Senior Clinical Pharmacy Coordinator—Family Medicine
Assistant Residency Program Director—PGY1 Pharmacy Residency, The Brooklyn Hospital Center
Clinical Assistant Professor of Pharmacy Practice, Arnold and Marie Schwartz College, Long Island University, Brooklyn, New York
Upon completion antibiotics for acne beginning with l cheap cefixime 100mg with mastercard, students should be able to perform tasks related to installation antimicrobial lock therapy purchase 100mg cefixime amex, configuration and management of virtual machines vaccinia virus cefixime 100 mg line. Upon completion antibiotics for uti in breastfeeding buy cefixime 100 mg otc, students should be able to design and implement normalized database structures by creating simple database tables, queries, reports, and forms. Topics include reverse engineering, design for manufacturability, and mock-up construction. Upon completion, students should be able to generate working drawings and models based on physical design parameters. Topics include basic design, creation, editing, rendering and analysis of solid models, and creation of multiview drawings. Upon completion, students should be able to use design techniques to create, edit, render and generate a multiview drawing. Topics include sketching, measurements, lettering, dimensioning, geometric construction, orthographic projections and pictorials, drawings, sections, and auxiliary views. Upon completion, students should be able to understand and apply basic drawing principles and practices. Topics include detailed working drawings, hardware, fits and tolerances, assembly and sub-assembly, geometric dimensioning and tolerancing, intersections, and developments. Topics include emerging standards, key technologies and related design issues, terminology, media formats, career paths, and ethical issues. Emphasis is placed on data dictionaries, normalization data integrity, data Surry Community College 395 2020-2021 art/design techniques in a digital environment. Emphasis is placed on designing, creating, editing and integrating, visual components consisting of bit-mapped and vectorbased images, drawings, banners, text, simple animations, and multiple layers. Upon completion, students should be able to produce basic high-quality interactive multimedia applications. Emphasis will be placed on review of digital animation concepts and exploration of various animation software packages. Topics include format conversion and a review of current technologies and digital formats. Upon completion, students should be able to modify existing audio and video content to meet a range of production requirements associated with digital media applications. Upon completion, students should be able to design and produce a range of visual products using advanced digital design techniques and principles. Emphasis is placed on understanding principles of design and typography, and applying them effectively in projects. Emphasis is placed on the evaluation of emerging digital media technologies and presenting those findings to the class. Topics include portfolio development, resume design, and preparation of media contacts. Upon completion, students should be able to prepare themselves and their work for a career in the digital media workplace. Emphasis is placed on project definition, testing, presentation, and implementation. Upon completion, students should be able to complete, maintain, and implement a digital media project. Topics include the history of storytelling, its value and purpose, techniques of the storyteller, and methods of collecting verbal art. Topics include supply and demand optimizing economic behavior prices and wages, money, interest rates, banking system, unemployment, inflation, taxes, government spending, and international trade. Upon completion, students should be able to explain alternative solutions for economic problems faced by private and government sectors. Topics include the price mechanism, supply and demand, optimizing economic behavior, costs and revenue, market structures, factor markets, income distribution, market failure, and government intervention. Upon completion, students should be able to identify and evaluate consumer and business alternatives in order to efficiently achieve economic objectives. Topics include major schools of economic thought; aggregate supply and demand; economic measures, fluctuations, and growth; money and banking; stabilization techniques; and international trade. Upon completion, students should be able to evaluate national economic components, conditions, and alternatives for achieving socioeconomic goals. Upon completion, students should be able to design a career/professional development plan, and appropriate environments, schedules, and activity plans. Topics include receptive and expressive sign language usage including English-based systems, American Language, deaf culture and identity, assistive technology, and use of sign language as a classroom management strategy. Upon completion, students should be able to communicate at an introductory level using sign language, describe aspects of deaf culture and identity, and identify assistive technology for children with hearing loss in the education system. Upon completion, students should be able to identify appropriate relationship building strategies between diverse families, children birth through adolescence, schools, and communities and demonstrate a variety of communication skills including appropriate use of technology to support every child. Upon completion, students should be able to compare/contrast typical/atypical developmental characteristics, explain biological and environmental factors that impact development, and identify evidencebased strategies for enhancing development for children that are culturally, linguistically, and ability diverse. Emphasis is placed on knowledge, observation and assessment of developmental sequences in approaches to play/learning, emotional/social, health/physical, language/communication and cognitive domains. Topics include designing responsive/supportive learning environments, cultural, linguistic and socio-economic influences on behavior, appropriate expectations, the importance of communication with children/families including using technology and the use of formative assessments in establishing intentional strategies for children with unique needs. Emphasis is placed on observation of process driven learning experiences in art, music, creative movement, dance, and dramatics for every young child age birth through eight, integrated through all domains and academic content. Upon completion, students should be able to examine, create, and adapt developmentally creative learning materials, experiences, and environments for children that are culturally, linguistically, and ability diverse. Topics include music, movement, and whole language concepts, learning approaches for culturally, linguistically, and ability diverse children, and use of assistive technology. Upon completion, students should be able to integrate music, movement and language across the curriculum for each child. Topics include health and nutritional guidelines, common childhood illnesses, maintaining safe and healthy learning environments, health benefits of active play, recognition and reporting of abuse/neglect, and state regulations. Topics include the historical and philosophical influences on education, various perspectives on educational issues, and experiences in birth through grade 12 classrooms. Upon completion, students should be able to reflect on classroom observations, analyze the different educational approaches, including classical/traditional and progressive, and have knowledge of the various roles of educational systems at the federal, state and local level. Emphasis is placed on the characteristics of exceptionalities and delays, early intervention/special education, transitions, observation, developmental screening, formative assessment of children, and collaborating with families and community partners. Upon completion, students should be able to demonstrate responsive curriculum planning, respectful relationships and exposure to a variety of developmentally appropriate experiences/materials that support a foundation for healthy development and growth of culturally, linguistically and ability diverse children birth to 36 months. Topics include entry level teacher licensure exam preparation, performance based assessment systems, requirements for entry into teacher education programs, the process to become a licensed teacher in North Carolina, and professionalism including expectations within the field of education. Upon completion, students should be able to utilize educational terminology and demonstrate knowledge of teacher licensure processes including exam preparation, technology based portfolio assessment, and secondary admissions processes to the school of education at a senior institution. Emphasis is placed on exploring fundamental concepts, developmentally appropriate scope and sequence, and teaching strategies to engage each child in the discovery approach. Upon completion, students should be able to understand major concepts in each content area and implement appropriate experiences for young children. Upon completion, students should be able to understand, evaluate, and use curriculum to plan for individual/group needs. Upon completion, students should be able to articulate a developmentally appropriate program philosophy, locate current state licensing regulations, analyze a business plan and examine comprehensive program policies and procedures. Topics include program evaluation/accreditation, involvement in early childhood professional organizations, leadership/mentoring, family, volunteer and community involvement and early childhood advocacy. Upon completion, students should be able to define and evaluate all components of early childhood programs, develop strategies for advocacy and integrate community into programs. Upon completion, students should be able to select, plan, implement and evaluate developmentally appropriate language and literacy experiences for children who are culturally, linguistically and ability diverse. Emphasis is placed on designing, implementing and evaluating developmentally appropriate activities and environments for all children; supporting/engaging families; and modeling reflective and professional practices based on national and state guidelines. Topics include goal setting and career assessment, ethics, public safety, the engineering method and design process, written and oral communication, interpersonal skills and team building, and computer applications. Upon completion, students should be able to understand the engineering process, the engineering profession, and utilize college resources to meet their educational goals.
Clinical interviewing skills are emphasized antibiotics not helping uti best cefixime 100mg, and there is a weekly didactic seminar series antibiotics cause uti 100mg cefixime otc. Students will receive exposure to children with a wide variety of pediatric gastrointestinal antibiotic prophylaxis joint replacement cefixime 100 mg overnight delivery, hepatic and/or pancreatic disorders as well as disorders of under and over nutrition virus ti snow cefixime 100 mg on-line. Students are also encouraged to participate in various divisional teaching sessions. Students will be asked to present an interesting case on the last Wednesday of their rotation. The student will participate in outpatient clinics, inpatient consults, dermatology rounds, and grand rounds. Students are also encouraged to design and complete clinical research projects and contribute to the online image resource dermatlas. The goal of this elective is to provide the student with an overview to neurodevelopmental disabilities including cerebral palsy, autism, intellectual disability, attention deficit hyperactivity disorder and other disorders of communication and learning. Students will actively participate in the diagnostic and interdisciplinary evaluation and management of infants, children, and adolescents with neurodevelopmental disorders. This elective is recommended for those students who are considering careers in pediatrics, neurology, genetics, physiatry, or psychiatry. This elective will give the student experience in the "trenches" of managing pediatric epilepsy. Participation in clinic with the preceptors on Tuesday and Thursday afternoons 1-5 p. The student can also spend time with ketogenic diet patients and in epilepsy surgery cases as available. Clinical experience in the care of full-term and nearterm newborns, including both normal and "at-risk" infants. Student will be expected to follow newborns and families throughout the nursery stay. On completion of the clerkship, the student should be able to: perform a newborn physical exam, including assessment of gestational age; recognize normal patterns of transition at birth; recognize risk factors for and signs of abnormal transition; identify many normal variants and abnormal findings; understand the diagnosis and management of common neonatal problems (such as jaundice, suspected sepsis, feeding problems, congenital infections, drug withdrawal, skin rashes); understand important issues in counseling parents regarding care of the newborn. Students will have the opportunity to attend deliveries with the pediatric house staff and participate in resuscitation, if interested. The student may participate in a variety of ongoing research on allergic disease in asthmatic children. Current projects include basic research on the immunochemistry of animal allergens and assessment of hypersensitivity based on sera and basophils, environmental (indoor) allergens, as well as clinical research on the human response to measured concentrations of airborne allergens. A multidisciplinary center for the study of home environment in determining the severity of asthma in children offers many exciting research opportunities E 18. Students who choose this elective will increase their depth of knowledge in at least one pediatric content area. Prerequisite: Basic Clerkship in Pediatrics There are currently ~2500 homeless children in Baltimore City. Recent studies of homeless East Baltimore families by the elective faculty demonstrate low hepatitis B vaccine coverage, high rates of obesity, and frequent exposure to domestic violence. These findings are consistent with existing literature which documents that homeless children have poorer overall health than their housed peers. The purpose of this service-based learning curriculum is for medical students to develop the knowledge, skills and attitudes necessary to address the complex healthcare needs of homeless families. Students will spend mornings at the Ark and afternoons at the House of Ruth, learning firsthand about health issues of homeless children, and will work collaboratively with these organizations to implement a health education program. One afternoon/week at the House of Ruth will be spent doing pre-school physical examinations under the supervision of a pediatric faculty member. The student will present his/her work formally to the faculty group at the conclusion of the elective. It is our hope that this educational, handson experience will empower and motivate the students to continue to advocate for these vulnerable children throughout their careers. Night float call with the resident they are "paired" with is optional but encouraged. Students will be expected to give a case presentation on a critical care topic of their choice at the end of the rotation. Prerequisite: Basic Clerkship in Pediatrics Students will have the opportunity to become familiar with pediatric oncology patient care during this one month inpatient-based rotation. The elective includes exposure and education to a wide-range of oncologic conditions and complications. Students primarily manage selected inpatients with resident, fellow, and attending supervision. Students may have the opportunity to see consults in concert with the inpatient team and to follow the progress of patients as they transition to the outpatient setting. Murphy Professor of Oncology, Professor of Medicine, Professor of Pathology, Professor of Pharmacology and Molecular Sciences J. Coffey Professor of Urology, Professor of Oncology, Professor of Pharmacology and Molecular Sciences D. This eight day section introduces students to a history of pharmacology, and fundamental principles of pharmacokinetics, drug development, autonomic pharmacology, molecular imaging, and alternative and complementary medicine. It is intended to illustrate how catalysis in biological systems can be understood using principles derived from organic reaction mechanisms. This nine-lecture course deals with the chemical mechanisms of enzymes, and builds on the basic principles of catalysis and organic reaction mechanisms that are presented in the course "Organic Mechanisms in Biology. The first half of the course includes lectures on receptors, enzymes, pharmacokinetics and drug metabolism, combinatorial chemistry, and drug design. The second half of the course includes lectures on therapeutic agents used in infectious diseases, cancer, cardiovascular diseases, endocrine disorders, inflammation, and psychiatric illness. In addition, a series of tutorials on specialty topics will be given concurrently for small groups. This virology course will focus on the molecular biology of virus infections, the unique strategies by which viruses alter cellular functions and the consequences of these cellular alternations on viral pathogenesis. Topics covered include mechanisms of replication and assembly, persistence versus apoptosis, immune evasion, host-host transmission, cell transformation, vaccines/therapeutics, and virus evolution. By arrangement with the staff, qualified students at various stages of their scientific development may be admitted to collaborate in research projects with members of the staff. This course will cover instrumentation methods and applications of high performance liquid chromatography and mass spectrometry. Presents principles underlying the drug development process from discovery through pre-clinical to all clinical phases. Throughout the course students develop, write and present detailed drug development plans and clinical protocols for new drugs. Grading will use participation passports, internet modules, and 360 degree evaluations. Students are invited to participate with faculty in the conduct of research relevant to rehabilitation. This elective is intended for students considering a career in physical medicine and rehabilitation. Students will care for inpatients on the Good Samaritan Hospital (stroke or spinal cord) or Johns Hopkins Hospital (complex medical) inpatient rehabilitation units. They will also care for outpatients in muscluskeletal medicine, electrodiagnosis, spasticity, prosthetics and pain clinics. Objectives of the course are to increase knowledge and proficiency in the following areas: Basic clinical skills, such as history taking, physical examination, and general knowledge pertaining to inpatient care; diagnosis, pathophysiology and treatment of certain conditions in which severe physical disability is a prominent feature; the contributions of non-physician health professions required for the comprehensive care of certain patients; the importance of patient and family education in reducing the cost of disability and preventing recurrent hospitalization for health crisis. Prerequisite: Basic Clerkship in Medicine or Pediatrics Over 100 million Americans suffer from one or more chronic diseases; over 35 million have severe disability as a result. These will be your patients in the future, irrespective of what specialty you ultimatley choose. The goal of this rotation is that all students should posses the knowledge, skills, and attitudes to provide care for persons with chronic diseases and disabilities. The clerkship will focus on issues of chronic disease and disability in a variety of clinical settings, and will have concurrent didactic work, discussion groups, and simulation experiences on an inpatient rehabilitation unit, visits to a sub-acute or chronic care facility, outpatient clinics which emphasize care of disabled and chronically ill patients, and home visits. Students will participate in interdisciplinary team meetings and patient/family conferences.
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Bessie Darling Black Massey; the income is to be used for scholarships in the School of Medicine infection prevention week generic cefixime 100mg visa. Manfred Mayer Scholarship Fund Established in 1985 by the colleagues and friends of Dr antibiotic resistance deaths each year order cefixime 100 mg with mastercard. Manfred Mayer to provide scholarships to support needy medical students with special consideration given to displaced persons or refugees xone antibiotic cheap 100 mg cefixime. John Scott McFarland Scholarship Fund An endowment fund established in 1965 under the will of Dr antibiotic resistance quorum sensing buy cefixime 100 mg lowest price. The income from the fund is to be used to assist worthy students in the School of Medicine. McGraw Scholarship Fund this scholarship was established by the McGraw Foundation in April 1983 with the purpose of providing assistance to financially needy students in the School of Medicine. Dorothy Reed Mendenhall Scholarship Fund An endowment fund, to provide an annual scholarship to a deserving woman medical student, was established in 1957 by members of the family of Dr. Rose Meinhardt Fund An endowed scholarship established by the estate of Rose Meinhardt to provide assistance to needy, deserving and outstanding students who wish to pursue a career in medical research. Houston Merritt Scholarship Fund Established in 1990 with a gift from the estate of H. Houston Merritt, this fund provides scholarship aid to students in the School of Medicine. Preference is given, whenever possible, to students from the state of North Carolina. Adolf Meyer, to be used for scholarship aid for students of the School of Medicine. Mildvan Alumni Endowed Scholarship Fund this fund was established in 2003 by the Mildvan family to honor their devotion to medicine and help needy M. Orville and Kathryn Miller Scholarship Fund An endowment fund established in 1965 by Mrs. The income from this fund is to be used to assist students in the Five Year Program with preference to be given to students from the state of Oregon. Morawetz are available to students in the School of Medicine who are in need of financial support. Powell to provide scholarship support to needy students in the School of Medicine. Sandra Morse to show gratitude for the joy the medical school students had given her during her 29 year tenure as Director of Financial Aid. The endowment income is to be used to provide assistance to financially needy students in the School of Medicine. Donald Mulder established this endowment fund to provide scholarships for needy medical students. Jesse Myers Scholarship Fund Established in 1971 in memory of Jesse Myers, who was killed in an automobile accident while he was a First Year student in the School of Medicine. Nelson served as a hospital trustee, a faculty member in the Department of Medicine at the School of Medicine, and as president of the Johns Hopkins Hospital. This fund provides scholarship assistance to deserving medical students in the School of Medicine. Nu Sigma Nu Medical Student Scholarship Fund was established in 1985 at the direction of Dr. William Hillis, an alumnus of the School of Medicine and a former member of our faculty. The income is to be used for scholarships to students in the School of Medicine, and it gives recognition to the past contributions of the Nu Sigma Fraternity to the community of the School of Medicine. Parents Fund for Medical Students Endowed in 1990 by parents of medical students with financial need. Pakula Scholarship for Medical Education this scholarship was established in 1999 through a gift from Dr. Papper Scholarship this fund was established to provide tuition scholarships to medical students. Gertrude Wills Parker and Edward Milton Parker Endowed Scholarship Fund Established in 1996 by Ronald E. Park Scholarship Fund An endowment fund, established by friends, former students, and professional colleagues of Dr. Park at the time of his eightieth birthday, December 30, 1957, with income allocated to student scholarships in the School of Medicine. Parsons was a Baltimore portrait painter whose paintings hang in the Johns Hopkins University and Hospital. Payne to honor the memory of Samuel Payne and to provide scholarships for deserving students from the state of Virginia. Penney Memorial Scholarship Fund An endowment fund was established in 1986 by Della N. Penney to provide financial assistance to needy and worthy students in the School of Medicine. Virginia Romberger Reber Pettijohn Scholarship Fund Established in 1995 by the Estate of Virginia R. Pettijohn, this fund is to be used to provide scholarship assistance to medical students with financial need. Giacomo and Jan Pirzio-Biroli Scholarship Fund this fund was endowed in 2001 by the estate of Giacomo Pirzio-Biroli, Class of 1951, and his wife, Jan M. The establishment of this fund, in his memory, will assist future generations of medical students to experience similarly enlightened medical education in the tradition of Johns Hopkins. Plock Memorial Scholarship Fund Family, friends, and former classmates established this endowed fund in 2002 in memory of Gregory L. The fund provides financial assistance to deserving students in the School of Medicine. Pomerene, this fund provides scholarship aid to students in the School of Medicine. Preference is given to the extent possible, to students who plan to become general practitioners in the field of family medicine. Pratt Scholarship Fund the income from this endowment, established in 1993, is used to provide scholarships for students in the School of Medicine. Morgan Department of Radiology and Radiological Science has established a scholarship fund for medical students which is enhanced from time to time by donations deriving from the earnings of the department. Raider to pay the tuition and/or other expenses of worthy students enrolled in the School of Medicine. Rita Meena Raju entered Johns Hopkins Medical School in 1993, and died suddenly after a brief illness in 1995. The purpose of this fund is to provide scholarship support to students who exemplify the highest ideals in the medical profession. Randall Scholarships the scholarship fund was endowed in 1961 by an alumnus of the School of Medicine who wished to remain anonymous. The purpose of the Randall Scholarships is to assist able and deserving medical students in a low income bracket. To qualify for renewal of these scholarships, students must maintain academic standing in the highest third of the class. Reinhard Medical Scholarship these are endowed scholarships made possible in 1951 by a bequest from the late Dr. Herbert Remmer Memorial Scholarship Fund this endowment fund was established by Hilda Remmer in 1986. The income from this fund provides scholarships for medical students with preference given to Jewish students. The income from this fund is to be used for scholarships for worthy students in the School of Medicine. Rosenfeld Scholarship Fund Established in 1990 by the Estate of Madalyn Schwentker Rosenfeld, this fund in memory of Louis M. Rosenfeld, and his sister, Carolyn Rosenfeld, is to be used to provide students residing in the state of Maryland with scholarship support. The income is available for scholarships for deserving women medical students of academic distinction and promise, preferably a student entering the first year. Morris Schapiro Scholarship Fund An endowment was established by the Morris Schapiro and Family Foundation in February, 1954, to aid needy, promising students. Schier Fund for Medical Student Aid this endowment was established with a gift from the estate of Ida F. Schier in memory of her brother, a Baltimore dairyman and national authority on the handling of milk.
Medullary carcinoma of the thyroid: a study of the clinical features and prognostic factors in 161 patients antibiotics for sinus infection necessary buy cefixime 100mg otc. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer antibiotics for uti in renal failure generic cefixime 100 mg with amex. Prognostic factors and risk group analysis in follicular carcinoma of the thyroid antibiotic ointment for sinus infection purchase cefixime 100 mg fast delivery. Risk group stratification and prognostic factors in papillary carcinoma of the thyroid antibiotics used for diverticulitis order cefixime 100 mg line. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve Very advanced disease. Approximately two-thirds of these lesions arise in the nasal cavity and paranasal sinuses; one quarter are found in the oral cavity and the remainder occur only sporadically in other mucosal sites of the head and neck. To reflect this aggressive behavior, primary cancers limited to the mucosa are considered T3 lesions. Mucosal Melanoma of the Head and Neck 97 In order to view this proof accurately, the Overprint Preview Option must be set to Always in Acrobat Professional or Adobe Reader. The anatomic extent criteria to define moderately advanced (T4a) and very advanced (T4b) disease are given below. For a description of anatomy, refer to the appropriate anatomic site chapter based on the location of the mucosal melanoma. For the rules for classification, refer to the appropriate anatomic site chapter based on the location of the mucosal melanoma. Please contact your Customer Service Representative if you have questions about finding this option. Esophagus and Esophagogastric Junction 103 In order to view this proof accurately, the Overprint Preview Option must be set to Always in Acrobat Professional or Adobe Reader. In contrast, this revision is data driven, based on a risk-adjusted randomsurvival-forest analysis of worldwide data. The previous system was neither consistent with these data nor biologically plausible. Some explanations for the discrepancy relate to the interplay among T, N, and M, histopathologic type, biologic activity of the tumor (histologic grade), and location. The unique lymphatic anatomy of the esophagus links N to T, permitting lymph node metastases from superficial cancers (pT1); this renders prognosis similar to that of more advanced (higher pT) N0 cancers. Similarly, advanced cancers (higher pT) with a few positive nodes may have a similar prognosis to those of less advanced cancers (lower pT) with more positive nodes. Previous staging recommendations ignored histopathologic type, but availability of data on a large mixture of adenocarcinoma and squamous cell carcinomas from around the world has permitted assessing the association of histopathologic type with survival. Although at first glance these multiple trade-offs seem to create a less orderly arrangement of cancer classifications within and among stage groupings compared with previous stage groupings, when viewed from the perspective of the interplay of these important prognostic factors, the new staging system becomes biologically compelling and consistent with a number of other cancers. In addition, patients undergoing surgery alone with pT4 and pM1 cancers represent a select population; placing them into stage groups, therefore, required either combining some classifications or using literature as a supplement. Patients with cervical esophageal cancer, sometimes treated as a head-andneck tumor, were also poorly represented. The location of the primary tumor is defined by the position of the upper end of the cancer in the esophagus. This is best expressed as the distance from the incisors to the proximal edge of the tumor and conventionally by its location within broad regions of the esophagus. It also arbitrarily divides the esophagus into equal thirds: upper, middle, and lower (Table 10. However, clinical importance of primary site of esophageal cancer is less related to its position in the esophagus than to its relation to adjacent structures (Figure 10. Anatomically, the cervical esophagus lies in the neck, bordered superiorly by the hypopharynx and inferiorly by the thoracic inlet, which lies at the level of the sternal notch. Although length of the esophagus differs somewhat with body habitus, gender, and age, typical endoscopic measurements for the cervical esophagus measured from the incisors are from 15 to <20 cm (Figure 10. If thickening of the esophageal wall begins above the sternal notch, the location is cervical. The upper thoracic esophagus is bordered superiorly by the thoracic inlet and inferiorly by the lower border of the azygos vein. Anterolaterally, it is surrounded by the trachea, arch vessels, and great veins, and posteriorly by the vertebrae. Typical endoscopic measurements from the inci- sors are from 20 to <25 cm (Figure 10. The middle thoracic esophagus is bordered superiorly by the lower border of the azygos vein and inferiorly by the inferior pulmonary veins. It is sandwiched between the pulmonary hilum anteriorly, descending thoracic aorta on the left, and vertebrae posteriorly; on the right, it lies freely on the pleura. Typical endoscopic measurements from the incisors are from 25 to <30 cm (Figure 10. The lower thoracic esophagus is bordered superiorly by the inferior pulmonary veins and inferiorly by the stomach. It is bordered anteriorly by the pericardium, posteriorly by vertebrae, and on the left by the descending thoracic aorta. It normally passes through the diaphragm to reach the stomach, but there is a variable intra-abdominal portion, and because of hiatal hernia, this portion may be absent. Typical endoscopic measurements from the incisors are from 30 to 40 cm (Figure 10. Cancers arising in this segment have been variably staged as esophageal or gastric tumors, depending on orientation of the treating physician. Anatomy of esophageal cancer primary site, including typical endoscopic measurements of each region measured from the incisors. Esophagus and Esophagogastric Junction 105 In order to view this proof accurately, the Overprint Preview Option must be set to Always in Acrobat Professional or Adobe Reader. The esophageal wall has three layers: mucosa, submucosa, and muscularis propria (Figure 10. In the columnarlined esophagus the muscularis mucosae may be a two-layered structure. The mucosal division can be classified as m1 (epithelium), m2 (lamina propria), or m3 (muscularis mucosae). The submucosa has no landmarks, but some divide it into inner (sm1), middle (sm2), and outer thirds (sm3). There is no serosa; rather, adventitia (periesophageal connective tissue) lies directly on the muscularis propria. In close proximity to the esophagus lie pleura-peritoneum, pericardium, and diaphragm. Aorta, carotid vessels, azygos vein, trachea, left main bronchus, and vertebral body also are in close proximity, but cancers invading these structures are usually unresectable (T4b). Lymphatic drainage of the muscularis propria is more limited, but lymphatic channels pierce this layer to drain into regional lymphatic channels and lymph nodes in the periesophageal fat. Up to 43% of autopsy dissections demonstrate direct drainage from the submucosal plexus into the thoracic duct, which facilitates systemic metastases. The longitudinal nature of the submucosal lymphatic plexus permits lymphatic metastases orthogonal to the depth of tumor invasion. Implications of the longitudinal nature of lymphatic drainage are that the anatomic site of the cancer and the nodes to which lymphatics drain from that site may not be the same.
