DOCSLIB.ORG

The Lymphatic System

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Lymphatic System The Lymphatic System The lymphatic system is similar to the blood system and has just as many vessels - but they contain lymph, which is clear and so cannot be seen (unless a suitable dye is injected). The lymphatics differ from the blood system in that the blood continually circulates through each part of the body while the lymph just drains from each part. Lymphatics drain away the excess protein and water which continually escape from the blood in small amounts, plus some substances made in the tissues, and any foreign substances which enter them. Lymphatics start, in almost every tissue, as many tiny vessels which gradually join together into bigger ones. Lymph is pumped into and along these vessels by the movements of adjacent muscles and by the contractions of the walls of the larger lymphatics. This pumping is aided by many valves inside the vessels. Finally the lymphatic system empties into the blood (largely in the lower neck). On its way along the lymphatics, the lymph is filtered in the lymph nodes (lymph glands). These remove foreign matter (e.g. bacteria) and start any necessary immune reactions. Oedema (Edema) The lymphatics help to remove the excess fluid and protein which enters the tissues from damaged blood vessels, in any inflammation (e.g. after a burn, or other injury). If they cannot remove it all, the part swells (oedema, edema). However this swelling is usually only temporary, because the tissues heal and the blood vessels no longer leak excessively. In an acute injury, e.g. a sprained ankle, the lymphatics are essentially normal. Although there is initial swelling, this is gradually removed over days to weeks. The overload is only temporary although, depending on the severity of the injury, some fibrosis will occur. This may remain for months or even permanently. Lymphoedema (Lymphedema) However if the lymphatic system is damaged or blocked, protein continues to enter the tissues from the blood capillaries in the normal way, and a build-up occurs in the tissues the lymphatics should be draining. The accumulation of protein in the tissues causes excess fluid to enter them and the tissues to swell. The swelling decreases the oxygenation of the tissues, interferes with their normal functioning, and makes them heal more slowly than normal. To some extent, the protein is also removed by some of the cells in the tissues (e.g. the macrophages). These assist the lymphatic system and can partly take over its role if it is blocked. However in lymphoedema, the chronic excess protein causes these cells also to cease to function. The excess protein also acts as a stimulus for chronic inflammation. One of the results of this is the formation of much excess fibrous tissue. The chronic inflammation causes more blood capillaries to form and to be dilated. This makes the limb feel hot. This heat, combined with the stagnant protein provides a perfect site for bacterial growth (Secondary Acute Inflammation, S.A.I. or dermato-lymphangio-adenitis, D.L.A.). The patient may be very ill, with constant infections, and need hospitalisation. Fungal infections are also very frequent, and are often difficult to clear up. These infections, themselves, place greater loads on the lymphatics, and so worsen the lymphoedema. Any infection or other inflammation (e.g. after injury, sunburn, etc.) makes the lymphoedema worse. If the swelling is rapid (e.g. after an operation), it can cause great pain. This is because the tissues are being torn apart. Adjacent areas, which are receiving excess lymph diverted from the blocked region, also often ache (e.g. the shoulder adjacent to a lymphoedematous arm). If swelling is slow (e.g. primary lymphoedema), there may be no pain at all, except during bouts of infection. Lymphoedema is usually considered only to occur in the arm or leg, but any organ or region may suffer from it: the genitals, the gut, the lungs, the liver as a consequence of chronic hepatitis, etc. Lymphoedema has a number of other effects: it decreases mobility, causes embarrassment, can lead to depression, and causes a general worsening of the patient's life and health. If the lymphoedema is severe, especially if more than one limb is involved, the patient is excessively heavy. This may be confused with obesity, but dieting is useless if it is just lymphoedema; however if there is obesity, dieting is recommended. Even if only one limb is affected, the added weight can cause clumsiness and this makes the limb more liable to injury and consequent bacterial infection. Lymphatic drainage from the legs is more difficult than from the arms, walking is more difficult and the excess weight discourages this. So lymphoedema of the legs is often worse than that of the arms. When lymphoedema first occurs it will pit if pressed with a thumb. It gradually becomes larger and harder; it no longer pits. If lymphoedema lasts for some years, the swelling gets worse, and skin changes occur. There is loss of hair and alterations to the nails. The skin may get very thick, with huge folds and warts - elephantiasis. A few patients with long-term lymphoedema develop an angiosarcoma (Stewart-Treves Syndrome). Any lymphoedema left untreated will gradually progress along this route. What does Lymphoedema feel like? Feeling of tightness and heaviness in the limb. 'Bursting' pains Aching buttocks (leg lymphoedema) or back of the shoulder (arm lymphoedema). Pins and needles in the limb. 'Shooting' pains up the limb. A feeling of 'tightness' and tenderness in the elbow or back of the knee. Pain in joints (e.g. elbow, knee and ankle), similar to arthritis and often diagnosed as this. Tenderness in the groin of an affected leg. 'Blown up' abdomen if a leg is affected or in 'lymphoedema-all-over'. The limb or affected areas are warmer than other parts - but not red, which suggests infection (SAI) as well. In some primary lymphoedemas there can be a very gradual increase in size, but no particular pain - just a feeling of heaviness in the limb. However any infection makes it painful because of the rapid increase in size and the worsening of the lymphoedema that this causes. Joints, in particular the knee, can also become lymphoedematous - it feels like (and is often diagnosed as) 'arthritis' - which in a way it is. Sometimes lymph can leak through the skin which is then particularly vulnerable to infection. Causes of Lymphoedema There are many reasons why the lymphatic system may fail, with two main groups: primary and secondary. Primary (lack of lymphatic vessels) Usually there are simply too few lymphatics; sometimes there are many, but they are very dilated and do not pump properly; sometimes it is a combination of both. This lymphoedema can appear before birth (connatal lymphoedema), during puberty, which is most common for primary lymphoedemas (lymphoedema praecox), or later in life, e.g. from 30-40 onwards (lymphoedema tarda). Occasionally there is a narrowing of one of the major lymph trunks, e.g. at the outlet of the thoracic duct. Primary lymphoedema can also start following the onset of a secondary lymphoedema in another part of the body, e.g. postmastectomy (secondary) lymphoedema may initiate a primary lymphoedema in the leg on the same side, Secondary (blocked or cut lymphatic vessels) Secondary lymphoedema can occur if the lymphatic drainage is blocked or cut, from: 1.Surgery, especially for carcinoma with the removal of lymph nodes or a lot of tissue (e.g. an operation for melanoma) means cutting many lymphatics. 2.Radiotherapy, which kills any tumour cells, destroys the lymph nodes, blocking them with fibrous tissue. 3.Accidental trauma may tear lymphatic vessels which may not rejoin when the blood vessels do; any excess fibrous tissue caused by the damage can later shrink and constrict them. 4.Parasites (e.g. filarial worms) block the lymphatic drainage. The swelling may occur when the worms grow, damage the lymphatics and destroy their valves. It usually occurs only some years after the worms are injected - when they die and breakdown, causing inflammation which blocks the lymphatics. 5.Paralysis of a limb prevents lymphatic pumping, so causing wheel-chair oedema. 6.Chronic venous insufficiency often involves the lymphatics running beside the veins, thus eventually adding lymphoedema to the venous oedema. 7.Lipodema (this is not itself lymphoedema, but can cause it secondarily) When does lymphoedema occur, and how rapidly? Once lymphatics are damaged, lymphoedema may occur at any time. Sometimes it starts at once and lasts for life; oedema may occur for a few weeks, then go away, and may or may not return; sometimes it appears years after the event. Once the lymphatics are damaged, a very trivial thing may set it off, e.g.: a bee-sting, sunburn, carrying heavy weights, or a long aircraft flight. Apart from the acute stage which occurs briefly after the blockage and then goes away, once lymphoedema starts it gets progressively worse. This worsening is usually slow in primary lymphoedemas and rapid in secondary ones. It is usually a steady increase unless some inflammation occurs (e.g. infection, injury, burn), when it gets worse very quickly. Grades of Lymphoedema Grade 1 swelling will pit if the skin is pressed and is reduced if the limb is elevated. Grade 2 has much more excess fibrous tissue, so it does not pit, and is not much reduced by elevation (e.g. in bed overnight or for 2-3 days). The limb gradually 'hardens' because of the excess fibrous (scar) tissue due to the chronic inflammation. Elephantiasis (Grade 3) has gross changes to the skin: many protrusions & huge bulges. Regions affected by lymphoedema Primary Lymphoedema This can range from only part of one limb, to many parts of the body, including the gut (causing protein-losing enteropathy, intestinal lymphangiectasia) and lungs.
Load more

Recommended publications
  • A Misunderstood Teenager with Paediatric Inflammatory Multisystem Syndrome – Temporarily Associated with SARS-Cov-2 Admitted Under Adult Medicine
    LESSONS OF THE MONTH Clinical Medicine 2021 Vol 21, No 1: e96–9 Lessons of the month: A misunderstood teenager with paediatric inflammatory multisystem syndrome – temporarily associated with SARS-CoV-2 admitted under adult medicine Authors: Sachin T PatelA and Harry WrightB The emergence of SARS-CoV-2 has proven to be a challenge low total protein (52 g/L), albumin (28 g/L), globulin (23 g/L) and to healthcare bodies globally. The virus has been associated alkaline phosphatase (49 U/L). A surgical review was sought, and with a spectrum of clinical features, from anosmia to they recommended radiological imaging. Contrast computed gastrointestinal upset to multiorgan dysfunction in the tomography (CT) of the chest, abdomen and pelvis showed most severe cases. Given the range of features observed, it is multiple enlarged mesenteric nodes, especially in the RIF, possibly ABSTRACT important to be aware that infectious diseases can present in keeping with mesenteric adenitis (Fig 1). The visualised appendix atypically. Furthermore, in many hospitals, including our own, was unremarkable and both lung fields were clear. All other teenagers aged 16 to 18 years old are admitted under the abdominal and pelvic viscera were unremarkable. care of adult medical services. Clinicians should be aware of As appendicitis was ruled out by the surgical team, he was patients presenting with the novel condition of paediatric started on intravenous (IV) aciclovir 600 mg, 3 times a day, and IV inflammatory multisystem disorder – temporarily associated ceftriaxone 2 g, 12 hourly, to cover for meningitis. He also received with SARS-CoV-2 (PIMS-TS).
    [Show full text]
  • Familial Mediterranean Fever and Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) Syndrome: Shared Features and Main Differences
    Rheumatology International (2019) 39:29–36 Rheumatology https://doi.org/10.1007/s00296-018-4105-2 INTERNATIONAL REVIEW Familial Mediterranean fever and periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome: shared features and main differences Amra Adrovic1 · Sezgin Sahin1 · Kenan Barut1 · Ozgur Kasapcopur1 Received: 10 June 2018 / Accepted: 13 July 2018 / Published online: 17 July 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Autoinflammatory diseases are characterized by fever attacks of varying durations, associated with variety of symptoms including abdominal pain, lymphadenopathy, polyserositis, arthritis, etc. Despite the diversity of the clinical presentation, there are some common features that make the differential diagnosis of the autoinflammatory diseases challenging. Familial Mediterranean fever (FMF) is the most commonly seen autoinflammatory conditions, followed by syndrome associated with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA). In this review, we aim to evaluate disease charac- teristics that make a diagnosis of FMF and PFAPA challenging, especially in a regions endemic for FMF. The ethnicity of patient, the regularity of the disease attacks, and the involvement of the upper respiratory systems and symphonies could be helpful in differential diagnosis. Current data from the literature suggest the use of biological agents as an alternative for patients with FMF and PFAPA who are non-responder classic treatment options. More controlled studies
    [Show full text]
  • Periodic Fever with Aphtous Pharyngitis Adenitis (PFAPA) What
    Pædiatric Rheumatology InterNational Trials Organisation Periodic fever with Aphtous Pharyngitis Adenitis (PFAPA) What is it? The patient suffers from recurrent attacks of fever and affects children in early childhood, two to four years). This disease has a chronic course, but is a benign disease with a tendency toward improvement over time. This disease was recognised for the first time in 1987 and called Marschalls’ syndrome at that time. How common is it? The frequency of PFAPA is not known, but the disease appears to be more common than generally appreciated. What are the causes of the disease? The exact cause of the disease is currently unknown. During periods of fever, the immune system is activated. This activation leads to an inflammatory response with fever and inflammation of the mouth, or throat. This inflammation is self-limited as there are no signs of inflammation to be found between two episodes. There is no infectious agent present during attacks. Is it inherited? Familial cases have been described, but no genetic cause has been found so far. Is it contagious? Infectious agents may play a role in the PFAPA syndrome, but it is not an infectious disease and is not contagious. What are the main symptoms? The main symptom is a recurrent fever, accompanied by a sore throat, mouth ulcers, or enlarged cervical lymph nodes (an important part of the immune system). The episodes of fever start abruptly and last for three to six days. During episodes, the child looks very ill and complains about at least one of the three above-mentioned symptoms.
    [Show full text]
  • Staphylococcal Suppurative Mesenteric Lymphadenitis S
    Postgrad Med J: first published as 10.1136/pgmj.59.689.191 on 1 March 1983. Downloaded from Postgraduate Medical Journal (March 1983) 59, 191-193 Staphylococcal suppurative mesenteric lymphadenitis S. K. JAIN S. K. KHANNA M.S. M.S., F.I.C.S., F.A.C.S. Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India Summary grade fever, constipation and awareness of a mass in Two young adult males presenting with suppurative the left upper abdomen. mesenteric lymphadenitis, caused by coagulase posi- On examination, he was toxic and febrile. He had a tive staphylococcus, with unusual clinical findings are tender, firm lump 8 x 6 cm which was pulsatile, with reported. Pre-operative and operative differential restricted mobility in the left hypochondrium. There diagnosis and management are discussed. Previous was no hepatosplenomegaly are reviewed. The condition is Investigations showed haemoglobin was 11-75 g/dl publications briefly and white blood cell count 9 8 x 109/litre with 71% extremely rare in adults and the pathogenesis is not neutrophils. Blood culture was sterile. Chest X-ray, well understood. intravenous pyelography and barium meal were essentially normal. by copyright. The pre-operative diagnosis was of perigastric KEY WORDS: Staphylococcus, mesenteric lymphadenitis. abscess or mycotic aneurysm of splenic artery, and the patient was explored by a mid-line vertical supra- Introduction umbilical incision. There was a soft lymph node mass, 14 x 10 cm, in Non-specific mesenteric lymphadenitis is one of the root of the mesentery near the duodeno-jejunal the common causes of acute abdominal pain in flexure, containing 150 ml of creamy pus which was children, although rarely seen in adults.
    [Show full text]
  • Prednisone for the Treatment of Acute Nonspecific Mesenteric Lymphadenitis
    Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 Jul 25; 8(C):82-85. https://doi.org/10.3889/oamjms.2020.4219 eISSN: 1857-9655 Category: C - Case Reports Section: Case Report in Pediatrics Prednisone for the Treatment of Acute Nonspecific Mesenteric Lymphadenitis Momcilo Pavlovic1*, Zeljko Rokvic2, Karolina Berenji3 1Children’s Ambulatory Care Center Subotica, Serbia; 2Department of Diagnostic Imaging, General Hospital Subotica, Serbia; 3Department of Hygiene and Human Ecology, Public Health Institute, Subotica, Serbia Abstract Edited by: Igor Spiroski BACKGROUND: Acute nonspecific mesenteric lymphadenitis refers to a common pediatric problem that has no Citation: Pavlovic M, Rokvic Z, Berenji K. Prednisone for the Treatment of Acute specific treatment. Nonspecific Mesenteric Lymphadenitis. Open Access Maced J Med Sci. 2020 Jul 25; 8(C):82-85. CASE REPORT: In our study, we describe seven children presenting with abdominal pain as the main symptom of a https://doi.org/10.3889/oamjms.2020.4219 disease. All patients were treated with prednisone 1 mg/kg (max 40 mg daily) for a maximum of 5 days. In addition, Keywords: Mesenteric lymphadenitis; Corticosteroids; Abdominal pain; Children we evaluated the intensity of the pain using a numeric rating scale and achieved a clinically important difference in *Correspondence: Momcilo Pavlovic, Children’s acute pain relief of 85.3%. After administering corticosteroid therapy, the abdominal pain resolved after 1.7 (1–4) Ambulatory Care Center Subotica, Prvomajska days in all children without any other disturbances. 20, 24000 Subotica, Serbia. Tel.: +381638233331. E-mail: [email protected] Received: 20-Dec-2019 CONCLUSION: In selective patients with mesenteric lymphadenitis, prednisone can be used as an acceptable form Revised: 16-Jul-2020 of treatment to reduce the duration of abdominal pain.
    [Show full text]
  • Granulomatous Inflammation in Lymph Nodes Draining Cancer: a Coincidence Or a Significant Association!
    International Journal of Medicine and Medical Sciences Vol.1(2) pp. 013-016, February, 2009 Available online http://www.academicjournals.org/ijmms 2009 Academic Journals Review Granulomatous inflammation in lymph nodes draining cancer: A coincidence or a significant association! Alka Bhatia1*, Yashwant kumar2 and Anjali Solanki Kathpalia3 1Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh, India. 2Department of Pathology and Laboratory Medicine, Grecian Super speciality Hospital Mohali, India. 3Department of Pathology, PGIMER, Chandigarh, India. Accepted 10 January, 2009 Granulomatous inflammation is considered to be an immune mechanism against infections or certain non-neoplastic conditions. Rarely granuloma formation may be noted in neoplastic disorders also. However a granulomatous response in the lymph nodes draining cancers is unusual. Such granulomas may sometimes show tumour cells in their centre. The exact cause of this phenomenon is not known but an immunologic reaction to tumour antigens has been suggested. A close scrutiny of such granuloma is necessary to avoid under diagnosis of a metastatic disease. Subtle morphological fea- tures which may be helpful in differentiating a co-existing infection or tumour induced granuloma need to be addressed. Moreover the biologic significance of such a granulomatous response in inducing tu- mour remission or in shielding tumour cells from host lymphocytes also requires further investigation. Key words: Granuloma, cancer, metastasis. INTRODUCTION Diagnosis of granulomatous inflammation is a common has been variously labelled as sarcoid reaction or sarcoid practice in pathology. The common causes of granulo- like lymphadenopathy by different authors (Gregori et al., matous reaction are infective agents like mycobacteria, 1962). It has been observed in many malignancies e.g.
    [Show full text]
  • Exotics Oncology: Special Focus on Updates on Therapies for Rabbits & Ferrets
    Exotics Oncology: Special Focus on Updates on Therapies for Rabbits & Ferrets La’Toya Latney, DVM Exotic Companion Animal Medicine Service Penn Vet THYMOMAS IN RABBITS Rabbits possess a persistent thymus, which does not involute with age. The thymus is comprised of thymic epithelium, reticuloendothelial tissue, and lymphoid tissue. Primary thymic neoplasms recognized in rabbits include (1) benign neoplasm of thymic epithelial cells, (2) thymic carcinoma, a rare malignant neoplasm of the epithelial cells and (3) thymic lymphoma, which is a malignant neoplasm of the lymphoid tissue of the thymus. Clinically, thymomas are diagnosed as lymphoid-rich, epithelial-rich, or mixed lymphoepithelial. The incidence in pet rabbits is largely unknown, however in one retrospective study, thymomas comprised 7% of all neoplasms in 55 colony rabbits in rabbits 2-4 years of age in 1949. More recently, in a retrospective evaluation of 1,100 female rabbits more than 2 years of age submitted for necropsy over a 17-year period, 4 cases of the 234 rabbits that had neoplasia were thymomas (Andres 2012). Literary resources are mainly comprised of clinical case reports (Guzman, Kunzel, Pilny, Bennett, Kovalik, Wagner, Quesenberry, Florizoone, Vernau). Based on current literature, there is no specific sex predisposition, but the common age range is 3-10 years of age, with the median age of 6 years (Kunzel, Andres). Certain breeds have been consistently prominent in clinical case reports, including Netherland dwarves and Lionhead rabbits (Kunzel, Andres). Clinical signs commonly include severe dyspnea and nasal flaring, third eyelid protrusion, orthopneic body position, and bilateral exophthalmos due to caval compression resulting in the pooling of blood in retrobulbar venous plexus.
    [Show full text]
  • Mycobacterium Abscessus Cervical Lymphadenitis: an Immunocompetent Child
    MYCOBACTERIUM ABSCESSUS CERVICAL LYMPHADENITIS: AN IMMUNOCOMPETENT CHILD Jenn-Tzong Chang, Yung-Feng Huang, Yen-Ting Lin, Yung-Ching Liu,1 Lin-Hui Chiu,2 Hui-Zin Tu,2 and Kai-Sheng Hsieh Department of Pediatrics, 1Division of Infectious Disease, Department of Internal Medicine, and 2Division of Microbiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Nontuberculous mycobacterium (NTM) is one of the well-known causes of cervicofacial lym- phadenopathy in children under 5 years of age. Children often present with a painless cervical mass that fails to respond to conventional antibiotics. They are often referred under the suspicion of a neo- plasm or bacterial adenitis rather than NTM cervical lymphadenitis. The lack of systemic symptoms, modest or negative purified protein derivative test and absence of exposure to active tuberculosis are characteristics of NTM lymphadenitis. The diagnosis usually requires the isolation of pathogen or pathologic proof. Complete excision is the choice of treatment by the majority of authors in the literature. This not only enables rapid diagnosis but ensures the lowest recurrence rate. Medical management is sometimes successful when complete resection is impossible or refused. To our knowledge, the incidence of NTM cervical lymphadenitis in children is increasing throughout the world. However, such reports of children in Taiwan is lacking. Clinicians should suspect a possible nontuberculous mycobacterial infection when a cervical lump is found in a child. Key Words: immunocompetent, lymphadenitis, Mycobacterium abscessus, nontuberculous mycobacteria, Taiwan (Kaohsiung J Med Sci 2006;22:415–9) Nontuberculous mycobacteria (NTM) are ubiquitous However, most NTM infections occur in seemingly organisms that are found in soil, water, and food healthy children [5].
    [Show full text]
  • Procalcitonin, C-Reactive Protein and Erythrocyte
    ORIGINAL ARTICLES PROCALCITONIN, C-REACTIVE PROTEIN AND ERYTHROCYTE SEDIMENTATION RATE IN PERIODIC FEVER, APHTHOUS STOMATITIS, PHARYNGITIS AND CERVICAL ADENITIS (PFAPA SYNDROME) Cecilia Lazea1, Rodica Manasia1, Calin Lazar1, Laura Damian2 1Department Pediatrics I, Emergency Pediatric Hospital, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca 2Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca Abstract Aim. Although PFAPA syndrome is the most common cause of recurrent fever in children, the diagnosis is rarely established and it is a diagnosis of exclusion because there are no specific diagnostic tests. The aim of this study was to assess the value of procalcitonin, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in diagnosis of febrile attacks in PFAPA syndrome. Material and methods. C-reactive protein, erythrocyte sedimentation rate and procalcitonin were measured in 16 children with PFAPA syndrome during febrile attacks and in 12 children with bacterial pneumonia (control group A) and 18 children with bacterial tonsillitis (control group B). Results. No significantly statistic differences were recorded for CRP and ESR between the PFAPA group and control groups. Procalcitonin was undetectable in all children with PFAPA syndrome. Conclusion. Procalcitonin can be a useful marker for differential diagnosis between febrile attacks of PFAPA syndrome and acute bacterial infection in children. Keywords: PFAPA syndrome, procalcitonin, C-reactive protein, erythrocyte sedimentation rate INTRODUCTION is established on clinical criteria and on exclusion of other causes of recurrent fever in children. During PFAPA syndrome (periodic fever, aphthous stoma- flares, acute phase reactants (ESR, CRP and leuco- titis, pharyngitis and cervical adenitis) or Marshall cytes) are elevated. Usually procalcitonin does not syndrome was described in 1987 by Marshall and it is characterized by recurrent episodes of fever lasting increase during fever attacks (8-11).
    [Show full text]
  • Lets Talk Lymphoedema
    ‘Lymphoedema is a little-known illness and this book will help suf- ferers and their carers cope – and who better to help write it than someone like Gemma Levine who is a suferer herself.’ – Dame Judi Dench ‘I was always aware of the terrible disease lymphoma, as my dad died with that condition, but was totally unaware of the further ongoing condition lymphoedema. Any knowledge that can help explain this condition is a must-read.’ – Sir Alex Ferguson ‘What we know about, we can work to heal, and in the meantime give strength to those who sufer. That is why this book is so import- ant. I salute two remarkable people, Gemma Levine and Professor Peter Mortimer, for helping us learn about this terrible condition. Bless you both for opening our eyes and hearts.’ – Rabbi Lord Jonathan Sacks ‘Cancer touches all our lives and it is a sad fact that lymphoedema afects 40 per cent of cancer patients. This condition has been widely ignored in our generation. Let us hope there will be a cure in our children’s lifetime.’ – Dame Joan Collins ‘It is important, when an unfamiliar condition with a strange name is explained, for us all to understand. That is what is happening here. As a result, those who have sufered in the shadows will now know their condition is widely recognised and that they have our sympathy and concern.’ – Baroness Joan Bakewell ‘At last someone has written something about this debilitating condition, which causes so much sufering; this is a book that needed to be written and should be read.’ – Lord Paddy Ashdown ‘This is exactly what people sufering from lymphoedema need to have by them; professionally informed, but with the insight of those who live with it on a day-to-day basis.’ – Lord David Owen ‘Lymphoedema is the ugly child of cancers which, although wide- spread, is largely unknown.
    [Show full text]
  • Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 Published: November 27, 2017
    Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 Published: November 27, 2017 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Publish Date: November 27, 2017 Introduction Grades Grade 5 The NCI Common Terminology Criteria for Grade refers to the severity of the AE. The CTCAE Grade 5 (Death) is not appropriate for some AEs Adverse Events is a descriptive terminology which displays Grades 1 through 5 with unique clinical and therefore is not an option. can be utilized for Adverse Event (AE) reporting. A descriptions of severity for each AE based on this grading (severity) scale is provided for each AE general guideline: Definitions term. A brief Definition is provided to clarify the Grade 1 Mild; asymptomatic or mild meaning of each AE term. A single dash (-) symptoms; clinical or diagnostic indicates a Definition is not available. SOC observations only; intervention System Organ Class (SOC), the highest level of the not indicated. 1 MedDRA hierarchy, is identified by anatomical or Grade 2 Moderate; minimal, local or Navigational Notes physiological system, etiology, or purpose (e.g., noninvasive intervention A Navigational Note is used to assist the reporter SOC Investigations for laboratory test results). indicated; limiting age- in choosing a correct AE. It may list other AEs that CTCAE terms are grouped by MedDRA Primary appropriate instrumental ADL*. should be considered in addition to or in place of SOCs. Within each SOC, AEs are listed and Grade 3 Severe or medically significant but not the AE in question. A single dash (-) indicates a accompanied by descriptions of severity (Grade).
    [Show full text]
  • Lymphatic Leukemia
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1935 Lymphatic leukemia Blair S. Adams University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Adams, Blair S., "Lymphatic leukemia" (1935). MD Theses. 367. https://digitalcommons.unmc.edu/mdtheses/367 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. LYMPHATIC LEUKEMIA BY BLAIR STONE ADAMS SENIOR THESIS UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 1935 480666 The various blood dyscrasias have always fascinated me. More than a year ago, at the Douglas County Hospital, an autopsy-v.erified case of acute IJmphatic leukemia which had previously been diagnosed as 1. bronchopneumonia, and 2. en­ cephalitis lethargica, furthered my interest, and subsequent­ ly prompted me to make thiS rather comprehensive but far from exhaustive review of the literature on lymphatic leukemia. DEFINITION Leukemia is a systemic disease characterized by a hyper­ plasia of the leucocyt-producing tissues, and accompanied by a secondary disturbance of the composition of the blood, which manifests itself in alterations in the relative pro­ portions of the leucocytes; the appearance of forms not normally found in the peripheral circulation. and usually by an increase in the total number of white cells.
    [Show full text]