Chronic Lower Extremity Edema

Chronic Lower Extremity Edema


Lower limb edema .

The lower-limb edema may be unilateral or bilateral and takes on different meanings . The review will also look at whether it is of acute onset or is chronic . In all cases, we will consider whether the edema is venous or lymphatic .

Venous edema is often a soft swelling , Pitting, with increased local heat and increasing standing .

The lymphatic edema is rather firm , does not the bucket . The blue test is abnormal in that the injection of patent blue subcutaneously is not accompanied by a reduction along the lymphatic channels but spreadsheet under the skin .

LACE OF VARIOUS TESTS IMAGING

In suspected cases of phlebitis, The Doppler confirms the diagnosis and clarifies if possible the seat of the clot. If it is proximal (iliofemoral) , the risk of embolism leads to practice phlebocavographie which can be supplemented if necessary by placing a filter endoluminal .

If the edema is unilateral but chronic. The venography look for arguments in favor of a chronic phlebitis . If venography is normal , the etiology lymphatic will be demonstrated by a test and a blue lymphatic blockage by lymphography.

Edema can finally have a cause the joint compression process, especially in the scarpa ; it can be caused by arteritis or an arteriovenous malformation as Klippel-Trenaunay .
Chronic Lower Extremity Edema

If the edema is bilateral , after eliminating the general causes , will seek a bilateral phlebitis or compression by a cave phlebocavographie. The absence of a venous anomalies will find a lymphedema and its causes . Note that the compression or invasion by a retroperitoneal process, edema is often mixed : venous and lymphatic

EVALUATION QUESTIONS

QCM 13.1: before a vein substitute suprapubic , what is the diagnosis to evoke ?

A - iliac vein thrombosis ,

B - arteritis associated ,

C - valvular insufficiency ,

D - SVC thrombosis ,

E - sural thrombosis .

QCM 13.2: Radiological signs which can be seen in the aftermath of DVT when venography performed in the lower ?

A - irregular contours venous ,

B - gaps in the image cup, surrounded by the contrast,

C - laminated aspect of the venous system ,

D - pack vascular

E - arteriovenous fistula .

QCM 13.3: A patient has bilateral edema of the lower . Phlebography revealed extrinsic compression of the inferior vena cava . The examinations for first-line guiding the etiologic diagnosis are:

A - abdominal and pelvic ultrasound ,

B - aortography ,

C - abdominopelvic CT ,

D - cavography by jugular

E - MRI pelvis .

QCM 13.4: What is the review to be carried out before a unilateral chronic swelling of the lower limb. When the Doppler is normal?

A - pelvic CT ,

B - cavography,

C - after lymphography blue test ,

D - arteriography ,

E - Monitoring .

How Do I Become a Medical Professional? - Medical Scientist Training

Health and longevity Into Space

We perceive sound a lot concerning health and medical professionals to take up-to-the-minute job titles, number of jobs and wages and benefits in the 21st century. We become familiar with what is unique to the aging residents of Canada and America and the detail that the Legion of age the most growth since the beginning of 1990 women over 80 years. With long-term is the existence of medical circumstances and diseases inherent in the progression of aging. A university lecturer of mine said it would be to live a long life in the most excellent probable health and suddenly die without pain medicine. Health Professions and the field of medicine today strive to achieve this goal.

By adding to the proceedings of the aging population, new technologies available to help people from birth to old age. One of these developments, the range of home test kits available health, some with a mobile phone app scannable. Another advance is the growth of organs by the use of pig tissue powder in a matrix used in the laboratory and used in surgical patients. progress is the third new world of prosthetics, a number that came very close to the amputation to participate in the Olympics, instead of the Paralympics. One of the most recent developments is the discovery of Canada to a process by which cells of a patient own skin can be changed in the blood for transfusions.

The theory of traveling and living in space and on other planets opens a new breed of research and new jobs in the 2010s. The book The dangers of space, a tour guide, Neil F. Comins, PhD, is a good glimpse of the future. Dr Comins gives some scenarios based on reality and how to override them. Living in space is not the easiest routine, but can be done.

All these future developments and many more lead medical career and health care to the list of Top 10 jobs for the future in the United States. While other job titles on the list should grow significantly in 2020, health and medical application easily increase in 2030, 2050 and the end of the century.

Medical and health professions in the list of Kiplinger 10

A total of six of the top 10 highest demand jobs projected through 2020 by Kiplinger magazine
his health and medical professions. all but one at least a college degree in four years.
Biomedical Engineering - Bachelor
Personal care attendants and home - in the short term OJT (on the job training) - Short term training certificate obtained in a number of regions. like home help.
Medical scientists - Promotion * - projected increase in the number of 40 +% or 44,000 jobs from 2010 to 2020. At the end of the 9 / 2010, the increase was 8% at 18 months.
Physician Assistant - Master
Biochemists / biophysicists - PhD
Coaches - Bachelor

This deals with the qualifications and training required for medical scientist, below.

OPPORTUNITIES

Individuals can start using in home care or personal care aide position and work as a doctor, given the options available for grants and educational programs to educational work for reimbursement, such as described below.

Climb the ladder, Educational

Health and Medical Careers - Helps MD, Part I
Medical professionals, health assistants to physicians and nurse practitioners in the DOS, is one of the most dynamic sectors in the United States. The American Health industry provides many jobs and careers ...
Health and Medical Careers - Part 2
Medical and health care in high demand fields of employment for the entire century 21st century. Some people are reluctant to take the course ...

Medical scientists

During the week of Thanksgiving 2010, more than 10,300 jobs as a medical scientist or a related position listed on Indeed.com and SimplyHired.com in America, with most of the twelve monthly salaries range from $ 30 000 to $ 90,000, the largest peak is at $ 50K - $ 70K. Not all of these functions requires. PhD (doctorate), as the Occupational Outlook Handbook U.S. Department of Labor data lists of their qualifications, however, the highest paid positions in medical science in the highest levels of education. Those who earn a PhD and an MD have the most advantages in terms of medical science.

1. Kelly Scientific Resources
2. SUNY Upstate
3. Albany Medical Center
4. Beckman Coulter
5. Kaiser Permanente
6. U.S. Navy
7. Genzyme Corporation
8. Oklahoma University Medical Center
9. Weill Cornell Medical College
10. Aerotek
11. Johnson & Johnson Company
12. Adecco Technical and Adecco Medical & Science
13. CyberCoders
14. Cedars-Sinai
15. Eli Lilly and Company
16. Merck
17. Elsevier
18. St. Joseph Hospital
19. Cornell University
20. Metro Health System

What is Medical Scientist candidates study?

A student with a focus of medical science is the study of STEM courses in high school years: Science, technology, engineering and mathematics. Science, including biology, chemistry, physics and computer science. Botany is useful in relation to human health, vaccines and drugs. English grammar and writing of the utmost importance in the American positions. Mathematics lies in trigonometry and calculus of this career field. High School AP Courses can accomplish the requirements of a science program for pre-medical undergraduate - contact the individual college. A standard training at university level is the PhD program in biological sciences, where 6 + years of work. Specialties may include genetics, pathology, bioinformatics and a combination of MD-PhD program is often to be had in the medical colleges, which are 7 or 8 years of clinical research and training. Drug Administration, gene therapy, blood draws, and all-encompassing research procedures require a medical license with the State Council premises.

Grossest Medical Stories

These true stories of medical phenomena point to a number of the most unpleasant diseases, and accidents never documented. It is legally binding to note that most of these stories share the theme of parasites, and invasion in the body. Such a piece of classified and personal self - the body, appropriate the prey of a creature, definitely sends shivers downward your spine.

# 5 Beetle Boy

This strange and disturbing true story from a little Indian boy named Chandan Goswami 13yearold. Chandan dilemma is that urine life full of beetles in his urine after hatching the eggs in her body. This Reuters story in 2003 said that the eggs were hatching a fistula (passage leading from the body cavity to the outer surface), near the groin of Chandan. The main objective was to find the egg to destroy them. Unfortunately it was reported by Chandan treatments proved ineffective, and there is no solution for now .....

# 4 Worm living things in the eyes of the child


A patient of five years of the Republic of Honduras was a major nuisance in the form of a red bump on his eye. Believing that evil to be a cyst or growth, the Group of the U.S. Air surgeons who were treating him were surprised to find a worm living entrenched in the wound.

The boy had slight Myiasis (fly infestation in the human body). The worm was human botfly larva, it is of a type known to lay their eggs on cattle, but rarely in a place like a human eye. Botfly larva was extracted from the anterior orbit, and its operation accomplished by putting the boy to sleep and cutting of the conjunctiva, where the larva was removed.

# 3 Bosom Infestation


This is one reported case from Nigeria ....

We report a 70 year old woman who presented with a history of several weeks of itching sinus relief right chest. The sinuses enclosed wriggle larvae of C. cannibals. 14 larvae were extracted from the chest and sinuses moderately well recovered after extraction.

Yes, you read correctly. Within this woman had fly larvae living Tumbu therein and extract. To achieve this is very uncommon but not impracticable. Auspiciously, the woman was capable to get better from the infection, and was cautious to extend deeper into her womb.

# 2 The Brown Recluse Bite

The brown recluse spider is notorious for its powerful poison necrotic, painless bite imperceptible (until the poison in the sets), and love dark places. This personal story I can relate to my mother, has since been bitten by a recluse spider a few years ago.

She was picking grapes friends garden, when she went in because of severe itching on her inner thighs. At first it just looked like a regular rash, and she put ointment on it. Several days later the rash had turned into a dark brown patch ban severely stung and itched. She went to the doctor right away and found that the poisonous spider bit her. She was able to get the bite treated in a very painful though (doctor uses a surgeon's knife to cut off the piece rotten infected) procedure.

She was very lucky compared to this man .....

# 1 First Aid by Stapler

This story when I read that I had doubts. Bec. I could not understand how this person might begin to go through its self-administered first aid.

When I finished reading it, I do not know whether to laugh or cry. Because I was disgusted, and amused at once.

When a man aged 40 came to a hospital to ask to see a doctor who specializes in "problems of men", it was shown Toa cell. There he carefully unwrapped three feet smelling, stained gauze from around the scrotum, which had swollen to twice the size of a grapefruit.

Added during the inspection, it was discovered that his left testicle was missing completely, and anchored in the swollen, tender and weeping wound, a number of dark objects which the patient was admitted to a thumb nail basis of weapons industrial base.

It turns out that man has used only until noon in the studio, where he frequently had sex the thrill of insertion his penis on the fan belt of cloth moving a piece of machinery. One day, the excitement had made him lose his concentration and the fan belt had torn his scrotum in the steering wheel, throwing him several feet on the ground and remove his left testicle. Rather than go to the hospital, he self-administered first aid with a stapler and then continued to work when his colleagues returned. It was two weeks before he had time to visit the hospital.

After reading this story, a mix of emotions is understandable. The nature of his act, and then crazy decision to try to repair his act is both mind blowing ridiculous and hilarious at the same time.

Top 10 American Medical Schools for Research

Best College Rankings basic academic and practical Scores

U.S. News and World Reports in recent times the American Medical Schools ranked by a system of questionnaires sent to administrators on best practices.

The school rankings are based on the collection of two brands of databases: expert opinions about program quality and statistics of the school that result in measurements of the relative quality of the schools' faculty teaching abilities and achievements, research, and students skills and performance. More than 146 medical programs in America were examined in this way. For medical programs, U.S. News and World report also surveyed professionals who hire new graduates in a position to the practical results of medical education and training of the respective employer to see. For this list, published in 2009, analysts used the journal Administration and professional results of the survey, average them together and published the resulting lists.

Top 10 American Medical Schools for Research

[1] Harvard University - Boston, Massachusetts

[2] Johns Hopkins University - Baltimore, Maryland

[3] University of Pennsylvania - Philadephia

[4] Washington University - St. Louis, Missouri

[5] University of California - San Francisco

[6] TIE: Duke University - Durham, North Carolina in the Research Triangle; Stanford University - California; University of Washington - Seattle, Washington State; Yale University - New Haven, Connecticutt

[7] Columbia University College of Physicians аnd Surgeons - New York

[8] University of California, Los Angeles - David Geffen School of Medicine; University of Michigan at Ann Arbor, College of Osetopathic Medicine

[9] University of Chicago - Pritzker School of Medicine

[10] University of Pittsburg - Pennsylvania

ADHD Medications

For decades, medications have been used to treat symptoms of ADHD (Attention Deficit Hyperactivity Disorder) treatment. This better medicine, the dose to take, who needs what, and so was discussed at time taken. One thing that is essential to understand about ADHD drugs is that they are symptoms, they do not cure ADHD.

There are advantages and disadvantages of ADHD drugs. Some people believe that the behavior is a better option, while others have found that drugs are the best solution for them. Before we take a look at some types of medication for ADHD, look at some general information:

Drugs

Drugs that appear to be largely effective in treating ADHD symptoms are a class of drugs known as stimulants. These drugs have side effects for the reason that they excite the body. Stimulants mostly work on dopamine, a neurotransmitter that has been shown to play a role in ADHD liability. There are a numeral ADHD drugs have recently come out that do not fit in this class, and treatment of various nuerotransmitter.

The Food and Drug Administration (FDA) recently approved a medication for ADHD is not a stimulant. Atomoxetine drugs or Strattera. It's moving parts on the neurotransmitter norepinephrine as a substitute for dopamine. The toois thought to play a role in ADHD. More studies will be made on this point, but for most children who use these drugs non-stimulants, a significant improvement in their symptoms of date.

Regardless of the positive domino effect of atometine, stimulants are still the figure one preferred drugs for ADHD. The subsequent is a catalog of some trade names and generic drugs offered refreshments, and how old the child can utilize:

Commerce, generic name, age approved
Adderall, amphetamines, 3 years and over
Concerta, methylphenidate, ages 6 and older
Cylert, Pemoline, ages 6 and older
Dexedrine, dextroamphetamine, 3 years and over
Dextrostat, dextroamphetamine, 3 years and over
Focalin, dexmethylphenidate, ages 6 and older
Metadate ER (extended version), methylphenidate, and more than 6
Metadate CD, methylphenidate, ages 6 and older
Ritalin, methylphenidate, ages 6 and older
Ritalin SR methylphenidate, ages 6 and older
Ritalin LA (long acting), methylphenidate, and more than 6

Side Effects

In large-scale, side effects of stimulants, which are what ADHD medications typically include a ecreased appetite, headache, abdominal pain, difficulty sleeping, nervousness, and social withdrawal. For some people, these drugs to suppress their personalities, and they feel they have more in a trance, others are targeted and therefore boring. Many of these side effects can be managed by adjusting the dosage or when (which means the time of day), the drug is administered. In some cases you may need to change the type of drug.

Most side effects of stimulant medications are minor and, as mentioned above are directly related to the dose of medication should be taken. Higher doses turn out more side effects.

The most common adverse events, regardless of the choice of drug, appetite, insomnia, anxiety and increased irritability. So basically you are trading the ability to concentrate because they are not hungry and unable to sleep.

In many desires fluctuate, but it is important to recognize that appetite is a side effect of such drugs, and therefore the right amounts of food are, if you want to eat or not consumed.

Such as difficulty falling asleep, your side effects, there are several options you can try. For example, you can reduce the dose or take earlier in the day, or take an additional drug. A small number of children to build tics throughout treatment, and at times this can be primarily contain by changing the dosage, but in a number of cases, the child merely can not tolerate stimulants, and in these cases, an antidepressant frequently used instead.

What you should know

Often parents get excited because their child on medication, and they see improvements in the school. This leads to the thought that they just need to keep their children on medication and all will be well. However, it is important to understand that even if it can help control the symptoms, drugs against ADHD are not healed, and only work when they were taken. Thus, for best long-term results should be combined with behavioral medicine.

Behavioral, psychological and practical support to help ADHD children cope with everyday problems and feel better, so on days when they forget to take their medications, or should they choose to go out of it, they crash and burn.

Results

So what do ADHD drugs? Well, it varies from person to person, but in general, stimulants dramatically reduce hyperactivity and impulsivity and improve the ability to focus, work and learn. Medications may also improve physical coordination, as required in writing and in sports.

Some people get better results from a drug, some of the other. It is important to work with your doctor about what medication and what dosage is best for you or your child. If the child shows no improvement in symptoms after taking a drug for a week, the doctor may try dose adjustment. If still no improvement, the child may be transferred to another drug.

This raises the question many parents want to stimulant drugs answered.are sure? The answer is that, like any medicine, when used in conjunction with medical supervision at the right time and in the right dosage, they are considered very safe. If misused, they can cause problems.

Stimulants do not make the child feel "high", although sometimes they say they are funny, which is often a consequence of the depressive personality. It is believed that stimulants do not cause addiction, but it is always important not to overuse or abuse of these drugs.

Facts to Know

Although you may be opposed to the drug by giving your child, it is important to realize that drugs for ADHD help many children focus and be more successful in school, home and play. This success means avoiding negative experiences, which usually means that the happiest children, and one with a problem of high self-esteem and less later in life. about 80 percent of children who need medication for ADHD still need to adolescence. Over 50 percent need medication as adults. So if you do not want your child medication for ADHD still, you should also start from behavioral therapy.

Saving money tip

Drug prices are generally based more on the number of pills prescribed, rather than the total number of milligrams. So if possible, buy pills with dosage amounts larger, and cut in half. For example, instead of taking a pill of 10 mg twice daily (60 tablets), it is generally cheaper to get a prescription for, and take half a pill of 20 mg twice daily (30pills ).

Based on the average wholesale price for Adderall and Ritalin you would save about 15-30% per month.

Drug options:

The stimulant drugs come in forms long-term and short. The new extended-release stimulants can be taken before school and take a long time, if the child does not need to go to the school nurse a pill every day.

Long-acting stimulants Options

The long-acting stimulants in general have duration of 8to12 hours and can be used one time per day. They are principally valuable for kids who do not want to get a dose at school.

AdderallXR

Adderall (XR) is accepted for use in children beyond the age of 6years, but customary Adderall canbe worn in young children 3to5 years. Adderall(XR) is a sustained release form of Adderall, a stimulant which contains dextroamphetamine popular and amphetamine. It is available as 10 mg, 15 mg, 20 mg, 25 mg and 30 mg, and unlike many other extended-release capsule can be open and spread on food, beverages, or if your child can not swallow a pill.

Concerta

Concerta is a sustained release form of methylphenidate(Ritalin). It is presented as 18mg, 36mg and 54mg tablets and is designed to operate for 12hours. As Adderall(XR), it is simply accepted for children over 6years.

Metadate CD

This is an extended form acting methylphenidate(Ritalin).

Ritalin

This is a newer long-acting form of methylphenidate(Ritalin). It is presented in 10(mg}, 20(mg), 30(mg), 40(mg) and capsules. It can also be opened and sprinkled on something if your child can not swallow the capsules whole.

Short / intermediate acting stimulants options

While long-term medications are useful for those who require only short bursts of concentration, as a test to take, or simply need during the afternoon, so the short-term incentives are a good option.

Short/mediumacting stimulants consist of:
>Ritalin(MethylphenidateHCl)
>Ritalin(SR)
>Methylin chewabletablets and drinking New!
>Metadate(ER)
>Methylin(ER)
>Focalin
>Dexedrine(DextroamphetamineSulfate)
>Dextrostat
>Adderall
>Adderall(generic)
>Dexedrine spansules
>Shortacting Ritalin, Adderall & Dexedrine have the improvement of being to be had in common form, which is typically less expensive than further stimulants. and Methylin chewabletablet news and drink are very suitable for children with ADHD who can not swallow pills.

How to Find Jobs and Work in Medical Billing and Coding for Insurance

Canada vs. America

Medical billing, medical coding and medical billing and coding jobs in fairly high demand in the U.S. in 2010. This phenomenon is partly due to the aging population and its overall need for health care in larger quantities than those with younger population cohorts. Addition, the U.S. presidential administration encouraged additional health and medical resources are made available a larger proportion of the total U.S. population, leading to higher numbers of medical procedures completed each day. Registered any case must be coded and stored in the file, leading to new jobs in the coding and billing for health insurance and medical reasons as stranded practical preparation and retention of medical records.

In Canada, very few of these coding and billing terms found in job search over the Internet. Billing and coding are often treated by a medical receptionist, one much larger numbers listed for Canada.

American Medical
Receptionists, job descriptions vary and compeered listed on Indeed.com and even Canada. The U.S. position is not often a proposed medical billing and coding, while the Canadian Medical Receptionist often seems to do.

Medical Receptionist Jobs in Canada
The list of cities below have the greatest number of vacancies for Medical Receptionist in the nation, in order of higher to lower number. Cities in bold are those 2011 Best Cities for life in Canada designated by Money Sense Personal Financial Website.

1. Calgary AB
2. Edmonton AB
3. Toronto
4. Ottawa
5. Vancouver BC
6. Victoria BC
7. Mississauga ON
8. Winnipeg MB
9. Montreal, QC
10. Saskatoon SK
11. Halifax NS
12. Englehart ON
13. Coquitlam BC
14. Waterloo on

Top rental

1. Office Team
2. Diversified Staffing Solutions and Diversified Staffing Services
3. AC Recruiting
4. Vancouver Coastal Health Authority
5. Times-Colonist (newspaper) Ad
6. Provincial Health Services Authority
7. Startek Canada

Medical billing JOBS
New York City is the largest urban area of ​​the U.S. Medical Billing jobs, which more than twice the number posted by the second place Boston, Massachusetts. A total of 14 cities or metropolitan regions list significant amounts of medical billing jobs, as described below, left.

Location in America
Cities with the largest numbers of jobs lists for medical bills:

1. New York, NY
2. Boston MA
3. Seattle WA
4. Atlanta GA
5. Phoenix AZ
6. Chicago IL
7. Los Angeles CA
8. Houston TX
9. Pittsburgh PA
10. York PA
11. Baltimore MD
12. Billings MT
13. Dallas TX
14. Philadelphia PA

Job titles
Specification under the classification function names and responsibilities of Medical Billing including the following list of titles:

1. Medical billing and coding
2. Medical Biller
3. Medical Records ROI Specialist
4. Medical Billing Specialist
5. Medical Billing Associate
6. Medical Billing Clerk
7. Business Security Consultant
8. Compensation Manager
9. Director of Revenue and Business Cycle Analysis
10. Medical billing and coding and the Receptionist

Business Presentations Most medical billers in the U.S.

1. Planned Parenthood - Planned Parenthood's list of medical billing positions more than others
medical companies and recruiters.
2. Health Career Choices
3. Medical Careers Online
4. Accountemps
5. Robert Half Finance & Accounting
6. Ajilon Finance
7. Rotech Healthcare
8. Medical Career Direct
9. McKesson
10. Companies tied for the # 10 spot: ACG Inc., Walgreens, Aerotek Professional Services;
An Apple

Medical coding JOBS

Medical Coding Job Titles
1. Medical Records ROI Specialist
2. Medical Coder
3. Home Therapies RN (Registered Nurse)
4. Coding Specialist
5. Coder
6. Director of Revenue & Business Cycle Analysis
7. Compensation
8. HIM Manager
9. Coding Auditor
10. Medical Coder - Clinical
11. Medical Billing and Coding Receptionist
12. Medical Coder - Outpatient
13. Coding Quality Manager

Locations with the most jobs
The cities with the most advertising jobs medical coding is similar to the above list of medical billing positions.

1. New York, NY
2. Atlanta GA
3. Phoenix AZ
4. Chicago IL
5. Houston TX
6. San Antonio TX
7. Seattle WA
8. Boston MA
9. Washington DC
10. San Francisco
11. Los Angeles
12. Cleveland OH
13. Las Vegas NV

Listing the largest numbers of companies Coding Jobs

1. Maxim Coding Solutions
2. Planned Parenthood
3. Kforce Professional Staffing
4. Kaiser Permanente
5. Sedgwick Claims Management Services
6. Fresenius Medical Care
7. Port Health
8. UnitedHealth Group
9. Health Career Choices
10. Aerotek
11. Medical Careers Online
12. Amedisys
13. Brookdale Senior Living

Medical coding in the UK
These types of jobs are included in the category of clinical codes and Coding.

Related Jobs Top titles

1. Registered General Nurses (RGNs)
2. Clinical Managers
3. Nurses - a specialty,
4. Registered Nurses (RNS)
5. Theatre Scrub Nurses
6. Registered doctors
7. Operating Department Practitioners
8. Substance Abuse Nurses
9. Home Managers (Nurses)
10. Optometrists

Top Employers

1. Boots
2. Sammons Group and Sammons Josephine
3. White Recruitment
4. StaffNurse.com
5. UK carers
6. Flame Health
7. Axess
8. British jobs
9. Professional Social Care Solutions
10. Same Approach
11. Dynamic selection

Prime locations with jobs

1. London
2. Nottingham
3. Manchester
4. West Midlands
5. Birmingham
6. Oxford
7. Southampton
8. Essex
9. Surrey
10. Kent
11. Hampshire
12. Liverpool
13. Surrey

 
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