Outcome of mediastinal lypmh node biopsy by cervical mediastinoscopy

Objective: To analyze the outcome of mediastinal lypmh node biopsy by conventional mediastinoscopy for diagnostic purpose in patients with mediastinal lymph node enlargement

Study design: Descriptive case series

Place and Duration of study: The study was conducted at 2 private hospitals of Karachi, from July 2012 to June 2014

Methodology: Patients aged 12 year and above, of either sex, who presented with CT-proven mediastinal lymph node enlargement in whom diagnosis could not be confirmed via other investigations, were included. Patients underwent conventional mediastinoscopy under general anesthesia. Patients with previous history of thyroid or neck surgery, severe superior vena caval syndrome [SVC] or cervical spondylosis were excluded from the study. Multiple lymph node stations were biopsied and sent for histopathology. Biopsy reports were followed and results analyzed

Results: Out of 32 patients 19 were males and 13 females. Age range was from 25 to 55 year. The most common diagnosis was tuberculosis. The mean duration of the procedure was 40 minutes. Lymph node stations 2 and 4 were most commonly biopsied and an average of 4 biopsy samples were obtained per patient

Conclusion: Mediastinscopy is an invaluable and relatively cost effective procedure in the diagnosis of patients with mediastinal lymph node enlargement in whom the diagnosis could not be confirmed by other investigations

BCG vaccination is associated with decreased severity of tuberculosis in Pakistan

Vaccination with Bacille Calmette-Guerin [BCG] is given at birth to protect against tuberculosis [TB] in Pakistan. The country ranks 6th amongst high-burden countries worldwide and has an incidence of 231/100,000 population. This was a cross-sectional multi-center hospital-based study. TB patients [n = 218] with pulmonary [PTB, n = 120] or extrapulmonary [ETB, 98] were recruited, and the presence of a BCG vaccination scar was documented. Cases were further classified into minimal, moderate and advanced PTB or less severe [LETB] or severe disseminated [D-ETB] disease. The association of age, gender and severity of TB infections with BCG vaccination of the individual TB cases was investigated. No difference was found of the BCG vaccination status of PTB and ETB cases, or in relation to age or gender. Patients under 29 years of age comprised the largest group. There were more females with ETB than PTB. The largest group within ETB comprised those with tuberculous lymphadenitis [LNTB, 39%]. A significantly greater number of LNTB cases had received BCG vaccinations than had those with pleural [unilateral] TB [p = 0.004], and tuberculous meningitis [p = 0.027] groups. Also, there were more immunized patients with pulmonary as compared with pleural disease [p = 0.001]. LNTB represents localized granulomatous disease and the observation of higher vaccination rates in this group suggests that BCG has protected against more severe forms of TB in this high-burden region.