2012 Group 2 Term 2 Project - Lymphatic System - FINAL

4/4/2012
CLASS OF 2012
THE LYMPHATIC SYSTEM
T&T College of Therapeutic Massage and Beauty Culture | Group 2
April 4, 2012
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Team Members Group 2 Class of 2012
NAME Diane Blackman Ricardo Gonzales-Campbell Ivana Hackshaw Usha Harriram Sheila Hilaire Margaret Jones Karrifa Karim Abdul Karem Khan Joanne Yates-Boopsingh
ID 473 479 480 514 481 483 484 485 513
Group 2 / Class of 2012
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Table of Contents
General function of Lymphatic System ......................................................................................................... 7 and Structures ............................................................................................................................................... 7 Organization/Structure ............................................................................................................................. 7 Lymphoid tissue ........................................................................................................................................ 7 Primary lymphoid organs .......................................................................................................................... 7 Secondary lymphoid organs...................................................................................................................... 8 Lymph nodes ......................................................................................................................................... 8 Lymphatics ............................................................................................................................................ 8 Comparison of Immunity types..................................................................................................................... 9 Diseases & Disorders of the Lymphatic System .......................................................................................... 11 Allergies .............................................................................................................................................. 12 Autoimmune diseases ........................................................................................................................ 12 Lymphadenitis .................................................................................................................................... 13 Tonsillitis ............................................................................................................................................. 14 The Immune System - in More Detail ......................................................................................................... 15 Introduction ............................................................................................................................................ 15 The Complement System ........................................................................................................................ 15 Phagocytes .............................................................................................................................................. 15 Lymphocytes - T cells and B cells ............................................................................................................ 16 The development of B-Cells and T-Cells ..................................................................................................... 21 Humoral and Cell-Mediated Immunity ....................................................................................................... 23 The Immune system................................................................................................................................ 23 Humoral Immunity .................................................................................................................................. 23 Cell-mediated immunity ......................................................................................................................... 24 The Mechanisms of Allergy, Autoimmunity and Isoimmunity ................................................................... 25 The Mechanisms of Allergy: .................................................................................................................... 25 The Mechanisms of Autoimmunity:........................................................................................................ 25 The Mechanisms of Isoimmunity: ........................................................................................................... 25 Major Types Of Deficiencies Of The Immune Systems & Their Causes ...................................................... 27 Group 2 / Class of 2012 5
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Introduction to the human immune system........................................................................................... 27 Major types of immunity ........................................................................................................................ 27 Deficiencies Of The Immune Systems ..................................................................................................... 29 Lymphoedema ............................................................................................................................................ 31 Introduction ............................................................................................................................................ 31 Signs and symptoms ............................................................................................................................... 31 Causes ..................................................................................................................................................... 33 Pathophysiology...................................................................................................................................... 34 Diagnosis ................................................................................................................................................. 34 Stages .................................................................................................................................................. 34 Grades ................................................................................................................................................. 35 Treatment ............................................................................................................................................... 36 Compression ....................................................................................................................................... 36 Complete decongestive therapy or manual lymph drainage ............................................................. 37 HOW LONG WILL TREATMENT LAST? ................................................................................................. 40 Before and After Treatment ............................................................................................................... 41 Surgical techniques ............................................................................................................................. 42 Low level laser therapy ....................................................................................................................... 42 Infection Prevention ........................................................................................................................... 43 Complications...................................................................................................................................... 44 Precautions ............................................................................................................................................. 44 General Recommendations .................................................................................................................... 45 Bibliography ................................................................................................................................................ 46 Bibliography ................................................................................................................................................ 46 Massage Therapy :The lymphatic System Indications and Contraindications............................................ 47
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General function of Lymphatic System and Structures

by Usha Harriram
The lymphatic system has multiple interrelated functions: it is responsible for the removal of interstitial fluid from tissues it absorbs and transports fatty acids and fats as chyle from the digestive system it transports white blood cells to and from the lymph nodes into the bones The lymph transports antigen-presenting cells (APCs), such as dendritic cells, to the lymph nodes where an immune response is stimulated. Lymphoid tissue is a specialized connective tissue - reticular connective, that contains large quantities of lymphocytes.
Organization/Structure
The lymphatic system can be broadly divided into the conducting system and the lymphoid tissue. The conducting system carries the lymph and consists of tubular vessels that include the lymph capillaries, the lymph vessels, and the right and left thoracic ducts. The lymphoid tissue is primarily involved in immune responses and consists of lymphocytes[4] and other white blood cells enmeshed in connective tissue through which the lymph passes. Regions of the lymphoid tissue that are densely packed with lymphocytes are known as lymphoid follicles. Lymphoid tissue can either be structurally well organized as lymph nodes or may consist of loosely organized lymphoid follicles known as the mucosa-associated lymphoid tissue (MALT)
Lymphoid tissue
Lymphoid tissue associated with the lymphatic system is concerned with immune functions in defending the body against the infections and spread of tumors. It consists of connective tissue with various types of white blood cells enmeshed in it, most numerous being the lymphocytes. The lymphoid tissue may be primary, secondary, or tertiary depending upon the stage of lymphocyte development and maturation it is involved in. (The tertiary lymphoid tissue typically contains far fewer lymphocytes, and assumes an immune role only when challenged with antigens that result in inflammation. It achieves this by importing the lymphocytes from blood and lymph.[5])
Primary lymphoid organs

The central or primary lymphoid organs generate lymphocytes from immature progenitor cells. The thymus and the bone marrow constitute the primary lymphoid tissues involved in the production and early selection of lymphocytes.
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Secondary lymphoid organs

Secondary or peripheral lymphoid organs maintain mature naive lymphocytes and initiate an adaptive immune response. The peripheral lymphoid organs are the sites of lymphocyte activation by antigen. Activation leads to clonal expansion and affinity maturation. Mature lymphocytes recirculate between the blood and the peripheral lymphoid organs until they encounter their specific antigen. Secondary lymphoid tissue provides the environment for the foreign or altered native molecules (antigens) to interact with the lymphocytes. It is exemplified by the lymph nodes, and the lymphoid follicles in tonsils, Peyer's patches, spleen, adenoids, skin, etc. that are associated with the mucosaassociated lymphoid tissue (MALT). Lymph nodes For more details on this topic, see lymph node. A lymph node showing afferent and efferent lymphatic vessels A lymph node is an organized collection of lymphoid tissue, through which the lymph passes on its way to returning to the blood. Lymph nodes are located at intervals along the lymphatic system. Several afferent lymph vessels bring in lymph, which percolates through the substance of the lymph node, and is drained out by an efferent lymph vessel. The substance of a lymph node consists of lymphoid follicles in the outer portion called the "cortex", which contains the lymphoid follicles, and an inner portion called "medulla", which is surrounded by the cortex on all sides except for a portion known as the "hilum". The hilum presents as a depression on the surface of the lymph node, which makes the otherwise spherical or ovoid lymph node bean-shaped. The efferent lymph vessel directly emerges from the lymph node here. The arteries and veins supplying the lymph node with blood enter and exit through the hilum. Lymph follicles are a dense collection of lymphocytes, the number, size and configuration of which change in accordance with the functional state of the lymph node. For example, the follicles expand significantly upon encountering a foreign antigen. The selection of B cells occurs in the germinal center of the lymph nodes. Lymph nodes are particularly numerous in the mediastinum in the chest, neck, pelvis, axilla (armpit), inguinal (groin) region, and in association with the blood vessels of the intestines.[2] Lymphatics Tubular vessels transport back lymph to the blood ultimately replacing the volume lost from the blood during the formation of the interstitial fluid. These channels are the lymphatic channels or simply called lymphatics.[6]
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Comparison of Immunity types

by Margaret Jones
NON-SPECIFIC AND SPECIFIC IMMUNITY COMPARISON OF: INHERITED AND ACQUIRED IMMUNITY ACTIVE AND PASSIVE IMMUNITY
An immune system is a system of biological structures and processes within an organism that protects against diseases. In order to function properly, an immune system must detect a wide variety of agents from viruses, parasitic worms and distinguish them from healthy tissues. NON-SPECIFIC IMMUNITY is a defense mechanism that works against a wide variety of invaders. This innate immune system is our first line of defense mechanism against invading organisms. The body presents an effective barrier to most organisms and very few infectious agents can penetrate them. It tolerates a number of commensal organisms which compete effectively with many potential pathogens, the bio-chemical and physical that is the bodys defense are; Skin a great physical barrier, like a water proof wall Mucus sticky, germs get stuck in it, it also has an antibody in it Cilia hairs that pass debris up throat and out to the nostrils Lysozyme and enzyme present in tears that break down bacteria Phagocytes various cells that scavenge up and engulf cell debris Commensal bacteria non-harmful bacteria on the skin and gut that leave little or no room for harmful bacteria to attach and limit nutrients for them to grow
The non-specific defense are present in all normal individuals, it is also our second line of defense and also affords protection against re-exposure to the same pathogen. This system is constitutively present and ready to be mobilized upon infection and also alert the specific arm of the immune system to infection.
SPECIFIC IMMUNITY also called adaptive immunity is not present at birth, but it is learned. As a persons immune system encounters foreign substances called antigens, the components of specific immunity learn the best way to attack each antigen and begin to develop a memory for that antigen. Specific immunity, because it remembers a specific antigen it tailors an attack on that particular antigen should it show up again. It takes time for an attack to take place after initial exposure to a new antigen however, because a memory is formed, subsequent response to a previously encountered antigen are more rapid and effective. Lymphocytes are a type of white blood cell responsible for specific immunity, Group 2 / Class of 2012 9
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typically the response begin when antibodies produced by B cells called lymphocytes encounter antigen. Lymphocytes enable the body to remember antigens and to distinguish self from non-self. Lymphocytes circulates in the bloodstream and lymphatic system and move into tissues as needed.
Immunity to disease is classified as inherited or acquired. INHERITED IMMUNITY is the immunity against diseases that affects animals but do not affect humans, because of the immune system that human are born with. An example of a disease that affects animals and do not affect humans, is the disease feline leukemia, it affects cats but do not affect humans.
ACQUIRED IMMUNITY is a form of immunity that is obtained during a person life, it may be naturally or artificially acquired. Naturally acquired immunity is obtained by the development of antibodies resulting from an attack of infectious diseases or by the transmission of antibodies from mother through the placenta to the fetus or to the infant through colostrum and breast milk. Artificially acquired immunity is obtained by a vaccination induced with a substance that contains the antigen, it stimulates a primary response against the antigen without causing symptoms of the disease. An injection of immune gamma globulin which temporarily boost a patients immunity against a disease is also an artificially acquired active immunity.
Natural and Artificial immunity may be active or passive. NATURALLY ACQUIRED PASSIVE IMMUNITY occurs, when the person is exposed to a live pathogen develop the disease and becomes immune as a result of the primary immune response.
ARTIFICIALLY ACQUIRED PASSIVE IMMUNITY occurs, when a person is given a short term immunization by injecting antibodies that is not produced by the recipients cells. Immunology tolerance for foreign antigens can be induced experimentally by creating conditions of high zone tolerance, for example by injecting large amounts of a foreign antigen into the host organism. Another example is injecting a small amount of foreign antigen over long period of time.
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Diseases & Disorders of the Lymphatic System

by Sheila Hilaire
With the network of vessels and nodes that transport and filter lymph fluid containing antibiotics and white blood cells, the lymphatic system is considered to be the first line of defense against any infection or diseases from invading microorganisms. It follows therefore, given the interconnectivity of the system; any breakdown can result in a host of diseases/disorders of the body. The following are a few of the diseases that can impair the lymphatic system or its parts.
HIV & AIDS: Human Immunodeficiency Virus & Acquired Immune Deficiency Syndrome, a disorder caused by a virus (HIV) that infects helper T cells and weakens immune responses. Allergy: An abnormal immune reaction to an otherwise harmless substance. Autoimmune disease: Condition in which the body produces antibodies that attack and destroy the body's own tissues. Graves' disease: Disorder, in which an antibody binds to specific cells in the thyroid gland, forcing them to secrete excess thyroid hormone. Lymphadenitis: Inflammation of lymph nodes. Lymphangitis: Inflammation of lymphatic vessels. Lymphoma: General term applied to cancers of the lymphatic system, which include Hodgkin's lymphoma and non-Hodgkin's lymphomas. Multiple Sclerosis: Disorder in which immune cells attack and destroy the insulation covering nerve fibers in the central nervous system, causing muscular weakness and loss of coordination. Systemic lupus Erythematosus: Lupus or SLE, disorder in which antibodies attack the body's own tissues as if they were foreign. Tonsillitis: Infection and swelling of the tonsils. HIV impairs the body's ability to produce an immune response. Specifically, the virus infects helper T cells. Once inside a helper T cell, HIV can replicate or reproduce within the cell and kill it in ways that are still not completely understood. When the newly formed viruses break out of the dying helper T cell, they continue the cycle by infecting other helper T cells. In response, the body produces more helper T cells, which only provides the virus with more hosts in which to grow and spread. Group 2 / Class of 2012 11
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Because helper T cells play a central role in directing the body's immune response, their destruction brings about a drop in cell-mediated immunity. The number of antibodies produced in the body declines, leaving it defenseless against a wide range of invaders. Many different types of infections and cancers can develop, taking advantage of the body's weakened immune response. These infections, normally harmless when the body is functioning properly, are known as opportunistic infections.
Allergies An allergy is an abnormal immune reaction to an otherwise harmless substance. Normally, when a foreign microorganism enters the body, antibodies are produced to bind to the antigens on the foreign particles, and a series of immune reactions take place. When harmless, everyday substances cause the same series of immune reactions, the condition is known as allergy. The offending substance is called an allergen. Reactions may be to airborne particles (plant pollens, animal fur, house dust, cigarette smoke), food (nuts, eggs, fish, milk), drugs (penicillin or other antibiotics), insect bites (bees, wasps, mosquitoes, fleas), or even materials (wool and latex). Symptoms vary according to type of allergic reaction. In the most common type of reaction, antibodies stimulated by the allergen cause certain cells to release histamine into the surrounding interstitial fluid. Histamine causes small blood vessels in the area to expand and become "leaky." Excess fluid and mucus develop, and symptoms such as a runny nose, a scratchy or irritated throat, and red, watery eyes appear. Other allergens cause reddened, itchy skin, while others affect the digestive track causing swelling and/or tingling in the lips or throat, nausea, cramping, or diarrhea. Anaphylactic shock is the most severe allergic reaction and may lead to death.
Autoimmune diseases Autoimmune diseases are those in which the body produces antibodies and T cells that attack and damage the body's own normal cells, causing tissue destruction. The reaction can either take place in a number of tissues at the same time or in a single organ. The following are just a few of the many types of autoimmune diseases. Graves' disease, also called hyperthyroidism, occurs when an antibody binds to specific cells in the thyroid gland, forcing them to secrete excess thyroid hormone. Symptoms of this condition include weight loss with increased appetite, shortness of breath, tiredness, weak muscles, anxiety, and visible enlargement
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Multiple sclerosis (MS) is a disease in which immune cells attack and destroy the insulation covering nerve fibers in the central nervous system. When the myelin is destroyed, nerve messages are sent more slowly and less efficiently. As a result, the brain and spinal cord no longer communicate properly with the rest of the body. When this occurs, vision, balance, strength, sensation, coordination, and other bodily functions are impaired. Women are twice as likely to get the disease as men. While drugs have slowed the progress of the disease in many patients, there is no cure. Systemic Lupus Erythematosus is a disease in which antibodies begin to attack the body's own tissues and organs as if they were foreign. The cause of SLE is unknown. It can affect both men and women of all ages, but 90 percent of those afflicted are women. Among the many symptoms of the disease are fevers, weakness, muscle pain, weight loss, skin rashes, joint pain, headaches, vomiting, diarrhea, and inflammation of the lining of the lungs or the lining around the heart. Aspirin or ibuprofen is used in the early stages and more severe symptoms are treated with stronger drugs, including steroids. Drugs to decrease the body's immune response may also be used for the severely ill. Lymphadenitis Lymphadenitis is the inflammation of lymph nodes. The cause is often an infection of the nodes by bacteria entering through brakes in the skin, or by a virus. The infection may occur in a limited number of nodes in a specific area or in many nodes over a wider area. If the lymph vessels connecting the affected nodes are also inflamed, that condition is known as lymphangitis. In children, the swollen nodes often appear in the neck because they are close to the ears and throatlocations of frequent bacterial infections in children. Treatment for lymphadenitis and lymphangitis usually involves antibiotics, such as penicillin.
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Lymphomas Lymphoma is a type of cancer in which cells of the lymphatic system (B cells and T cells) become abnormal and begin to grow uncontrollably. Since lymphatic tissue is found throughout the body, lymphomas can occur anywhere. There are many types of lymphomas, but they are generally divided into two main groups: Hodgkin's lymphoma and non-Hodgkin's lymphomas.. Hodgkin's Lymphoma (or Hodgkin's disease) can occur at any age, although people in early adulthood and late adulthood are most affected. The cancer begins in a lymph node causing swelling and pain. In advanced cases of the cancer, the spleen, liver, and bone marrow may also be affected. Symptoms include fatigue, weight loss, night sweats, and itching. As the cancer spreads throughout the body, the immune response becomes less effective. Hodgkin's is usually treated through chemotherapy or radiation therapy or a combination of both. Non-Hodgkin's Lymphomas encompass over twenty-nine types of lymphomas. Again, the exact cause of these lymphomas is unknown. In general males suffer from these cancers more than females. The aged between sixty and sixty-nine are at the highest risk of contracting these lymphomas. Non-Hodgkin's lymphomas also tend to strike people suffering from AIDS. Symptoms for non-Hodgkin's lymphomas are similar to those for Hodgkin's lymphoma. Along with swelling of lymph nodes, patients may experience loss of appetite, weight loss, nausea, vomiting, and pain in the lower back, headaches, fevers, and night sweats. The liver and spleen may enlarge, as well. Immune responses may be weakened. Treatment for non-Hodgkins lymphomas also includes chemotherapy, radiation and in severe cases, bone marrow transplants may be necessary. Tonsillitis Tonsillitis is an infection and swelling of the tonsils. The condition is caused by bacteria or viruses that have entered the body through the mouth or sinuses. In addition to swollen and red tonsils, symptoms include mild or severe sore throat, fever, chills, muscle aches, earaches, and tiredness. While anyone can be afflicted with tonsillitis, the disease is most common in children between the ages of five and ten.
Works Cited Lymphatic System Diseases. Buzzle. Intelligent Life on the Web. 2012, Web. 10 February 2012. Lymphatic Research Foundation Family of Sites. Lymphatic Research Foundation. 2006. Web. 15 February 2012 Thibobeaum, Gary and Kevin Patton. The Human Body in Health& Diseases. St. Louis: Mosby, 20002. Print
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The Immune System - in More Detail

by Joanne Yates-Boopsingh
Introduction
The immune system is one of nature's more fascinating inventions. With ease, it protects us against billions of bacteria, viruses, and other parasites. Most of us never reflect upon the fact that while we hang out with our friends, watch TV, or go to school, inside our bodies, our immune system is constantly on the alert, attacking at the first sign of an invasion by harmful organisms. The immune system is very complex. It's made up of several types of cells and proteins that have different jobs to do in fighting foreign invaders, We will take a look at the parts of the immune system in some detail.
The Complement System
The first part of the immune system that meets invaders such as bacteria is a group of proteins called the complement system. These proteins flow freely in the blood and can quickly reach the site of an invasion where they can react directly with antigens - molecules that the body recognizes as foreign substances. When activated, the complement proteins can -
trigger inflammation attract eater cells such as macrophages to the area coat intruders so that eater cells are more likely to devour them kill intruders
Phagocytes
This is a group of immune cells specialized in finding and "eating" bacteria, viruses, and dead or injured body cells. There are three main types, the granulocyte, the macrophage, and the dendritic cell. Group 2 / Class of 2012 15
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THE LYMPHATIC SYSTEM The granulocytes (also known as Neutrophils ) often take the first stand during an infection. They attack any invaders in large numbers, and "eat" until they die. The pus in an infected wound consists chiefly of dead granulocytes. A small part of the granulocyte community is specialized in attacking larger parasites such as worms. The macrophages ("big eaters") are slower to respond to invaders than
the granulocytes, but they are larger, live longer, and have far greater capacities. Macrophages also play a key part in alerting the rest of the immune system of invaders. Macrophages start out as white blood cells called monocytes. Monocytes that leave the blood stream turn into macrophages.
The dendritic cells are "eater" cells and devour intruders, like the
granulocytes and the macrophages. And like the macrophages, the dendritic cells help with the activation of the rest of the immune system. They are also capable of filtering body fluids to clear them of foreign organisms and particles.
Lymphocytes - T cells and B cells
The lymphatic system
The receptors match only one specific antigen.
White blood cells called lymphocytes originate in the bone marrow but migrate to parts of the lymphatic system such as the lymph nodes, spleen, and thymus. There are two main types of lymphatic cells, T cells and B cells. The lymphatic system also involves a transportation system - lymph vessels - for transportation and storage of lymphocyte cells within the body. The lymphatic system feeds cells into the body and filters out dead cells and invading organisms such as bacteria. On the surface of each lymphatic cell are receptors that enable them to recognize foreign substances. These receptors are very specialized - each can match only one specific antigen. To understand the receptors, think of a hand that can only grab one specific item. Imagine that your hands could only pick up apples. You would be a true apple-picking champion - but you wouldn't be able to pick up anything else. In your body, each single receptor equals a hand in search of its "apple." The lymphocyte cells travel through your body until they find an antigen of the right size and shape to match their specific receptors. It might seem limiting that the receptors of each lymphocyte cell can only match one specific type of antigen, but the body makes up for this by producing so many different lymphocyte cells that the immune system can recognize nearly all invaders. 16
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T cells T cells come in two different types, helper cells and killer cells. They are named T cells after the thymus, an organ situated under the breastbone. T cells are produced in the bone marrow and later move to the thymus where they mature. Helper T cells are the major driving force and the main regulators of the
immune defence. Their primary task is to activate B cells and killer T cells. However, the helper T cells themselves must be activated. This happens when a macrophage or dendritic cell, which has eaten an invader, travels to the nearest lymph node to present information about the captured pathogen. The phagocyte displays an antigen fragment from the invader on its own surface, a process called antigen presentation. When the receptor of a helper T cell recognizes the antigen, the T cell is activated. Once activated, helper T cells start to divide and to produce proteins that activate B and T cells as well as other immune cells.
The killer T cell is specialized in attacking cells of the body infected by viruses and sometimes also by bacteria. It can also attack cancer cells. The killer T cell has receptors that are used to search each cell that it meets. If a cell is infected, it is swiftly killed. Infected cells are recognized because tiny traces of the intruder, antigen ,can be found on their surface.
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B Cells The B lymphocyte cell searches for antigen matching its receptors. If it finds such antigen it connects to it, and inside the B cell a triggering signal is set off. The B cell now needs proteins produced by helper T cells to become fully activated. When this happens, the B cell starts to divide to produce clones of itself. During this process, two new cell types are created, Plasma cells and B memory cells. The plasma cell is specialized in producing a specific protein, called an antibody, that will respond to the same antigen that matched the B cell receptor. Antibodies are released from the plasma cell so that they can seek out intruders and help destroy them. Plasma cells produce antibodies at an amazing rate and can release tens of thousands of antibodies per second. When the Y-shaped antibody finds a matching antigen, it attaches to it. The attached antibodies serve as an appetizing coating for eater cells such as the macrophage. Antibodies also neutralize toxins and incapacitate viruses, preventing them from infecting new cells. Each branch of the Y-shaped antibody can bind to a different antigen, so while one branch binds to an antigen on one cell, the other branch could bind to another cell - in this way pathogens are gathered into larger groups that are easier for phagocyte cells to devour. Bacteria and other pathogens covered with antibodies are also more likely to be attacked by the proteins from the complement system.
The Memory Cells are the second cell type produced by the division of B cells. These cells have a prolonged life span and can thereby "remember" specific intruders. T cells can also produce memory cells with an even longer life span than B memory cells. The second time an intruder tries to invade the body, B and T memory cells help the immune system to activate much faster. The invaders are wiped out before the infected human feels any symptoms. The body has achieved immunity against the invader.
We will expand on the development of B and T Cells in the following chapter.
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Conclusion
Although rather long and complex, our presentation is just a glimpse of the immune system and the intricate ways in which its various parts interact. Immunity is a fascinating subject that still conceals many secrets. When the immune system is fully understood, it will most likely hold the key to ridding humankind of many of its most feared diseases.
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The development of B-Cells and T-Cells

by Abdul Kareem-Khan
B-Cells Development
First Stage: First Stage:
T-Cells
Transformation of Stem cells into immature B-cells occur in: Liver and bone marrow before birth Bone marrow alone in adults
Second Stage:
Lymphocytes that have undergone their first stage in: Thymus Gland Stem cells seed the thymus and shortly before and after birth they develop T-Cells
Second Stage:
Immature B-cells become activated B-Cells B-Cells. This happens when an immature B-Cell comes in contact with certain protein molecules-antigens whose shape fits the shape of the immature B-Cell surface antibody molecules. The B-Cells lock unto the antibodies and become activated. The activated cell develops into clones of two kinds by dividing repeatedly and rapidly. The two kind of cells are Plasma Cells and Memory Cells.
Immature T-Cells become Sensitized TTCells. Cells This happens when a T-Cell comes into contact with its specific antigen and the antigen binds to the protein on the T-Cell surface.
Function Antibody Factories of the body. Immediately produces humoral immunity. This is resistance to disease organisms produce by the actions of antibodies binding to surface antigens while circulating in the body Produces cell-mediated immunity Some Sensitized T-Cells kill invading cells directly. Many releases compounds into the area around the enemy cells that attracts macrophages into the neighbourhood of the enemy cell which then destroys the cell by phagocytosing.
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Humoral and Cell-Mediated Immunity

by Ivana Hackshaw
The Immune system

The human immune system is a very complicated set of pathways that allow the human body to respond to foreign invaders such as bacteria, viruses, and other infectious agents, as well as foreign material such as pollen. The human immune system consists of numerous different types of cells, each of which have a specific task assigned to them in the defense of the body. The human immune system is divided into two main parts: humoral immunity, which deals with infectious agents in the blood and body tissues, and cell-mediated immunity, which deals with body cells that have been infected. In general, the humoral system is managed by B-cells (with help from T-cells), and the cell-mediated system is managed by T-cells. Both systems exhibit fascinating complexity and interrelationships that allow them to fine-tune immune reactions to almost any antigen, or molecule that stimulates an immune response. An antigen is any substance that causes the immune system to produce antibodies against it.
Humoral Immunity
The term "humoral" refers to the non-cellular components of the blood, such as plasma and lymphatic fluid. The humoral immune response denotes immunologic responses that are mediated by antibodies. However, both B and T lymphocytes, as well as dendritic cells and other antigen presenting cells, are necessary for the formation of antigen-specific antibody. Humoral immunity includes the primary and secondary immune responses to antigen. During the primary immune response, an antigen is encountered by the host for the first time. Virgin B cells need to be activated and proliferate before an effective immune response can be generated. This primary response may be too slow to protect against many pathogens, therefore polyspecific natural antibodies with low affinity and the innate immune system may be utilized to limit microbial replication at the onset of infection. By comparison, the secondary antibody response, which results from the activation of a memory B cell, is faster and more effective in halting the progress of infection due to increased antibody binding affinities. Vaccination induces a primary immune response so that the patient produces the faster and more effective secondary response upon natural exposure to a pathogen, and is one of the most important contributions of immunology to disease prevention. The humoral system of immunity is also called the antibody-mediated system because of its use of specific immune-system structures called antibodies. The first stage in the humoral pathway of immunity is the ingestion (phagocytosis) of foreign matter by special blood cells called macrophages. The macrophages digest the infectious agent and then display some of its components on their surfaces. Cells called helper-T cells recognize this presentation, activate their immune response, and multiply rapidly. This is called the activation phase. Group 2 / Class of 2012 23
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The next phase, called the effector phase, involves a communication between helper-T cells and B-cells. Activated helper-T cells use chemical signals to contact B-cells, which then begin to multiply rapidly as well. B-cell descendants become either plasma cells or B memory cells. The plasma cells begin to manufacture huge quantities of antibodies that will bind to the foreign invader (the antigen) and prime it for destruction. B memory cells retain a "memory" of the specific antigen that can be used to mobilize the immune system faster if the body encounters the antigen later in life. These cells generally persist for years.
Cell-mediated immunity
The second arm of the immune response is refered to as Cell Mediated Immunity (CMIR). As the name implies, the functional "effectors" of this response are various immune cells. Cell-mediated immunity (CMI) is an immune response that does not involve antibodies but rather involves the activation of macrophages and NK-cells, the production of antigen-specific cytotoxic Tlymphocytes , and the release of various cytokines in response to an antigen . Cellular immunity protects the body by: activating antigen-specific cytotoxic T-lymphocytes (CTLs) or killer-T cells, that are able to destroy body cells displaying epitopes of foreign antigen on their surface, such as virus-infected cells, cells with intracellular bacteria, and cancer cells displaying tumor antigens. Killer-T cells recognize these displays and respond by ingesting or otherwise destroying the infected cell. Killer-T cells are also important in the body's defenses against parasites, fungi, protozoans, and other larger cells that might have found their way into the body. The killer-T cells recognize these large invaders by their foreign proteins and then destroy them. Killer-T cells also produce T memory cells which "remember" a specific protein or antigen. The combination of T-cell and B-cell memory assures the body of familiarity with any antigens or foreign agents that have been present in the body within the last few years. A response to an agent against which the body has already formed memory cells is called a secondary response. All other responses are primary responses. Activating macrophages and NK cells, enabling them to destroy intracellular pathogens; and Stimulating cells to secrete a variety of cytokines that influence the function of other cells involved in adaptive immune responses and innate immune responses. Cell-mediated immunity is directed primarily microbes that survive in phagocytes and microbes that infect non-phagocytic cells. It is most effective in removing virus-infected cells, but also participates in defending against fungi, protozoans, cancers, and intracellular bacteria. It also plays a major role in transplant rejection.
References http://en.wikipedia.org/wiki/Humoral_immunity http://library.thinkquest.org/C004367/be7.shtml http://faculty.ccbcmd.edu/courses/bio141/lecguide/unit5/cellular/cmioverview/cmioverview.html
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The Mechanisms of Allergy, Autoimmunity and Isoimmunity

By Karrifa Karim
The Mechanisms of Allergy:

The term allergy is used to describe hypersensitivity of the immune system to relatively harmless environmental antigens. Antigens that trigger an allergic response are often called allergens. Immediate allergic responses involve antigen antibody reactions. Before such a reaction occurs, a susceptible person must be exposed to an allergen repeatedly triggering the production of anti-bodies. After a person is thus sensitized, exposure to an allergen causes antigen-antibody reactions that trigger the release of histamine, kinins and other inflammatory substances. There responses usually cause typical allergy symptoms such as runny nose, conjunctivitis, and urticaria (hives). In some cases, however, these substances may cause constriction of the airways, relaxation of blood vessels, and irregular heart rhythms that can progress to a life-threatening condition called ana-phylactic shock. Drugs called anti-histamines are sometimes used to relieve the symptoms of this type of allergy. Delayed allergic responses, on the other hand, involve cell-mediated immunity. In contact dermatitis, for example, T cells trigger events that lead to local skin inflammation a few hours or days after initial exposure to an antigen. Exposure to poison ivy, soaps, and certain cosmetics may cause contact dermatitis in this manner Hypersensitive individuals may use hypoallergenic products (products without common allergens) to avoid such allergic reactions.
The Mechanisms of Autoimmunity:

Autoimmunity is an inappropriate and excessive response to self-antigens. Disorders that result from autoimmune responses are called autoimmune disorders. Self-antigens are molecules that are native to a persons body and that are used by the immune system to identify components of self. In autoimmunity, the immune system inappropriately attacks these antigens.
The Mechanisms of Isoimmunity:

Isoimmunity is excessive reaction of the immune system to antigens from a different individual of the same species. It is important in pregnancy, and tissue transplants. During pregnancy, antigens from the fetus may enter the mothers blood supply and sensitize her immune system. Antibodies that are formed as a result of this sensitization may enter the fetal circulation and cause an inappropriate immune reaction. Other pathological conditions may also be caused by damage to developing fetal tissues resulting from attack by the mothers immune system. Examples include congenital heart defects, Graves disease, and myasthenia gravis. Group 2 / Class of 2012 25
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Tissue or organ transplants are medical procedures in which tissue from a donor is surgically grafted into the body. For example, skin grafts are often done to repair damage caused by burns. Donated whole blood tissue is often transfused into a recipient after massive hemorrhaging. A kidney is sometimes removed from a living donor and grafted into a person suffering from kidney failure. Unfortunately, the immune system sometimes reacts against foreign antigens present in the grafted tissue causing what is often called a rejection syndrome. The antigens most commonly involved in transplant rejection are called human lymphocyte antigens. (HLAs). Rejection of grafted tissues can occur in two ways. One is called host-versus-graft rejection because the recipients immune system recognizes foreign HLAs and attacks them, destroying the donated tissue. The other is graft-versus-host rejection because the donated tissue (for example, bone marrow) attacks the recipients HLAs, destroying tissue throughout the recipients body. Graft versus host rejection may lead to death. There are two ways to prevent rejection syndrome. One strategy is called tissue typing, in which HLAs and other antigens of a potential donor and recipient are identified. If they match, tissue rejection is unlikely to occur. Another strategy is the use of immunosuppressive drugs in the recipient. Immunosuppressive drugs such as cyclosporine and prednisone suppress the immune systems ability to attack the foreign antigens in the donated tissue.
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Major Types Of Deficiencies Of The Immune Systems & Their Causes

by Diane Blackman
Introduction to the human immune system

The purpose of the immune system is to act as the body's own army, in defence against this constant stream of possible infections and toxins through a series of steps called the immune response, the immune system attacks organisms and substances that invade body systems and cause disease. Immunodeficiency disorders are a group of disorders in which part of the immune system is missing or defective. Therefore, the body's ability to fight infections is impaired. As a result, the person with an immunodeficiency disorder will have frequent infections that are generally more severe and last longer than usual.
The human immune system is divided into two primary types called the Acquired Immune System and Innate Immune System each of which plays a role in defending the body. Defects can occur in any component of the immune system or in more than one component. These defects can be inherited and/or present at birth (congenital) or acquired. Congenital immunodeficiency disorders Congenital immunodeficiency is present at the time of birth, and is the result of genetic defects. There are more than 70 known types of congenital diseases. Congenital immunodeficiency is caused by genetic defects, which generally occur while the foetus is developing in the womb. These defects affect the development and/or function of one or more of the components of the immune system Acquired immunodeficiency disorders Acquired immunodeficiency is more common than congenital immunodeficiency. It is the result of an infectious process or other disease. Acquired immunodeficiency is the result of a disease process, and it occurs later in life. The causes can be diseases, infections, or the side effects of drugs given to treat other conditions.
Major types of immunity

Immune system diseases and disorders are categorized depending upon the activity of the immune system. An overactive immune system has as much potential for inducing health hazards as an under active immune system. Following is the list of immune system disorders. Immune System Diseases Immune Deficiency Conditions SCID AIDS Group 2 / Class of 2012 27
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Allergies (food, drug, insect sting, particular substance) Anaphylaxis Asthma Autoimmune Diseases Common Variable Immunodeficiency HTLV Primary Immune Deficiency
Immune Deficiency Conditions: This is the largest group of immune system diseases and disorders and comprises variety of diseases that suppress the immune system. Often, the cause of immune deficiency conditions is some underlying chronic illness such as diabetes and cancer. SCID: SCID is an immune system disorder which is hereditary. The cause of SCID is a series of genetic abnormalities, particularly on the X chromosome. Several types of recurrent infections are common in people suffering from SCID. AIDS: HIV/AIDS is a serious immune failure and a leading cause of death worldwide. AIDS occurs in the later stages of progression of HIV and causes the immune system of the body to collapse completely. AIDS is considered as a life-threatening, sexually transmitted disease, though it can be transmitted through the means of blood transfusion as well. Allergies/Hay fever/Hives: Allergies can be defined as an aggravated immune response to a normally harmless substance. There are myriad allergens such as pollen grains, mold spores, latex rubber and certain food items like peanuts or drugs like penicillin etc., which can cause allergies. Anaphylaxis: Anaphylaxis is a serious and extreme form of allergy. In this condition, the allergen acts as a trigger and causes a series of physical discomforts in a person. Anaphylaxis may lead to an emergency, if not diagnosed and treated on time. Asthma: Asthma, a chronic lung disorder, is caused due to inflammation of the air passage. Allergens, irritants or even stimulants such as physical activity can trigger the inflammation and induce variety of discomforts in a person. The symptoms of asthma include wheezing, coughing, shortness of breath, chest tightness, etc. Autoimmune Diseases: Autoimmune diseases is a group of immune system disorders, in which the cells of immune system misinterpret signals and start attacking its own body cells. Autoimmune diseases cause serious health hazards in an individual. The list of autoimmune diseases is quite long. Common Variable Immunodeficiency: Common variable immunodeficiency syndrome results due to the reduced number of anti bodies in the body. This disorder is mostly found in adult human beings. Although, it may be present at the time of birth, the symptoms do not surface until the person enters his twenties. Symptoms include bacterial infections of the ears, sinuses, bronchi and lungs. Painful swollen joints in the knee, ankle, elbow or wrist are also common. Some patients may report enlarged lymph 28
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nodes, spleen, etc. HTLV: Human T-cell lymphotropic viruses (retroviruses), HTLV-I, HTLV-II seriously affect the human immune system. They are most prevalent among drug users and people with multiple sex partners. People with genital ulcers and a history of syphilis are also prone to HTLV. The mode of transmission of HTLV is through intimate sexual contact, blood transfusion or during pregnancy.
Types of immunity
References http://futuresurgeon0607.blogspot.com
7hplus.com virtualmedicalcentre.com Tappans Handbook of healing massage techniques
Kids health.org
Deficiencies Of The Immune Systems

The purpose of the immune system is to act as the body's own army, in defence against this constant stream of possible infections and toxins. Immunodeficiency disorders are a group of disorders in which part of the immune system is missing or defective, therefore the body's ability to fight infections is impaired. Congenital immunodeficiency
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is present at the time of birth, and is the result of genetic defects which generally occur while the foetus is developing in the womb. Acquired immunodeficiency is more common than congenital immunodeficiency. It is the result of an infectious process. The causes can be diseases, infections, or the side effects of drugs given to treat other conditions. Immune System Diseases SCID: SCID is an immune system disorder which is hereditary. The cause of SCID is a series of genetic abnormalities, particularly on the X chromosome. AIDS: HIV/AIDS is a serious immune failure that occurs in the later stages of progression of HIV and causes the immune system of the body to collapse completely. Allergies/Hay fever/Hives/Anaphylaxis: (food, drug, insect sting, particular substance) Allergies can be defined as an aggravated immune response to a normally harmless substance. Asthma is a chronic lung disorder, is caused due to inflammation of the air passage. Anaphylaxis is a serious and extreme form of allergy Autoimmune Diseases: Autoimmune diseases is a group of immune system disorders, in which the cells of immune system misinterpret signals and start attacking its own body cells.
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Lymphoedema
by Ricardo Gonzales- Campbell
Introduction
Lymphoedema is a swelling, which occurs due to a failure of the lymphatic system. Swelling occurs most commonly in the limbs, but can occur in other parts of the body and can affect people of all ages. It is a chronic condition, which tends to progress if left untreated. It is important to remember that lymphoedema can be treated successfully in order to prevent this progression and improve quality of life. For the majority of patients, this can be achieved by specialist treatment, known as Complex Decongestive Therapy (CDT). The goal of this therapy is to reduce the swelling and maintain freedom from symptoms. CDT is virtually free from side-effects and is the treatment of first choice for lymphoedema. It is important that patients have an understanding of lymphoedema and all aspects of treatment. This will help them to maintain the benefits of therapy and manage their condition. It is important that people who may be at risk of developing lymphoedema, e.g. those with a family history of lymphoedema, or those who undergo surgery/radiotherapy treatment for cancer, are aware of the signs and symptoms of lymphoedema and that early detection and prompt treatment is always recommended. It is also very important that they are aware of preventative measures to take to help avoid lymphoedema developing.
Signs and symptoms

Symptoms may include severe fatigue, a heavy swollen limb or localized fluid accumulation in other body areas, including the head or neck, discoloration of the skin overlying the lymphedema, and eventually deformity (elephantiasis). Lymphedema should not be confused with edema arising from venous insufficiency, which is not lymphedema. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder which is treated the same way as lymphedema. Presented here is an extreme case of severe unilateral hereditary lymphedema which had been present for 25 years without treatment:
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Comparison of normal and swollen limb
Size of swollen foot, toes underneath
Another view of lymphedemic foot
Foot and leg (held vertically) Presented here is a severe case of combined primary lymphedema and lipedema (Stage 3) before and after treatments:[1]
Stage 3 lymphedema front view before treatments
Stage 3 lymphedema back view before treatments
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Stage 3 lymphedema front view after treatments, 65 pounds lost in 14 days
Stage 3 lymphedema back view after treatments, 65 pounds lost in 14 days
Causes
Lymphedema may be inherited (primary) or caused by injury to the lymphatic vessels (secondary). It is most frequently seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment of cancer, most notably breast cancer. In many patients with cancer, this condition does not develop until months or even years after therapy has concluded. Lymphedema may also be associated with accidents or certain diseases or problems that may inhibit the lymphatic system from functioning properly. In tropical areas of the world, a common cause of secondary lymphedema is filariasis, a parasitic infection. It can also be caused by a compromising of the lymphatic system resulting from cellulitis. While the exact cause of primary lymphedema is still unknown, it generally occurs due to poorly developed or missing lymph nodes and/or channels in the body. Lymphedema may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). In men, lower-limb primary lymphedema is most common, occurring in one or both legs. Some cases of lymphedema may be associated with other vascular abnormalities. Secondary lymphedema affects both men and women. In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed. Head and neck lymphedema can be caused by surgery or radiation therapy for tongue or throat cancer. It may also occur in the lower limbs or groin after surgery for colon, ovarian or uterine cancer, in which removal of lymph nodes or radiation therapy is required. Surgery or treatment for prostate, colon and testicular cancers may result in secondary lymphedema, particularly when lymph nodes have been removed or damaged. The onset of secondary lymphedema in patients who have had cancer surgery has also been linked to aircraft flight (likely due to decreased cabin pressure). For cancer survivors, therefore, wearing a prescribed and properly fitted compression garment may help decrease swelling during air travel.
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Some cases of lower-limb lymphedema have been associated with the use of tamoxifen, due to the blood clots and deep vein thrombosis (DVT) that can be caused by this medication. Resolution of the blood clots or DVT is needed before lymphedema treatment can be initiated.
Pathophysiology
The flow of lymph from the legs towards the heart is the result of the soleus muscle also known as the calf pump. As a person walks, the soleus contracts, squeezing lymph out of the leg via the lymphatic vessels. When the muscle relaxes, valves in the vessels shut preventing the fluid from returning to the lower extremities.[2] The lymph from the legs is filtered through the inguinal nodes in the groin area on its way to the thoracic duct. Blockage of the inguinal nodes can contribute to swelling in the legs. From the thoracic duct, the lymph is returned to the venous circulation through the left subclavian vein.[3]
Diagnosis
Assessment of the lower extremities begins with a visual inspection of the legs. Color, presence of hair, visible veins, size of the legs and any sores or ulcerations should be noted. Lack of hair may indicate an arterial circulation problem.[2] If swelling is observed, the calf circumference should be measured with a tape measure. This measurement can be compared to future measurements to see if the swelling is getting better. Determine if elevating the legs makes the swelling go away. Pressure should be applied with the fingertips over the ankle to determine the degree of swelling. The assessment should also include a check of the popliteal, femoral, posterior tibial, and dorsalis pedis pulses. When checking the femoral pulse, feel for the inguinal nodes and determine if they are enlarged. Enlargement of the nodes lasting more than three weeks may indicate infection or some other disease process requiring further medical attention.[4] The diagnosis or early detection of lymphedema is difficult. The first signs may be subjective observations such as "my arm feels heavy" or "I have difficulty these days getting rings on and off my fingers". These may be symptomatic of early stage of lymphoedema where accumulation of lymph is mild and not detectable by any difference in arm volume or circumference. As lymphedema develops further, definitive diagnosis is commonly based upon an objective measurement of difference between the affected or at-risk limb at the opposite unaffected limb, e.g. in volume or circumference. Unfortunately, there is no generally accepted worldwide criterion of difference definitively diagnostic, although a volume difference of 200 ml between limbs or a 4 cm (at a single measurement site or set intervals along the limb) is often used. Recently, the technique of bioimpedance measurement (which measures the amount of fluid in a limb) has been shown to have greater sensitivity than these existing methods, and holds promise as a simple diagnostic and screening tool.[5] Impedance analysers specifically designed for this purpose are now commercially available. Stages Whether primary or secondary, lymphedema develops in stages, from mild to severe. Methods of staging are numerous and inconsistent across the globe. Systems of staging lymphedema range from three to as many as eight stages. 34
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New Staging System of Lymphedema to Improve Accurate Diagnosis, Treatment Plan, Measurable Outcomes and Insurance Coverage A new staging system has been set forth by Lee, Morgan and Bergan[6] and endorsed by the American Society of Lymphology.[citation needed] This system provides a clear technique which can be employed by clinical and laboratory assessments to more accurately diagnose and prescribe therapy for lymphedema, as well as obtain measurable outcomes. In this improved version, four stages are identified (I-IV). Clear descriptors of symptoms and clinical presentation must be established at the assessment by the physician to prescribe interventions, monitor efficacy and support medical necessity. Physicians and researchers can use additional laboratory assessments, such as bioimpedance, MRI, or CT, to build on the findings of a clinical assessment (physical evaluation). From this, results of therapy can be accurately be determined and reported in documentation, as well as in research. Risk and latency is another measurement altogether. Current research using bioimpedance to measure risk of lymphedema is very promising.
The most common method of staging was defined by the Fifth WHO Expert Committee on Filariasis:[7][8] Stage 0 (latent): The lymphatic vessels have sustained some damage which is not yet apparent. Transport capacity is still sufficient for the amount of lymph being removed. Lymphedema is not present. Stage 1 (spontaneously reversible): Tissue is still at the "non- pitting" stage: when pressed by the fingertips, the tissue bounces back without any indentation. Usually upon waking in the morning, the limb or affected area is normal or almost normal in size. Stage 2 (spontaneously irreversible): The tissue now has a spongy consistency and is considered "pitting": when pressed by the fingertips, the affected area indents and holds the indentation. Fibrosis found in Stage 2 lymphedema marks the beginning of the hardening of the limbs and increasing size. Stage 3 (lymphostatic elephantiasis): At this stage, the swelling is irreversible and usually the limb(s) or affected area is very large. The tissue is hard (fibrotic) and unresponsive; some patients consider undergoing reconstructive surgery, called "debulking". This remains controversial, however, since the risks may outweigh the benefits, and the further damage done to the lymphatic system may in fact make the lymphoedema worse.
Grades Lymphedema can also be categorized by its severity (usually referenced to a healthy extremity):[citation
needed]
Grade 1 (mild edema): Lymphedema involves the distal parts such as a forearm and hand or a lower leg and foot. The difference in circumference is less than 4 centimeters, and other tissue changes are not yet present.
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Grade 2 (moderate edema): Lymphedema involves an entire limb or corresponding quadrant of the trunk. Difference in circumference is more than 4 but less than 6 centimeters. Tissue changes, such as pitting, are apparent. The patient may experience erysipelas. Grade 3a (severe edema): Lymphedema is present in one limb and its associated trunk quadrant. The difference in circumference is greater than 6 centimeters. Significant skin alterations, such as cornification or keratosis, cysts and/or fistulae, are present. Additionally, the patient may experience repeated attacks of erysipelas. Grade 3b (massive edema): The same symptoms as grade 3a, except two or more extremities are affected. Grade 4 (gigantic edema): Also known as elephantiasis, in this stage of lymphedema, the affected extremities are huge due to almost complete blockage of the lymph channels. Elephantiasis may also affect the head and face.
Treatment
If your doctor has diagnosed that you have lymphoedema, you should be referred to a fully trained and certified lymphoedema therapist. Treatment for lymphedema varies depending on the severity of the edema and the degree of fibrosis of the affected limb. Most people with lymphedema follow a daily regimen of treatment as suggested by their physician or certified lymphedema therapist. The most common treatments for lymphedema are a combination of manual compression lymphatic massage, compression garments or bandaging. Complex decongestive physiotherapy is an empiric system of lymphatic massage, skin care, and compressive garments. Although a combination treatment program may be ideal, any of the treatments can be done individually. Compression Garments Elastic compression garments are worn by persons with lymphedema on the affected limb following complete decongestive therapy to maintain edema reduction. Depending on the therapist's discretion, a compression garment may be custom-fit or purchased in over-the-counter, standard sizes. Compression garments are meant to be worn every day to maintain edema reduction and must be replaced on a regular basis. Support garments may be the only Garment of Choice for patients with Scrotal edema. Bandaging or wrapping Compression bandaging, also called wrapping, is the application of several layers of padding and shortstretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the proper therapeutic tension necessary to safely reduce lymphedema and may in fact end up 36
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producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas. Sequential gradient pump therapy Compression pump technology utilizes a multi-chambered pneumatic sleeve with overlapping cells to promote movement of lymph fluid. Pump therapy may be used in addition to other treatments such as compression bandaging and manual lymph drainage. In many cases, pump therapy may help soften fibrotic tissue and therefore potentially enable more efficient lymphatic drainage. Sequential pump therapy may also be used as a home treatment method, usually as part of a regimen also involving compression garments or wrapping. A Stanford University medical study showed that patients receiving the combined modalities of MLD/CDT and pneumatic pumping had a greater overall reduction in limb volume than patients receiving only MLD/CDT.[9] However, some therapists have begun to raise concern that compression pumps can cause genital swelling when used on persons with leg lymphedema. Complete decongestive therapy or manual lymph drainage Complete decongestive therapy (CDT) is a primary tool in lymphedema management consisting of manual manipulation of the lymphatic ducts,[10] short stretch compression bandaging, therapeutic exercise, and skin care. The technique was pioneered by Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders. Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription. Once the lymphedema is reduced, increased patient participation is required for ongoing care, along with the use of elastic compression garments and non-elastic directional flow foam garments. Manual manipulation of the lymphatic ducts consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system. In the bloods passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination. The treatment is very gentle and a typical session will involve drainage of the neck, trunk, and involved extremity (in that order), lasting approximately 40 to 60 minutes. CDT is generally effective on nonfibrotic lymphedema and less effective on more fibrotic legs, although it has been shown to help break up fibrotic tissue. The treatment you will receive is known as Complex Decongestive Therapy (CDT). CDT is regarded as the treatment of first choice in the management of lymphoedema and consists of two phases, symbolised here by the two circles.
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Phase 1 - Intensive Phase (blue) Phase 2 - Maintenance Phase (green)

Phase 1 - the Intensive Phase aims to reduce the swelling as much as possible, and to start to break down any fibrosis which may have developed. You will also be taught skills to help you to manage your condition. Phase 2 - the Maintenance Phase aims to maintain and further improve the treatment outcome of Phase 1. PHASE 1 - the Intensive Phase of treatment must include the following four components: (i) Manual Lymphatic Drainage (MLD) MLD is a gentle manual treatment that improves the function of the lymphatic system. MLD gently mobilises lymph out of a swollen area into healthy lymph vessels that drain into the blood stream.
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(ii) Skin and nail care A common complication of lymphoedema is that there is an increased risk of infection such as cellulitis. Careful skin, nail care and hygiene are essential to minimise the occurrence of such infections.
(iii) Multi-layer compression bandaging The use of multi-layered bandages increases the tissue pressure and helps to prevent the reaccumulation of swelling between treatments. Bandaging can also help to break down areas of fibrosis and reshape the limb until it is ready to be fitted with a medical compression garment.
(iv) Remedial Exercises The bandaged limb should be exercised regularly. Exercise activates the muscle and joint pumps of the affected limb, which over time can further help to reduce any swelling.
It is necessary that all four components are carried out during your treatment, regardless of the severity of your swelling. With patients' full cooperation expertly performed CDT should result in the swelling being reduced or almost eliminated. Group 2 / Class of 2012 39
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HOW LONG WILL TREATMENT LAST? The treatment takes approximately one-and-a-half hours per day for a minimum of two weeks in the early stages of lymphoedema. Treatment may last up to six weeks if your lymphoedema has become more advanced. This is because a greater amount of time is required to help improve the skin condition and to help break down and soften any fibrosis. When your limb is as free as possible from swelling, you will be measured for a medical compression garment. To ensure an exact fit and correct compression - essential for effectiveness and comfort - it is recommended that you should be accurately measured for custom-made garments by your therapist or by specially trained personnel. (Fig.4)
Fig.4
Two garments should always be supplied to allow for washing and to enable you to wear your garment at all times during the day. Your compression garments should be replaced regularly by your therapist to ensure they remain effective. PHASE 2 - The Maintenance Phase of treatment is 'life-long' and ideally should include six monthly checkups and further periods of intensive treatment (CDT) as required. It consists of: Wearing compression garments daily Regular MLD as indicated by your therapist Exercises to do at home Skin and nail care Self-treatment as indicated by your therapist 40
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Fig. 5
When patients cooperate fully with Phase 2 of CDT, and especially wear their custom-made compression garments at all times during the day, they can keep swelling to a minimum. (Fig. 5) Before and After Treatment
Before and After Complex Therapy (CDT)
Decongestive treatment
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Surgical techniques Surgical techniques for correcting lymphedema may be excisional or physiological. However, surgery for lymphedema does not cure the disease or eliminate the need for decongestive treatment. Surgical treatment is used only in extreme cases in order to reduce the weight of the affected limb, to help minimize the frequency of inflammatory attacks, to improve cosmesis, and to potentially reduce the risk of secondary angiosarcoma.[10] Although surgery has shown to reduce edema in the short-term, there is a lack of evidence to suggest that it is beneficial in the long-term. Excisional techniques include: Circumferential excision of the lymphedematous tissue followed by skin grafting (Charles technique); longitudinal removal of the affected segment of skin and subcutaneous tissue and primary closure (Homans technique); excision of subcutaneous tissue and tunneling of a dermal flap through the fascia into a muscular compartment of the leg (Thompson technique). Lympholymphatic anastomosis (autologous lymphatic grafts to bridge obstructed lymphatic segments); lymphovenous shunt (anastomosis of lymphatic channels to veins); lymphangioplasty enteromesenteric flap omental transfer (pedicled portion of omentum transposed to the affected limb). Modified liposuction has been developed in Sweden in recent years to remove adipose tissue associated with longstanding lymphedema, primarily in the upper region. This technique is meant to reduce the volume of a limb and does not cure lymphedema. Compression garments and compression bandages must still be worn after the operation. Low level laser therapy Low level laser therapy (LLLT) has been cleared by the U.S. Food and Drug Administration (FDA) for the treatment of lymphedema in November 2006.[11] According to the US National Cancer Institute, Studies suggest that low-level laser therapy may be effective in reducing lymphedema in a clinically meaningful way for some women. Two cycles of laser treatment were found to be effective in reducing the volume of the affected arm, extracellular fluid, and tissue hardness in approximately one-third of patients with post-mastectomy lymphedema at 3 months post-treatment. Suggested rationales for laser therapy include a potential decrease in fibrosis, stimulation of macrophages and the immune system, and a possible role in encouraging lymphangiogenesis.[12][13]
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Infection Prevention WHAT PRECAUTIONS OR PREVENTATIVE MEASURES SHOULD I TAKE? If you are at risk of, or have already developed lymphoedema, it is very important that you are aware of the following precautions:
SKIN CARE It is vital that the affected area is cleansed and moisturised daily with non-scented cream to reduce the risk of infections such as cellulitis developing. Any injury to the affected limb or area will increase your risk of infection and further swelling. If you feel generally unwell, or have any signs of infection, such as increased temperature or hot red tender swelling, you must contact your doctor immediately, so that suitable antibiotics can URGENTLY be prescribed for you.
Patient with cellulitis in left leg
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Early prevention and disease regression in breast cancer
In 2008 an NIH study revealed that early diagnosis of lymphedema in breast cancer patients (called stage 0 in the article) associated with an early intervention, a compression sleeve and gauntlet for 1 month, led to a return to preoperative baseline status. In a 5-year follow up, patients remained at their preoperative baseline, suggesting that preclinical detection of lymphedema can halt if not reverse its progression.
Complications
When the lymphatic impairment becomes so great that the lymph fluid exceeds the lymphatic system's ability to transport it, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid causes tissue channels to increase in size and number, reducing the availability of oxygen. This interferes with wound healing and provides a rich culture medium for bacterial growth that can result in infections: cellulitis, lymphangitis, lymphadenitis, and in severe cases, skin ulcers. It is vital for lymphedema patients to be aware of the symptoms of infection and to seek treatment at the first signs, since recurrent infections or cellulitis, in addition to their inherent danger, further damage the lymphatic system and set up a vicious circle. In rare cases, lymphedema can lead to a form of cancer called lymphangiosarcoma, although the mechanism of carcinogenesis is not understood. Lymphedema-associated lymphangiosarcoma is called Stewart-Treves syndrome. Lymphangiosarcoma most frequently occurs in cases of longstanding lymphedema. The incidence of angiosarcoma is estimated to be 0.45% in patients living 5 years after radical mastectomy.[14][15] Lymphedema is also associated with a low grade form of cancer called retiform hemangioendothelioma (a low grade angiosarcoma).[16] Since lymphedema is disfiguring, causes difficulties in daily living and can lead to lifestyle becoming severely limited, it may also result in psychological distress. (Wikipedia, 2012)
Precautions
BY TAKING THE FOLLOWING PRECAUTIONS YOU CAN HELP TO REDUCE YOUR RISK OF INFECTION:
AVOID
cuts scratches burns razors insect bites fungal infections sunburn
USE
washing-up gloves/thimble/emery boards gardening gloves/wear long trousers when gardening oven gloves electric razors insect repellents hygiene/meticulous skin care high sun protection factors
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TRAUMA To reduce the risk of trauma and infection you should also avoid: Injections in the affected limb/area Acupuncture in the affected limb/area Blood samples being taken from the affected limb Blood Pressure readings in the affected limb Extremes of hot or cold e.g. very hot baths, saunas, solariums or over-exposure to the sun.
Tight, restrictive clothing e.g. tight bra straps, waistbands,watches etc.
General Recommendations
Try to use the swollen arm or leg normally because using the muscles will help to improve lymphatic circulation. Avoid over-exertion as this may increase swelling. If your arm is at risk of developing lymphoedema, or is already swollen, avoid lifting or carrying heavy objects. If your leg is at risk of developing lymphoedema, or is already swollen, do not go barefoot and avoid standing or sitting for long periods. It is very important to keep your weight within normal limits. Keep the affected limb clean and well moisturised. This will help to reduce episodes of infection. If possible, try to keep the affected limb raised for short periods throughout the day. Seek professional advice from your therapist before flying because this may cause increased swelling.
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Bibliography
The Northern Ireland Lymphodema Support Group. (n.d.). General REcommendations. Retrieved 3 20, 2012, from The Northern Ireland Lymphodema Support Group: http://www.nilsg.co.uk/GeneralRecommendations.aspx The Northern Ireland Lymphoedema Support Group. (n.d.). Retrieved 3 20, 2012, from The Northern Ireland Lymphoedema Support Group: http://www.nilsg.co.uk/Introduction.aspx The Northern Ireland Lymphoedema Support Group. (n.d.). Before and After Treatment. Retrieved 3 22, 2012, from The Northern Ireland Lymphoedema Support Group: http://www.nilsg.co.uk/Treatment/Before---After-CDT-Treatment.aspx The Northern Ireland Lymphoedema Support Group. (n.d.). Complex Decongestive Therapy (CDT). Retrieved 3 25, 2012, from The Northern Ireland Lymphoedema Support Group: http://www.nilsg.co.uk/Treatment/Complex-Decongestive-Therapy-(CDT).aspx The Northern Ireland Lymphoedema Support Group. (n.d.). Infection Prevention. Retrieved 3 20, 2012, from The Northern Ireland Lymphoedema Support Group: http://www.nilsg.co.uk/InfectionPrevention.aspx The Northern Ireland Lymphoedema Support Group. (n.d.). Precautions. Retrieved 3 20, 2012, from The Northern Ireland Lymphoedema Support Group: http://www.nilsg.co.uk/Precautions.aspx
Bibliography
Wikipedia. (2012, 2 27). Lymphedema. Retrieved 3 14, 2012, from Wikipedia: http://en.wikipedia.org/wiki/Hereditary_lymphoedema
Other References Interview with Donna Fossett LCMT.
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April 4, 2012
Massage Therapy :The lymphatic System Indications and Contraindications

By Ricardo Campbell-Gonzales There are many indications for the use of lymphatic facilitation. One important indication is edema or excessive interstitial fluid due to trauma (Benjamin, 2010). As a massage therapist there are a number of condition which we will encounter which is an absolute contraindication for massage. One such condition is lymphoedema which is as a consequence of lymph system dysfunction that allows the accumulation of protein-rich fluid in interstitial spaces (Benjamin, 2010). There are two types called Primary (resulting as a result of 'natural defect in the person's body) and Secondary as a result to surgery usually for cancer. In such cases Complete/complex decongestive therapy is a treatment for lymphoedema. The treatment of lymphoedema should only be undertaken by someone who has been properly trained to perform the CDP in its many facets. Other contraindications include infection, thrombosis or blood clots, phlebitis, pitting edema and major heart problems such as congestive heart failure (Benjamin, 2010). Benjamin went on to further state that any conditions that can be worsened by increased fluid circulation warrants caution when applying lymphatic techniques. These include kidney disease, asthma, thyroid conditions and menstruation in women.
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April 4, 2012
Photo of Group 2 at Passion Day - Term 1
48

2012 Group 2 Term 2 Project - Lymphatic System - FINAL

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4/4/2012

THE LYMPHATIC SYSTEM

T&T College of Therapeutic Massage and Beauty Culture | Group 2

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

Team Members Group 2 Class of 2012

ID 473 479 480 514 481 483 484 485 513

Group 2 / Class of 2012

April 4, 2012 Blank Page

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

General function of Lymphatic System and Structures

Primary lymphoid organs

Group 2 / Class of 2012

THE LYMPHATIC SYSTEM

Secondary lymphoid organs

THE LYMPHATIC SYSTEM

Comparison of Immunity types

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

Diseases & Disorders of the Lymphatic System

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

Group 2 / Class of 2012

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

The Immune System - in More Detail

The Complement System

Lymphocytes - T cells and B cells

The lymphatic system

The receptors match only one specific antigen.

THE LYMPHATIC SYSTEM

Group 2 / Class of 2012

THE LYMPHATIC SYSTEM

We will expand on the development of B and T Cells in the following chapter.

THE LYMPHATIC SYSTEM

Group 2 / Class of 2012

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

The development of B-Cells and T-Cells

Group 2 / Class of 2012

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

Humoral and Cell-Mediated Immunity

The Immune system

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

The Mechanisms of Allergy, Autoimmunity and Isoimmunity

The Mechanisms of Allergy:

The Mechanisms of Autoimmunity:

The Mechanisms of Isoimmunity:

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

Major Types Of Deficiencies Of The Immune Systems & Their Causes

Introduction to the human immune system

Major types of immunity

THE LYMPHATIC SYSTEM

THE LYMPHATIC SYSTEM

Deficiencies Of The Immune Systems

Group 2 / Class of 2012

THE LYMPHATIC SYSTEM