The look I gave today when someone took my only working computer.
This picture shows a 49-years-old woman with Elephantiasis nostras verrucosa (ENV), a rare form of chronic lymphedema that causes progressive cutaneous hypertrophy.
The edema is an abnormal accumulation of fluid in the interstitial tissue: beneath the skin or in one or more cavities of the body and it is clinically shown as swelling.
Six factors can contribute to the formation of edema:
- Increased hydrostatic pressure in the capillaries;
- Reduced oncotic pressure within blood vessels;
- Increased tissue oncotic pressure;
- Increased blood vessel wall permeability (for example in anaphylaxis or in inflammation);
- Obstruction of fluid clearance in the lymphatic system (lymphedema);
- Changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney.
Edema can be generalized (Anasarca, usually caused by liver failure, renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency) or organ-specific, through tissue specific mechanisms:
- Lymphedema, where abnormal accumulation of interstitial fluid is caused by failure of the lymphatic system. This may be due to obstruction, destruction of lymph vessels by radiotherapy, or infiltration of the lymphatics by infection (such as elephantiasis).
- Myxedema, a cutaneous edema, which is caused by increased deposition of mucopolysaccharides, that hold water in the skin.
- Cerebral edema, where there is an extracellular fluid accumulation in the brain. It causes drowsiness or loss of consciousness.
- Pulmonary edema occurs when the pressure in blood vessels in the lung is raised because of obstruction to the removal of blood via the pulmonary veins. This is usually due to failure of the left ventricle of the heart. It can also occur in altitude sickness or on inhalation of toxic chemicals. Pulmonary edema produces shortness of breath. Pleural effusions may occur when fluid also accumulates in the pleural cavity.
- Periorbital edema is the edema surrounding the eyes. The periorbital tissues are most noticeably swollen immediately after waking, perhaps as a result of the gravitational redistribution of fluid in the horizontal position.
(Picture by The New England Journal of Medicine).
A poster showing microbes left behind when nurses neglect to “scrub the hub” for at least 15 seconds and allow to air dry. This is really something.