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News on Health & Science

Mouth Indicates Body’s Overall Health

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The mouth or oral cavity area is an excellent indicator of the whole body’s health, says a University of Maryland Dental School professor.
……....CLICK & SEE.
Professor Li Mao insists surface tissues inside the cheek could be checked to detect tobacco-induced damage in the lungs.

This could prove to be an important advancement in designing future lung cancer prevention trials.

“We hypothesized that tobacco-induced molecular alterations in the oral epithelium are similar to those in the lungs,” said Mao.

The expert added: “This might have broader implications for using the mouth as a diagnostic indicator for general health.”

“I feel that dentists should play a major role in prevention of cancer and Dr. Mao is the leading oral cancer researcher in the country. He crosses the bridge between medicine and dentistry,” said University of Maryland Dental School Dean Christian S. Stohler, DMD, DrMedDent, a leader in the movement to retool dental education.

“Being a physician helps expand dental health care and he wants to change how patients are being treated because his background is in head and neck cancer,” Stohler added.

Source: The study is published in the journal Cancer Prevention Research.

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Health Problems & Solutions

Some Health Quaries & Answers

Q: My one-year-old son developed watery diarrhoea. We went to several doctors who first prescribed tests and then gave him antibiotics. Eventually I was told he had developed “milk intolerance” and was switched to soya milk. Can I give him goat or buffalo milk? Can I use a tinned product like Nan or Lactogen instead?

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A:
Your son has developed an inability to digest lactose, the sugar in milk, probably as a consequence of gastroenteritis. Since he is a year old, and you do not want to give him soya milk, try keeping him on other foods (no milk) for 72 hours. Very often the intestine recovers its ability to digest milk in that time. Nan, Lactogen, goat and buffalo milk all contain lactose. Switching him to these products will not solve the problem.

Lung cancer
Q: My daughter is 24 years old and has been diagnosed with lung cancer. How is it possible? She does not smoke.

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A: The factors that contribute to the development of lung cancer in non-smoking women are postulated to be exposure to second hand smoke, high levels of the hormone estrogen, genetic factors, or abnormal embryonic remnants in the lung that mutate. None of these (except exposure to second hand smoke) can be changed.

Sugar or honey?
Q: I am diabetic, but my blood sugar level is well under control. I use Equal in my tea and coffee. Recently I read that it is bad for health. Can I use honey instead?

 

A: Honey contains fructose, glucose and sucrose. All these are sugars, so substituting honey for sugar will not help. The main constituent of Equal is aspartame (L-aspartyl-L-phenylalanyl-methyl-ester) which is about 200 times as sweet as sugar with virtually no calories. This compound breaks down in the system to:

1) Phenylalanine (50 per cent), which can be neurotoxic and in some susceptible people cause seizures

2) Aspartic acid (40 per cent), which can cause brain damage in the developing brain

3) Methanol (10 per cent), which turns into formaldehyde

The quantities taken by diabetic patients in tea and coffee are small and probably insufficient to cause these adverse reactions. People who drink large quantities of diet cola or such drinks are more likely to be affected. The reactions are idiosyncratic and vary from individual to individual.

Weight gain
Q: I gained 4 kg after I got married. This now makes me 75 kg. Also, I have not been able to conceive.

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A: Y
our lifestyle may have changed after marriage. The best thing to do is to stop snacking, cut out chocolates and puddings, and always refuse a second helping. You also need to exercise. An hour a day is sufficient, but you need to vigorously cross train. Run one day, swim the next and cycle the third. Combine this with yoga if you want that hourglass figure.

Bed wetting
Q: My nine-year-old son still wets his bed. This is an embarrassment to us.

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A: Bed wetting is said to be primary when bladder control has never been achieved and secondary when there is a reversion to it after six dry months. Most children achieve night time bladder control by the age of three. But around 30 per cent of children continue to wet their bed. Even without treatment, this percentage falls to 20 per cent by the age of six. However, one per cent of adolescents continue to wet their bed. Bed wetting may be familial and is commoner in boys. If urine and blood test results are normal, and there is no structural abnormality, then the outlook for such children is good. About 15 per cent gets spontaneously cured. Berating the child, punishment or humiliation is not an answer to the problem.

A few simple measures may help:

* Limit fluid intake after 7pm

* Avoid caffeinated drinks (colas, tea and coffee)

* Encourage the child to go to the toilet before bedtime

* Avoid punishment

* Encourage success

* Leave a light on in the bathroom

* Make the child wear simple underclothes without complicated bows and zippers so that they can be easily pulled up or down if required.

Gasping for air
Q: I have been diagnosed with emphysema. I am breathless most of the time. How did I get this?

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A:
Emphysema usually follows lung damage as a result of long-term cigarette smoking, air pollution or occupational exposure to dust as in the case of coal miners. It runs in some families where many members have a genetically determined deficiency of an enzyme called Alpha-1-antitrypsin. It can occur in poorly controlled asthmatics. Lung function decreases with age so it can occur in older people without any of these risk factors. It is also commoner in men.

It can be treated with inhalers, nebulisers, oxygen, bronchodilators and appropriate antibiotics whenever an infection flares up. In the case of smokers, treatment will not succeed unless smoking is stopped.

Source: The Telegraph (Kolkata, India)

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News on Health & Science

Nanoparticle May Cause Lung Cancer

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The fledgling science of nanotechnology promises huge advances in science and medicine, but there are concerns about its safety.

In particular, the microscopic particles it employs have been shown to have toxic effects on the lungs.

The research, by the Chinese Academy of Medical Sciences, appears in the Journal of Molecular Cell Biology.

However, experts said it was not possible to draw general conclusions about all nanoparticles from a study focusing on one specific type.

Nanotechnology involves the modification of atoms and molecules to create new materials which may have unusual physical, chemical, and biological properties.

“This provides us with a promising lead for developing strategies to prevent lung damage caused by nanoparticles” says Chengyu Jiang, Chinese Academy of Medical Sciences

In medicine alone it is hoped it could be used to develop more effective and better targeted drugs, and new ways to detect and treat disease.

The market is potentially huge, but safety concerns threaten to hold progress back.

Research has shown that most nanoparticles migrate to the lungs, but there is also concern about potential damage to other organs.

The latest research focused on a class of nanoparticles being widely developed in medicine – polyamidoamine dendrimers (PAMAMs).

In tests on cells in the lab, the researchers found the particles cause lung damage by triggering a type of programmed cell death known as autophagic cell death.

Autophagy plays a normal part in cell growth and renewal, but over-activity can lead to unwanted cell death.

However, the researchers also found autophagy could be blocked by using a drug inhibitor.

The findings were confirmed in tests on mice. Animals exposed to PAMAMs showed higher levels of lung inflammation, and higher death rates.

But those that were first injected with the inhibitor were less badly affected.

New strategies
Lead researcher Dr Chengyu Jiang said: “This provides us with a promising lead for developing strategies to prevent lung damage caused by nanoparticles.

Nanomedicine holds extraordinary promise, particularly for diseases such as cancer and viral infections.

“But safety concerns have recently attracted great attention and with the technology evolving rapidly, we need to start finding ways now to protect workers and consumers from any toxic effects that might come with it.”

“The idea is that, to increase the safety of nanomedicine, compounds could be developed that could either be incorporated into the nano product to protect against lung damage, or patients could be given pills to counteract the effects.”

Dr Laura Bell, of the charity Cancer Research UK, said: “It’s great to see new advances being made to ensure the safety of nanomedicine but this research is still at an early stage and has yet to be tested in people.

“Nanotechnology is an expanding area of research with exciting potential and establishing its safety is essential if we are to realise its potential to treat people with cancer.”

It is not clear at this stage whether other types of nanoparticles cause lung damage via the same route.

Professor Ken Donaldson, an expert in respiratory toxicology at the University of Edinburgh, said PAMAMs were highly specialised, and it would be wrong to draw any general conclusions about nanoparticles in general from the study.

Professor Donaldson said PAMAMs were made by the drug industry in tiny amounts, while other nanoparticles were made in much bigger quantities, and potentially posed much more of a risk of accidental exposure.

He said: “The problem is that all nanoparticles are lumped together as if they are one thing and they most certainly are not.”

You may click to see->
*Nano device ‘times drug release’
*Nano-treatment to torpedo cancer
*Gold nanoparticles to trap toxins
*’Nanoparticles’ could carry cancer drugs


Source:
BBC NEWS:11Th. June,’09

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Diagnonistic Test News on Health & Science

Video-Asisted Thoracic Surgery (VATS)

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Introduction:
Video-assisted thoracic surgery (VATS) is a recently developed type of surgery that enables doctors to view the inside of the chest cavity after making only very small incisions. It allows surgeons to remove masses close to the outside edges of the lung and to test them for cancer using a much smaller surgery than doctors needed to use in the past. It is also useful for diagnosing certain pneumonia infections, diagnosing infections or tumors of the chest wall, and treating repeatedly collapsing lungs. Doctors are continuing to develop other uses for VATS.
..VATS->…  CLICK & SEE
When compared with a traditional open chest procedure, VATS has reduced the amount of chest wall trauma, deformity, and post-operative pain. While an open procedure generally requires a 30-40 cm incision, video-assisted biopsies can be performed through three 1 cm ports , and a VATS lobectomy, a resection of one lobe of the lung, is performed using a 5-8 cm incision.

How do you prepare for the test?
Discuss the specific procedures planned during your chest surgery ahead of time with your doctor. VATS is done by either a surgeon or a trained pulmonary specialist. You will need to sign a consent form giving the surgeon permission to perform this test. Talk to your doctor about whether you will stay in the hospital for any time after the procedure, so that you can plan for this.

You may need to have tests called pulmonary function tests (see page 33) before this surgery, to make sure that you can recover well.

If you are taking insulin, discuss this with your doctor before the test. If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.

You will be told not to eat anything for at least eight hours before the surgery. An empty stomach helps prevent the nausea that can be a side effect of anesthesia medicines.

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.

What happens when the test is performed?

VATS is done in an operating room. You wear a hospital gown and have an IV (intravenous) line placed in your arm so that you can receive medicines through it.

VATS is usually 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. Your anesthesiologist can use this tube to make you breathe using only one of your lungs. This way the other lung can be completely deflated and allow the surgeon a full view of your chest cavity on that side during the procedure.

If VATS is being used only to evaluate a problem on the inside of the ribcage (not the lung itself), then it can sometimes be done using regional anesthesia. With regional anesthesia, you are not asleep during the surgery, but are given medicines that make you very groggy and that keep you from feeling pain in the chest. This is done with either a spinal block or an epidural block, in which an anesthesiologist injects the anesthetic through a needle or tube in your back or neck. You do your own breathing with this type of anesthesia, but one of your lungs will be partly collapsed to allow the doctors to move instruments between the lung and the chest wall.

When you meet with the thoracic surgeon, a physical exam will be performed and your treatment options will be discussed. The thoracic surgeon will discuss the benefits and potential risks of the surgical procedure that is recommended for you.

In general, preoperative tests include: (links will open in a new window)

*Blood tests
*Pulmonary function test (breathing test)
*CT scan
*Electrocardiogram

Your surgeon will determine if any additional preoperative tests are needed, based on the type of procedure that will be performed. If a cardiac (heart) evaluation is necessary, a consultation with a cardiologist will be scheduled in our internationally-renowned Miller Family Heart & Vascular Institute.

As part of your preoperative evaluation, you will meet with an anesthesiologist who will discuss anesthesia and post-operative pain control.

The thoracic surgery scheduler will schedule any additional tests and consultations that have been requested by your surgeon. In general, after your first meeting with your surgeon, all tests are scheduled on a single returning visit for your convenience.

You spend the surgery lying on your side. A very small incision (less than an inch long) is made, usually between your seventh and eighth ribs. Carbon dioxide gas is allowed to flow into your chest through this opening, while your lung on that side is made to partly or completely collapse. A tiny camera on a tube, called a thoracoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen.

If you are having a procedure more complicated than inspection of the chest and lung, the doctor makes one or two other small incisions to allow additional instruments to reach into your chest. These additional incisions are usually made in a curving line along your lower ribcage. A wide variety of instruments are useful in VATS. These include instruments that can cut away a section of your lung and seal the hole left in your lung using small staples, instruments that can burn away scar tissue, and tools to remove small biopsy samples such as lymph nodes from your chest.

At the end of your surgery, the instruments are removed, the lung is reinflated, and all but one of the small incisions are stitched closed. For most patients, a tube (called a chest tube) is placed through the remaining opening to help drain any leaking air or fluid that collects after the surgery.

If you are having general anesthesia, it is stopped so that you can wake up within a few minutes of your VATS being finished, although you will remain drowsy for a while afterward.

How long will you stay in the hospital after thoracoscopic surgery?
The length of your hospital stay will vary, depending on the procedure that is performed. In general, patients who have thoracoscopic lung biopsies or wedge resections are able to go home the day after surgery. Patients who have a VATS lobectomy are usually able to go home 3 to 4 days after surgery.
Risk Factors:
It is easier for patients to recover from VATS compared with regular chest surgery (often called “open” surgery) because the wounds from the incisions are much smaller. You will have a small straight scar (less than an inch long) wherever the instruments were inserted. There are some potentially serious risks from VATS surgery. Air leaks from the lung that don’t heal up quickly can keep you in the hospital a longer time and occasionally require additional treatment. About 1% of patients have significant bleeding requiring a transfusion or larger operation.

Sometimes, especially if cancer is diagnosed, your doctors will decide that you need a larger surgery to treat your problem in the safest manner possible. Your doctors might discuss this option with you ahead of time. That way, if necessary, the doctors can change over to a larger incision and do open chest surgery while you are still under anesthesia. Death from complications of VATS surgery does occur in rare cases, but less frequently than with open chest surgery.

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.

Irritation of the diaphragm and chest wall can cause pain in the chest or shoulder for a few days. Some patients experience some nausea from medicines used for anesthesia or anxiety.

What will happen after your thoracoscopic surgery?
Your thoracic surgery team, including your surgeon, surgical residents and fellows, surgical nurse clinicians, social workers and anesthesiologist, will help you recovery as quickly as possible. During your recovery, you and your family will receive updates about your progress so you’ll know when you can go home.

Your health care team will provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.

Most patients stay in the hospital for at least one day after a VATS procedure to recover from the surgery. Most patients have a chest tube left in the chest for a few days, to help drain out leaking air or collections of fluid. You should notify your doctor if you experience fever, shortness of breath, or chest pain.

Follow-Up Appointment: A follow-up appointment will be scheduled 7 to 10 days after your surgery. Your surgeon will assess the wound sites and your recovery at your follow-up appointment and provide guidelines about your activities and return to work.

Most people who undergo minimally invasive thoracic surgery can return to work within 3 to 4 weeks.

How long is it before the result of the test is known?
Your doctor can tell you how the surgery went as soon as it is finished. If biopsy samples were taken, these often require several days to be examined.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/video-assisted-thoracic-surgery.shtml
http://www.cancernews.com/data/Article/242.asp
http://my.clevelandclinic.org/thoracic/services/video_assisted.aspx

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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.
CLICK & SEE THE PICTURES

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

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