Medical Tests & Procedures Archive


The crucial, controversial carotid artery Part I: The artery in health and disease

You don't have to be a brain surgeon to know it is vitally important for your brain to receive an uninterrupted supply of blood. That's because nerve cells require a constant supply of oxygen. Even a brief disruption stuns nerve cells, impairing their function, while more prolonged oxygen deprivation kills the cells. If only a small, noncritical area of your brain is affected, you may not notice the damage. Unfortunately, however, the damage is often very noticeable indeed. Brief or partial interruptions of blood flow cause transient ischemic attacks (TIAs), while prolonged or complete blockages are the major cause of cerebrovascular accidents — strokes.

Shocking statistics

Stroke is the fourth leading cause of death in the United States, taking about 136,000 lives annually. Another 660,000 Americans survive strokes each year, but many are so disabled that they cannot return to work. In human terms, it's an enormous burden of suffering; in dollar terms, it costs $74 billion a year to care for stroke victims and make up for their lost productivity.

Fibroid embolization and surgery have similar five-year outcomes

Every year in the United States, hundreds of thousands of women are treated for fibroids — noncancerous growths that form in the uterus. Fibroids can cause pelvic pain, lower abdominal pressure, and heavy menstrual bleeding. Fibroids usually shrink after menopause, and before menopause, symptoms can sometimes be managed with medications. For women with severe bleeding who can't or don't want to "wait it out," the usual approach has been surgery — myomectomy (which removes only the fibroids) or hysterectomy, which removes the uterus (and ends childbearing).

Since 1995, an alternative treatment has been available for women wanting to avoid surgery — uterine artery embolization (UAE), a minimally invasive procedure that shrinks fibroids by cutting off their blood supply. Short-term studies (one to two years) have shown that UAE and surgery produce similar improvement in symptoms and quality of life. Now, a controlled study has found that the same is true even after five years, although women receiving UAE are more likely to require further treatment. Results were published online in BJOG: An International Journal of Obstetrics and Gynaecology (April 12, 2011).

Diagnosing and treating interstitial cystitis

Also called painful bladder syndrome, this frustrating disorder disproportionately affects women.

Interstitial cystitis is a chronic bladder condition that causes recurring bouts of pain and pressure in the bladder and pelvic area, often accompanied by an urgent and frequent need to urinate — sometimes as often as 40, 50, or 60 times a day, around the clock. Discomfort associated with interstitial cystitis can be so excruciating that, according to surveys, only about half of people with the disorder work full-time. Because symptoms are so variable, experts today describe interstitial cystitis as a member of a group of disorders collectively referred to as interstitial cystitis/painful bladder syndrome. (In this article, we'll call it interstitial cystitis, or IC.)

Among the one to two million Americans with IC, women outnumber men by as much as eight to one, and most are diagnosed in their early 40s. Several other disorders are associated with IC, including allergies, migraine, irritable bowel syndrome, fibromyalgia (a condition causing muscle pain), chronic fatigue syndrome, and vulvodynia (pain or burning in the vulvar area that isn't caused by infection or skin disease).

Diagnosing Alzheimer's disease


New criteria divide the disease into three stages.

Doctors take a two-pronged approach to diagnosing Alzheimer's disease. First, they ask patients questions and perhaps have them fill out one of the standardized questionnaires used to assess memory and other parts of thinking. The purpose is to evaluate people's cognitive problems to see if what they're experiencing is consistent with Alzheimer's. Forgetfulness coupled with abnormal social behavior, for example, might indicate a different brain disease. And mild problems with short-term memory could be ascribed to normal aging.

Second, doctors will order various tests to rule out other conditions that can affect mental functioning. Any CT or MRI brain scans or blood tests that might be done are part of this process of elimination.

Bypass vs. angioplasty

Comparisons have produced mixed results, but the heyday for both procedures (especially bypass) may be winding down.

Yes, it's an oversimplification, but at one level, coronary artery disease is a plumbing problem. The coronary arteries supply the heart with blood. When they get gunked up with atherosclerotic plaque, not enough blood can get through. If the blockage isn't too bad, the result is angina, the pain caused by a heart working with an inadequate blood supply. If the blockage is bigger or the plaque ruptures, the result can be a heart attack, the death of heart tissue that was suddenly starved for blood and oxygen.

Is robotic surgery better?

The first robotic surgery was performed in the mid-1980s. Now thousands of operations are being done with the assistance of robots. A better term might be robotic instrumentation because, ultimately, there's always a human surgeon with his or her hands on the controls.

Even without robots, a lot of surgery is less hands-on than it used to be. For decades, surgeons have been doing many common abdominal operations with laparoscopes — tube-like instruments with video cameras on the ends — and long-handled surgical instruments. Surgeons watch magnified images on video monitors to see what they are doing so they can guide the surgical instruments.

Abdominal aortic aneurysms: Triple A, double trouble

The aorta is the largest artery in the body; it's also the strongest. But size and strength are not enough to protect this crucial blood vessel; in fact, the aorta is one of the body's most vulnerable arteries.

Although many things can go wrong with the aorta, the most common is an aneurysm; it's an unfamiliar term, but it's a well-chosen name based on the ancient Greek word that means "to widen."

Weight-loss surgery can help - and harm - the heart

Understand the risks and limitations before embarking on this last-ditch option.

An operation that changes how the stomach and intestines digest food has been hailed as a potential lifesaver for people who are severely overweight. It can dramatically improve blood sugar, lower blood pressure and cholesterol, lessen sleep apnea (a dangerous pattern of breath holding during sleep), and improve heart function. But these benefits, which accrue only with a lifelong commitment to healthy eating and exercise, must be balanced against possible risks.

Ask the doctor: What is pericardial effusion?

Q. My doctor told me I have pericardial effusion. I know it has something to do with fluid in the heart. Can you tell me more?

A. Pericardial effusion is the medical term for a buildup of fluid inside the sac that surrounds the heart. This sac, called the pericardium, protects the heart, helps hold it in shape, and prevents it from expanding too much when blood volume increases.

Ask the doctor: Do cataracts need to be ripe for surgery?

Q. I think I may have cataracts. I heard somewhere that they need to be ripe before I get surgery. Is that true?

A. The lens of the eye is normally clear and has a consistency that is a bit stiffer than Jell-O. A cataract is a clouding of the lens caused by degradation and clumping of various proteins in the tissue. When that happens, the lens also gets stiffer, and in extreme cases, a lens can get as hard as a rock.

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