Tag Archives: Lymph node

Overcoming Oedema

 

Swollen feet — medically called  oedema — can make life miserable. Shoes and slippers don’t fit — they are tight and uncomfortable and sometimes impossible to put on. The feet feel like dead weights, and walking becomes a Herculean task. It is much easier to simply sit. But inactivity makes the swelling worse, and the sufferer is caught in a vicious cycle of swelling-inactivity-more swelling.

CLICK  & SEE THE PICTURES

The fluid that accumulates and causes oedema leaks from tiny blood vessels called capillaries. This can occur as a result of increased pressure, damage to the vessels or a fall in the protein concentration of the blood. As soon as the body senses that the capillaries are leaking, compensatory mechanisms come into play and fluid is retained in the body by the kidney. The amount of fluid circulating in the body therefore increases. This, in turn, causes the capillaries to leak more. This fluid from the capillaries leaks into the surrounding tissue, causing the swelling. At least five litres of fluid need to be retained before actual swelling appears.

Feet swell before any other part of the body. This is because the hydrostatic pressure on the blood vessels of the lower limbs are, by virtue of gravity, one metre more than the pressure on the face. Also, when we sit and stand, our feet are at a lower level than the heart and this aggravates the problem.

To demonstrate oedema, press firmly with your forefinger and maintain the pressure for 10 seconds. A persistent dimple like depression indicates the presence of oedema.

However, swollen feet do not always indicate disease. Overweight individuals may develop some amount of swelling at the end of a stationery day. (Fat is fluid at body temperature). This can be normal. The swelling can extend up to the knees.

Salt also causes fluid retention. If you consume a lot of salty snacks and pickles, the kidney is not able to handle the sodium overload and fluid is retained.

Women are more prone to develop oedema than men. The female hormones oestrogen and progesterone cause fluid retention. Women tend to “swell up” during the pre-menstrual period, pregnancy and if they are on hormones, either as oral contraceptive pills or as part of hormone replacement therapy (HRT). This can extend to the hands, making finger rings tight. The face may also appear puffy. This type of oedema disappears spontaneously in a few days once menstruation occurs, the baby is born or the hormones discontinued.

Oedema can be a side effect of prescribed medication like nifedepine, amlodepin and other anti-hypertensives. Medicines for pain belonging to the non-steroidal anti-inflammatory drugs (NSAIDs) group can also cause fluid retention. Some like diclofenac may damage the kidneys. If you develop swelling while on medication, consult your doctor.

At times, oedema can be the first sign of a serious underlying medical condition. If the heart is unable to pump blood efficiently, blood can accumulate in the capillaries of the legs, ankles and feet, causing oedema.

The liver regulates the protein content of the blood. It is also responsible for adjusting the hormones and chemicals that regulate the fluid content of the body. The organ can become damaged as a result of alcoholism, hepatitis B infection or other diseases. This injury results in scar formation and is called cirrhosis. Fluid can then accumulate in the legs and abdomen. But two of the causal factors can be prevented — don’t drink excessively and take your hepatitis B immunisations.

Damaged kidneys cannot excrete excess fluid. The oedema then occurs typically around the legs and eyes. Kidney damage can occur for a variety of reasons. Preventable causes are uncontrolled, neglected diabetes and hypertension.

The veins in the leg may be damaged or weak. Sometimes the valves in these veins — which prevent back flow of blood — may be inefficient. Chronic venous insufficiency and varicose veins can result in swelling.

Excess fluid from tissues is cleared by the lymphatic system. These drain into lymph nodes and eventually into the large veins. Infections like filaria can damage the lymphatic system. The nodes can be infiltrated by cancerous deposits. The nodes may have been removed or damaged during surgery. All this can result in swelling. Usually this is present in any one limb and not symmetrically on both sides of the body.

Always keep in mind:-
• Oedema can be treated if the causal factor is removed

• Reduce weight if the BMI (body mass index or weight divided by height in metre squared ) is more than 23

• Walk, jog or swim for 40 minutes a day

• Try to move the legs every half hour during the day

• Do not add extra salt to food and avoid salty snacks

• Keep the feet elevated

• Use elastocrepe bandages or compression stockings on affected limbs

• Do not consume NSAIDs unnecessarily

• Seek medical advice immediately for filaria

• Use diurectics to get rid of fluid only if prescribed by a doctor

• Control diabetes and hypertension.

Source: The Telegraph (Kolkata, India)

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Anoscopy

Definition:
An anoscopy is an examination of the rectum in which a small tube is inserted into the anus to screen, diagnose, and evaluate problems of the anus and anal canal.

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Anoscopy views the anus and anal canal by using an anoscope. An anoscope is a plastic, tube-shaped speculum that is a smaller version of a sigmoidscope. Before the anoscope is used, the doctor completes a digital rectal examination with a lubricated, gloved index finger. The anoscope is then lubricated and gently inserted a few inches into the rectum. This procedure enlarges the rectum to allow the doctor to view the entire anal canal with a light. If any suspicious areas are noticed, a piece of tissue can be biopsied.
What is the Purpose of the test?
Doctors use anoscopy to diagnose rectal cancer and cancer of the anus. This procedure can also help the doctor:

*:detect any lesions that could not be felt during a digital examination

*determine whether squamous cell carcinomas involving lymph nodes in or near the groin (inguinal lymph nodes) originated in the genital area or in or near the anus or rectum

*confirm the source of malignancies that have spread to the anorectal area from other parts of the body
Doctors also perform anoscopy to determine whether a patient has hemorrhoids or anal:

*growths or nodules (polyps)
*ulcer-like grooves (fissures)
*inflammation
*infection

.How do you prepare for the test?
Before the test, you might want to empty your bladder or have a bowel movement to make yourself more comfortable. The doctor may suggest using:

*a laxative,
*an enema,
*or some other preparationto clear the rectum.

What happens when the test is performed?
This test is usually done in a doctor’s office. You need to remove your underwear.After removing underwear, the patient bends forward over the examining table or lies on one side with knees drawn up to the chest. The doctor performs a digital examination to make sure no tumor or other abnormality will obstruct the passage of a slender lubricated tube (anoscope). As the doctor gently guides the anoscope a few inches into the rectum, the patient is told to bear down as though having a bowel movement, thenrelax.

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By tensing and relaxing, the patient makes it easier for the doctor to insert the anoscope, and discover growths in the lining of the rectum that could not be detected during the digital examination.

Directing a light into the anoscope gives the doctor a clear view of any tears or other irregularities in the lower anus or rectum. A doctor who suspects that a patient may have cancer will remove tissue for biopsy in the course of this procedure.

Slowly withdrawing the anoscope allows the doctor to thoroughly inspect the entire anal canal. As the procedure is being performed, the doctor explains what is happening, and why the patient feels pressure.

Removing tissue samples for biopsy can pinch, but anoscopy does not usually cause pain. Patients do experience the sensation of needing to have a bowel movement.

Risk Factors:
There are no significant risks from anoscopy. Sometimes, especially if you have hemorrhoids, you may have a small amount of bleeding after the anoscope is pulled out.

Must you do anything special after the test is over?
You can return to your normal activities immediately.
How long is it before the result of the test is known?
Your doctor can tell you about your anoscopy exam right away.

RESULTS:

Normal Results

A normal anoscopy reveals NO evidence of:

*tumor
*tissue irregularities
*polyps
*fissures
*hemorrhoids
*inflammation
*infectionor other abnormalities. The size, color, and shape of the anal canal look like they should.

Abnormal Results

Abnormal results of anoscopy can indicate the PRESENCE of:

*cancer
*abscesses
*polyps
*inflammation
*infection
*fissures
*hemorrhoids

Resources:
https://www.health.harvard.edu/fhg/diagnostics/anoscopy.shtml
http://www.answers.com/topic/anoscopy-1

Lymph Node Biopsy

Introduction :A lymph node biopsy removes lymph node tissue to be looked at under a microscope for signs of infection or a disease, such as cancer. Other tests may also be used to check the lymph tissue sample, including a culture, genetic tests, or tests to study the body’s immune system (immunological tests).

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Lymph nodes are part of the immune system. They are found in the neck, behind the ears, in the armpits, and in the chest, belly, and groin. You may click see an illustration of lymph nodes and the immune system.

Lymph nodes in healthy people are usually hard to feel. However, lymph nodes in the neck, armpit, or groin can get bigger and become tender. Swollen lymph nodes usually mean an infection, but the swelling can also be caused by a cut, scratch, insect bite, tattoo, a drug reaction, or cancer.

There are several ways to do a lymph node biopsy. The lymph node sample will be looked at under a microscope for problems.

The nodes produce and harbor infection-fighting white blood cells (lymphocytes) that attack both infectious agents and cancer cells. Cancer, infection, and some other diseases can change the appearance of lymph nodes. For that reason, your doctor may ask a surgeon to remove lymph nodes, to be examined microscopically for evidence of these problems.

Usually, one or more entire lymph nodes are removed and examined under the microscope by a pathologist. On occasion, the doctor does a needle biopsy to remove a portion of a lymph node to see whether a cancer already diagnosed has spread to that point.

How it is done:There are several ways to do a lymph node biopsy. The lymph node sample will be looked at under a microscope for problems.

*A fine-needle aspiration biopsy puts a thin needle into the lymph node and removes cells to look at. A needle biopsy is done to check the cause of a big lymph node.

*A core needle biopsy uses a needle fitted with a special tip. The needle goes through the skin to the lymph node to take a sample of tissue about the size of a pencil lead.

*An open biopsy makes a cut in the skin and removes the lymph node. If more than one lymph node is taken, the biopsy is called a lymph node dissection. Open biopsy and lymph node dissection let your doctor take a bigger sample than a needle biopsy.

Why It Is Done:
Lymph node biopsy is done to:

*Check the cause of enlarged lymph nodes that do not return to normal size on their own.

*Check the cause of symptoms, such as an ongoing fever, night sweats, or weight loss.

*Check to see if a known cancer has spread to the lymph nodes. This is called staging and is done to plan cancer treatment.

*Remove cancer.

How to prepare yourself for the test:

Tell your doctor if you:

*Are taking any medicines.

*Are allergic to any medicines, including anesthetics.

*Are allergic to latex.

* You’re taking NSAIDs or any medications that might cause bleeding.

* You have a condition that bleeds easily such as an ulcer in your stomach or small intestine, or if you’re pregnant.

*Have any bleeding problems or take blood thinners, such as aspirin, heparin, warfarin (Coumadin), enoxaparin sodium (Lovenox), or clopidogrel bisulfate (Plavix).

You will be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will indicate. To help you understand the importance of the biopsy, fill out the medical test information.

If you take a blood thinner, you will probably need to stop taking it for a week before the biopsy.

If a lymph node biopsy is done under local anesthesia, you do not need to do anything else to prepare for the biopsy.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. An intravenous line (IV) is put in your arm, and a sedative medication is given about an hour before the biopsy. Arrange for someone to drive you home if you have general anesthesia or are given a sedative.

Other tests, such as blood tests or X-rays, may be done before the lymph node biopsy.

How It Is Done:
This depends on the location of the lymph nodes to be biopsied. Fortunately many lymph nodes, such as those in your neck, armpits, and groin, are found close to the surface of the skin. These can all be reached through an incision in the skin.

Some lymph nodes are located deeper in your body, such as in the middle of your chest. To reach them, your doctor may insert a tube-like viewing instrument (a scope) through a slit in the skin into the target area to see the lymph nodes, and then remove them with tiny surgical scissors located at the end of the scope. Sometimes removing lymph nodes for microscopic examination requires surgery.

When lymph nodes beneath the skin are biopsied, you lie on an examining table. The doctor cleans the skin at the biopsy site and injects a local anesthetic. Next, the doctor makes a small incision in the skin and the tissue just beneath it until he or she can see the lymph node and cut it out. Following such a biopsy, it’s normal to bleed slightly. After applying pressure to the incision site to stop the bleeding, the doctor will cover the area with a bandage. You’ll usually be able to go home within several hours.When a biopsy involves inserting a scope, or surgery, general anesthesia may be required.

Fine-needle aspiration biopsy:-
A needle biopsy of a big lymph node near the skin is usually done by a hematologist, a radiologist, or a general surgeon. A needle biopsy of a lymph node deeper within the body is usually done by a radiologist using a CT scan or ultrasound to help guide the needle. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy.

Your doctor numbs your skin where the needle will be inserted. Once the area is numb, the needle is put through the skin and into the lymph node. The biopsy sample is sent to a lab to be looked at under a microscope. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

You may click to see an illustration of a fine-needle lymph node biopsy.

Core needle biopsy:-
A core needle biopsy is usually done by a general surgeon or radiologist.

You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy.

Your doctor numbs your skin where the needle will be inserted. Once the area is numb, a small cut is made in the skin. A needle with a special tip is put through the skin and into the lymph node. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A core needle biopsy takes about 20 minutes.

You may click to see an illustration of a core needle lymph node biopsy.

Open biopsy and lymph node dissection:-
An open biopsy of a lymph node is done by a surgeon. For a lymph node near the surface of the skin, the biopsy site is numbed with local anesthetic. For a lymph node deeper in the body or for lymph node dissection, you may have general anesthesia.

You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the biopsy). You will be given a cloth or paper covering to use during the biopsy. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lymph node).

You will lie on an examining table and the skin over the biopsy site will be cleaned with a special soap. The area is covered with a sterile sheet. A small cut will be made so the whole lymph node or a slice of it can be taken out.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. You can usually return to your normal activities the next day.

An open biopsy usually takes from 30 to 60 minutes. If you have had a lymph node dissection to remove cancer, the surgery may take longer.

You may click to see an illustration of an open lymph node biopsy

How It Feels:
You will feel only a quick sting from the needle if you have a local anesthesia to numb the skin. You may feel some pressure when the biopsy needle is put in. After a fine-needle aspiration biopsy or core needle biopsy, the site may be tender for 2 to 3 days. You also may have a bruise around the site.

If you have general anesthesia for an open lymph node biopsy, you will not be awake during the biopsy. After you wake up, the area may be numb from a local anesthetic that was put into the biopsy site. You will also feel sleepy for several hours.

For 1 to 2 days after an open lymph node biopsy, you may feel tired. You may also have a mild sore throat from the tube that was used to help you breathe during the biopsy. Using throat lozenges and gargling with warm salt water may help with the sore throat.

After an open biopsy, the area may feel tender, firm, swollen, and bruised. You may have fluid collect near the biopsy site. You may also have fluid leak from the biopsy site. The tenderness should go away in about a week, and the bruising usually fades within 2 weeks. However, the firmness and swelling may last for 6 to 8 weeks. Do not do any heavy lifting or other activities that stretch or pull the muscles around the area.

Risk Factors:

The biopsy site will feel tender for a few days. There’s a slight risk of infection or bleeding. Depending on the location of the lymph node being removed, there is a slight risk of blood vessel or nerve damage. An infection can be treated with antibiotics.

Call your doctor immediately if:

*Your pain lasts longer than a week.

*You have redness, a lot of swelling, bleeding, or pus from the biopsy site.

*You have a fever.

*There is fluid buildup in the area where the lymph node was taken out (lymphedema). This occurs most often when removing the lymph nodes that run in a line from under the arm to the collarbone (axillary lymph nodes). This can happen immediately after surgery or even months or years later. Most people who have a lymph node biopsy do not have a problem with lymphedema.

*Numbness in the skin near the biopsy site. This may be caused by nerve damage.

Results:
A lymph node biopsy removes lymph node tissue to be looked at under a microscope for signs of infection or a disease, such as cancer. Test results from a lymph node biopsy are usually available within a few days. Finding some types of infections may take longer.

The lymph node sample is usually treated with special dyes (stains) that color the cells and make problems more visible.

Lymph node biopsy  Normal: The lymph node has normal numbers of lymph node cells.

The structure of the lymph node and the appearance of the cells in it are normal.

No signs of infection are present.

Abnormal: Signs of infection, such as mononucleosis (mono) or tuberculosis (TB), may be present.

Cancer cells may be present. Cancer may begin in the lymph node, such as Hodgkin’s lymphoma, or may have spread from other sites, such as in metastatic breast cancer.

What Affects the Test:
A needle biopsy takes tissue from a small area, so there is a chance that a cancer may be missed.

How long is it before the result of the test is known?
Results will probably be ready in several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/lymph-node-biopsy.shtml
http://www.webmd.com/cancer/lymph-node-biopsy

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Video-Asisted Thoracic Surgery (VATS)

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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Mediastinoscopy

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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