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Diagnonistic Test

Lymph Node Biopsy

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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).

…………....CLICK & SEE

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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Herbs & Plants

Semecarpus anacardium

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Botanical Name: Semecarpus anacardium
Family: Anacardiaceae
Genus: Semecarpus
Species:S. anacardium
Kingdom:Plantae
Order: Sapindales

vernacular Name: Sans- Bhallataka, Hind- Bhela. It was called “marking nuts” by Europeans because it was used by washermen to mark the cloths before washing, as it imparted water insoluble mark to the cloth. It’s also known as “Ker” in Kannada.

It is known as Bhallaatak  in India and was called “marking nut” by Europeans, because it was used by washermen to mark cloth and clothing before washing, as it imparted a water insoluble mark to the cloth. It is also known as ker beeja in Kannada and bibba in Marathi and Jeedi Ginja in Telugu.

Habitat :Semecarpus Anacardium (the Oriental Anacardium) is a native of India and is closely related to the cashew.Available throughout india, in semi-green and moist deciduous forests.

Description:It is a deciduous tree, found in the outer Himalayas. The nut is about 2.5 cm long, ovoid and smooth lustrous black. In Ayurveda, the fruit is considered a rasayana for longevity and rejuvenation,and is processed before use, as it is toxic in nature.

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Properties:
Bhallataka is sweet and astringent in taste, sweet in the post digestive effect and has hot potency. It alleviates kapha and vata dosas and possesses light, unctuous sharp (tiksna) and hot (usna) attributes. It is extremely heat generating, appetizer, digestant, rejuvenative, aphrodisiac herb and alleviates the skin and rheumatic disorders. (Bhavaprakasa Nighantu)

Classical Ayurvedic Preparations:

*Bhallatakasava
*Bhallataka taila
*Bhallataka ksirapaka and ksara
*Tiladi modaka
*Bhallataka modaka
*Amrtabhallatakavaleha
*Sanjivani guti etc.

Bhallataka is used both, internally as well as externally. The fruits, their oil and the seeds have great medicinal value, and are used to treat the wide range of diseases. Externally, the oil, mixed with coconut or sesame oil, is applied on wounds and sores to prevent the pus formation. It soothens and heals the cracked feet, when mixed with fala (Shorea robusta). For better healing of wounds, it works well, when medicated with garlic, onion and ajavayana in sesame oil. The topical application of its oil and swollen joints and traumatic wounds effectively controls the pain. In glandular swellings and filariasis, the application of its oil facilitates to drain out the discharges of pus and fluids and eases the conditions.

Since bhallataka is extremely hot and sharp in its attributes, it should be used with caution. Individuals showing allergic reactions to it, should stop and avoid the usage of bhallataka. It should not be used in small children, very old persons, pregnant women and individuals of predominant pitta constitution. The use of the same should be restricted in summer season. For its allergic reactions like rash, itching and swelling, the antidotes used externally are coconut oil, rala ointment, ghee, coriander leaves pulp or butter mixed with musta (Cyperus rotundus).

Internally, bhallataka is widely used in a vast range of diseases because of its multifarious properties. As it augments the agni, it is extremely beneficial in the diseases like piles, colitis, diarrhea, dyspepsia, ascites, tumours and worms which are caused mainly due to weakened agni. For this, one fruit of bhallataka is hold with tong over a flame and heated slightly. On gentle pressing, the oil starts dripping gradually. This oil is collected on the beatle leaf with small amount of sugar on its surface or in a cup of milk. Approximately 10 drops in children and 15-20 drops in adults are sufficient. It augements the appetite, cleanses the bowels, dispels the trapped gases and eliminates the worms. This is how the bhallataka is used as a household remedy.

Bhallataka is highly praised to treat the piles (haemorrhoids) of vata and kapha types, meaning in non – bleeding conditions. It is an effective adjuvant in the treatment of ascites and tumours. In bronchial asthma and cough, it is one of the best medicament for which, its preparation bhallatakasava is commonly used. It reduces the bronchospasms and their frequency too. Cardiac debility, associated with odema can be treated with great benefit. The milk medicated with bhallataka or bhallataka modaka mitigates the skin diseases like scabies, eczema, ringworm infestations. As a nervine tonic, it is beneficial in the diseases due to vata, like sciatica, paralysis, facial palsy, epilepsy, rheumatic conditions and also asa brain tonic. The combination, bhallataka, haritaki, tila (sesame seeds) powders with jaggery, awards excellent results in chronic rheumatic disorders. Bhallataka is said to augment the memory, as it boosts the sadhaka pitta and nourishes the nervine tissue. It also works well as aphrodisiac by its stimulant action and enhances the seminal fluids. In dysmenorrheal (painful menstruation) and oligomenorrhea (scanty menstruation), the medicated milk or its oil is salubrious. It reduces the urinary output, hence beneficial in diabetes of kapha type,

Bhallataka is the best rejuvenative (rasayana) for skin ailments, vata disorders and as a preventive measure to increase the body resistance. It augments the appetile, improves digestion, eliminates ama and clears up srotasas – the micro channels of all the systems, hence facilitates the nourishment of all the tissues (dhatus). It does not work as an anabokic rejuvenative like bala (Sida cordifolia), satavari (Asparagus racemosus), milk or ghee. Winter is the best season for its usage. One should adopt a bland and cooling diet consisting of rice, milk, butter, ghee. The salt and spices should be strictly restricted and during bhallataka treatment, it is recommended to avoid exposure to sun, heat and excessive sex. The toxic symptoms of its internal use are skin rashes, burning, itching, and excessive thirst and sweating, reductin in urine output with sloky coloured urine, sometimes blood in the urine (heamaturia) may appear. The fresh juice of the leaves of amlika (Tamarindus indica) internally, is one of the antidotes for such symptoms.

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According to Ayurveda :-
It is katu ,tikta, kashaya, ushna, anthelmintic, helpful in deranged kapha, vata, intestinal infections, epistasis, polyuria and piles

Parts Used: Fruits and bark.

Therapeutic Uses:

Fruits: in asthma, ascites, epilepsy, neuralgia, psoriasis and rheumatism; as abortifacient and vermifuge; decoction mixed with milk and butter-fat efficacious in asthma, gout, hemiplegia, neuritis, piles, rheumatism, sciatica, and syphilitic complaintskernel is anthelmintic, cardiotonic, carminative and digestive;
The fruits are acrid, bitter, astringent, digestive, carminative, purgative, liver tonic, expectorant, stomachic, laxative, tonic and oleaginous. The fruit is useful in leucoderma, scaly skin, allergic, dermatitis, poisonous bites, leprosy, cough, asthma, and dyspepsia.
Also act as insecticides, antiseptic, termite repellents and herbicide. It is extremely beneficial in the diseases like piles, colitis, diarrhea, dyspepsia, ascites, tumours and worms. The topical application of its oil on swollen joints and traumatic wounds effectively controls the pain.

The fruit is acrid, hot, sweetish; digestible, aphrodisiac, anthelmintic; stays. looseness of bowels; removes” vata “,” kapha “, ascites, skin diseases, piles, dysentery, tumours, fevers, loss of appetite, urinary discharges; heals ulcers; strengthens the teeth; useful in insanity, asthma.

The rind of the fruit is sweet, oleagenous, digestible, acrid, sharp; stomachic, anthelmintic, laxative; cures ” vata “, bronchitis, leprosy, ulcers, ascites, piles, dysentery, tumours, inflammations, fevers; causes ulceration

The sweet fruit is carminative, tonic, aphrodisiac; lessens inflammation, stomatitis, piles, fever, weakness and paralysis; expels bad humours from the body.

The pulp is tonic; good for piles.

The smoke from the burning pericarp is good for tumours.

The oil is hot and dry, anthelmintic, aphrodisiac, tonic; makes hair black; good for leucoderma, coryza, epilepsy and other nervous diseases; lessens inflammation; useful in paralysis and superficial pain;

oil used externally in gout, leprosy and leucoderma; bark: brownish gum exudate found useful in nervous disorders.

A brown gum exudes from the bark which regard as a valuable medicine in scrofulous, venereal and leprous affections .

The nut is used internally in asthm, after having been steeped in butter-milk, and is also given as vermifuge., debility and in leprous, scrofulous and venereal affections.

Medicinal uses:
Recent studies have shown the fruit to be a good anti-inflammatory agent and effective in various types of cancers.

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.

Resources:
http://en.wikipedia.org/wiki/Semecarpus_anacardium
http://www.ayurvedakalamandiram.com/herbs.htm#bhallataka
http://www.herbalcureindia.com/herbs/bhallataka.htm
http://www.motherherbs.com/semecarpus-anacardium.html

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Diagnonistic Test

Electrophysiological Testing of the Heart

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Definition:
An electrophysiology (EP) study is a test that records the electrical activity and the electrical pathways of your heart. This test is used to help determine the cause of your heart rhythm disturbance and the best treatment for you. During the EP study, your doctor will safely reproduce your abnormal heart rhythm and then may give you different medications to see which one controls it best or to determine the best procedure or device to treat your heart rhythm.
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Sometimes doctors will recommend a treatment called ablation that can be done during EPS testing. Ablation uses electricity to kill the cells in the heart muscle that seem to cause the abnormal rhythm.

You may click to see:->Electrophysiology Study

 

Why Do you Need an Electrophysiology Study?
*To determine the cause of an abnormal heart rhythm.

*To locate the site of origin of an abnormal heart rhythm.

*To decide the best treatment for an abnormal heart rhythm.

Sometimes an EP study is conducted before implantable cardioverter/defibrillator (ICD) placement to determine which device is best and afterwards to monitor treatment success.

How do you prepare for the test?
*You will need to sign a consent form giving your doctor permission to perform this test. Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Also tell your doctor if you have ever had an allergic reaction to any heart medicines.

*Talk with your doctor ahead of time if you are taking insulin, or if you take aspirin, nonsteroidal antiinflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test. Most people need to have a blood test done some time before the procedure to make sure they are not at high risk for bleeding complications.

*Your doctor may tell you not to eat anything for 12 or more hours before the test. A few people require an anti-anxiety medicine which occasionally causes nausea, and therefore some doctors prefer to have you come with an empty stomach. You might need to plan to spend the night in the hospital afterwards for recovery.

*Ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications one to five days before your EP study. If you have diabetes, ask your doctor how you should adjust your diabetes medications.

*Do not eat or drink anything after midnight the evening before the EP study. If you must take medications, take them only with a small sip of water.

*When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry or valuables at home.

*Your doctor will tell you if you can go home or must stay in the hospital after the procedure. If you are able to go home, bring a companion to drive you home.

What happens when the test is performed?
The test is done by a specialist using equipment and cameras in the cardiology department. You wear a hospital gown and lie on your back during the procedure. You have an IV (intravenous) line placed in a vein in case you need medicines or fluid during the procedure. Your heart is monitored during the test.

A catheter (a hollow, sterile tube that resembles spaghetti) is inserted through the skin into a blood vessel-typically in your groin, but possibly in the neck or arm. Before the catheter is placed, medicine through a small needle is used to numb the skin and the tissue underneath the skin in that area. The numbing medicine usually stings for a second. A needle on a syringe is then inserted, and some blood is drawn into the syringe, so that the doctor knows exactly where the blood vessel is located. One end of a wire is threaded into the blood vessel through the needle and the needle is pulled out, leaving the wire temporarily in place. This wire is several feet long, but only a small part of it is inside your blood vessel. The catheter can then be slipped over the outside end of the wire and moved forward along it like a long bead on a string, until it is in place with one end inside the blood vessel. The wire is pulled out of the catheter, leaving the catheter in place. Now the catheter can be moved easily forwards and backwards inside your blood vessel by the doctor, who holds the outside end of the catheter while using special controls to point the tip of the catheter in different directions. The doctor carefully moves the catheter to the large blood vessels in your chest and into the chambers of your heart.

As your physician maneuvers the catheter, he or she watches a live video x-ray to know exactly where the catheter is. Instruments on the tip of the catheter allow it to sense electrical patterns from your heart and also to deliver small electrical shocks to the heart muscle (or a stronger electrical burn if you are having ablation). The electrical shocks, too small for you to feel, are used to “tickle” the heart muscle in different places to see if your abnormal rhythm is triggered by one sensitive area of your heart. If the rhythm changes, your doctor gives you small doses of different medicines through this catheter to see which ones work best to change the rhythm back to normal. In some cases the doctor may need to give your heart some additional mild shocks to get it back into a normal rhythm. Because this catheter is in place inside your heart and can give the shocks directly to the heart muscle, very small amounts of electricity are used.

After the catheter has been pulled out, a pressure bandage (basically a thick lump of gauze) is taped tightly to your groin to reduce bleeding. The test usually requires one to two hours to perform.

Many patients are able to feel palpitations (an irregular or fast heartbeat) from the rhythm changes. A few patients also experience shortness of breath or dizziness when they are not in a normal heart rhythm. Other than the brief sting of the numbing medicine and some soreness in your groin area afterward, you are not likely to feel any pain. For some people, the procedure provokes anxiety. Some patients also have a difficult time lying still for the time it takes to perform this test.
What Can you Expect During the Electrophysiology Study?
*You will lie on a bed and the nurse will start an intravenous (IV) line into your arm or hand. This is so you can receive medications and fluids during the electrophysiology study. You will be given a medication through your IV to relax you and make you drowsy, but it will not put you to sleep.

*The nurse will connect you to several monitors.
Your groin will be shaved and cleansed with an antiseptic solution. Sterile drapes are used to cover you, from your neck to your feet. A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

An electrophysiologist (a doctor who specializes in the diagnosis and treatment of abnormal heart rhythms) will numb your groin with medication and then insert several catheters into the vein in your groin. Guided by the fluoroscopy machine, the catheters are threaded to your heart. The catheters sense the electrical activity in your heart and are used to evaluate your heart’s conduction system. The doctor will use a pacemaker to deliver the electrical impulses through one of the catheters to increase your heart rate.

You may feel your heart beating faster or stronger. Your nurses and doctor will want to know about any symptoms you are feeling. If your arrhythmia occurs, your doctor may give you medications through your IV to test their effectiveness in controlling it. If necessary, a small amount of energy may be delivered by the patches on your chest to bring back a normal heart rhythm. Based on the information collected during the study, the doctor may continue with an ablation procedure or device implant (pacemaker or ICD).

The EP study takes about two to four hours to perform. However, it can take longer if additional treatments such as catheter ablation are performed at the same time.

Risk Factors:
There are significant risks from this procedure. Most important, some abnormal heart rhythms (arrhythmia) can be life-threatening, and your doctors will purposefully cause you to go through a few extra episodes of arrhythmia during the testing. If your doctors recommend electrophysiologic testing, they feel that this is a risk worth taking because it will allow them to take better care of you in the future. Because you are right in the lab and attached to a monitor while you undergo the rhythm changes, it is easy for them to treat you should your arrhythmia occur and cause you symptoms.

Ablation has some additional risks, because it intentionally causes some scarring of a small part of the heart muscle. Complications are rare, but new rhythm changes can occur. A very rare complication occurs if the ablation instrument burns a hole through the heart muscle. This causes bleeding and may require immediate surgery.

There are some more minor risks from the test. Among them is bleeding from the place where the catheter was inserted. If bleeding occurs but the blood collects under the skin, it can form a large painful bruise called a hematoma. A few people are allergic to the medicines used in the procedure, and this can cause a rash or other symptoms.

Must you do anything special after the test is over?
You will need to lie flat for around six hours after this procedure. If you received anti-anxiety medicine through your IV during the procedure, you might feel sleepy at the end of the procedure and you might not remember much of the test. You should not drive or drink alcohol for the rest of the day.

Depending on what happened during your test, you might need to wear a heart monitor in the hospital for a few hours or overnight.

What Happens After the EP Study?
The doctor will remove the catheters from your groin and apply pressure to the site, to prevent bleeding. You will be on bed rest for about one to two hours.

An EP study can be frightening, but this test allows the doctor to decide the best treatment for you. In many cases, EP testing and the therapy following can greatly reduce the likelihood of spontaneous arrhythmia. If you have any questions, do not hesitate to ask your doctor or nurse.

How long is it before the result of the test is known?
Your doctors can tell you how the testing went as soon as it is over. If you had ablation done, the results will not be certain until you have had some time to see if your arrhythmia seems to be under control after the treatment.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/electrophysiological-testing-of-the-heart.shtml
http://www.webmd.com/heart-disease/guide/diagnosing-electrophysiology

http://www.londoncardiac.ca/pages/bfs.html

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Diagnonistic Test

Pulmonary Function Tests

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Alternative Names: PFTs; Spirometry; Spirogram; Lung function tests
Definition:Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move oxygen into the blood. These tests can tell your doctor what quantity of air you breathe with each breath, how efficiently you move air in and out of your lungs.
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Pulmonary Function Testing has been a major step forward in assessing the functional status of the lungs as it relates to :

1.How much air volume can be moved in and out of the lungs
2.How fast the air in the lungs can be moved in and out
3.How stiff are the lungs and chest wall – a question about compliance
4.The diffusion characteristics of the membrane through which the gas moves (determined by special tests)
5.How the lungs respond to chest physical therapy procedures

Pulmonary Function Tests are used for the following reasons :

1.Screening for the presence of obstructive and restrictive diseases

2.Evaluating the patient prior to surgery – this is especially true of patients who :
a. are older than 60-65 years of age
b. are known to have pulmonary disease
c. are obese (as in pathologically obese)
d. have a history of smoking, cough or wheezing
e. will be under anesthesia for a lengthy period of time
f. are undergoing an abdominal or a thoracic operation

Note : A vital capacity is an important preoperative assessment tool. Significant reductions in vital capacity (less than 20 cc/Kg of ideal body weight) indicates that the patient is at a higher risk for postoperative respiratory complications. This is because vital capacity reflects the patient’s ability to take a deep breath, to cough, and to clear the airways of excess secretions.

3.Evaluating the patient’s condition for weaning from a ventilator. If the patient on a ventilator can demonstrate a vital capacity (VC) of 10 – 15 ml/Kg of body weight, it is generally thought that there is enough ventilatory reserve to permit (try) weaning and extubation.

4.Documenting the progression of pulmonary disease – restrictive or obstructive

5.Documenting the effectiveness of therapeutic intervention

How do you prepare for the test?
Do not eat a heavy meal before the test. Do not smoke for 4 – 6 hours before the test. You’ll get specific instructions if you need to stop using bronchodilators or inhaler medications. You may have to breathe in medication before the test.

No other preparation is necessary.

How the Test Will Feel ?
Since the test involves some forced breathing and rapid breathing, you may have some temporary shortness of breath or light-headedness. You breathe through a tight-fitting mouthpiece, and you’ll have nose clips.

What happens when the test is performed?
This testing is done in a special laboratory. During the test, you are instructed to breathe in and out through a tube that is connected to various machines.

A test called spirometry measures how forcefully you are able to inhale and exhale when you are trying to take as large a breath as possible. The lab technicians encourage you to give this test your best effort, because you can make the test result abnormal just by not trying hard.

A separate test to measure your lung volume (size) is done in one of two ways. One way is to have you inhale a small carefully measured amount of a specific gas (such as helium) that is not absorbed into your bloodstream. This gas mixes with the air in your lungs before you breathe it out again. The air and helium that you breathe out is tested to see how much the helium was diluted by the air in your lungs, and a calculation can reveal how much air your lungs were holding in the first place.

The other way to measure lung volume is with a test called plethysmography. In this test, you sit inside an airtight cubicle that looks like a phone booth, and you breathe in and out through a pipe in the wall. The air pressure inside the box changes with your breathing because your chest expands and contracts while you breathe. This pressure change can be measured and used to calculate the amount of air you are breathing.

Your lungs’ efficiency at delivering oxygen and other gases to your bloodstream is known as your diffusion capacity. To measure this, you breathe in a small quantity of carbon monoxide (too small a quantity to do you any harm), and the amount you breathe out is measured. Your ability to absorb carbon monoxide into the blood is representative of your ability to absorb other gases, such as oxygen.

Some patients have variations of these tests-for example, with inhaler medicines given partway through a test to see if the results improve, or with a test being done during exercise. Some patients also have their oxygen level measured in the pulmonary function lab (see “Oxygen saturation test,” page 29).

Why the Test is Performed  ?

Pulmonary function tests are done to:
*Diagnose certain types of lung disease (especially asthma, bronchitis, and emphysema)
*Find the cause of shortness of breath
*Measure whether exposure to contaminants at work affects lung function
It also can be done to:

*Assess the effect of medication
*Measure progress in disease treatment
*Spirometry measures airflow. By measuring how much air you exhale, and how quickly, spirometry can evaluate a broad range of lung diseases.

Lung volume measures the amount of air in the lungs without forcibly blowing out. Some lung diseases (such as emphysema and chronic bronchitis) can make the lungs contain too much air. Other lung diseases (such as fibrosis of the lungs and asbestosis) make the lungs scarred and smaller so that they contain too little air.

Testing the diffusion capacity (also called the DLCO) allows the doctor to estimate how well the lungs move oxygen from the air into the bloodstream.

Risk Factors:
The risk is minimal for most people. There is a small risk of collapsed lung in people with a certain type of lung disease. The test should not be given to a person who has experienced a recent heart attack, or who has certain other types of heart disease.

Must you do anything special after the test is over?
Nothing.

Normal Results:
Normal values are based upon your age, height, ethnicity, and sex. Normal results are expressed as a percentage. A value is usually considered abnormal if it is less than 80% of your predicted value.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean:
Abnormal results usually mean that you may have some chest or lung disease.

Considerations:
Your cooperation while performing the test is crucial in order to get accurate results. A poor seal around the mouthpiece of the spirometer can give poor results that can’t be interpreted. Do not smoke before the test.

How long is it before the result of the test is known?
Your doctor will receive a copy of your test results within a few days and can review them with you then.

Resources:
https://www.health.harvard.edu/diagnostic-tests/pulmonary-function-testing.htm
http://www2.nau.edu/~daa/lecture/pft.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003853.htm

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Cold Virus Decoded, Cure Now Possible

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Curing the common cold, one of medicine’s most elusive goals, may now be in the realm of the possible. Researchers said on Thursday that they had decoded the genomes of the 99 strains of common cold virus and developed a catalog of its vulnerabilities
“We are now quite certain that we see the Achilles’ heel, and that a very effective treatment for the common cold is at hand,” said Stephen Liggett, an asthma expert at the University of Maryland and co-author of the finding.
Besides alleviating the achy, sniffly misery familiar to everyone, a true cold-fighting drug could be a godsend for the 20 million people who suffer from asthma and the millions of others with chronic obstructive pulmonary disease. The common cold virus, a rhinovirus, is thought to set off half of all asthma attacks.

Even so, it might be difficult to kindle the interest of pharmaceutical companies. While the new findings are “an interesting piece of science”, said Glenn Tillotson, an expert on antiviral drugs at Viropharma in Exton, Pennsylvania, he noted that the typical cost of developing a new drug was now $700 million, “with interminable fights with financiers and regulators”. Because colds are mostly a minor nuisance, drug developers say, people would not be likely to pay for expensive drugs. And it would be hard to get the Food and Drug Administration to approve a drug with any serious downside for so mild a disease.
Perhaps the biggest reason the common cold has long defied treatment is that the rhinovirus has so many strains and presents a moving target for any drug or vaccine. This scientific link in this chain of problems may now have been broken by a research team headed by Liggett and Ann Palmenberg, a cold virologist at the University of Wisconsin.

Fernando Martinez, an asthma expert at the University of Arizona, said the new rhinovirus family tree should make it possible for the first time to identify which particular branch of the tree held the viruses most provocative to asthma patients. The rhinovirus has a genome of about 7,000 chemical units, which encode the information to make the 10 proteins that do everything the virus needs to infect cells and make more viruses. By comparing the 99 genomes with one another, the researchers were able to arrange them in a family tree based on similarities in their genomes.

That family tree shows that some regions of the rhinovirus genome are changing all the time but that others never change. The fact that the unchanging regions are so conserved over the course of evolutionary time means that they perform vital roles and that the virus cannot let them change without perishing. They are therefore ideal targets for drugs because, in principle, any of the 99 strains would succumb to the same drug.

Sources: The Times Of India

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