Fiber-optic bronchoscopy with transbronchial needle aspiration (TBNA) is useful to sample mediastinal nodes and to diagnose central parenchymal lesions. Enlarged lymph nodes occur in lung cancer and other neoplasms, tuberculosis, and sarcoidosis. Knowledge of nodal status is particularly important to stage lung cancer. Mediastinoscopy, mediastinotomy, and thoracoscopy are valuable surgical techniques for mediastinal staging, but are invasive and require general anesthesia. TBNA with bronchoscopic guidance necessitates only conscious sedation and can be used to sample abnormal lymph nodes that are in proximity to an airway [28,29,30]. Subcarinal and paratracheal lymph nodes are most accessible. One important disadvantage of TBNA compared to surgical techniques is that the target node is not visible through the bronchoscope unless erosion of mucosa has occurred. Typically, the bronchoscope needle is directed through the airway based on findings identified on the preprocedure CT scan in conjunction with distortions of the airway encountered during the procedure.
Conventional fluoroscopy with a C-arm is often used to guide TBNA in the lung and improve the yield of the procedure. However, in the mediasti-
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Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.