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Guidelines for determining tions discount 20mg cialis sublingual overnight delivery erectile dysfunction treatment in kl, shorter length of stay purchase 20mg cialis sublingual with mastercard most effective erectile dysfunction pills, and lower costs compared which patients are candidates for surgical intervention to facilities with fewer than 50 cases annually [97] discount cialis sublingual 20mg overnight delivery erectile dysfunction causes young males. Turk weight; ideal weight is based on the 1983 M etropolitan Restrictive techniques are generally less diffcult to Life Insurance height and weight tables’ determination perform than malabsorptive techniques with fewer of the weight associated with the longest life expec- long-term complications but may result in less weight tancy [98] cheap cialis sublingual 20 mg otc erectile dysfunction net doctor. Typically an open procedure, the vertical Three main categories of bariatric surgery exist – banded gastroplasty is performed by stapling off the malabsorptive, restrictive, and combined restrictive fundus parallel to the lesser curvature and applying a and malabsorptive procedures [99]. M alabsorptive sur- band to narrow the distal opening of this small com- geries cause a reduced absorption of calories and nutri- partment (~50 mL) into the body of the stomach. Resultant weight loss adjustable gastric banding procedure, the upper 5% of from malabsorptive techniques often comes with nutri- the stomach is partitioned off using an infatable, sili- tional defcits including protein, vitamin, and mineral cone band. A gastric pouch of approximately 20 mL is insuffciencies that must be medically managed long- created by infating the band using a subcutaneous term. This band can be adjusted by the physician at ity of the stomach to store food, thereby inducing offce visits to accommodate the needs of the patient, satiety earlier in the meal, which results in reduced and periodic adjustments may be necessary up to six energy intake. Four currently recommended sur- bariatric surgery worldwide [91] and has both restric- gical options – biliopancreatic diversion with/without tive and malabsorptive features. In the restrictive com- duodenal switch, vertical banded gastroplasty, laparo- ponent, a 15–25 mL gastric pouch is divided from the scopic adjustable gastric banding, and gastric bypass – distal stomach with four rows of staples or completely are used worldwide. Continuity of the pouch with the jejunum is the biliopancreatic diversion with/without duode- re-established using a Roux-Y limb, incorporating a nal switch is the least commonly performed bariatric malabsorptive element as the distal stomach, duode- procedure among the four [101] and is considered a num and part of the proximal jejunum are bypassed. Empirical evidence suggests that this sorption is controlled by the length of the common surgery results in decreased plasma levels of the hor- limb. W ith the duodenal switch, the pylorus is mone ghrelin [102, 103], mainly secreted in the fun- preserved using a vertical-sleeve gastrectomy, and a dus of the stomach and known to stimulate appetite duodeno-ileostomy is created. Surgical treatment of obesity results in substantial the vertical banded gastroplasty and laparoscopic weight loss that is largely maintained by patients and adjustable gastric banding are restrictive techniques leads to amelioration or even resolution of co-morbidities where a small upper gastric compartment is constructed [100] as well as decreased mortality [105]. Swedish Obesity Study is a large, prospective trial that 5 Assessment and Treatment of Excess Weight 39 compared bariatric surgery patients with matched, (67 lb) that has been maintained for 5. Although low in fat, regularly self-monitoring weight and food weight loss peaked at 1–2 years, long-term weight loss intake [112], limiting the variety of foods eaten [113], outcomes from bariatric surgeries at 15 years were eating breakfast [114], and restricting time spent 27 ± 12%, 18 ± 11%, and 13 ± 14%, for gastric bypass, watching television [115]. Factors associated with vertical banded gastroplasty, and gastric banding, weight regain in this group have included a greater ini- respectively; the mean 15-year weight change among tial weight loss, shorter period of time in weight main- the control group was ±2% [106]. Lifelong adjust- tenance and psychological factors like depressive ments in eating behaviors and medical supervision are symptoms, increases in disinhibition (vulnerability to essential following these surgical procedures, however, loss of control over eating), and decreases in eating and patients need to be counseled about the lifestyle restraint (conscious control of eating) [111, 115, 116]. Two elements of weight loss treatment have Long-term maintenance of lost weight has remained been noted as particularly beneficial for weight the Achilles heel of weight loss treatment as approxi- loss maintenance – pharmacotherapy and physical mately one third of weight lost among patients treated activity. Both sibutramine and orlistat, combined with with lifestyle modifcation is regained by the frst year dietary modifcation and caloric defcit, have been after treatment [107]. Average 4-year weight losses repeatedly shown to be effcacious in promoting long- approximate 1. The greatest challenge in obesity treatment for that received 15 mg of the drug continuously (−3. The intermittent sibutramine group received sustain the weight loss they have achieved. Turk Physical activity has been frequently highlighted as of encouragement for motivation and support [131]. A made by an individual who is known to the patient contributing factor to the need for physical activity has [133]. Additionally, a practitioner could suggest that a been labeled the energy gap [127]. Some experts believe that, Obesity and overweight are chronic conditions with in the current obesogenic environment promoting less- numerous adverse health effects that require direct, than-healthful foods in large portions, increasing ongoing attention by the health care provider. The goals energy expenditure through physical activity is an eas- of weight loss treatment are improved overall health and ier way to fll this energy gap [127]. Current frst-line treatment consists of physical activity for maintenance of weight loss of lifestyle modifcation that includes dietary, physical remains somewhat unclear however, because most evi- activity, and behavioral therapy, with pharmacotherapy dence does not come from randomized controlled and bariatric surgery as subsequent weight loss modali- trials [49]. The treatment of this chronic disor- among individuals who had lost at least 10% of their der requires a multidisciplinary approach including original weight and maintained that loss for 24 months, health professionals with expertise in nutrition, exercise, physical activity levels were 275 min per week; and possibly clinical psychology as members of the others have noted similar fndings with this level of comprehensive, weight management health care team activity at 2 years after a very-low-calorie diet [129]. Health care providers have a major part imately 60 min of daily, moderate-intensity physical in helping this ever-increasing subgroup of patients suc- activity, like brisk walking for 4 miles [49]. Although cessfully lose and maintain weight so that patients can these levels of physical activity may be challenging for continue to beneft from the physical and psychological many patients to maintain, they seem to be associated effects of a lower body weight. W ith weight loss typically peaking at 6 months after initiation of a behavioral lifestyle treatment plan [130], References a weight maintenance plan should be introduced at this time. National Institutes of Health (1998) Clinical guidelines on the identifcation, evaluation, and treatment of overweight sustained, frequent contact with the health care practi- and obesity in adults-the evidence report. Obes Res 6(suppl tioner who provides ongoing support, instruction, and 2):51S–209S health monitoring are recommended to promote long- 2. These visits might the obesity pandemic: W here have we been and where are we going? Obes Res 12(suppl 2):88S–101S be handled via an offce nurse, allowing patients to 3. Retrieved from http:// W -C (2004) Body mass index and obesity-related metabolic www. Kushner’s personality Eriksen M P (2009) Are Asians at greater mortality risks for type diet. Public Health Nutr 12(4):497–506 questionnaire and a food diary in a short-term recall situa- 11. J Am Diet Assoc 87(10):1374–1377 the Study of Obesity & International Obesity Task Force 25. A statement for professionals from the American Cancer and Nutrition in Norfolk cohort: a population-based Heart Association Council on Nutrition, Physical Activity, prospective study. Circulation 116(25):2933–2943 and M etabolism: endorsed by the American College of 15. Obesity 14(2):336–341 gers are associated with better short- and long-term weight 16. Prev M ed 39(3):612–616 A, Heshka S (2005) Race-ethnicity-specifc waist circum- 30. M iller W R, Rollnick S (1991) M otivational interviewing ference cutoffs for identifying cardiovascular disease risk preparing people to change addictive behavior. M ed Sci Sports Exerc 41(2):459–471 on hunger, appetite, and weight loss in obese men feeding ad 50. N Engl J M ed 348(21):2074–2081 adherence, weight loss, and ftness in overweight women: a 37. Centers for Disease Control and Prevention (2010) Physical (2010) Long-term effects of low-carbohydrate versus low- activity statistics, 1988–2008 no-leisure time physical activ- fat diets in obese persons. Patient Prefer Adherence 3:151–160 for weight loss in obese patients with type 2 diabetes mellitus: 62. Arch Intern M ed 167:1277–1283 nology to deliver a behavioral weight loss program. N Engl J M ed 353(20): updated recommendation for adults from the American 2111–2120 5 Assessment and Treatment of Excess Weight 43 64. J Abnorm Psychol 78(1):107–126 Human Services interim public health recommendations.
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It produces an extended pressor response best 20mg cialis sublingual erectile dysfunction medication nz, stimulates having two chains of the triad structure lying side by side in release of aldosterone order 20 mg cialis sublingual with visa impotence propecia, inhibits release of renin cheap 20 mg cialis sublingual amex erectile dysfunction bathroom, and impairs a staggered fashion in such a way that two terminal nodules renal excretion buy cheap cialis sublingual 20mg line erectile dysfunction treatment las vegas. It is elevated in myocardial infarction and are associated with the central nodule of a third molecule. Gly Gly Gly α-Chain Y Y Y polymer thus formed is stabilized under the action of a fbrin- X X X stabilizing factor, another component of the coagulation sys- tem. Fibrin itself is also cleaved by plasmin into similar but includes a 400-kDa α heavy chain and two 200-kDa light shorter fragments collectively designated fbrin degradation chains designated β-1 and β-2. Of course, any excess of such fragments will impair molecule is arranged in the form of a cross. The domain the normal coagulation process—an event with serious clini- structures of the α and β chains resemble one another. Laminins have biological functions and fbrinolytic proteins and with C5b67 complex to block its characteristics that include facilitation of cellular adhe- insertion into lipid membranes. It decreases nonselective lysis of Laminins also facilitate neurite regeneration, an activity autologous cells by insertion of soluble C5b67 complexes associated with the foot of the molecule. In plasma, 65-kDa and 75-kDa glycoproteins that facilitate adherence of cells as well as the ability of cells to spread and to differentiate are known as serum spreading factors. The structure consists of a triple helix of 95-kDa polypeptides forming a tropo- collagen molecule that is resistant to proteases. Several types of collagen have been described and most of them can be cross-linked through lysine side chain. It facilitates epithelial tissue differentiation and consists of six 210-kDa proteins that are all alike. They all consist of two proteoglycan polypeptide chains; the larger of these chains (α) is different binding site for each member of the family; the smaller chain (β) is com- figure 2. It is present on leukocytes, monocytes, macrophages, and ucts, even though they possess a high degree of homology. It is associated with the development or A human T lymphocyte encircled by a ring of sheep stabilization of synapses. S-laminin is homologous to the β-1 red blood cells is referred to as an E rosette. Laminin facilitates cell attachment and used previously as a method to enumerate T lymphocytes migration. Its function appears to be for attach- lymphocytes to exit the blood circulation and circulate into ment of cells and for the outgrowth of neurites. It T and B lymphocytes, natural killer cells, macrophages, mediates neutrophil rolling on the endothelium. Ligands are sialylated Lewis X and related node homing via binding to high endothelial venules, pre- glycans. P-selectins are involved in the binding of leuko- sentation of chemokines or growth factors to migrating cells, cytes to endothelium and platelets to monocytes in areas of and growth signal transmission. Weibel-Palade bodies are P-selectin granules found in Many cancer cells and their metastases express high levels of endothelial cells. It may be used as a diagnostic or prognostic marker surface following activation of an endothelial cell by such for selected human malignant diseases. Cytoplasmic domains of cadherins may interact interaction with monocytes and neutrophils. L-selectin is also Naive T Cell found on neutrophils where it acts to bind the cells to acti- vated endothelium early in the infammatory process. Lymphocytes from Peyer’s patches home to mucosal endothelial cells bearing ligands for the lymphocyte homing receptor. Thus, endothelial cell addressins in separate ana- tomical locations bind to lymphocyte homing receptors leading to organ-specifc lymphocyte homing. The structure of chemotactic factors and even the active region in their mol- ecules have been determined in many instances. However, advances in the clarifcation of their mechanism of action have been facilitated by the use of synthetic oligopeptides with chemotactic activities. The specifcity of such compounds Micropore filter depends both on the nature of the amino acid sequence and the position of amino acids in the peptide chain. Positively charged His and negatively charged Glu in this position are signifcantly less active, sub- stantiating the role of a neutral amino acid in the second posi- Chemotactic tion at the N-terminal. Neutrophil chemoattractants also include bac- Downregulation or mutation of the E-cadherin/catenin genes terial products such as N-formyl methionyl peptides, fbrin- can disrupt intercellular adhesion, which may lead to cellular olysis products, oxidized lipids such as leukotriene B4, and transformation and tumor progression. These chemotactic factors are derived from both infamma- These cells move into infammatory agents by chemotaxis. The of monocytes in various pathologic or physiologic condi- number of cells on the flter separating the cell chamber from tions. Neutrophil chemotaxis assays are performed using the the chemotaxis chamber refects the chemotactic infuence of microchamber technique. Chemotactic factors include substances of both endogenous Chemotactic receptors are specifc cellular receptors for and exogenous origin. In bacteria, such receptors are desig- products of tissue injury, chemical substances, various pro- nated sensors and signalers and are associated with various teins, and secretory products of cells. The cellular receptors for chemot- among them are those generated from complement and actic factors have not been isolated and characterized. This name is related to their leukocytes, the chemotactic receptor appears to activate concurrent ability of stimulating the release of mediators a serine proesterase enzyme, which sets in motion the from mast cells. Some chemotactic factors act specifcally sequence of events related to cell locomotion. Others have a appear specifc for the chemotactic factors under consider- broader spectrum of activity. Many of them have additional ation, and apparently the same receptors mediate all types activities besides acting as chemotactic factors. It has been found in chicken cal events leading to one or another type of response. Using a fbroblasts and mononuclear cells, yet no human or murine synthetic peptide N-formyl-methionyl-leucyl-phenylalanine, homolog is known. The presence of spare receptors may enhance the in wounded tissues suggests that it has a role in the wound sensitivity in the presence of small concentrations of chemo- response and/or repair. Tissue sources include epithelial Chemokinesis refers to the determination of the rate of cells and platelets. A chemotactic peptide is a peptide that attracts cell migra- A Boyden chamber (Figure 2. The two chambers in the apparatus are separated by a micropore fl- Chemotactic deactivation represents the reduced chemo- ter. The cells to be tested are placed in the upper chamber and tactic responsiveness to a chemotactic agent caused by prior a chemotactic agent such as F-met-leu-phe is placed in the incubation of leukocytes with the same agent but in the lower chamber.
Rhytids in the glabella buy cialis sublingual 20 mg mastercard erectile dysfunction generic drugs, the infux of solution into the cells with possible rup- nasolabial fold buy cheap cialis sublingual 20 mg on line erectile dysfunction onset, and marionette lines can be improved cialis sublingual 20mg otc impotence gandhi. Loss of fat volume (the most frequent problem) There are very few serious complications of autolo- 2 purchase cialis sublingual 20 mg on-line erectile dysfunction treatment in kolkata. Swelling (especially with over injection) the harvesting of large amounts of fat using liposuc- 5. Prolonged erythema (usually temporary over a short donor area but facial fat transfer is usually with small period of time) 31 Facial Augmentation with Autologous Fat 353 a1 a2 a3 b1 b2 c1 c2 c3 Fig. M icrocalcifcations (has not been reported in the body’s cellulite with three 5 mm incisions. Fischer A, Fischer G (1977) Revised technique for cellulitis fat reduction in riding breeches deformity. Bull Int Acad sight from retinal artery occlusion (can occur with Cosm Surg 2(4):40–43 injection in the glabellar or nasal areas) 18. Plus all of the problems following liposuction if a Congress of Plastic Surgery, Tokyo, Feb 1982 large amount of fat is removed 19. Second Asian Congress of Plastic Surgery, Pattiyua, Thailand, Feb 1984 Autologous fat transfer has been a very successful 22. If care is taken in the transfer 4(2):123–129 process and postoperatively, there will be 40–60% fat 23. Verderame P (1909) Ueber fettransplantation bei adharenten third fat transfer (using the patient’s frozen fat) may be knochennarben am orbitalran. Czerny M (1895) Plastischer Ersatz der brusterlruse durch & Co, New York, p 74 ein lipom. Hilse A (1928) Histologische ergebuisse der experimentellen 47:433–442 freien fettgewebstronsplantation. W ertheimer E, Shapiro B (1948) the physiology of adipose M ed Belgique 28:440 tissue. Niechajev I, Sevchuk O (1994) Long-term results of fat Survival of autologous fat grafts in humans and mice. Asken S (1987) Autologous fat transplantation: micro and cylinder transplantation: an experimental comparative study macro techniques. Bircoll M (1988) Autologous fat transplantation: an evalua- controlled demonstrations. Plast Reconstr Surg 101(7):1940–1944 status of free fat graft autotransplantation in plastic and 67. Anat Rec 124(4):723–739 (1990) Comparative study of survival of autologous adipose 72. Hiragun A, Sato M , M itsui H (1980) Establishment of tissue taken and transplanted by different techniques. Chajchir A, Benzaquen I, M oretti E (1993) Comparative fate of suctioned and surgically removed fat after reimplan- experimental study of autologous adipose tissue processed tation for soft-tissue augmentation. Brandow K, Newman J (1996) Facial multilayered micro 87(2):219–227 lipo-augmentation. Berdeguer P (1995) Five years of experience using fat for volume suction lipectomy: an analysis of 108 patients. Scand J Plast Reconstr surg consideration in fat transfer: a possible role for maintaining Hand Surg 26(1):33–36 interstitial protein to reduce shrinkage of transferred volume. M arcel Bioactivation of free-fat transfers: a potential new approach Dekker, Inc. Shiffman M A (2000) Effect of various methods of fat 1022–1030 harvesting and reinjection. Aesthetic Plast Surg 17(1):43–47 Face and Neck Remodeling with 32 Ultrasound-Assisted Lipoplasty (Vaser) Alberto Di Giuseppe and George Commons 32. To contour diffcult areas such as the mandible border, the neck line, and the chin. To access to facial surgery even patients who refused the author has utilized internal ultrasound solid probe major open surgery operations, which normally to face and neck since 1996 in order to defat heavy faces leads to a longer recovery time. W hen utilizing the solid probe in the face, the power administrated was 30% of the total potential of the ultrasound tool in order to reduce undesired side effects of ultrasound energy 32. To reduce numbers and extension of scars of the the harmonic lift can be used in young patients with fatty face for remodeling procedures of face and neck. Each patient is evaluated as to the aims tially the majority of facial contouring surgery. To induce skin retraction, in face and neck, even in commissural folds, jowls, and waddle neck. Face and neck lift in Fitzpatrick type 4–6, thus minimal trauma by utilizing a solid probe and the avoiding keloid formation and postinfammatory ultrasound energy instead of an open approach and hyper pigmentation that may occur with skin reju- a scalpel. Young patients who require only treatment of device, able to emulsify fat in specifc target, with a chubby cheeks and double chin. To achieve dermal stimulation and retraction in the School of M edicine, University of Ancona, neck beyond areas amenable to laser resurfacing. A blunt-tipped, 14-gauge cannula is used to Other indications include rhytids in the malar area, infltrate the subcutaneous tissues of the neck, jowls, crow’s feet, frontal, nasolabial, glabella (horizontal and cheeks, temple, and brow. Digital pressure aids in vertical), and neck as well as descent of the cheek fat, directing and expanding the fuid evenly. The areas include frontal from the hairline to the undermining, the vectors of muscle tension, relaxation brow, glabella, dorsum of the nose, temple, lateral canthal creases and folds, and crisscrossing lines of tunneling region (crow’s feet), cheeks to nasolabial grooves, chin, and dermal stimulation. Incisions are placed at differ- jowls, and anterior neck from chin to sternal notch (ante- ent sites to allow ease of access depending on the rior triangles). In the forehead incisions are the tip of the probe tents the skin while it is withdrawn. The skin allel to the hairline while submental incisions are at the softens and smoothes following use of the probe. Preauricular incisions are made at the sequence of dissection starts with the submen- the earlobe and upper and lower eyelid incisions are at tal area and neck from the submental and earlobe inci- blepharoplasty sites. The probe is then used over the mandible, cheek nique reduces bleeding and bruising and decreases and temple reaching the nasolabial fold, side of the surgical time. M odifed Klein’s solution [2] used nose, and the crow’s feet in a radiating fashion through contains 1,000 mL of normal saline with 1 mL the earlobe incision. Intravenous access to the glabella and central portion of the fore- sedation is generally utilized but when general head releasing the cutaneous insertion of the corruga- anesthesia is used with lidocaine it is reduced to tor and procerus muscles without altering skin 200 mg and sodium bicarbonate is eliminated. The rest of the forehead is dissected through Approximately 350–500 mL of solution is utilized on a separate hairline incision (Fig. Patients may seek good predictable aesthetic outcome (contouring of the neck/jowls) with maximum safety, fast recovery, and minimum down-time.
Lymph flows from afferent lymphatics to subcapsular system: in the respiratory system the aggregations are sinus generic cialis sublingual 20mg free shipping erectile dysfunction psychological treatment techniques, and then along trabeculae to the cortical and relatively small and are present in the walls of the tra- medullary sinuses buy 20mg cialis sublingual with visa erectile dysfunction doctors in utah, and exits via efferent lymphatics chea and large bronchi buy cialis sublingual 20 mg with mastercard erectile dysfunction at age 50. Thus order 20 mg cialis sublingual with visa muse erectile dysfunction medication reviews, lymph nodes filter the lymph that flows through Mucosa associated lymphoid tissue in the alimentary it (Clinical Box 18. Parenchyma contains splenic pulps made up of white Lymphadenopathy indicates infection in the area: Lymph nodes pulp and red pulp. Red pulps are present around the draining a particular area get enlarged in response to infection or white pulps (Figs. It consists indicates infection, tumor or malignancy in the mammary gland, especially in females, and submandibular lymphadenopathy in throat of lymphoid nodule containing B cells, central artery infections. It is surrounded by a capsule made up of elastic and organized as splenic cords separated by venous sinu- smooth muscle fibers. The arrange- ment of splenic circulation (open and closed circula- tion) in the red pulp and location of the sinusoids help in filtering senescent and abnormal cells (Fig. Larger aggregations extend into the cells are detected and destroyed in the pulp, invariably, splenectomy submucosa. Individual lymphocytes may infiltrate the leads to increased cell count and splenomegaly results in decreased epithelium and may pass through it into the mucosa. Spleen plays important role in immunity (Clinical Box • As a rule these masses of lymphoid tissue do not 18. Macrophages in spleen help in phagocytosis of receive afferent lymph vessels, and have no lymph pathogens or antigens. Germinal centers in the spleen However, they are centers of lymphocyte production. Spleen also Lymphocytes produced here pass into lymph nodes of helps in production of antibodies. Spleen removes old and abnormal red cells, white lymphocytes pass through the overlying epithelium cells and platelets. Spleen helps in hepatic stage of hemopoiesis during Mucosa-associated Lymphoid Tissue intrauterine life. Extramedullary hemopoiesis takes place in Respiratory System in spleen in postnatal life in pathological conditions. Spleen acts as an important reservoir of blood in In the respiratory system the aggregations are relatively mammals. Also, in chronic In the alimentary system examples of aggregations of parasitic infections like malaria and kala azar, spleen is enlarged as lymphoid tissue are tonsils, Peyer’s patches and lymphoid spleen fights against such abnormalities. Suspended in lymph there are cells that are chiefly in relation to the mucosa of the respiratory, alimentary lymphocytes. Large mol- more or less equal to that of the lymphoid tissue present ecules of fat (chylomicrons) that are absorbed from the in lymph nodes and spleen. After a fatty meal these tions of lymphoid tissue have some features in common fat globules may be so numerous that lymph become as follows: milky (is called chyle). Under these conditions the lymph • These aggregations are in the form of one or more vessels can be seen easily as they pass through mesen- lymphatic follicles (nodules) having a structure similar tery. Diffuse lymphoid tissue (termed the parafol- Functional Anatomy licular zone) is present in the intervals between the nodules. The significance of the nodules and of the Lymphatics drain lymph from different tissues of the body diffuse aggregations of lymphocytes is the same as and empty the same into the subclavian veins at their already described in the case of lymph nodes. Lymphatic vessels typically begin as blind tubular area consists of T lymphocytes. For example, in the close relationship to the lining epithelium of the intestine, villous lacteals are lymphatic bulbs. Movement of fluid in them is facilitated by contraction of organs in which they are present and the contraction of arterioles and venules with which they are often associated. Note, there is no valve Collecting Lymphatics in initial lymphatics, but the valves are present in collecting lym phatics. Black arrows indicate the direction of flow of fluid move Collecting lymphatics are tubular and larger lymphatics. Lymph flow is further facilitated by skeletal muscle con- interconnected lymph vessels and then from these traction, negative intrathoracic pressure (during inspi- vessels into tubular lymphatic vessels and the larger ration), and suction effect created by higher velocity of lymphatic vessels (Fig. Substances that increase lymph flow are called lym- lar to that of smooth muscles of blood vessels. It is formed by Types of Lymphatics transcapillary exchange and exchange between tissue fluid and lymphatic ducts. Lymph flow is much slower Lymphatics are of two types: Initial lymphatics and collect- (1 mL/min in thoracic duct) than blood. Presence of more lipid Initial Lymphatics gives milky color to the lymph, hence called chyle. Initial lymphatics are lymphatic bulbs and interconnected Functions of Lymphatic Circulation vessels (lymphatic capillaries). Extra amount of fluid left in the tissue space by capil- several ways: lary filtration is taken up by lymphatics and returned 1. No fenestrations in endothelium (non-fenestrated) tribute to water content of plasma to some extent. In liver and intestine, a significant quantity of protein absent enters into interstitial space. This protein is returned Initial lymphatics lack valves and smooth muscles in to circulation via lymphatics. Tissue fluid enters into them through gaps or 50% of circulating protein in the blood. Thus, lympha- loose junctions between the endothelial cells present in tics maintain protein content of plasma. Mononuclear phagocytes in lymph nodes remove bac- the active phase of the disease process. Enlarged lymph nodes teria and pathogenic organisms from lymph draining (lymphadenopathy) in a particular part of the body provide clinical clue to the physician to locate the site of infection. Thus, they play protective function submandibular lymph glands indicate infection in the throat (Clinical Box 18. Lymph node, spleen and associated lymphatic tissue are secondary lymphoid organs where the lymphocytes reside and mature. Splenomegaly and lymphadenopathy indicates infection or proliferation of abnormal cells in general. Functions of thymus, functions of spleen, composition and functions of lymph, & lymphatic circulation may come as Short Questions in exams. In Viva, examiners may ask… hormones secreted from thymus, how T cells are developed in thymus, functions of thymus, spleen and lymph node, composition of lymph, and design of lymphatic circulation. Name the primary and secondary lymphoid organs and outline the general principles of immunity. Give the physiological basis of rejection of organ transplants and the prevention of its rejection. List different types of immunotherapy and describe importance of monoclonal antibodies in immunotherapy. The specific defense mechanisms of the body are col- ments that threaten our normal health is the immunity.
