Changes in normal human leg lymph protein concentration, output, and lymph flow/lymph protein concentration relationship, as well as lactate dehydrogenase and alkaline phosphatase activity were followed during procedures known to increase capillary filtration as venous stasis, muscular exercise and warming of tissues. Lymph flow increased by 83% during two hour ergometer cycling, and by 117% during two hour warm water foot bath. During a two hour period of venous stasis lymph flow dropped by 50%. There was an increase in lymph flow during the rest period following all three types of experiment, most pronounced after foot warming. An inverse relationship between the lymph flow rate and lymph protein concentration was found. Lymph enzymes followed the same pattern of changes as total protein.

Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient’s medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.

The twenty-four hour variation in concentration and output of total protein, lactate dehydrogenase and alkaline phosphatase has been studied in the peripheral lymph from the legs of 5 healthy volunteers over a period of five days. The highest concentration of these proteins was found in lymph collected during the first two hours after a night's rest. During the day a continuous decrease in concentration occurred without any direct correlation to lymph flow. The variation in lymph protein concentration between early morning and late day was about 40%, lactate dehydrogenase and alkaline phosphate about 90% and 45% respectively.