Tag: Hodgkin’s lymphoma

Epstein-Barr infection

Description: The Epstein-Barr virus, also called EBV, is an extremely common virus that infects most people at one time or another during their lifetimes. There are several forms of Epstein–Barr virus infection. Infectious mononucleosis, nasopharyngeal carcinoma, and Burkitt’s lymphoma can all be caused by the Epstein–Barr virus.

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It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with particular forms of cancer, such as Hodgkin’s lymphoma, Burkitt’s lymphoma, nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV), such as hairy leukoplakia and central nervous system lymphomas. There is evidence that infection with the virus is associated with a higher risk of certain autoimmune diseases, especially dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren’s syndrome, and multiple sclerosis.

Infection with EBV occurs by the oral transfer of saliva and genital secretions.

Most people become infected with EBV and gain adaptive immunity. In the United States, about half of all five-year-old children and 90 to 95 percent of adults have evidence of previous infection. Infants become susceptible to EBV as soon as maternal antibody protection disappears. Many children become infected with EBV, and these infections usually cause no symptoms or are indistinguishable from the other mild, brief illnesses of childhood. In the United States and other developed countries, many people are not infected with EBV in their childhood years. When infection with EBV occurs during adolescence, it causes infectious mononucleosis 35 to 50 percent of the time.

EBV infects B cells of the immune system and epithelial cells. Once the virus’s initial lytic infection is brought under control, EBV latently persists in the individual’s B cells for the rest of the individual’s life.

Symptoms:
Epstein-Barr virus infection generally causes a minor cold-like or flu-like illness, but, in some cases, there may be no symptoms of infection.Initial symptoms of infectious mononucleosis are fever, sore throat, and swollen lymph glands. Sometimes, a swollen spleen or liver involvement may develop. Heart problems or involvement of the central nervous system occurs only rarely, and infectious mononucleosis is almost never fatal. There are no known associations between active EBV infection and problems during pregnancy, such as miscarriages or birth defects. Although the symptoms of infectious mononucleosis usually resolve in 1 or 2 months, EBV remains dormant or latent in a few cells in the throat and blood for the rest of the person’s life. Periodically, the virus can reactivate and is commonly found in the saliva of infected persons. Reactivated and post-latent virus may pass the placental barrier in (also seropositive) pregnant women via macrophages and therefore can infect the fetus. Also re-infection of prior seropositive individuals may occur. In contrast, reactivation in adults usually occurs without symptoms of illness.

EBV also establishes a lifelong dormant infection in some cells of the body’s immune system. A late event in a very few carriers of this virus is the emergence of Burkitt’s lymphoma and nasopharyngeal carcinoma, two rare cancers. EBV appears to play an important role in these malignancies, but is probably not the sole cause of disease.

Most individuals exposed to people with infectious mononucleosis have previously been infected with EBV and are not at risk for infectious mononucleosis. In addition, transmission of EBV requires intimate contact with the saliva (found in the mouth) of an infected person. Transmission of this virus through the air or blood does not normally occur. The incubation period, or the time from infection to appearance of symptoms, ranges from 4 to 6 weeks. Persons with infectious mononucleosis may be able to spread the infection to others for a period of weeks. However, no special precautions or isolation procedures are recommended, since the virus is also found frequently in the saliva of healthy people. In fact, many healthy people can carry and spread the virus intermittently for life. These people are usually the primary reservoir for person-to-person transmission. For this reason, transmission of the virus is almost impossible to prevent.

The clinical diagnosis of infectious mononucleosis is suggested on the basis of the symptoms of fever, sore throat, swollen lymph glands, and the age of the patient. Usually, laboratory tests are needed for confirmation. Serologic results for persons with infectious mononucleosis include an elevated white blood cell count, an increased percentage of certain atypical white blood cells, and a positive reaction to a “mono spot” test.
Causes:
Epstein–Barr can cause infectious mononucleosis, also known as ‘glandular fever’, ‘Mono‘ and ‘Pfeiffer’s disease’. Infectious mononucleosis is caused when a person is first exposed to the virus during or after adolescence. Though once deemed “The Kissing Disease,” recent research has shown that transmission of EBV not only occurs from exchanging saliva, but also from contact with the airborne virus. It is predominantly found in the developing world, and most children in the developing world are found to have already been infected by around 18 months of age. Infection of children can occur when adults mouth feed or pre-chew food before giving it to the child. EBV antibody tests turn up almost universally positive.

Treatment:
There is no specific treatment for infectious mononucleosis, other than treating the symptoms. No antiviral drugs or vaccines are available. Some physicians have prescribed a 5-day course of steroids to control the swelling of the throat and tonsils. The use of steroids has also been reported to decrease the overall length and severity of illness, but these reports have not been published.

It is important to note that symptoms related to infectious mononucleosis caused by EBV infection seldom last for more than 4 months. When such an illness lasts more than 6 months, it is frequently called chronic EBV infection. However, valid laboratory evidence for continued active EBV infection is seldom found in these patients. The illness should be investigated further to determine if it meets the criteria for chronic fatigue syndrome, or CFS. This process includes ruling out other causes of chronic illness or fatigue.

Prognosis:
There is currently no specific cure for an Epstein-Barr virus infection. Treatment includes measures to help relieve symptoms and keep the body as strong as possible until the disease runs its course. This includes rest, medications to ease body aches and fever, and drinking plenty of fluids. People who are in good health can generally recover from an Epstein-Barr virus infection at home with supportive care, such as rest, fluids and pain relievers.

Prevention:
Treatment of most viral diseases begins with preventing the spread of the disease with basic hygiene measures. However, controlling the spread of the Epstein-Barr virus is extremely difficult because it is so common and because it is possible to spread the Epstein-Barr virus even when a person does not appear sick. Many healthy people who have had an Epstein-Barr virus infection continue to carry the virus in their saliva, which means they can spread it to others throughout their lifetimes. However, avoiding contact with another person’s saliva by not sharing drinking glasses or toothbrushes is still a good general disease prevention measure.

Regular exercise with healthy food habits and healthy life style is the best way of prevention.

Research:
As a relatively complex virus, EBV is not yet fully understood. Laboratories around the world continue to study the virus and develop new ways to treat the diseases it causes. One popular way of studying EBV in vitro is to use bacterial artificial chromosomes. Epstein–Barr virus and its sister virus KSHV can be maintained and manipulated in the laboratory in continual latency. Although many viruses are assumed to have this property during infection of their natural host, they do not have an easily managed system for studying this part of the viral lifecycle. Genomic studies of EBV have been able to explore lytic reactivation and regulation of the latent viral episome.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus
http://en.wikipedia.org/wiki/Epstein–Barr_virus_infection
http://www.healthgrades.com/conditions/epstein-barr-virus

Ailmemts & Remedies

Lymphoma

Post author By Mukul
Post date April 25, 2010
No Comments on Lymphoma

Definition:
The most common type of lymphoma is called Hodgkin’s disease. All other lymphomas are grouped together and are called non-Hodgkin’s lymphomas.…..CLICK & SEE

The lymphatic system is part of the body’s immune defense system. Its job is to help fight diseases and infection.

The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarms, groin, neck, chest, and abdomen.

Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue also is found in other parts of the body, including the stomach, intestines, and skin.

Non-Hodgkin’s lymphoma, also called non-Hodgkin lymphoma, is cancer that originates in your lymphatic system, the disease-fighting network spread throughout your body. In non-Hodgkin’s lymphoma, tumors develop from lymphocytes — a type of white blood cell.

Non-Hodgkin’s lymphoma is more common than the other general type of lymphoma — Hodgkin’s disease.

Many different subtypes of non-Hodgkin’s lymphoma exist. The most common non-Hodgkin’s lymphoma subtypes include diffuse large B-cell lymphoma and follicular lymphoma.

Within normal lymph nodes there are microscopic clusters (follicles) of specialized lymphocytes. In some malignant lymphomas, the lymphocytes arrange themselves in a similar pattern that is called follicular or nodular. Small cell and follicular lymphomas typically have a chronic course with an average survival of 6 to 12 years. In the more aggressive lymphomas, the normal appearance of the lymph node is lost by diffuse involvement of tumor cells, which are usually moderate-sized or large.

Hodgkin’s disease, the most common lymphoma, has special characteristics that distinguish it from the others. Often it is identified by the presence of a unique cell, called the Reed-Sternberg cell, in lymphatic tissue that has been surgically removed for biopsy.

Hodgkin’s disease tends to follow a more predictable pattern of spread, and its spread is generally more limited than that of the non-Hodgkin’s lymphomas. By contrast, the non-Hodgkin’s lymphomas are more likely to begin in extranodal sites (organs other than the lymph nodes, like the liver and bones).

There are about ten different types of Non-Hodgkin’s lymphoma. Some types spread more quickly than others. The type is determined by how the cells look under a microscope (histology). The histologies are grouped together, based on how quickly they spread, into low-grade, intermediate-grade, or high-grade lymphomas.

Symptoms :
The most common symptom of non-Hodgkin’s lymphomas is a painless swelling in the lymph nodes of the neck, underarm, or groin. Other symptoms may include fevers, night sweats, tiredness, weight loss, itching, and reddened patches on the skin. Sometimes there is nausea, vomiting, or abdominal pain.

Symptoms of non-Hodgkin’s lymphoma may include:

*Swollen lymph nodes in your neck, armpit or groin
*Abdominal pain or swelling
*Chest pain, coughing or trouble breathing
*Fatigue
*Fever
*Night sweats
*Weight loss

As lymphomas progress, the body is less able to fight infection. These symptoms are not sure signs of cancer, however. They also may be caused by many common illnesses, such as the flu or other infections. But it is important to see a doctor if any of these symptoms lasts longer than 2 weeks.

Causes:
The cause of most lymphoma is unknown. Some occur in individuals taking drugs to suppress their immune system.

Non-Hodgkin’s lymphoma occurs when your body produces too many abnormal lymphocytes — a type of white blood cell. Normally, lymphocytes go through a predictable life cycle. Old lymphocytes die, and your body creates new ones to replace them. In non-Hodgkin’s lymphoma, your lymphocytes don’t die, but continue to grow and divide. This oversupply of lymphocytes crowds into your lymph nodes, causing them to swell.

B cells and T cells
There are two types of lymphocytes, and non-Hodgkin’s lymphoma usually involves one or the other.

*B cells. B cells fight infection by producing antibodies that neutralize foreign invaders. Most non-Hodgkin’s lymphoma arises from B cells.

*T cells. T cells are involved in killing foreign invaders directly. Non-Hodgkin’s lymphoma occurs less often in T cells.
Whether your non-Hodgkin’s lymphoma arises from your B cells or T cells helps to determine your treatment options.

Risk factors:
In most cases, people diagnosed with non-Hodgkin’s lymphoma don’t have any obvious risk factors, and many people who have risk factors for the disease never develop it. Some factors that may increase the risk of non-Hodgkin’s lymphoma include:

*Medications that suppress your immune system. If you’ve had an organ transplant, you’re more susceptible because immunosuppressive therapy has reduced your body’s ability to fight off new illnesses.

*Infection with certain viruses and bacteria. Certain viral and bacterial infections appear to increase the risk of non-Hodgkin’s lymphoma. Viruses linked to increased non-Hodgkin’s lymphoma risk include HIV, hepatitis C virus and Epstein-Barr virus. Bacteria linked to an increased risk of non-Hodgkin’s lymphoma include the ulcer-causing Helicobacter pylori.

*Chemicals. Certain chemicals, such as those used to kill insects and weeds, may increase your risk of developing non-Hodgkin’s lymphoma. More research is needed to understand the possible link between pesticides and the development of non-Hodgkin’s lymphoma.

*Older age. Non-Hodgkin’s lymphoma can occur at any age, but the risk increases with age. It’s most common in people in their 60s or older.

Diagnosis:
Tests and procedures used to diagnose non-Hodgkin’s lymphoma include:

*Physical examination. Your doctor may conduct a physical exam to determine the size and condition of your lymph nodes and to find out whether your liver and spleen are enlarged.

*Blood and urine tests. Swollen lymph nodes are common and most often signal that your body is fighting an infection. Blood and urine tests may help rule out an infection or other disease.

*Imaging tests. An X-ray or computerized tomography (CT) scan of your chest, neck, abdomen and pelvis may detect the presence and size of tumors. Magnetic resonance imaging (MRI) scans can help your doctor determine whether your brain and spinal cord are affected. Doctors also use positron emission tomography (PET) scanning to detect non-Hodgkin’s lymphoma. Imaging tests can help determine the stage of your lymphoma.

*Removing a sample of lymph node tissue for testing. Your doctor may recommend a biopsy procedure to sample or remove a lymph node for testing. Analyzing lymph node tissue in a laboratory may reveal whether you have non-Hodgkin’s lymphoma and, if so, which type.

*Looking for cancer cells in your bone marrow. To find out whether the disease has spread, your doctor may request a biopsy of your bone marrow. This involves inserting a needle into your pelvic bone to obtain a sample of bone marrow.

Determining your type of non-Hodgkin’s lymphoma :-
Doctors classify non-Hodgkin’s lymphoma into many different types. Several methods for classifying types of non-Hodgkin’s lymphoma exist. Each method uses different combinations of factors, including:

*Whether your cancer involves B cells or T cells

*How the cells appear when examined using a microscope

*Specific genetic changes within the cancer cells

*Which antigens are present on the surface of the cancer cells

Doctors also assign a stage (I through IV) to the disease, based on the number of tumors and how widely the tumors have spread.

Treatment:
Treatment isn’t always necessary
If your lymphoma appears to be slow growing (indolent), a wait-and-see approach may be an option. Indolent lymphomas that don’t cause signs and symptoms may not require treatment for years.

Delaying treatment doesn’t mean you’ll be on your own. Your doctor will likely schedule regular checkups every few months to monitor your condition and ensure that your cancer isn’t advancing.

Treatment for lymphoma that causes signs and symptoms
If your non-Hodgkin’s lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment.

Treatment planning takes into account the type of lymphoma, the stage of disease, whether it is likely to grow slowly or rapidly, and the general health and age of the patient. Common treatment options for several types are as follows:

Low Grade
Low-grade lymphomas include small lymphocytic, follicular small cleaved, and follicular mixed cell. For low-grade lymphomas, which usually grow very slowly and cause few symptoms, the doctor may wait until the disease shows signs of spreading before starting treatment.

Although low-grade lymphomas grow slowly and respond readily to chemotherapy, they almost invariably return and are generally regarded as incurable. The long-term outcome has not been favorably affected by the use of intermediate chemotherapy. Single agent or combination chemotherapy or radiation therapy may be required when the disease progresses or begins to cause symptoms.

Intermediate and High Grades
Intermediate grade includes follicular large cell, diffuse small cleaved, diffuse mixed cell, and diffuse large cell. The chance of recovery and choice of treatment depend on the stage of the cancer, age, and overall condition. Whatever the origin, the features that best predict the prognosis and guide decisions about therapy are the size, shape and pattern of the lymphocytes as seen microscopically.

Intermediate- and high-grade lymphomas are curable. Treatment for intermediate- or high-grade lymphomas usually involves chemotherapy, with or without radiation therapy. In addition, surgery may be needed to remove a large tumor.

Combination chemotherapy is almost always necessary for successful treatment. Chemotherapy alone, or abbreviated chemotherapy and radiation, cure 70 to 80 percent of patients with limited intermediate-grade lymphoma. Advanced disease can be eradicated in about 50 percent of patients.

Hodgkin’s Disease
The usual treatment for most patients with early stage Hodgkin’s disease is high-energy radiation of the lymph nodes. Research has shown that radiation therapy to large areas at high doses (3,500 to 4,500 rads) is more effective in preventing relapse than radiation of the diseased nodes alone.

Combination chemotherapy also is effective in the treatment of early stage Hodgkin’s disease. In addition, chemotherapy is the treatment of choice for advanced (stages III and IV) Hodgkin’s disease and for patients who have relapsed after radiotherapy. Drugs and radiation are sometimes given together, mainly in treating patients with tumors in the chest or abdomen.

Coping and support:
A diagnosis of cancer can be overwhelming. With time you’ll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:

*Learn everything you want to know about your cancer. Find out everything you need to know about your cancer in order to help you make treatment decisions. Ask your doctor for the type and stage of your cancer, as well as your treatment options and their side effects. Ask your doctor where you can go for more information. Good places to start include the National Cancer Institute and the Leukemia & Lymphoma Society.

*Build a strong support system. Having a support system of close friends and family may help you cope. Though you may feel tempted to keep to yourself, be open with your loved ones. Friends will ask you if there’s anything they can do to help you. Think of requests ahead of time, such as preparing meals or just being there to talk.

*Connect with other cancer survivors. Sometimes you’ll feel as if your friends and family can’t understand what you’re going through. In these cases, other cancer survivors can offer support and practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are. Ask your doctor about support groups in your area. Or go online to Internet message boards, such as those offered by the Leukemia & Lymphoma Society.

*Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But don’t choose goals you can’t possibly reach. You may not be able to work a 40-hour week, for example, but you may be able to work at least part time. In fact, many people find that continuing to work can be helpful.

*Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for when you may need to rest more or limit what you do.

*Stay active. Receiving a diagnosis of cancer doesn’t mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. Stay involved as much as you can.

*Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself may help you cope with having cancer. It may also help you maintain a more positive attitude as you face the challenge of cancer.

Resources:
http://www.mayoclinic.com/health/non-hodgkins-lymphoma/DS00350
http://www.healthscout.com/ency/68/304/main.html#SymptomsofLymphoma

Tags Atlanta, Cancer, Conditions and Diseases, Diagnosis, Emory University, Emory University School of Medicine, Eric Berry, Health, Hematologic, Hodgkin's lymphoma, Kansas City, Kansas City Chiefs, Lymphoma, Magnetic resonance imaging, Missouri, Non-Hodgkin, Non-Hodgkin lymphoma

News on Health & Science

How Scratching Curbs the Itch?

Post author By Mukul
Post date April 9, 2009
No Comments on How Scratching Curbs the Itch?

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Itching brings with it that ever-increasing urge to scratch, which always works wonders, but not much is known about the physiological mechanisms behind this phenomenon.

Now scientists have watched spinal nerves transmit that relief signal to the brain in monkeys, a possible step toward finding new treatments for persistent itching in people.
....click & see

Nerve cells play a key role in itching

More than 50 conditions can cause serious itching, including AIDS, Hodgkin’s disease and the side effects of chronic pain treatment, said Glenn Giesler, a neuroscientist at the University of Minnesota in Minneapolis. Some terminal cancer patients even cut back on pain medication just to reduce the itch, he said.

Scratching can lead to serious skin damage and infections in people with chronic itch, he said. So scientists want to find ways for such people to relieve their distress “without tearing up their skin,” he said.

While medications can relieve some kinds of itch, other cases resist current treatments.

Nobody knows just how scratching relieves itch. But the federally funded monkey study, reported Monday on the website of the journal Nature Neuroscience by Giesler and colleagues, takes a step in unraveling the mystery.

The scientists focused on a kind of spinal nerve that transmits the “itch” signal to the brain. The researchers sedated long-tailed macaques for the experiment and placed recording electrodes on their spinal nerves. They injected a chemical into a leg to produce itching. The nerves fired electrical signals in response. Then the researchers scratched the leg with a hand-held metal device that simulates three monkey fingers. The firing rate dropped — the apparent signature of the “relief” signal. In contrast, when researchers scratched the leg without causing an itch first, the firing rate jumped. So the nerves somehow “know” to react much differently if there’s an itch to be relieved than if there isn’t.

Sources: The Times Of India

How scratching can stop an itch (news.bbc.co.uk)
Scientists sniff out prion secret (news.bbc.co.uk)
Biogen Idec Aims to Regenerate Damaged Nerves, Crack Multi-Billion Dollar Market (xconomy.com)
Itch (Pruritus) – Diagnosis, Prevention & Treatment (healthhype.com)
Causes of Itchy Skin (healthhype.com)

Tags AIDS, Cancer, Chronic pain, Conditions and Diseases, Health, Hodgkin's lymphoma, Itch, Minneapolis, Nature Neuroscience, Neuron, Times Of India, University of Minnesota

Diagnonistic Test

Mediastinoscopy

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Definition:
Mediastinoscopy is a surgery that allows doctors to view the middle of the chest cavity and to do minor surgery through very small incisions. It allows surgeons or pulmonary doctors to remove lymph nodes from between the lungs and to test them for cancer or infection. It is also useful for examining the outside surface of the large tubes of the airways (such as the trachea) or for evaluating tumors or masses in the middle chest.
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During a mediastinoscopy, a small incision is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope (mediastinoscope) is inserted through the opening. A tissue sample (biopsy) can be collected through the mediastinoscope and then examined under a microscope for lung problems, such as infection, inflammation, or cancer. See an illustration of mediastinoscopy.

In many cases mediastinoscopy has been replaced by other biopsy methods that use computed tomography (CT), echocardiography, or bronchoscopy to guide a biopsy needle to the abnormal tissue. Mediastinoscopy may still be needed when these methods cannot be used or when they do not provide conclusive results.

It allows surgeons or pulmonary doctors to remove lymph nodes from between the lungs and to test them for cancer or infection. It is also useful for examining the outside surface of the large tubes of the airways (such as the trachea) or for evaluating tumors or masses in the middle chest.

Why It Is Done?
Mediastinoscopy is done to:

* Detect problems of the lungs and mediastinum, such as sarcoidosis.
* Diagnose lung cancer or lymphoma (including Hodgkin’s disease). Mediastinoscopy is often done to check lymph nodes in the mediastinum before considering lung removal surgery to treat lung cancer. Mediastinoscopy can also help your doctor recommend the best treatment (surgery, radiation, chemotherapy) for lung cancer.
* Diagnose certain types of infection, especially those that can affect the lungs (such as tuberculosis).

How To Prepare for the Test?
Discuss to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will indicate. This procedure is done by either a surgeon or a trained pulmonary specialist. You will need to sign a consent form giving your surgeon permission to perform this test.

Be sure to discuss with your doctor what may be done following each possible biopsy result. If a lymph node contains cancer, surgery may be done to remove the cancer while you are still asleep. To help you understand the importance of this procedure, fill out the medical test information form (What is a PDF document?) .

Before you have a mediastinoscopy, tell your doctor if you:

* Are taking any medications.
* Have allergies to any medications, including anesthetics.
* Have any bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin).
* Are or might be pregnant.

Also, certain conditions may make it more difficult to do a mediastinoscopy. Let your doctor know if you have:-

* Had a mediastinoscopy or open-heart surgery in the past. The scarring from the first procedure may make it difficult to do a second procedure.
* A history of neck problems or a neck injury, especially hyperextension of the neck.
* Any physical problems of your chest, including those that have been present since birth (congenital).
* Recently had radiation therapy to the neck or chest.

You will receive general anesthesia and be asleep during the mediastinoscopy. To prepare for your procedure:

* Do not eat or drink anything for at 8 to 10 hours before the procedure. If you take daily medications, ask your doctor whether you should take them on the day of the procedure.
* Leave your jewelry at home. Any jewelry you wear will need to be removed before the procedure.
* Remove glasses, contact lenses, and dentures or a removable bridge just prior to the procedure. These will be given back to you as soon as you wake up after the procedure.
* Arrange to have someone drive you home after the procedure if you do not need to stay in the hospital.

Your doctor may order certain blood tests, such as a complete blood count or bleeding factors, before your procedure.

Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.

How It Is Done ?
Mediastinoscopy is done in an operating room.Mediastinoscopy is done by a chest (thoracic) surgeon and surgical assistants.

Before the procedure, an intravenous (IV) line will be placed in a vein to give you fluids and medications. After you are asleep, a tube will be placed in your throat (endotracheal or ET tube) to help you breathe during the procedure. Your neck and chest will be washed with an antiseptic soap and covered with a sterile drape.

This procedure is almost always done with general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube is put down your throat to help you breathe. One reason you need this tube is that your head is tilted far back during the procedure. The tube keeps your throat safely open even while your neck is bending backwards.

An incision will be made just above your breastbone at the base of your neck or on the left side of your chest near the breastbone between the 4th and 5th ribs. A tiny camera on a tube, called a mediastinoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen. Your doctor will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected for examination. After the scope is removed from your chest, the incision will be closed with a few stitches and covered with a bandage.

The doctor makes one or two other small incisions to allow additional instruments to reach into your chest. These incisions are usually made next to your sternum, between ribs. A wide variety of instruments are useful in mediastinoscopy. These include instruments that can clip away a lymph node and remove it through one of the small chest incisions. Other instruments can be used to stop bleeding blood vessels by using a small electrical current to seal them closed.

At the end of your surgery, the instruments are removed, the lungs are reinflated, and the small incisions are stitched closed. The anesthesia is stopped so that you can wake up within a few minutes of your procedure, although you will remain drowsy for a while afterward.

The entire procedure usually takes about an hour. After the procedure, you will be taken to the recovery room.

Some people may go home after the procedure if the general anesthesia wears off and they are able to swallow fluids without gagging or choking. Other people may need to stay in the hospital for 1 or 2 days. If your stitches are not the dissolving type, you will need to return to your doctor in 10 to 14 days to have them removed. Mediastinoscopy usually leaves only a tiny scar.

How It Feels
Before the procedure you may be given medication that will make you sleepy and relaxed. You will receive general anesthesia during the mediastinoscopy, which will cause you to be asleep. After you wake up, you may feel sleepy for several hours. You may feel tired for 1 to 2 days after the procedure and have some general aches and pains. You may also have a mild sore throat from the tube in your throat during the procedure. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.
Risk Factors:
You will have a small straight scar (less than an inch long) wherever the instruments were inserted. You may have some discomfort for a few days in the areas of the incisions. Sometimes work in the middle chest can temporarily injure a nerve, which can weaken your vocal cord muscles for a while and cause hoarseness. In rare cases, bleeding complications might require a transfusion or larger chest surgery. Air leaks from the lung can also occur and occasionally require additional treatment such as a drainage tube, called a chest tube, that is placed into the chest between your ribs and left there for a few days.

General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections.

Complications from mediastinoscopy are uncommon but may include bleeding, infection, a collapsed lung (pneumothorax), a tear in the esophagus, damage to a blood vessel, or injury to a nerve near the voice box (larynx) which may cause permanent hoarseness.

After the procedure, contact your doctor immediately if you have:

* Bleeding from your stitches.
* A fever.
* Severe chest pain.
* Swelling in the neck.
* Shortness of breath.
* Difficulty swallowing.
* Hoarseness of your voice that lasts more than a few days or continues to get worse.

Must you do anything special after the test is over?
You should notify your doctor if you experience fever, shortness of breath, shoulder pain, or chest pain. You should not drive or drink alcohol for the rest of the day.

Results:

Mediastinoscopy is a surgical procedure to examine the inside of the chest between and in front of the lungs (mediastinum).

Normal:-

Lymph nodes are small, smooth, and appear normal.

No abnormal tissue, growths, or signs of infection are present.

Abnormal:-

Lymph nodes may be enlarged or appear abnormal, which may indicate sarcoidosis, infection, or cancer. Tissue samples are removed and examined under the microscope.

Abnormal growths (such as a tumor) or signs of infection (such as an abscess) may be found in the chest cavity, or mediastinum.

What Affects the Test?
If you have had mediastinoscopy or open-heart surgery, you may not be able to have this procedure. Scarring from the first procedure may make it difficult to do a second procedure.
What To Think About?
If a lymph node biopsy needs to be examined quickly (while you are still asleep), the sample will be taken immediately to the laboratory. There it will be frozen and sliced into very thin sections for examination under a microscope. If the lymph nodes show that you have cancer, surgery may be done right away to remove the cancer while you are still asleep. If a frozen section sample is not needed, a permanent section is made and the results usually are available in 2 to 4 working days.

Respources:
https://www.health.harvard.edu/diagnostic-tests/mediastinoscopy.htm
http://www.webmd.com/a-to-z-guides/mediastinoscopy-21507