume:  477 ( Pt 2)     ISSN:  0022-3751     ISO Abbreviation:  J. Physiol. (Lond.)     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-11-10     Completed Date:  1994-11-10     Revised Date:  2010-08-25    
Medline Journal Info:
Nlm Unique ID:  0266262     Medline TA:  J Physiol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  355-63     Citation Subset:  IM    
Department of Physiological Medicine, St George's Hospital Medical School, London.
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MeSH Terms
Aged, 80 and over
Arm / physiopathology*
Blood Pressure
Breast Neoplasms / radiotherapy*,  surgery*
Extracellular Space
Lymphedema / physiopathology*
Mastectomy, Radical
Mastectomy, Segmental
Mastectomy, Simple
Middle Aged
Osmotic Pressure
Postoperative Complications / physiopathology*
Retrospective Studies
Grant Support
//Wellcome Trust

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