Medical Tests & Procedures Archive

Articles

Take the hassle out of taking warfarin

Less frequent testing or home monitoring may be options.

Despite the recent FDA approval of easier-to-use anticlotting drugs, millions of Americans continue to take warfarin (Coumadin, Jantoven, generic) to prevent dangerous blood clots. The most worrisome clots—which can cause a stroke or potentially fatal shutdown of lung function—arise from atrial fibrillation, deep-vein thrombosis, or the presence of an artificial heart valve.

Overuse, underuse, and valuable use

Asking "Is this really necessary?" is always appropriate.

By Thomas Lee, M.D.
Editor in Chief, Harvard Heart Letter

Among the many uncertainties in health care today is the question of whether some doctors might recommend and deliver too much care. Stories like the one about a Maryland cardiologist who implanted hundreds of unneeded stents are rare, and the vast majority of doctors put the people they treat first, far ahead of any personal financial interests.

Treating pelvic organ prolapse

Options range from doing nothing to surgical repair.

Pelvic relaxation is weakness or laxity in the supporting structures of the pelvic region. Bladder, urethral, rectal, or uterine tissue may then bulge into or out of the vagina. This is called pelvic organ prolapse. It's not a dangerous condition, and it doesn't necessarily worsen over time, but it can drastically affect a woman's quality of life by causing discomfort and embarrassment and limiting sexual and physical activity.

Pelvic organ prolapse was once rarely recognized, and rarely discussed when it was recognized. But today it has become a priority because women are living longer and want to stay active. Many primary care clinicians and gynecologists routinely screen women for symptoms, and a surgical subspecialty called urogynecology has arisen to correct prolapse conditions and the urinary incontinence that often results.

Teamwork in angioplasty-bypass decisions

New guidelines clarify the ifs and thens, but the choice is yours.

The release of new clinical guidelines usually gets more attention from doctors than from the people they treat. But anyone with clogged heart arteries or at risk of developing them should know about the updated guidelines on using bypass surgery and angioplasty to deal with such blockages (Circulation, Dec. 6, 2011).

Radiation for breast cancer is linked to narrowing of the coronary arteries

Women who undergo breast-conserving surgery (lumpectomy) for early-stage breast cancer usually receive radiation therapy as a part of their treatment. Radiation kills cancer cells left behind after surgery and helps prevent them from causing a recurrence or spreading to other tissues. For example, in a 2011 study in The Lancet involving more than 10,000 women treated with breast-conserving surgery, radiation cut the 10-year recurrence rate by one-third to one-half. Numerous studies have found that mastectomy (which removes the entire breast) is no more effective than lumpectomy plus radiation in improving survival rates. (Radiation may also be given after mastectomy, depending on the size of the cancer or extent of its spread.)

The main serious downside of radiation is potential damage to the heart. Several studies have found that women who receive radiation for breast cancer have an increased risk of heart disease and death from cardiac causes. It's a special concern for women with left-sided breast cancer, because the heart is mostly in the left chest. Since the early 1990s, technical advances have been introduced to lower the risk of exposing the heart to radiation. But it's unclear how much these newer techniques help — partly because heart disease usually develops more than 10 years after exposure, and follow-up studies have been too short. Also, it hasn't been clear exactly how radiation damages the heart.

No-surgery aortic valve replacement okay for some, not all

Seek help from a heart team when considering your options.

Age and unhealthy habits can harm the aortic valve, a three-flapped structure that ensures the one-way flow of blood from the heart's main pumping chamber to the rest of the body. In some people, the aortic valve becomes encrusted with calcium deposits that stiffen and narrow it, restricting blood flow. When people with this condition (called aortic stenosis) start feeling symptoms — such as dizziness, breathlessness, fatigue, and loss of appetite — quality of life goes inexorably downhill unless the valve is replaced.

Living with an implantable cardioverter-defibrillator

These high-tech devices can save — and change — a person's life.

Implantable cardioverter-defibrillators (ICDs) save many lives. They monitor the heart's rhythm and rate, emitting a low-energy electrical correction when they detect a minor heart rate abnormality. They can also deliver a more significant jolt, likened to a swift kick in the chest, to halt potentially life-threatening rhythm disruptions.

Experts update guidelines for treating essential tremor

About 10 million people in the United States have essential tremor (ET), a movement disorder that causes uncontrollable shaking of the hands and often the head as well, and sometimes a quavering voice. ET is an action tremor, meaning that the shaking is largely absent when you're at rest but increases when you try to use your hands — for example, to pick up a cup or use a fork. (ET is sometimes mistaken for Parkinson's disease, in which it's the other way around: the tremor is noticeable during rest and stops with activity.)

There's no cure for ET, but clinicians have various ways to control the symptoms, including drugs and surgery. The American Academy of Neurology (AAN) has issued updated treatment guidelines, based on a review of 252 studies published since 2005, when the AAN issued its first evidence-based guidelines for the treatment of ET. Results were published in Neurology (Nov. 8, 2011).

Ask the doctor: Which type of replacement valve should I get?

Q. I am 77 years old, and my doctor recommended surgery to replace my aortic valve. He said my choice is between a mechanical valve and a pig valve. Which is the preferred option?

A. Generally, people with mechanical and tissue (pig) valves do comparably well. However, your age and other factors can play a role in selecting one or the other. Tissue valves typically wear out before mechanical valves do, often in 15 years or less.

Ask the doctor: What else can I do for Dupuytren's contracture?

Q. I have Dupuytren's contracture in both hands. I've had "needle" surgery in one hand, and the fingers straightened. But they seem to want to contract again. What can I do?

A. Dupuytren's contracture is a disorder that develops when the palmar fascia — the tissue between the skin and tendons in the palm — thickens and contracts due to an abnormal buildup of collagen, causing one or more fingers (usually the little and ring fingers) to bend inward. Over time, Dupuytren's can make it difficult or impossible to grasp objects, button buttons, use a computer, and perform many other everyday activities. The treatment you mention sounds like needle aponeurotomy (also called percutaneous needle fasciotomy), in which a needle is used to sever the cords that are causing the fingers to contract. Unfortunately, recurrence following treatment is common.

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