The Lymphoid System
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INDIVIDUAL SANITARY MEASURE Denmark Daniel Oestmann And
DECISION MEMORANDUM— INDIVIDUAL SANITARY MEASURE Denmark Daniel Oestmann and Priya Kadam David Smith and Kevin Gillespie EQUIVALENCE REQUEST: Denmark requested an equivalence determination for an alternative post-mortem inspection i.e. visual inspection instead of palpation and incision of lung and liver and their associated lymph nodes of slaughtered market hogs. For purposes of determining equivalence, Danish market hogs are of the 220-240 pounds /six months of age range; the alternative post-mortem inspection procedure is not applicable to sows, boars, and roaster pigs. BACKGROUND: On December 16, 2008 in an FSIS-Denmark bilateral meeting a team of FSIS experts met and reviewed Denmark’s Supply Chain Inspection system, and presentations by Danish officials. The Supply Chain Inspection system allows inspection of market hogs raised under an integrated quality control program coupled with an on-site verification at slaughter establishments of visually inspected carcasses and organs to ensure that passed carcasses and parts are wholesome and not adulterated. As a part of this inspection system, on December 24, 2008, FSIS approved Denmark’s use of an alternative post- mortem inspection procedure omitting the incision of mandibular lymph nodes for market hogs used to detect granulomatous lymphadenitis which is mitigated through on-farm controls that are assessed and reported through government oversight when hogs come to slaughter. As a part of this Supply Chain Inspection system, in April 2010, Denmark proposed another alternate visual only post mortem inspection procedure, omitting the palpation of mesenteric lymph nodes of slaughtered market hogs used to detect granulomatous lymphadenitis is mitigated through on-farm controls that are assessed and reported through government oversight when hogs come to slaughter. -
Salvage Cisterna Chyli and Thoracic Duct Glue Embolization in 2 Dogs with Recurrent Idiopathic Chylothorax
Case Report J Vet Intern Med 2014;28:672–677 Salvage Cisterna Chyli and Thoracic Duct Glue Embolization in 2 Dogs with Recurrent Idiopathic Chylothorax D.C. Clendaniel, C. Weisse, W.T.N. Culp, A. Berent, and J.A. Solomon Key words: Chylous; Fluoroscopy; Interventional Radiology; Pleural Effusion; Thoracocentesis. Case Report Abbreviations: Case 1 PO administered by mouth 4-year-old male castrated English Mastiff weigh- PRN administered as needed Aing 72 kg (158 lb) was evaluated for acute dysp- nea after a 1-week history of restlessness, episodes of increased respiratory effort, and inappetance. The dog The sample was too lipemic to obtain an accurate total was otherwise healthy and received seasonal heart- protein concentration. No microorganisms or atypical worm preventative medication and routine vaccina- cells were identified. Comparison of the fluid triglycer- tions. ide concentration with the serum triglyceride concen- On initial examination, the dog was bright, alert, tration (57 mg/dL; reference interval 50–150 mg/dL), responsive, and had a body condition score of 5/9. combined with cytologic findings, was consistent with The body temperature was 101.8°F (38.7°C), and the chylous effusion. heart rate was 150 beats/min. There was an increased Thoracic radiography revealed a small hyperlucent respiratory effort during both inspiration and expira- region in the caudodorsal thorax, suggesting mild tion with an abdominal component. Thoracic ausculta- pneumothorax presumably secondary to recent tho- tion revealed decreased lung sounds in the ventral lung racocentesis. No evidence of valvular or myocardial fields. Heart sounds were of normal rhythm, but muf- disease was observed during echocardiogram evalua- fled. -
Lymphatic Dysregulation in Patients with Heart Failure JACC Review Topic of the Week
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY VOL. 78, NO. 1, 2021 ª 2021 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER THE PRESENT AND FUTURE JACC REVIEW TOPIC OF THE WEEK Lymphatic Dysregulation in Patients With Heart Failure JACC Review Topic of the Week a,b c d e Marat Fudim, MD, MHS, Husam M. Salah, MD, Janarthanan Sathananthan, MBCHB, MPH, Mathieu Bernier, MD, f g e,h i Waleska Pabon-Ramos, MD, MPH, Robert S. Schwartz, MD, Josep Rodés-Cabau, MD, PHD, François Côté, MD, j d a,b Abubaker Khalifa, MD, Sean A. Virani, MD, MSC, MPH, Manesh R. Patel, MD ABSTRACT The lymphatic system is an integral part of the circulatory system and plays an important role in the volume homeostasis of the human body. The complex anatomy and physiology paired with a lack of simple diagnostic tools to study the lymphatic system have led to an underappreciation of the contribution of the lymphatic system to acute and chronic heart failure (HF). Herein, we discuss the physiological role of the lymphatic system in volume management and the evidence demonstrating the dysregulation of the lymphatic system in HF. Further, we discuss the opportunity to target the lymphatic system in the management of HF and different potential approaches to accessing the lymphatic system. (J Am Coll Cardiol 2021;78:66–76) © 2021 by the American College of Cardiology Foundation. he circulatory system consists of the cardio- lead to interstitial edema with clinical manifestations T vascular system and the lymphatic system. such as extremity and tissue edema, including pulmo- The cardiovascular system is a closed, high- nary edema. -
Cancer and Lymphatics: Part I
Cancer And Lymphatics: Part I Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT In the human body, cells receive nutrition and oxygen from lymph, a fluid that is recirculated through the body via an extensive network of vessels. Upon arriving at one of many nodes found within the body, the lymph is filtered to discern healthy cells from those carrying disease or infection. However, cancer can either develop in the lymph nodes around the body, or it can travel there via the lymphatic vessel network. -
Microlymphatic Surgery for the Treatment of Iatrogenic Lymphedema
Microlymphatic Surgery for the Treatment of Iatrogenic Lymphedema Corinne Becker, MDa, Julie V. Vasile, MDb,*, Joshua L. Levine, MDb, Bernardo N. Batista, MDa, Rebecca M. Studinger, MDb, Constance M. Chen, MDb, Marc Riquet, MDc KEYWORDS Lymphedema Treatment Autologous lymph node transplantation (ALNT) Microsurgical vascularized lymph node transfer Iatrogenic Secondary Brachial plexus neuropathy Infection KEY POINTS Autologous lymph node transplant or microsurgical vascularized lymph node transfer (ALNT) is a surgical treatment option for lymphedema, which brings vascularized, VEGF-C producing tissue into the previously operated field to promote lymphangiogenesis and bridge the distal obstructed lymphatic system with the proximal lymphatic system. Additionally, lymph nodes with important immunologic function are brought into the fibrotic and damaged tissue. ALNT can cure lymphedema, reduce the risk of infection and cellulitis, and improve brachial plexus neuropathies. ALNT can also be combined with breast reconstruction flaps to be an elegant treatment for a breast cancer patient. OVERVIEW: NATURE OF THE PROBLEM Clinically, patients develop firm subcutaneous tissue, progressing to overgrowth and fibrosis. Lymphedema is a result of disruption to the Lymphedema is a common chronic and progres- lymphatic transport system, leading to accumula- sive condition that can occur after cancer treat- tion of protein-rich lymph fluid in the interstitial ment. The reported incidence of lymphedema space. The accumulation of edematous fluid mani- varies because of varying methods of assess- fests as soft and pitting edema seen in early ment,1–3 the long follow-up required for diagnosing lymphedema. Progression to nonpitting and irre- lymphedema, and the lack of patient education versible enlargement of the extremity is thought regarding lymphedema.4 In one 20-year follow-up to be the result of 2 mechanisms: of patients with breast cancer treated with mastec- 1. -
Hematopoietic and Lymphoid Neoplasm Coding Manual
Hematopoietic and Lymphoid Neoplasm Coding Manual Effective with Cases Diagnosed 1/1/2010 and Forward Published August 2021 Editors: Jennifer Ruhl, MSHCA, RHIT, CCS, CTR, NCI SEER Margaret (Peggy) Adamo, BS, AAS, RHIT, CTR, NCI SEER Lois Dickie, CTR, NCI SEER Serban Negoita, MD, PhD, CTR, NCI SEER Suggested citation: Ruhl J, Adamo M, Dickie L., Negoita, S. (August 2021). Hematopoietic and Lymphoid Neoplasm Coding Manual. National Cancer Institute, Bethesda, MD, 2021. Hematopoietic and Lymphoid Neoplasm Coding Manual 1 In Appreciation NCI SEER gratefully acknowledges the dedicated work of Drs, Charles Platz and Graca Dores since the inception of the Hematopoietic project. They continue to provide support. We deeply appreciate their willingness to serve as advisors for the rules within this manual. The quality of this Hematopoietic project is directly related to their commitment. NCI SEER would also like to acknowledge the following individuals who provided input on the manual and/or the database. Their contributions are greatly appreciated. • Carolyn Callaghan, CTR (SEER Seattle Registry) • Tiffany Janes, CTR (SEER Seattle Registry) We would also like to give a special thanks to the following individuals at Information Management Services, Inc. (IMS) who provide us with document support and web development. • Suzanne Adams, BS, CTR • Ginger Carter, BA • Sean Brennan, BS • Paul Stephenson, BS • Jacob Tomlinson, BS Hematopoietic and Lymphoid Neoplasm Coding Manual 2 Dedication The Hematopoietic and Lymphoid Neoplasm Coding Manual (Heme manual) and the companion Hematopoietic and Lymphoid Neoplasm Database (Heme DB) are dedicated to the hard-working cancer registrars across the world who meticulously identify, abstract, and code cancer data. -
CP1733 Add Primary Anatomic Structure Context Group
34 CP-1733 - Add Primary Anatomic Structure Context Group for Anatomic Pathology Page 1 1 Status Assigned 2 Date of Last Update 2019/10/27 3 Person Assigned David Clunie 4 mailto:[email protected] 5 Submitter Name David Clunie 6 mailto:[email protected] 7 Submission Date 2017/08/19 8 Correction Number CP-1733 9 Log Summary: Add Primary Anatomic Structure Context Group for Anatomic Pathology 10 Name of Standard 11 PS3.3, PS3.6, PS3.16 12 Rationale for Correction: 13 The Whole Slide Imaging (and other IODs) use the Specimen Module, which includes Primary Anatomic Structure without specifying 14 a Context Group to use. 15 Specify an appropriate Context Group. Use it as Baseline rather than Defined to allow the use of other coding schemes for the same 16 concepts. 17 [Ed.Note.: A first pass at populating the necessary codes for histopathology was made by taking all the topography sites mentioned 18 in ICD-O-2 and canonicalizing, sorting and unifying them. These have not yet been matched to existing codes used in the standard 19 or other sources, but will be, pending feedback on each concepts appropriateness in the list (or otherwise). In addition, "umbilical 20 cord" was added manually. and used to illustrate a potential mapping.] 21 [Ed.Note.: We probably do not want to just reuse, as opposed to include, CID 4031 Common Anatomic Regions, since there will be 22 specific structures that are commonly sampled but not used as radiology imaging regions. Conversely, there may be may regions 23 in CID 4031 that are radiology-specific and we might not want to re-use. -
The Cisterna Chyli and Thoracic Duct in Pigs (Sus Scrofa Domestica)
Original Paper Veterinarni Medicina, 55, 2010 (1): 30–34 The cisterna chyli and thoracic duct in pigs (Sus scrofa domestica) M. Duras Gomercic1, T. Trbojevic Vukicevic1, T. Gomercic1, A. Galov2, T. Fruk3, H. Gomercic1 1Faculty of Veterinary Medicine, University of Zagreb, Croatia 2Faculty of Science, University of Zagreb, Croatia 3Veterinary Station of Varazdin, Croatia ABSTRACT: Anatomical variations of the thoracic duct course are common in humans and domestic animals. They are important in thoracic surgery and in application of surgical techniques in experimental animals. The pig is a frequently used animal model due to numerous similarities between human and porcine anatomy and physiology. We revealed the position of the cisterna chyli, and the origin, course and termination of the thoracic duct by fine dissection on fifteen Yorkshire pig carcasses. The pigs were 2.5 months old with a body mass range from 10 to 15 kg. In this study we present our macroscopic observations. The cisterna chyli and thoracic duct had a common position, form and course in ten (67%) specimens. Anatomical variations of the precardiac course of the thoracic duct were observed in five animals (33%). Knowledge of these anatomical features should enhance the use of swine as an experimental model. Keywords: anatomy; lymphatic system; swine The thoracic duct is the chief collecting vessel due to numerous similarities between human and of the lymphatic system (Sisson and Grossman, porcine anatomy and physiology. The use of pigs 1956). It conveys lymph from the cisterna chyli to for teaching purposes in medicine and surgery has the venous angle (Vollmerhaus, 1981). The cisterna increased greatly in recent years, because they are chyli receives lymph from the abdomen, pelvis and tractable, readily available from commercial sup- hindlimbs. -
ANATOMIC and PATHOLOGIC ASSESSMENT of FELINE LYMPH NODES USING COMPUTED TOMOGRAPHY and ULTRASONOGRAPHY Mauricio Tobón Restrepo
ADVERTIMENT. Lʼaccés als continguts dʼaquesta tesi queda condicionat a lʼacceptació de les condicions dʼús establertes per la següent llicència Creative Commons: http://cat.creativecommons.org/?page_id=184 ADVERTENCIA. El acceso a los contenidos de esta tesis queda condicionado a la aceptación de las condiciones de uso establecidas por la siguiente licencia Creative Commons: http://es.creativecommons.org/blog/licencias/ WARNING. The access to the contents of this doctoral thesis it is limited to the acceptance of the use conditions set by the following Creative Commons license: https://creativecommons.org/licenses/?lang=en Doctorand: Mauricio Tobón Restrepo Directores: Yvonne Espada Gerlach & Rosa Novellas Torroja Tesi Doctoral Barcelona, 29 de juliol de 2016 This thesis has received financial support from the Colombian government through the “Francisco José de Caldas” scholarship program of COLCIENCIAS and from the Corporación Universitaria Lasallista. DEDICATED TO A los que son la razón y la misión de esta tesis… LOS GATOS. A mis padres y hermanos. A Ismael. Vor mijn poffertje. ACKNOWLEDGMENTS Tal vez es la parte que se pensaría más fácil de escribir, pero sin duda se juntan muchos sentimientos al momento de mirar atrás y ver todo lo que has aprendido y todas las personas que han estado a tu lado dándote una palabra de aliento… y es ahí cuando se asoma la lágrima… Sin duda alguna, comienzo agradeciendo a los propietarios de todos los gatos incluidos en este estudio, sin ellos esto no habría sido posible. A continuación agradezco a mis directoras de tesis, la Dra. Rosa Novellas y la Dra. Yvonne Espada. Muchas gracias por creer en mí, por apoyarme y por tenerme tanta paciencia. -
M. H. RATZLAFF: the Superficial Lymphatic System of the Cat 151
M. H. RATZLAFF: The Superficial Lymphatic System of the Cat 151 Summary Four examples of severe chylous lymph effusions into serous cavities are reported. In each case there was an associated lymphocytopenia. This resembled and confirmed the findings noted in experimental lymph drainage from cannulated thoracic ducts in which the subject invariably devdops lymphocytopenia as the lymph is permitted to drain. Each of these patients had com munications between the lymph structures and the serous cavities. In two instances actual leakage of the lymphography contrrult material was demonstrated. The performance of repeated thoracenteses and paracenteses in the presenc~ of communications between the lymph structures and serous cavities added to the effect of converting the. situation to one similar to thoracic duct drainage .The progressive immaturity of the lymphocytes which was noted in two patients lead to the problem of differentiating them from malignant cells. The explanation lay in the known progressive immaturity of lymphocytes which appear when lymph drainage persists. Thankful acknowledgement is made for permission to study patients from the services of Drs. H. J. Carroll, ]. Croco, and H. Sporn. The graphs were prepared in the Department of Medical Illustration and Photography, Dowristate Medical Center, Mr. Saturnino Viloapaz, illustrator. References I Beebe, D. S., C. A. Hubay, L. Persky: Thoracic duct 4 Iverson, ]. G.: Phytohemagglutinin rcspon•e of re urctcral shunt: A method for dccrcasingi circulating circulating and nonrecirculating rat lymphocytes. Exp. lymphocytes. Surg. Forum 18 (1967), 541-543 Cell Res. 56 (1969), 219-223 2 Gesner, B. M., J. L. Gowans: The output of lympho 5 Tilney, N. -
Board Review for Anatomy
Board Review for Anatomy John A. McNulty, Ph.D. Spring, 2005 . LOYOLA UNIVERSITY CHICAGO Stritch School of Medicine Key Skeletal landmarks • Head - mastoid process, angle of mandible, occipital protuberance • Neck – thyroid cartilage, cricoid cartilage • Thorax - jugular notch, sternal angle, xiphoid process, coracoid process, costal arch • Back - vertebra prominence, scapular spine (acromion), iliac crest • UE – epicondyles, styloid processes, carpal bones. • Pelvis – ant. sup. iliac spine, pubic tubercle • LE – head of fibula, malleoli, tarsal bones Key vertebral levels • C2 - angle of mandible • C4 - thyroid notch • C6 - cricoid cartilage - esophagus, trachea begin • C7 - vertebra prominence • T2 - jugular notch; scapular spine • T4/5 - sternal angle - rib 2 articulates, trachea divides • T9 - xiphisternum • L1/L2 - pancreas; spinal cord ends. • L4 - iliac crest; umbilicus; aorta divides • S1 - sacral promontory Upper limb nerve lesions Recall that any muscle that crosses a joint, acts on that joint. Also recall that muscles innervated by individual nerves within compartments tend to have similar actions. • Long thoracic n. - “winged” scapula. • Upper trunk (C5,C6) - Erb Duchenne - shoulder rotators, musculocutaneous • Lower trunk (C8, T1) - Klumpke’s - ulnar nerve (interossei muscle) • Radial nerve – (Saturday night palsy) - wrist drop • Median nerve (recurrent median) – thenar compartment - thumb • Ulnar nerve - interossei muscles. Lower limb nerve lesions Review actions of the various compartments. • Lumbosacral lesions - usually -
Anatomy and Physiology in Relation to Compression of the Upper Limb and Thorax
Clinical REVIEW anatomy and physiology in relation to compression of the upper limb and thorax Colin Carati, Bren Gannon, Neil Piller An understanding of arterial, venous and lymphatic flow in the upper body in normal limbs and those at risk of, or with lymphoedema will greatly improve patient outcomes. However, there is much we do not know in this area, including the effects of compression upon lymphatic flow and drainage. Imaging and measuring capabilities are improving in this respect, but are often expensive and time-consuming. This, coupled with the unknown effects of individual, diurnal and seasonal variances on compression efficacy, means that future research should focus upon ways to monitor the pressure delivered by a garment, and its effects upon the fluids we are trying to control. More is known about the possible This paper will describe the vascular Key words effects of compression on the anatomy of the upper limb and axilla, pathophysiology of lymphoedema when and will outline current understanding of Anatomy used on the lower limbs (Partsch and normal and abnormal lymph drainage. It Physiology Junger, 2006). While some of these will also explain the mechanism of action Lymphatics principles can be applied to guide the use of compression garments and will detail Compression of compression on the upper body, it is the effects of compression on fluid important that the practitioner is movement. knowledgeable about the anatomy and physiology of the upper limb, axilla and Vascular drainage of the upper limb thorax, and of the anatomical and vascular It is helpful to have an understanding of Little evidence exists to support the differences that exist between the upper the vascular drainage of the upper limb, use of compression garments in the and lower limb, so that the effects of these since the lymphatic drainage follows a treatment of lymphoedema, particularly differences can be considered when using similar course (Figure 1).