Lung biopsy

Lung biopsy involves removal of small piece of lung tissue to check for any conditions such as sarcoidosis, pulmonary fibrosis and lung cancer. It is essential to keep the physician informed if the patient is pregnant or taking medications such as warfarin or anticoagulants. Do not eat or drink for 8 to 10 hours before the lung biopsy. The secretions in the mouth and airways is dried up with some medications.

Needle lung biopsy is done with a long needle that is inserted through the chest wall. Ultrasound, fluoroscopy or CT scan are used to aid locating the abnormal lung tissue.

Open lung biopsy may need hospitalization for a couple of days. This procedure involves making an incision between the ribs to take a sample of lung tissue. This is preferred when a larger sample is required and is done under anesthesia. An endotracheal tube is passed through the airways to take a sample of lung tissue.

Bronchoscope lung biopsy is done in cases of suspected infection. The bronchoscope is inserted through the nose or mouth into the airways. This type of lung biopsy is used when abnormal tissue is near the breathing tubes.

VATS Video assisted thorascopic surgery involves use of thorasope to remove a sample of lung tissue.

Mediastinoscopy is conducted under general anesthesia. The mediastinoscope is inserted through an incision made between the lungs. Any abnormal tissues or lymph nodes are examined.

Fibrosis

The formation of excess fibrous connective tissue between the cells of various organs or tissues as a reactive process is called fibrosis. It can cause stiffening or hardening of tissues in skin, internal organs and joints. It can be reactive, pathological or in a benign state. When fibrosis arises from a single tissue, it is called Fibroma and in response to an injury it is called scarring.

Fibrosis may occur in many tissues within the body due to damage or inflammation, examples include:

• Pulmonary Fibrosis, affecting the lung
  
• Cystic Fibrosis affecting the mucus glands
  
• Heart Fibrosis, affects the heart that is damaged post myocardial infarction
  
• Liver Cirrhosis, accumulation of tough, fibrous scar tissue in the liver
  
• Bone marrow Fibrosis, affects the bone marrow and prevents normal production of blood cells
  
• Mediastinal Fibrosis, blocks respiratory channels and blood vessels due to calcified fibrosis of the lymph nodes
  
• Skin fibrosis, due to the formation of scar tissues due to injury.

Fibrosis formation

During the early stages of Lymphedema, tissues swell with protein-rich lymph that may not drain properly. The tissues are soft to touch; this condition is known as pitting edema. There is pressure on these tissues pushing the fluid aside thus leaving an indentation. If left untreated at this stage, the lymph may become fibrotic thus forming fibrosis. As fibrosis develops, the normal tissues are replaced by the scar-like structures that cause hindrance to lymph drainage. Fibrosis can occur in slightly swollen tissues too. As the lymph cannot drain properly, it leads to accumulation of protein molecules in the tissues thus increasing formation.

Fibrosis causes

• It may be caused by a disease or while treating the disease.
  
• Other causes could include burns, injuries, chemotherapy, radiation and gene mutation.
  
• It is also possible that the causes may remain idiopathic, i.e. the cause is unknown.
  

Effects of fibrosis

Symptoms of fibrosis can vary depending on the location and severity of the condition. Common symptoms include scarring.

• Fibrosis will harden the affected tissue, at times they also swell. These changes can make the tissues incapable of functioning properly; the fluid flow through these affected tissues might be reduced. When present in the lungs, the lung is unable to expand adequately leading to shortness of breath.
  
• Fibrosis of joints can cause pain and stiffness of the affected joint.
  
• Fibrosis in the shoulder may lead to frozen shoulder.
  
• Fibrosis of the tendons may lead to deformity of fingers and hand.

ANA blood test

Antinuclear antibodies (ANA) refer to the unusual antibodies that are detectable in the blood. ANA are gamma-globulins type of antibodies that are found in patients with certain autoimmune diseases. ANA are directed against certain components found in the nucleus of a cell in the body. These antibodies have the capacity of binding certain structures within the nucleus of the cells. The ANA test was first designed by Dr.George Friou in 1957. The laboratory blood test exposes the antibodies in the serum of the blood to cells. It is then determined whether or not antibodies are present that react to various parts of the nucleus of cells. Hence the term 'anti-nuclear' antibody is used.

Fluorescence techniques are adopted to detect the ANA antibodies in the cells. Thus ANA testing is sometimes referred to as fluorescent antinuclear antibody test (FANA). Nowadays, a method to detect antinuclear antibodies called enzyme linked immunosorbent assay (ELISA) is replacing the previous method of immunofluorescent assay technique. The ELISA method is less likely to produce false positive ANA result than the previous method.

Patterns also give doctors a clue as to the type of illness to look for while evaluating a patient. For instance, the disease Scleroderma shows in nucleolar pattern. If a person does not have any autoimmune disease, it is defined in speckled pattern. An ANA blood test is used in patients who might be suffering from Sjogren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison's disease, vitiligo, pernicious anemia, glomerulonephritis and pulmonary fibrosis. ANA can also be found in patients with conditions that are not considered autoimmune diseases such as chronic infections and cancer.

The result of the ANA test is expressed in titers. A titer of 1 to 80 (1:80) means that antibodies could be last detected when 1 part of the blood sample was diluted by 80 parts of another liquid. Usually this other liquid is a diluted salt solution. A larger second number indicates that the antibodies are present in greater concentration. Therefore a titer of 1 to 320 indicated higher concentration of antibodies in the blood than a titer of 1 to 80. The normal values of ANA blood test is : Titer below 1: 20 or 1:40 depending on the test method used.

Positive ANA test result is suggestive of autoimmune disease. It can also mean that the patient has drug induced lupus. Some drugs and infections can also induce false positive ANA test results. Steroids can cause a false-negative result. Medications, especially antibiotics such as isoniazid, penicillin, and tetracycline, birth control pills, lithium and some diuretics such as chlorthalidone can interfere with the test and affect the accuracy of the ANA test result.