Medical Tests & Procedures Archive

Can gentle vibration improve bone density and prevent fractures after menopause?

Soon you may be hearing a lot about low-intensity vibration therapy for strengthening bones and reducing the risk of fractures. Two low-intensity oscillating devices designed for home use are coming onto the market, and the Agency for Healthcare Research and Quality (AHRQ), which advises the federal government on health care matters, is expected to issue a report highlighting the evidence as well as the many unanswered questions about this unique approach to bone health.

Warts are an unsightly nuisance that can take a year or more to go away on their own. Several effective, noninvasive treatments are available.

Q. I am overweight and need abdominal surgery. Does being overweight make the surgery more difficult and add to the complication rate?

A. We all have a fair amount of fatty tissue in our abdominal cavities that surgeons must deal with during abdominal operations. The more fat you have, the more difficult the operation is for the surgeon. Excessive fatty tissue impairs access to the surgical site. It can also make the surgery itself — the cutting of tissue — more complex. Operations on obese patients tend to take longer for these and other reasons.

Results of landmark trial have little effect on use of angioplasty.

The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial should have been a game changer for people with stable angina (chest pain from cholesterol-clogged coronary arteries) or a severe narrowing in one or more coronary arteries. In such individuals, COURAGE showed that artery-widening angioplasty plus stent implantation was no better than optimal medical therapy at preventing heart attacks or improving survival. In other words, it made sense to first try medical therapy — that is, drug treatment and lifestyle changes — and turn to angioplasty if it didn't work.

The carotid arteries carry oxygen-rich blood from the heart to the front half of the brain. But these crucial arteries can become narrowed by the cholesterol-laden plaques of atherosclerosis. Blood clots, or thrombi, can form on the plaques, then break off and travel as emboli to the brain, where they lodge in small arteries, interrupting the vital flow of blood to brain cells. If the interruption is partial or brief, the brain cells recover; the patient experiences a transient ischemic attack (TIA) with no permanent damage. But if the blockage is complete, brain cells die, producing a stroke.

In many cases, a TIA warns of a future stroke, giving doctors time to perform a carotid ultrasound test to see if the artery is mildly (less than 50%), moderately (50% to 69%), or severely (70% to 99%) narrowed. Once the diagnosis of carotid stenosis (narrowing) is established, several treatment options must be considered.

The carotid arteries that run up either side of the neck are prone to becoming narrowed by cholesterol-filled plaque. A test called carotid ultrasound can identify a narrowing, also called a stenosis, quickly, safely, and without any immediate potential for harm. This test makes perfect sense for someone experiencing lightheadedness, memory loss, or the warning signs of a stroke or mini-stroke.

In people who have their carotid arteries checked "just in case," ultrasound doesn't do much good. University of Wisconsin researchers tracked almost 600 people who underwent carotid ultrasound for this reason. A year later, those whose scans had shown a significant narrowing were no more likely to have their blood pressure or cholesterol under control — two key steps for managing carotid stenosis — than those whose arteries were clear, or to have made healthy changes in diet, exercise, and other long-term health behaviors (Archives of Internal Medicine, March 28, 2011).

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.

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).

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).

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.