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Title EXPERIMENTAL STUDIES ON ASCITIC ABSORPTION
Author(s) TAHARA, HIROAKI
Citation 日本外科宝函 (1960), 29(4): 909-924
Issue Date 1960-07-01
URL http://hdl.handle.net/2433/207133
Right
Type Departmental Bulletin Paper
Textversion publisher
Kyoto University
EXPERIMENTAL STUDIES ON ASCITIC ABSORPTION
HIROAKI T AHARA
The !st Department of Surgery, Gifu Prefectural Medical School (Director: Prof. Dr. ATRUYA ONcTs口KA)
Recefred for publication May 11, 1960
INTRODUCTION
909
Since 1863, when v. REcKLINGHAUSEN, using the term “stoma”， discussed the peritoneal absorption, numerous studies have been reported. On absorbabilit~’ of the ascitic peritoneum, however, there are very few comments in the world literatures except for the results of modern isotope technique. Ascites in the peritoneal cavity has been vaguely thought to be the fluid accumulated due to unbalance between production and absorption. With the ascitic dogs, experimentall:i’produced by supra-diaphragmatic constriction of the inferior ¥'ena cava, I studied the absorbabilit.'・ of the peritoneum with various substances comparing with that of normal dogs.
ADMINISTRATION OF P32 INTO THE PERITONEAL CAVITY
1. Materials and methods Five normal adult mongrel dogs n℃ighing about 10 kg and five ascitic dogs
were used. After administration of P円 10pc per kg of body weight, into the peritoneal cavities of normal dogs and ascitic dogs (after ascites has been emptied), the blood samples from the V. femoralis and the lymph samples from the thoracic duct fistula were collected by every白veminutes for the first one hour, every ten minutes for the second one hour and every thirty minutes for the later three hours. Every sample was counted with Geiger斗＼fillercounter.
2. Results
a) Normal dogs
Results are shown in Table 1 and Figure 1.
b) Ascitic dogs
Results are shown in Table 2 and Figure 2.
3. Summary of this chapter Each mean value described above shows that P32 appears into the blood stream
of normal dog within five minutes and reaches peak after some thirty minutes which maintains approximately the same level following four and half hours. In ascitic dog, P32 appears into the blood stream within five minutes and gradually increases for three hours. However, in eycn case the level is far below than that
of normal dog (Fig. 3). Concerning the thoracic duct lymph, P'" appears faster into the lymph stream
of ascitic dog than that of normal dog. This is probably due to the high velocity
910 日本外科宝函第29巻第4号
of the lymphatic ft.ow of the thoracic duct in ascitic dog. In normal dog, the count
increases abruptl:yア untilone hundred minutes after the administration of P32 -On the contrary, in ascitic dog, increase of the count is slow and the highest value is
lower than that of normal dog (Fig. 4). In normal dog, P1' appears into the blood stream within five minutes, reaches
peak after about thirtぅァ minutes which keeps nearly the same level. Appearance of
P3" into the lymphatic ft.ow is later than that of the blood stream, but the value of
the lymph reaches higher peak than that of the blood abruptly and then decreases
quickl~’ to the level of the blood (Fig. 5).
In ascitic dog, the highest value of the blood and lymph are lower than that
of normal.tlog, but the inclination of the curve is the same as in normal dog (Fig.
6).
In conclusion, it will be able to saγthat the peritoneal absorbability of P1" in
ascitic dog is inferior to that of normal dog. And both blood and lymph serve as
the pathway of absorption. And then, lymphatic absorption can be considered to
begin later than blood stream absorption.
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912 日本外科宝函第29巻 第4号
ADMINISTRATION OF DIRECT SKY BLUE SOLUTION INTO THE PERITONEALぐAVITY AND VEINS
1. Materials and methods Normal adult mongrel dogs weighing about 10 kg and ascitic dogs with con-
striction of the thoracic inferior vena cava were used.
Following three methods were adopted.
a) Direct Sky Blue solution (lcc per kg of body weight) was administered
into the peritoneal cavit~· of加thnormal and ascitic dogs (ascites had been
emptied).
b) Direct Sky Blue solution (0.25 cc per kg of body weight) was injected into
the right V. femoralis of normal and ascitic dogs. c) Direct Sky Blue solution (0.25 cc per kg of bod｝ァ weight)was injected into
the left V. ccphalica antcbrachii of ascitic dogs.
In all cases, samples were collected from the right A. fcmoralis and the thoracic
duct fistula every白veminutes for the first one hour, every ten minutes for the
second one hour, and every thirty minutes for the later three hours after the ad-
Min.
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EXPERIMENTAL STUDIES ON ASCITIC ABSORPTION 913
ministration of Direct Sky Blue solution. Samples were measured spectrophotome-
trically.
2. Results
a) Results of Direct Sky Blue solution intraperitoneally administered normal
ex七tnction dogs are shown in Table 3 and Figure 7. 6・o, b) Results of Direct Sky Blue so-
lution intraperitoneally administered ascitic dogs are shown in Table 4
and Figure 8.
c) Results of Direct Sky Blue so・lution intravenously (right V. femora-
lis) administered normal dogs are shown in Table 5 and Figure 9.
d) Results of Direct Sky Blue so・
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in Table 6 and Figure 10. e) Results of Direct Sky Blue solution intravenously (V. cephalica antebrachii)
administered ascitic dogs are shown in Table 7 and Figure 11.
Summary of this chapter Each mean value of the concentration of Direct Sky Blue, administered into the
peritoneal cavity, shows that the ct~·e appears into the blood stream of normal dog
within five minutes and continues to increase for five hours, but in ascitic dog, the
dye appears into the blood stream within five minutes and reaches peak three hours
later, which keeps almost the same level. And yet the highest value of ascitic dog
is far lower than that of normal dog (Fig. 12). The value of the thoracic duct lymph has the same tendency as is illustrated
in Figure 13. In conclusion, Direct Skv Blue, the cl~℃， is absorbed through the peritoneum
normal dog easier than that of ascitic dog. In normal dog, Direct Sky Blue appears into the blood stream within five minutes, into the thoracic duct lymph within fifteen
minutes, but on the I＼判v the concentration of the dye in the lymph abruptly increases
of
第29巻日本外科宝函914
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EXPERIMENT AL STUDIES ON ASCITIC ABSORPTION
ext in。，tion
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916 日本外科宝函第29巻第4号
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and surpas田sthe concentration of the dye in the blood (Fig. 14). In ascitic dog, this inclination is the回 meas in normal dog but the appearance
of the dye into the thoracic duct lymph is somewhat faster than that of normal dog (Fig. 15).
After the administration of Direct Sky Blue solution into the right V. femoralis in normal dog, the concentration in the blood collected from the right A. femoralis and the lymph from the thoracic duct fistula were examined. Then, it was found that the dye appeared into the thoracic duct lymph within five minutes (Fig. 16).
Together the results described above and the fact that the appearance of the dye into the thoracic duct lymph was within白fteenminutes when it was adminis-tered intraperitoneally show that the dye 油田rbedfrom the peritoneum seems旬
enter into the blood stream at first, then from the blood stream appears into the lymph stream. The dye concentration in the lymph surpasses that of the blood on the way, and this fact indicates that the lymphatic absorption begins later.
Namely, the appearance of Direct Sky Blue into the thoracic duct lymph is due to the hematogenic absorption in the beginning, and then additional lymphatic ab-
1.0
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917 EXPERIMENTAL STUDIES ON ASCITIC ABSORPTION
ext inc七ion
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sorption follows in the later stage.
In ascitic dog, the highest value of the dye in the lymph is lower than that of normal dog. However, the inclination of the concentration is the回 mein both
cases (Fig. 17).
In the next experiment, Direct Sky Blue solution was injected into the left V.
cephalica antebrachii of a.scitic dog. There is no significant difference between the
result of ascitic dog administered into the V. femoralis and that of administered
into the V. cephalica antebrachii (Fig. 18).
In conclusion, the absorption of the dye from the peritoneal cavity is through
both hematogenic and lymphatic route, but the latter takes place in the later stage.
Fig. 15 Fig.
918
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ADMINISTRATION OF INDIA INK INTO THE
PERITONEAL CAVITY
1. Materials and methods
India ink, diluted with normal saline solution by seven times, was administered
seven cc per kg of body weight into the peritoneal cavities of both normal and
ascitic (ascites was emptied before experiments) dogs. Normal dogs were sacrificed
by injection of Ravonal (pentothal sodium) ten minutes, thirty rrtinutes and sixty
minutes after India ink administration. Ascitic dogs were sacrificed with the same
method ten minutes, thirty minutes, sixty minutes and three hundred minutes after
the procedure.
Then, the sternal lymph nodes were extirpated and examined microscopically.
2. Results
a) Results of normal dogs
Five dogs were sacrificed after ten minutes.
No. 1 ・・・・・Particlesof India ink were found.
No. 2・ー・・・Particlesof India ink were found.
EXPERIMENTAL STUDIES ON ASCITIC ABSORPTION 919
e玄tinction*.5
。。
ei.t1 nction 43
一一一一一blood一一－－~h
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No. 4・一・・ ・Particles of India ink were not found.
No. 5・・・・・・Particles of India ink were not found.
Five dogs were sacrificed after thirty minutes.
No. 1・・・・・・Particlesof India ink were found.
No. 2・・・・・・Particlesof India ink were found.
No. 3・・・・・・Particles of India ink were found.
No. 4・・・・・・Particlesof India ink were found.
No. 5・・ a・・・Particlesof India ink were found.
Four dogs were sacrificed after sixty minutes.
No. 1 ・・・・・・Particles of India ink were found.
No. 2・・・・・・Particlesof India ink were found.
No. 3 ・ ・ ・ ・・・Particles of India ink were found.
No. 4・・一・Particlesof India ink were found.
b) Results of ascitic dogs
Four dogs were sacrificed after ten minutes.
No. 1 ・・・・・・Particles of India ink were not found.
No. 2 ・・－－・Particles of India ink were found.
T¥ o. 3 ・・・Particles of India ink were found.
No. 4 ・・・・・Particles of India ink were not found.
Four dogs were sacrificed after thirty minutes.
920 日本外科宝函第29巻第4号
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No. 1・一・・・Particlesof India ink were found. No. 2…・・・Particles of India ink were not found. No. 3…・・・Particles of India ink were not found. No. 4・・・・・・Particlesof India ink were not found.
Five dogs were sacrificed after sixty minutes. No. 1 ・ ・ ・ ・・・Particles of India ink were not found. No. 2・・・・・・Particlesof India ink were found. No. 3・・・ ・・・Particles of India ink were 仰otfound. No. 4・・・ ・・・Particlesof India ink were not found. No. 5・・・・・・Particlesof India ink were not found.
Five dogs were sacrificed after three hundred minutes. • No. 1 ・ ・ ・ ・ ・・Particles of India ink were not found.
No. 2・・・・・・Particlesof India ink were found. No. 3…・・・Particles of India ink were found. No. 4・・・・・・Particlesof India ink were found. No. 5 ・・・・・・Particles of India ink were found.
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EXPERIMENTAL STUDIES ON ASCITIC ABSORPTION
3. Summary of this chapter
In the cases of ten minutes after
intraperitoneal administration of India-
ink, carbon particles were found obvious-ly in three out of five cases of normal
dogs, but were very slightly in two out
of four cases of ascitic dogs. In the
cases of thirty and sixty minutes after
procedure, particles of India ink were
found obviously in all normal dogs. In
ascitic dogs, on the contrary, particles
were found only one out of four after
thirty minutes cases, one out of five
after sixty minutes cases and four out
of five after three hundred minutes cases.
In conclusion, the peritoneal ab-sorbability of particles of India ink of
ascitic dog is inferior to that of normal dog.
DISCUSSION
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There have been many concepts
about absorption from the peritoneal cavity. In 1863, v. REcKLINGHAUSEN
stated that there was direct connecting stoma between the peritoneal cavity and lymphatics.
But this stoma was thought to be artefact by Kowssow, MuscATELLO, MAc-
CALLUM, DANDY, RowNTREE and others. On the other hand, STARLING, HAIDENHAIN,
HANBURGER and others described that the water soluble h’c was rapidly absorbed from the peritoneal cavity into the blood stream.
Recently, it has become clear that ascites is not a simple pool of body fluid, but a state of dynamic equilibrium, which is always coming in and out the peritoneal
cavity even though it seems to be in static state. McKEE, who observed the fact
that the labeled plasma protein given intraperitoneally appeared into the blood stream
and given intravenously it appeared into the peritoneal cavity, used the term “the ::irculation of ascitic fluid”．
Literatures on the peritoneal absorbability of experimental ascitic dog are very
few. In 1921, BoLTON investigated the absorbabilit:; b,・ 111c:l11只 ofclassical methods.
Recently McKEE described the results with the radioactive labeled er~·thrυc~·tes.
Now, administering the various substances. P1", Direct Sk>・ Blue solution or
[ndia ink, intraperitoneally to both normal and ascitic dりどお白mlingsof the blood,
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922 日本外科宝函第29巻第4号
lymph and ］~ ＇mph node samples show that the peritoneal absorbabilitγof ascitic dog
is inferior to that of normal【log.
But still remains the question why the peritoneal absorbability of the ascitic
dog is inferior to that of normal dog. According to MATSUDA, there is no significant
difference in the peritoneal absorbability between the normal rabbit and the rabbit
with injured liver after the intraperitoneal administration of phenolsulfonphthalein.
lMANAGA et al. re1nrterl that phenolsulfonphthalein, administered intraperitoneally,
appeared faster into the urine of normal dog than that of the dog with the con-
stricted V. hepatica. But, when the portocaval shunt was added to the dog with the
constricted V. hepatica, the appearance of the dye in旬 theurine became faster to the same grade of normal dog. Then, they concluded that the absorbability of the
peritoneum depended upon the portal blood circulation.
Namely, the absorbabilit~， of the peritoneum depends upon the portal blood
circulation and not upon the liver itself. But this problem requires for further
studies from various aspects.
CONCLUSION
¥'arious substances were administered into the peritoneal cavities and the blood
vessels of both ascitic and normal dogs. And their concentration in the blood and
h’mph were measured, and the sternal lymph nodes were examined microscopically.
Results obtained are as follows:
1. Collecting ancl counting the blood samples from A. femoralis and lymph samples
from the thoracic duct fistula after the administration of P32 into the peritone⑮l
cavities of both ascitic (ascites was emptied) and normal dog, the peritoneal absor-
bability of ascitic dog is inferior to that of normal dog.
2. Administrering Direct Sk~· Blue solution in the same way, the peritοneal ab-
sorbal』ilit；－’ ofascitic dog is inferior to that of normal dog.
3. P1" ancl Direct Sk＞’ Blue are absorbed from the peritoneal cavity through both
hematogenic and lymphogenic.
4. Microscoping the precipitation of intraperitoneally administered India ink, the
peritoneal absorbability of ascitic dog is inferior to that of normal dog.
In short, the peritoneal absorbability of ascitic dog is inferior to that of normal
dog, both with liquid and particles, and this is one of the reasons for ascites for-
ma ti on.
The gist of this paper was delivered in 1958, 1959 at the Annual Meeting of the Japanese Surgical Society.
RSFERENCES
l) Allen, L. and Vogt, E.: A Mechanism of Lymphatic Absorption from Pertitoneal Cavity. Am. J. l'hysio!.. 119, 776, 1931.
21 Bauer, F. K., Blahd, W. Tl. and Fields, :¥I.: Ascitic Fluid and Plasma Protein Exchange. J. Clin. lnYestり 32,553, 1りS3
3) Berson, S. A. and Yalr川.， R S.: The Di~tribution of !131 Labeled Hmnan Serum Alubumin introduced. into Ascitic Fluid. J. Clin. Invest. 33, 37/, 1954.
1 J Bolton, ( '. : Absorption from I'eritoneal C’a、ily.J. l'ath. Bad., 24, 429, 1921.
EXPERIME~TAL STUDIES ON ASCITIC ABSORPTIOX 923
5) Bryant, M. F., Howard, J. M. and Dra＼＼’horn, C. ¥V.: The Transfer of Water (Deutrium
oxide) across the Pleural and Peritoneal Membranes. Surg. Gynec. & Obst., 105, 417, 1957.
6) Cain, J. C., Grindlay, J. H., Bollman, J. L .. Flock, E. V. and Mann, F. C. : Lymph from
Liwr and Thoracic Duct. Surg. Gynec. & Obst., 85, 559, 1947.
7) Chunふ C.M.: Ueber die Lymphgefaesse des Omentum majus und Omentum minus beim Menschen und bei einigen Saeugetieren. Arch. Jap. Chir., 11, 1031, 1937.
8) Chung, C. M. . Ueber die Resorption corpusculaerer Stoffe der Lymphgefaesse des Omentum majus und Omentum minus. Arch Jap. Chir., 15, 25, 1938.
9) Courtice, F. C., Harding, J. and Steinbeck, A. W. : The RemoYal of Free Red Blood Cells from the Peritoneal Cavity of Animals. Austral. J. Exper. Biol., 31, 215, 1953.
10) Cunningham, R. S.: Studies in Absorption from Serous Cavities. Am. J. Physiol. 62, 2413, 1922.
11) Hahn, P. F., Miller, L. L. and Whipple, G. H. : Peritoneal Absorption ; Red Cells Labeled
by Radio-Iron Hemoglobin move promptly from Peritoneal Cavity into Circulation. J. Exper. Med., 80, 77, 194 l.
12) Hatta, H. : Relation between the Respiratory Movement and the Lymph Flow of Thoracic Duct. J. Hiroshima Med. Ass., t, 197, 1951.
13) Hatta, H. : Relation between the Lymph Flow of Thoracic Duct and the Movement of Dia-phragm. J. Hiroshima Med. Ass., 4, 199, 1951.
14) Imanaga, H., Kuroyanagi, Y., Yamamoto, S., Kato, T. and Takahashi, M.: Studies on
Mechanism of Ascites Formation. J. Jap. Surg. Soc., 59, 754, 1958.
15) Itani, K.: Studies on the Peritoneal Absorption of Particulate Matter. Arch. Jap. Chir., 28, 802, 1959.
16) Kawaishi, K.: Experimental and Clinical Studies on Intraperitoneal Blood Transfusion. J. J ap. Surg. Soc., 28, 1015, 1927.
17) MacCallum, W. G.: On the Mechanism of Absorption of Granular Materials from the Peri-toneum. Bull. Johns Hopkins Hosp., 14, 105, 1903.
18) McKee, F. W., Wilt, W. G., Hyatt, R. E. and Whipple, G. H. : The Circulation of Ascitic: Fluid. J. Exper. Med., 91, 115, 1950.
19) McKee, F. W. and Stewart, ¥V. B.: Passage of Radioacti,・e Erythrocytes from Peritoneal Cavity into Blood Stream during Experimental Ascite日.J. Exper. Med., 91, 599, 1950.
20) Matsuda, K.: An Experimental Study on the Peritoneal Function (Part 1 ). Hirosaki Med. J., 3, 34, 1952.
21〕 Matsuda,K.: An Experimental Study on the Peritoneal Function (Part 2 ). Hirosaki Med. J., 3, 165, 1952.
22) Matsuna且’a,F. and Matsuda, K. : Experimental and Clinical Studies on the Peritoneal Fune-tion. J. Jap. Soc. Int. Med., 40, 230, 1951.
23) Prentice, T. C., Siri, W. and Joiner, E. E.: Quantitafo・e Studies of Ascitic Fluid Circulation with Tritium-Labeled Water. Am. J. '.¥led., 13, 668, 1952.
24) Schoenberger, J. A., Kark, R. M., Kroll, G. and Eckert, E. : Endothelial Permeability in Man Studied with Albumin J131 Injected intravenously or intraperitoneally. J. Clin. Invest., 32, 601, 1953.
25) Schwartzkoif, W. und Pickert, H.: Nachweiss ¥'On Austauschvorgaengen zwischen Ascites und Blutbahnen mittels Evans-Blau. Klin. Wschr., 34, 9/10, 225, 1956.
26) Starling, E. H. and Tubby, A. H.: On Absorption from and Secretion into the Serous Cavi-ties. J. Physiol. 16, 140, 189!.
27) Takimoto, T. : Experimental and Clinical Studies on the Influence of N. splanchnicus upon Intraperitoneal Absorption. J. Jap. Surg. Soc., 48, 232, 1948.
28) Tanaka, Y. : Further Experimental Studies on the I》athologyand Physiology of Diaphragm. J. Jap. Surg. Soc., 24, 601, 1937.
29) Tashiro, K. : Roentogenolo宮icand Histologic Studies on the Lymphsystem of Liγing Body especially Lymph Node呂 belongingto the Peritoneal Cavity. J. Jap. Surg. Soc., 34, 430, 1933.
30) Ushiyama, H.: Clinical Stuclies on the Circulation of Asc:itic Fluid 1 I泊rt1 ). J. Jap. Soc. Int. Med., 46, 1049, 1957.
31) Ushiyama, H.：℃linical Studies on the Cit'Culation of Asc:itic Fluid 1.Part 2 ). J. Jap. Soc. Int. Med., 46, 1541, 1957.
32) Yabana, K. On the Intraperitoneal Absoq正ion.. J. Jap. Surg Svc., 25, 698, 1923.
924 日本外科宝函第29巻第4号
和文抄録
腹水腹膜の吸収能に関する実験的研究
岐阜県立医科大学第 l外科学教室（指導鬼束惇哉教浸）
田 原 浩 明
胸部下大静脈狭窄による腹水犬の腹膜吸収能を種々 3) スカイブルーを腹水火並びに正常犬の腹腔内に
の物質を腹腔内に注入して正常犬のそれと比較検討し 注入し，同様に血液及びリンパを採取し夫々の濃度を
た， 光電比色計で測定すると腹水犬の腹膜吸収能は正常犬
I) p32及びスカイブルーは血行性並びにリンパ行 のそれに比して劣る（Fig.12, Fig. 13).
性にp 量汗粒子はリンパ行性に腹腔内より吸収され 4) 墨汁を腹腔内に注入し，時間を追って胸骨リン
る． パ腺を刻出し量汁粒子の沈着状態を組織学的に検索す
2) p32 を腹水犬並びに正常犬の腹腔内に注入しP ると腹水犬では明らかに正常犬に比して少ない．
股動脈より血液を，胸管リンパ凄よりリンパを夫々時 即ち腹水犬ではその腹膜の吸収能は正常犬に比して
問を追って採取し放射能を測定すると，腹水犬では正 液状のものに就いても粒子状のものに就いても劣る．
常犬に比して腹膜の吸収能が劣る（Fig.3, Fig. 4 ). これが腹水貯溜の原因的因子の一つである．