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Whipple procedure

Definition
The Whipple procedure (pancreatoduodenectomy) is the most common operation to remove
pancreatic cancers. The Whipple procedure may also be used to treat some benign pancreatic
lesions and cysts and cancers in the bile duct and beginning part of the small intestine (duodenum).
About
The goal of the Whipple procedure (pancreatoduodenectomy) is to remove the head of the
pancreas, where most tumors occur. Because the pancreas is so integrated with other organs, the
surgeon must also remove the first part of small intestine (duodenum), the gallbladder, the end of
the common bile duct and sometimes a portion of the stomach. In the reconstruction phase of the
operation, the intestine, bile duct and remaining portion of the pancreas are reconnected.
The Whipple procedure is a difficult and demanding operation for both the person undergoing
surgery and the surgeon.
Laparoscopic option
A laparoscopic Whipple procedure may be offered to select individuals. The laparoscopic Whipple
procedure is performed through six small incisions in the abdominal wall. A laparoscope, a long thin
tube with a lighted camera at its tip, is inserted through one incision. The surgeon operates using
specially designed surgical instruments placed through the remaining incisions, guided by the
laparoscope images shown on a monitor in the operating room.
At Mayo Clinic, laparoscopic Whipple surgery usually takes four to five hours. Most people leave the
hospital in four to six days, compared with eight to 10 days for those who have conventional surgery.
One month after a laparoscopic Whipple procedure, most people are able to eat normally, and many
can return to work and normal activities.
Mayo Clinic researchers are evaluating the laparoscopic approach to see if the benefits found in
other minimally invasive surgeries less blood loss, shorter hospital stays and faster recovery
also apply in laparoscopic Whipple surgery.
Complications
The most common post-surgical complication of pancreatoduodenectomy is leaking of pancreatic
juices from the incision. If this occurs, a drain may be inserted through the skin to allow drainage for
several weeks after surgery. Weight loss is another frequent complication of the Whipple procedure.
Diabetes is a potentially serious concern for some people (a minority) after surgery. In general,
although many people do very well after the Whipple procedure, some develop immediate
complications that affect their quality of life.
To help ensure an uncomplicated recovery, Mayo Clinic specialists provide nutrition counseling and
ongoing supportive care.



Ultrasound

Definition
Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging
method that uses high-frequency sound waves to produce relatively precise images of structures
within your body. The images produced during an ultrasound examination often provide valuable
information for diagnosing and treating a variety of diseases and conditions.
Most ultrasound examinations are done using a sonar device outside of your body, though some
ultrasound examinations involve placing a device inside your body.
Why it's done
You may need to undergo an ultrasound for a variety of reasons. Ultrasound may be used, for
example, to:
Assess a fetus
Diagnose gallbladder disease
Evaluate flow in blood vessels
Guide a needle for biopsy or tumor treatment
Evaluate a breast lump
Check your thyroid gland
Study your heart
Diagnose some forms of infection
Diagnose some forms of cancer
Reveal abnormalities in the genitalia and prostate
Evaluate abnormalities of the muscles and tendons
Risks
Diagnostic ultrasound is a safe procedure that uses low-power sound waves. There are no direct
risks from a diagnostic ultrasound exam.
Although ultrasound is a valuable tool, it does have its limitations. Sound doesn't travel well through
air or bone, so ultrasound isn't effective at imaging parts of your body that have gas in them or that
are obscured by bone. Rather than using ultrasound to view these areas, your doctor may instead
order other imaging tests, such as CT or MRI scans, or X-rays.
How you prepare
How you prepare for an ultrasound depends on which area of your body needs evaluation:
Most ultrasound exams require no preparation.
Other exams such as of the gallbladder require that you forgo food and liquids for
up to six hours before the exam.
Still other exams such as a pelvic ultrasound require that you not urinate before
the exam to ensure that your bladder will be full, allowing better visualization of the
uterus, ovaries or prostate.
When scheduling your ultrasound, ask your doctor for specific instructions for your particular exam.
What you can expect
During an ultrasound exam, you usually lie on an examination table. A small amount of gel is applied
to your skin. The gel helps eliminate the formation of air pockets between the ultrasound and your
body. During the exam, a technician trained in ultrasound imaging (sonographer) presses a small
hand-held device (transducer), about the size of a bar of soap, against your skin over the area of
your body being examined, moving from one area to another as necessary.
Based on the same principles as sonar, a technology used to detect underwater objects, the
transducer generates and receives high-frequency sound waves that can't be heard by the human
ear.
As the sonographer places the transducer on your skin, crystals inside the transducer emit pulses of
sound waves that travel into your body. Your tissues, bones and body fluids reflect the sound waves
and bounce them back to the transducer. The transducer then sends this information to a computer,
which composes detailed images based on the patterns created by the sound waves.
Though the majority of ultrasound exams are performed with a transducer on your skin, some
ultrasounds are done inside your body (invasive ultrasounds). For these exams, a specialized
transducer is attached to a probe that's inserted into a natural opening in your body. Examples of
these exams include:
Transesophageal echocardiogram. A small, specialized transducer is inserted into your
esophagus to obtain images of the nearby heart. Such exams are typically performed
with sedation.
Transrectal ultrasound. A small, specialized transducer is inserted into a man's rectum
to view his prostate.
Transvaginal ultrasound. A small, specialized transducer is inserted into a woman's
vagina to view her uterus and ovaries.
Ultrasound is usually a painless procedure. However, you may experience some mild discomfort as
the sonographer guides the transducer over your body, especially if you're required to have a full
bladder. A typical ultrasound exam takes from 30 minutes to an hour.
Results
When your exam is complete, the sonographer and a radiologist generally view the ultrasound
images on film or on a computer monitor. The radiologist analyzes the images and sends a report of
the findings to your doctor.
If your ultrasound exam is for an urgent medical condition, your doctor should receive your results
immediately. Otherwise, you should have your results within a few days
Urinalysis

Definition
Urinalysis is a test that evaluates a sample of your urine. Urinalysis is used to detect and assess a
wide range of disorders, such as urinary tract infection, kidney disease and diabetes.
Urinalysis involves examining the appearance, concentration and content of urine. Abnormal
urinalysis results may point to a disease or illness. For example, a urinary tract infection can make
urine look cloudy instead of clear. Increased levels of protein in urine can be a sign of kidney disease.
Abnormal results of a urinalysis often require more testing and evaluation to uncover the source of
the problem.

Why it's done
Urinalysis is a common test that's done for several reasons:
To assess your overall health. Your doctor may recommend urinalysis as part of a
routine medical exam, pregnancy checkup, pre-surgery preparation, or on hospital
admission to screen for a variety of disorders, such as diabetes, kidney disease and liver
disease.
To diagnose a medical condition. Your doctor may suggest urinalysis if you're
experiencing abdominal pain, back pain, frequent or painful urination, blood in your
urine or other urinary problems. Urinalysis may help diagnose the cause of these
symptoms.
To monitor a medical condition. If you've been diagnosed with a medical condition,
such as kidney disease or urinary tract disease, your doctor may recommend urinalysis
on a regular basis to monitor your condition and treatment.
Other tests, such as pregnancy testing and drug screenings, also may require a sample of urine, but
they test for substances that urinalysis typically doesn't include. For example, pregnancy testing
measures a hormone called human chorionic gonadotropin (HCG). Drug screenings detect specific
drugs or their metabolic products, depending on the purpose of the testing
How you prepare
If your urine is being tested only for urinalysis, you can eat and drink normally before the test. If
you're having other tests at the same time, you may need to fast for a certain amount of time before
the test. Your doctor will give you specific instructions.
Many drugs, including nonprescription medications and supplements, can affect the results of a
urinalysis. Before a urinalysis, tell your doctor about any medications, vitamins or other supplements
you're taking
What you can expect
Depending on your situation, you may collect a urine sample at home or at your doctor's office. Your
doctor will provide a container for the urine sample. You may be asked to collect the sample first
thing in the morning because at that time your urine is more concentrated, and abnormal results
may be more obvious.
To get the most accurate results, the sample may need to be collected midstream, using a clean-
catch method. This method involves the following steps:
Cleanse the urinary opening. Women should spread their labia and clean from front to
back. Men should wipe the tip of the penis.
Begin to urinate into the toilet.
Pass collection container into your urine stream.
Urinate at least 1 to 2 ounces (30 to 59 milliliters) into the collection container.
Finish urinating into the toilet.
Deliver the sample as directed by your doctor.
If you can't deliver the sample to the designated area within 30 minutes of collection,
refrigerate the sample, unless you've been instructed otherwise by your doctor.
In some cases, your doctor may insert a thin, flexible tube (catheter) through the urinary tract
opening and into the bladder to collect the urine sample.
The urine sample is sent to a lab for analysis. You can return to your usual activities immediately
Results
For urinalysis, your urine sample is evaluated in three ways: visual exam, dipstick test and
microscopic exam.
Visual exam
A lab technician will examine the urine's appearance. Urine is typically clear. Cloudiness or unusual
odor may indicate a problem. Blood in the urine may make it look red or brown. A cloudy
appearance may indicate an infection. Urine color can be influenced by what you've just eaten. For
example, beets may add a red tint to your urine.
Dipstick test
A dipstick a thin, plastic stick with strips of chemicals on it is placed in the urine to detect
abnormalities. The chemical strips change color if certain substances are present or if their levels are
above normal. A dipstick test checks for the following:
Acidity (pH). The pH level indicates the amount of acid in urine. Abnormal pH levels may
indicate a kidney or urinary tract disorder.
Concentration. A measure of concentration, or specific gravity, shows how concentrated
particles are in your urine. Higher than normal concentration often is a result of not
drinking enough fluids.
Protein. Low levels of protein in urine are normal. Small increases in protein in urine
usually aren't a cause for concern, but larger amounts may indicate a kidney problem.
Sugar. Normally the amount of sugar (glucose) in urine is too low to be detected. Any
detection of sugar on this test usually calls for follow-up testing for diabetes.
Ketones. As with sugar, any amount of ketones detected in your urine could be a sign of
diabetes and requires follow-up testing.
Bilirubin. Bilirubin is a product of red blood cell breakdown. Normally, bilirubin is carried
in the blood and passes into your liver, where it's removed and becomes part of bile.
Bilirubin in your urine may indicate liver damage or disease.
Evidence of infection. If either nitrites or leukocyte esterase a product of white blood
cells is detected in your urine, it may be a sign of a urinary tract infection.
Blood. Blood in your urine requires additional testing it may be a sign of kidney
damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood
disorders.

Microscopic exam
Several drops of the urine are examined with a microscope. If any of the following are observed in
above-average levels, additional testing may be necessary:
White blood cells (leukocytes) may be a sign of an infection.
Red blood cells (erythrocytes) may be a sign of kidney disease, a blood disorder or
another underlying medical condition, such as bladder cancer.
Epithelial cells cells that line your hollow organs and form your skin in your urine
may be a sign of a tumor. But more often, they indicate that the urine sample was
contaminated during the test, and a new sample is needed.
Bacteria or yeasts may indicate an infection.
Casts tube-shaped proteins may form as a result of kidney disorders.
Crystals that form from chemicals in urine may be a sign of kidney stones.
Urinalysis alone usually doesn't provide a definite diagnosis. Depending on the reason your doctor
recommended this test, abnormal results may or may not require follow-up. Your doctor may need
to evaluate the results along with those of other tests, or additional tests may be necessary to
determine next steps.
For example, if you are otherwise healthy and have no signs or symptoms of illness, results slightly
above normal on a urinalysis may not be a cause for concern and follow-up may not be needed.
However, if you've been diagnosed with kidney or urinary tract disease, elevated levels may indicate
a need to change your treatment plan.
For specifics about what your urinalysis results mean, talk with your doctor



Urine cytology
Definition
Urine cytology is a test to look for abnormal cells in your urine. Urine cytology is used along with
other tests and procedures to diagnose urinary tract cancers. Urine cytology is most often used to
diagnose bladder cancer, though the test may also detect kidney cancer, prostate cancer, ureter
cancer and urethra cancer.
Your doctor may recommend a urine cytology test if blood has been detected in your urine
(hematuria). Urine cytology may also be used in people who have already been diagnosed with
bladder cancer and have undergone treatment. In these cases, a urine cytology test may help detect
a bladder cancer recurrence
Why it's done
Urine cytology is used along with other tests and procedures to diagnose cancers of the urinary
tract, including:
Bladder cancer
Ureter cancer
Urethra cancer
Urine cytology can best detect larger and more-aggressive urinary tract cancers. Urine cytology
might not detect small urinary tract cancers that grow more slowly
Risks
Risks of urine cytology testing depend on how your urine is collected. Most often urine is collected
by urinating into a sterile container, which carries no risk. If your urine is collected by inserting a
hollow tube (catheter) into your urethra, there is a risk of urinary tract infection. Ask your doctor
about the specific risks of your procedure.
How you prepare
To prepare for your urine cytology test, try to schedule your test for sometime after your first
morning urination. Urine eliminated during your first morning urination can't be used for urine
cytology. Cells held overnight in your bladder may be degraded, making them difficult to analyze in
the laboratory
What you can expect
Collecting a urine sample for testing
A urine cytology test requires a urine sample. Most often this is obtained by urinating into a sterile
container. In some cases, a urine sample is collected using a thin, hollow tube (catheter) that's
inserted into your urethra and moved up to your bladder.
Your doctor may ask you to provide additional urine samples on subsequent days. Testing multiple
urine samples that have been collected over several days may increase the accuracy of urine
cytology testing.
Examining the urine sample in the laboratory
Your urine sample is sent to a laboratory for testing by a doctor who specializes in examining body
tissues (pathologist). The pathologist analyzes any cells seen in the urine sample under a
microscope. The pathologist notes the types of cells and looks for signs in the cells that might
indicate cancer
Results
The pathologist will send the results of your urine cytology test to your doctor, who will report the
results to you. Ask your doctor how long you can expect to wait for your results.
Each laboratory has its own way of describing the results of a urine cytology exam. Some common
words used in pathology reports include:
Unsatisfactory specimen. This may mean that not enough cells or the wrong types of
cells were found in your urine sample. You may need to repeat the urine cytology test.
Negative. This means no cancer cells were identified in your urine sample.
Atypical. This indicates some abnormalities were found in the cells in your urine sample.
But while the cells weren't normal, they weren't abnormal enough to be considered
cancer.
Suspicious. This term may indicate that urine cells were abnormal and may be
cancerous.
Positive. A positive result indicates that cancer cells were found in your urine.
A urine cytology test can't be used alone to diagnose cancer. If atypical or cancerous cells are
detected using urine cytology, your doctor will likely recommend a cystoscopy procedure or
computerized tomography (CT) scan to examine your bladder and urinary tract for abnormalities


Uterine artery embolization
Definition
Uterine artery embolization is a minimally invasive treatment for uterine fibroids, noncancerous
growths in the uterus. In uterine artery embolization also called uterine fibroid embolization a
doctor uses a slender, flexible tube (catheter) to inject small particles (embolic agents) into the
uterine arteries, which supply blood to your fibroids and uterus.
Uterine fibroids stimulate formation of new blood vessels to the fibroid. During uterine artery
embolization, the embolic agents are injected into these fibroid blood vessels. The goal is to block
the fibroid vessels, starving the fibroids and causing them to shrink and die
Why it's done
Uterine fibroids can cause severe symptoms in some women, including heavy menstrual bleeding,
pelvic pain and swelling of the abdomen. Uterine artery embolization destroys fibroid tissue and
eases these symptoms. And it provides an alternative to surgery to remove fibroids (myomectomy).
You might choose uterine artery embolization if you are premenopausal and:
You have severe pain or heavy bleeding from uterine fibroids
You want to avoid surgery, or surgery is too risky for you
You want to keep your uterus
Optimizing a future pregnancy is not your chief concern

Risks
Rarely, major complications occur in women undergoing uterine artery embolization. The risk of
complications from uterine artery embolization is about the same as those for surgical treatment of
fibroids. These may include:
Infection. A degenerating fibroid can provide a site for bacterial growth and lead to infection
of the uterus (endomyometritis). Many uterine infections can be treated with antibiotics,
but in extreme cases, infection may require a hysterectomy.
Damage to other organs. Unintended embolization of another organ or tissue can occur,
although it's not as high a risk as with surgery. Whether you have embolization or surgery,
disruption of the ovarian blood supply is a possibility because the ovaries and uterus share
some blood vessels. If you're nearing menopause (perimenopausal), such a disruption could
lead to menopause but that's rare if you're age 40 or younger.
Possible problems in future pregnancies. Many women have or continue healthy
pregnancies after having uterine artery embolization. However, some evidence suggests
pregnancy complications, including abnormalities of the placenta attaching to the uterus,
may be increased after the procedure. If you want to have children, talk to your doctor
about the risks of surgery and how uterine artery embolization might affect your fertility and
future pregnancy.

Reasons to avoid this procedure
Avoid uterine artery embolization if you have:
A history of pelvic radiation
A history of kidney failure
Possible pelvic cancer
An active, recent or chronic pelvic infection
Poorly controlled diabetes
Inflammation of the blood vessels (vasculitis)
An untreated bleeding disorder
A severe allergy to contrast material containing iodine
Most fibroid sizes and locations can be treated with uterine artery embolization. Rarely a woman's
uterus can be so big that it's difficult to treat with any method, and hysterectomy may be required.
Discuss the benefits and risks of uterine artery embolization with your obstetrician-gynecologist or
an interventional radiologist a doctor who uses imaging techniques to guide procedures that
would be impossible with conventional surgery

How you prepare
Uterine artery embolization usually is performed by an interventional radiologist or a specialist in
obstetrics and gynecology who has training in uterine artery embolization.
On the evening before the procedure, don't eat or drink after midnight or after
whatever time your doctor advised. If you're taking medications, ask your doctor if you
should stop taking them before or after the procedure.
In the radiology procedure room, you'll have an intravenous (IV) line placed in one of
your veins to give you fluids, anesthetics, antibiotics and pain medications. You'll also
have a urinary catheter inserted into your bladder to keep the bladder empty during
your treatment.
After the procedure, typically you'll be moved to a room for an overnight stay in the
hospital and return home the next day
What you can expect
To see your uterus and blood vessels, the radiologist uses a fluoroscope. This device is a pulsed X-ray
beam that produces moving images of internal structures and displays them on a computer monitor.
During the procedure
The procedure includes:
Anesthesia. Typically you'll receive a type of anesthesia that reduces pain and helps you
relax, but leaves you awake (conscious sedation).
Blood vessel access. The doctor makes a small incision in the skin over your femoral
artery, a large blood vessel that passes lengthwise through your groin. Then your doctor
inserts a catheter into the artery and guides the catheter to one of the two uterine
arteries. Generally, the doctor can access both uterine arteries through one incision.
Blood vessel mapping and injection. An injected contrast fluid, usually containing
iodine, flows into the uterine artery and its branches and makes them visible on the
fluoroscope's monitor. The fibroids "light up" more brightly than other uterine tissue.
The radiologist identifies the right area of the uterine artery and then injects the blood
vessel with tiny particles made of plastic or gelatin. The particles are carried by the
blood flow to block the fibroid vessels. After injecting more contrast into the uterine
artery, the doctor checks additional images to make sure that blood is no longer
reaching the fibroids. The same steps are then repeated in the second uterine artery.
After the procedure
In the recovery room, the care team monitors your condition and gives you medication to control
any nausea and pain. When the effects of the anesthesia fade, they take you to your hospital room
for overnight observation.
Position. You must lie flat for several hours to prevent pooling and clotting of the blood
(hematoma) at the femoral artery site.
Pain. The primary side effect of uterine artery embolization is pain, which may be a
reaction to stopping blood flow to the fibroids and a temporary drop in blood flow to
normal uterine tissue. Pain usually peaks during the first 24 hours. To manage the pain,
you receive pain medication.
Observation. Post-embolization syndrome characterized by low-grade fever, pain,
fatigue, nausea and vomiting is frequent after uterine artery embolization. Doctors
believe that chemicals released by degenerating fibroids stimulate inflammation,
causing these symptoms. Post-embolization syndrome symptoms peak about 48 hours
after the procedure and usually resolve on their own within a week. Ongoing symptoms
that don't gradually improve should be evaluated for more-serious conditions, such as
an infection.
By the next day, your urinary catheter is removed, and you're encouraged to walk around. Recovery
is generally rapid, and complications are rare.
Recovery
Most women return home the day after the procedure with a prescription for oral pain medication.
Pain usually ends within a day or two, but in some women it may last up to a few weeks.
Monitor your recovery for:
Vaginal discharge. You might have a watery or mucus-like vaginal discharge for a few
weeks to a month after uterine artery embolization. The discharge should stop without
treatment. In a few women, remnants of fibroids are passed through the vagina.
Infection. Return to your obstetrician-gynecologist or primary care doctor for a follow-
up exam within four weeks of the procedure to make sure there's no infection. Signs and
symptoms of infection include fever, chills and pain. Delayed infections and vaginal
discharge are rarely reported weeks to months after the procedure.
Follow-up
You'll likely undergo a magnetic resonance imaging (MRI) exam over the next year to monitor
shrinkage or other changes in the fibroids or your uterus. Doctors usually schedule the first exam
three months after the procedure
Catheterization

The radiologist makes an incision less than 1/4 inch (6 millimeters) in the skin over your groin. He or
she then inserts a catheter into your femoral artery, guides it to one of your two uterine arteries and
releases tiny particles into the vessels.
Using embolic agents to stop blood flow
Small particles (embolic agents) are injected
into the uterine artery through a small catheter. The embolic agents then flow to the fibroids and
lodge in the arteries that feed them. This cuts off blood flow to starve the tumors

Results
Uterine artery embolization typically provides significant relief of symptoms. It also affects your
menstrual period and it may have an impact on fertility.
Symptom relief. Most women get significant symptom relief in the first three months
after treatment. In addition, some research shows that five years after treatment
uterine artery embolization continues to reduce symptoms such as heavy bleeding,
urinary incontinence and abdominal enlargement in most women. These results appear
to be comparable to that of myomectomy, in which the fibroids are surgically removed
and the uterus repaired.
Menstruation. Your menstrual period will probably resume within a few months. A small
number of women, however, enter menopause after the procedure. The risk appears
highest among women age 45 and older.
Impact on fertility. Although the risk of entering menopause after the procedure is low,
subtle ovarian damage may make getting pregnant more difficult. There also may be an
increased risk of pregnancy complications, especially involving abnormal placement or
attachment of the placenta. Despite these risks, many women have had successful
pregnancies after uterine artery embolization. However, more long-term, larger studies
are needed to determine the impact of uterine artery embolization on fertility and
pregnancy and the risks of uterine artery embolization must also be compared with
the risks of surgery
Testicular exam

Definition
A testicular exam is an inspection of the appearance and feel of your testicles. You can do a
testicular exam yourself, typically standing in front of a mirror.
Routine testicular exams may give you a greater awareness of the condition of your testicles and
help you detect when changes occur. Testicular exams may also help you identify potential testicular
problems.
If you detect lumps or other changes during a testicular exam, make an appointment with your
doctor
Why it's done
Testicular self-exams help you learn the normal feel and appearance of your testicles. That may
make it more likely that you'll notice subtle changes, should they occur. Changes in your testicles
could be a sign of a common benign condition, such as an infection or a cyst, or a less common
condition, such as testicular cancer.
Who should consider regular testicular exams?
It's not clear which men should consider regular testicular exams. Though often promoted as a way
to detect testicular cancer, testicular exams aren't proven to reduce the risk of dying of the disease.
Testicular cancer is a relatively uncommon type of cancer. It's also highly treatable at all stages, so
finding testicular cancer early doesn't make a cure more likely.
Doctors and medical organizations differ on their recommendations for testicular exams. The U.S.
Preventive Services Task Force doesn't recommend testicular exams because a benefit has never
been proven. The American Cancer Society recommends discussing cancer-related health issues,
such as testicular self-exams, with your doctor during routine checkups. If you're concerned about
your risk of testicular cancer, discuss the issue with your doctor. Together you can decide whether
regular testicular self-exams are right for you
Risks
Performing a testicular exam doesn't pose any direct risks. However, if you notice something
unusual that concerns you, the follow-up exams might lead to unnecessary worry and medical tests.
For example, if you discover a suspicious lump, you may undergo tests to determine its cause. This
could involve blood tests, ultrasound exams or a procedure to remove testicle tissue for examination
(biopsy). If the lump turns out to be noncancerous (benign), you might feel that you've undergone
an invasive procedure unnecessarily

How you prepare
No special preparation is necessary to do a testicular exam. You may find a testicular exam is easier
during or after a warm bath or shower. Heat relaxes the scrotum, making it easier for you to check
for anything unusual.
What you can expect
To do a testicular exam, stand unclothed in front of a mirror. Then:
Look for swelling. Hold your penis out of the way and examine the skin of the scrotum.
Examine each testicle. Using both hands, place your index and middle fingers under the
testicle and your thumbs on top.
Gently roll the testicle between your thumbs and fingers. Look and feel for any changes
to your testicle. These could include hard lumps, smooth rounded bumps, or new
changes in the size, shape or consistency of the testicle.
While you're doing the testicular exam, you may notice a few things about your testicles that seem
unusual but aren't signs of cancer. For example, bumps on the skin of your scrotum can be caused
by ingrown hairs, a rash or other skin problems. You may also feel a soft, ropy cord, which is a
normal part of the scrotum called the epididymis. It leads upward from the top of the back part of
each testicle.
Results
Make an appointment with your doctor if you find a lump or other change during a testicular self-
exam. Depending on the circumstances, your doctor may do a testicular exam followed by a blood
test, ultrasound or biopsy.
Most changes in your testicles aren't caused by testicular cancer. A number of noncancerous
conditions can cause changes in your testicles, such as a cyst, injury, infection, hernia and collection
of fluid around the testicles (hydrocele).









Tilt table test
Definition
A tilt table test is used to evaluate the cause of unexplained fainting (syncope). During a tilt table
test, you lie on a table that moves from a horizontal to a vertical position. Your heart rate and blood
pressure are monitored throughout the tilt table test.
Your doctor may recommend a tilt table test if you've had repeated, unexplained episodes of
fainting. A tilt table test may also be appropriate to investigate the cause of fainting if you've fainted
only once, but another episode would put you at high risk of injury due to your work environment,
medical history, age or other factors.
Doctors use a tilt table test to help diagnose the cause of fainting. During the test, your blood
pressure and heart rate are monitored. You begin by lying flat on a table. Straps are put around your
body to hold you in place. Then, the table is tilted to raise your body to a head-up position
simulating a change in position from lying down to standing up. This test allows doctors to evaluate
your body's cardiovascular response to the change in position
Why it's done
Your doctor may recommend a tilt table test if he or she suspects that neurocardiogenic syncope is
responsible for your fainting and needs additional testing to confirm the diagnosis.
Neurocardiogenic syncope happens when the part of your nervous system that controls blood flow
changes your heart rate and lowers your blood pressure for a short time. Then, less blood flows to
your brain and you may faint. This kind of syncope is also called vasovagal syncope, reflex syncope,
and the common faint.
With neurocardiogenic syncope, you may or may not have warning signs, such as skin paleness,
weakness, sweating, blurred vision or nausea. Neurocardiogenic syncope often is a response to
something like the sight of blood or an upsetting situation. But it can happen with no clear trigger.
This kind of syncope happens when you are standing or sitting
Risks
A tilt table test is generally safe, and complications are rare. But, as with any medical procedure, it
does carry a risk of complications.
Potential complications include:
Prolonged low blood pressure
Prolonged pause between heartbeats (asystole)
These complications usually go away when the table that you're lying on during the test is returned
to a horizontal position
How you prepare
You may be asked not to eat or drink for two hours or more before a tilt table test. You can take
your medications as usual, unless your doctor tells you otherwise
What you can expect
Before you start the tilt table test, a member of your health care team will do the following to
prepare you for the test:
Place sticky patches (electrodes) on your chest, legs and arms. The electrodes are
connected by wires to an electrocardiogram (ECG or EKG) machine that monitors your
heart rate.
Place a blood pressure cuff on your finger, on your arm or on both to check your blood
pressure during the tilt table test.
If needed, place an intravenous (IV) line into a vein in your arm for delivering
medication during the second part of the test, if needed.
During a tilt table test
For the test, you lie down on a table that can be moved from a horizontal to a vertical position. The
table has a footrest and safety belts. The belts are placed around your body during the test to help
ensure that you don't slip off the table. Once you're positioned on the table, the test progresses this
way:
Your heart rate and blood pressure are monitored for about five minutes while you're
lying flat (horizontal).
The bed is then moved to a vertical position (about a 60- to 90-degree angle).
Depending on the reason for the tilt table test, you may stay in the vertical position for
about five to 10 minutes, or you may remain in the vertical position for up to 45
minutes.
While you are in the vertical position, you remain as still as possible. During the test, if
you feel symptoms such as nausea, sweating, lightheadedness or irregular heartbeats,
tell a member of your health care team.
If you don't faint or experience any other symptoms after 45 minutes, the medication
isoproterenol (Isuprel) may be given through an IV line. This medication lowers your
diastolic blood pressure (the bottom number in a blood pressure reading), lowers
peripheral vascular resistance, increases your heart rate and may prompt the abnormal
nervous system reflex that causes vasovagal or neurocardiogenic syncope.
You then remain in the upright position and are monitored for another 15 to 20 minutes.
After a tilt table test
If you faint at any time during the test while you're in the vertical position, the table is returned to a
horizontal position immediately, and you're monitored closely. Most people regain consciousness
almost immediately. In some cases, if blood pressure and heart rate changes indicate you are about
to faint, the table is returned to a horizontal position, and you may not actually lose consciousness.
When your tilt table test is complete, you may return to your normal activities for the remainder of
the day
Results
The results of a tilt table test are based on whether or not you faint during the test and what
happens to your blood pressure and heart rate. Depending on the results, your doctor may
recommend additional tests to exclude other causes of fainting


Transcranial magnetic stimulation
Definition
Transcranial magnetic stimulation (TMS) is a procedure that uses magnetic fields to stimulate nerve
cells in the brain to improve symptoms of depression. Transcranial magnetic stimulation may be
tried when other depression treatments haven't worked.
With TMS, a large electromagnetic coil is placed against your scalp near your forehead. The
electromagnet used in TMS creates electric currents that stimulate nerve cells in the region of your
brain involved in mood control and depression.
Because TMS is a relatively new depression treatment approved by the Food and Drug
administration in 2008 more studies can help determine how effective it is, which treatment
techniques work best and whether it has any long-term side effects
Why it's done
Depression is a treatable condition, but sometimes standard treatments aren't effective.
Transcranial magnetic stimulation (TMS) may be used when standard treatments such as
medications and talk therapy (psychotherapy) don't work.
How it works
How TMS helps relieve depression isn't completely understood. It's thought that magnetic pulses
stimulate nerve cells in the region of your brain involved in mood control. This stimulation appears
to affect how this part of the brain is working, which in turn seems to ease depression symptoms
and improve mood
Risks
Transcranial magnetic stimulation (TMS) is the least invasive of the brain-stimulation procedures
used for depression. Unlike vagus nerve stimulation or deep brain stimulation, TMS doesn't require
surgery or implantation of electrodes. And, unlike electroconvulsive therapy (ECT), it doesn't cause
seizures or require complete sedation with anesthesia. However, TMS does have some risks and can
cause some side effects.
Common side effects
TMS often causes minor short-term side effects. These side effects are generally mild and typically
improve after the first week or two of treatment. They can include:
Headache
Scalp discomfort at the site of stimulation
Tingling, spasms or twitching of facial muscles
Lightheadedness
Discomfort from noise during treatment
Uncommon side effects
Serious side effects are rare. They can include:
Seizures
Mania, particularly in people with bipolar disorder
Hearing loss due to inadequate ear protection during treatment
More study is needed to determine whether TMS may have any long-term side effects
How you prepare
Before having the procedure, you may need a medical exam to make sure it's safe and a good option
for you. You may be asked a number of questions about your depression. Tell your doctor or mental
health provider if:
You're pregnant or thinking of becoming pregnant.
You have any metal or implanted medical devices in your body. Transcranial magnetic
stimulation (TMS) usually isn't recommended if this is the case.
You're taking any medications, including over-the-counter medications, herbal
supplements or vitamins. Bring a list of what you're taking to your doctor's appointment
and include dosages and how often you take them.
You have a history of seizures or mania, any past injuries or surgeries, or any other
physical or mental health problems.
Little preparation is needed. TMS isn't invasive, doesn't require anesthesia and can be performed in
a doctor's office. You don't need to arrange for someone to drive you home after treatment
unless, for the first treatment, you want someone to drive you so you get a sense of how you'll feel
afterward. Before considering treatment, check with your health insurance company to see whether
TMS is covered. Your policy may not cover it
What you can expect
Transcranial magnetic stimulation is usually done on an outpatient basis in a doctor's office or clinic.
It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily,
five times a week for four to six weeks.
Your first treatment
Before treatment begins, your doctor will need to identify the best place to put the magnets on your
head and the best dose of magnetic energy for you.
Most likely, during your first appointment:
You'll be taken to a treatment room. You'll be asked to sit in a reclining chair, and you'll
be given earplugs to wear during the procedure.
An electromagnetic coil will be placed against your head. The electromagnetic coil is
switched off and on repeatedly to produce stimulating pulses. This results in a tapping or
clicking sound that usually lasts for a few seconds, followed by a pause. You'll also feel a
tapping sensation on your forehead. This part of the process is called mapping.
The amount of magnetic energy needed will be determined. Your doctor will increase
the magnetic dose until your fingers or hands twitch. Known as your motor threshold,
this is used as a reference point in determining the right dose for you. During the course
of treatment, the amount of stimulation can be changed depending on your symptoms
and side effects.
Once the coil placement and dose are identified, you're ready to begin.
During transcranial magnetic stimulation
Here's what to expect during each treatment:
You'll sit in a comfortable chair. The magnetic coil is placed against your head.
The machine will be turned on. You'll hear clicking sounds and feel tapping on your
forehead.
The procedure will last about 40 minutes. You'll remain awake and alert. You may feel
some scalp discomfort during the treatment and for a short time afterward. The entire
appointment typically lasts about one to two hours.
After treatment, you can return to your normal daily activities.
There are different ways to perform the procedure. Techniques may change as experts learn more
about the most effective ways to perform treatments
Results
If TMS works for you, your depression symptoms may improve or go away completely. Symptom
relief may take a few weeks of treatment.
TMS may be less likely to work if:
Your mental illness causes detachment from reality (psychosis)
Your depression has lasted for several years
Electroconvulsive therapy (ECT) hasn't worked to improve depression symptoms
It's not yet known if TMS can be used to treat depression for the long term, or whether you can have
periodic maintenance treatments to prevent depression symptoms from returning. The
effectiveness of TMS may improve as researchers learn more about techniques, the number of
stimulations required and the best sites on the brain to stimulate


Transurethral needle ablation (TUNA)
Definition
Transurethral needle ablation (TUNA) is an outpatient procedure to treat urinary symptoms caused
by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). This procedure is
also called radiofrequency ablation or RF therapy.
During TUNA, a specially adapted visual instrument (cystoscope) is inserted through the tip of your
penis into the tube that carries urine from your bladder (urethra). Using the cystoscope, your doctor
guides a pair of tiny needles into the prostate tissue that is pressing on the urethra. Then radio
waves are passed through the needles to create scar tissue. This scarring shrinks prostate tissue,
opening up the urinary channel so that urine can flow more easily.
TUNA is one of several options for treating BPH. To determine the right treatment choice for you,
your doctor will consider how severe your symptoms are, what other health problems you have, and
the size and shape of your prostate
Why it's done
TUNA is used to ease urinary symptoms and complications resulting from blocked urine flow, such
as:
Frequent, urgent need to urinate
Difficulty starting urination
Slow (prolonged) urination
Increased frequency of urination at night (nocturia)
Stopping and starting again while urinating
The feeling you can't completely empty your bladder
Urinary tract infections
A number of procedures are available to treat BPH. In the long term, TUNA may be less effective
than surgical options, such as transurethral resection of the prostate (TURP) and open
prostatectomy. But TUNA has several advantages over traditional surgery:
It's typically done without an overnight hospital stay (on an outpatient basis).
It's less likely to cause bleeding and other complications than does surgery.
It may be a safer alternative if surgery isn't a good choice for you because of certain
other health problems.
It is less likely to cause difficulty holding urine (urinary incontinence) than is surgery
Risks
Risks of TUNA include:
Urinary tract infection. Urinary tract infections are a possible complication after any
enlarged prostate procedure. An infection is increasingly likely to occur the longer you
have a tube to drain urine (urinary catheter) in place after the procedure. It may require
antibiotics or other treatment.
Need for retreatment. Some men who have TUNA later require more treatment to ease
urinary symptoms usually surgery. Some men need further treatment because they
develop long-term prostate irritation that can cause swelling and pain (chronic
prostatitis).
New onset or worsening urinary symptoms. In some cases, TUNA can result in a chronic
inflammation within the prostate that can cause irritative urinary symptoms such as
frequency, urgency and in some cases pain with urination
How you prepare
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual
scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size
of your prostate and examine your urinary system. Your doctor may also want to do other tests,
such as blood tests or tests to measure urine flow.
Follow your doctor's instructions on what to do before your treatment. Here are some issues to
discuss with your doctor:
Your medications. Tell your doctor about any prescription, over-the-counter or
supplements you take. This is especially important if you take blood-thinning
medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and nonprescription
pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve,
others). Your surgeon may ask you to stop taking medications that increase your risk of
bleeding several days prior to the surgery.
Fasting before the procedure. Your doctor will likely ask you to not eat or drink anything
after midnight. On the morning of your procedure, take only the medications your
doctor tells you to with a small sip of water.
Arrangements after the procedure. You won't be able to drive yourself home after the
procedure. Plan to have someone available to drive you home. Ask your doctor ahead of
time how long you can expect to be at the surgery center or hospital.
Activity restrictions. Your doctor will likely ask you to avoid any strenuous activity, such
as heavy lifting, for three to five days. Don't have sex until your doctor says it's OK. Most
men can resume sexual activity after a few weeks.
Bowel prep. You may be given an enema kit, which is used to clear your bowels and
rectum at home, the morning of surgery. Shortly before your treatment, you will be
asked to urinate so that your bladder is empty
What you can expect
TUNA takes less than an hour. It's usually done as an outpatient procedure, which means you will go
home the day of the procedure.
You'll be given a local anesthetic to numb the prostate area. The anesthetic may be inserted through
the tip of your penis, or given in a shot via your rectum or in the area between your scrotum and
anus (perineum). You may also have intravenous (IV) sedation. With IV sedation, you'll be drowsy
but remain conscious during the procedure.
In some cases, spinal anesthesia or general anesthesia is used. With spinal anesthesia, you're numb
from the waist down. With general anesthesia, you are unconscious during the procedure.
During the procedure
A specially adapted visual instrument (cystoscope) is passed through the opening of your penis into
your urethra. Your doctor will insert the cystoscope until it reaches the prostate area.
When the cystoscope is in place, your doctor will insert small needles into your prostate through the
end of the cystoscope. Then, radio waves pass through them to heat and destroy prostate tissue
blocking urine flow. You may feel a little pain or discomfort.
After the procedure
After TUNA, you'll have a catheter that extends through the tip of penis into your bladder. This
allows you to pass urine until you can urinate on your own.
Side effects of TUNA can include:
Blood in your urine (hematuria). This shouldn't last for more than a few days after the
procedure.
Irritating urinary symptoms. You may experience painful urination, difficulty urinating,
or an urgent or frequent need to urinate. These symptoms usually improve within a
week or so.
Temporary difficulty urinating or urinary retention. A number of men have trouble
urinating (urinary retention) after the procedure. If this happens, you may need to have
a catheter in place for a few days. In some cases, a catheter is needed for a few weeks or
longer.
Urinary tract infection. Urinary tract infections are a possible complication after any
enlarged prostate procedure. An infection is increasingly likely to occur the longer you
have a catheter in place and may require antibiotics or other treatment. Some men have
recurring urinary tract infections after TUNA
Results
Several weeks may pass before you see a noticeable improvement in your urinary symptoms. It can
take a few months for some men to notice significant improvement. That's because your body needs
time to break down and absorb prostate tissue that has been destroyed.
Some men who have TUNA will eventually need additional procedures for enlarged prostate. More
studies are needed to determine the overall, long-term effectiveness of TUNA compared with other
procedures.
After TUNA, it's important to have a digital rectal exam once a year to check your prostate and
screen for prostate cancer, as you would normally. If you notice any worsening urinary symptoms,
make an appointment to see your doctor


Tubal ligation
Definition
A tubal ligation also known as having your tubes tied or tubal sterilization is a type of
permanent birth control. During a tubal ligation, the fallopian tubes are cut or blocked to
permanently prevent pregnancy. A tubal ligation disrupts the movement of the egg to the uterus for
fertilization and blocks sperm from traveling up the fallopian tubes to the egg. A tubal ligation
doesn't affect your menstrual cycle.
A tubal ligation can be done at any time, including after childbirth or in combination with another
abdominal surgical procedure, such as a C-section. It's possible to reverse a tubal ligation but
reversal requires major surgery and isn't always effective
Why it's done
Tubal ligation is one of the most commonly used surgical sterilization procedures for women. Tubal
ligation permanently prevents pregnancy, ending the need for any type of contraception. A tubal
ligation may also decrease the risk of ovarian cancer.
Tubal ligation isn't appropriate for everyone, however. Your doctor or health care provider will make
sure you fully understand the risks and benefits of this procedure. Your doctor may also talk to you
about other options, such as hysteroscopic sterilization. Hysteroscopic sterilization involves placing a
small coil or other insert into the fallopian tubes through the cervix. The insert causes scar tissue to
form and seal off the tubes
Risks
Tubal ligation is an abdominal operation. Risks associated with tubal ligation include:
Damage to the bowel, bladder or major blood vessels
Adverse reaction to anesthesia
Wound doesn't heal properly or becomes infected
Prolonged pelvic or abdominal pain
You may be at higher risk of complications from a tubal ligation if:
You've had previous pelvic or abdominal surgery
You have a history of pelvic inflammatory disease, obesity or diabetes
A tubal ligation won't protect you from sexually transmitted infections.
In the first year after a tubal ligation, an estimated 1 out of 100 women will get pregnant. The
younger you are at the time of a tubal ligation, the more likely the sterilization is to fail. If you do
conceive after having a tubal ligation, there's a higher chance that the pregnancy will be ectopic
when the fertilized egg implants outside the uterus, usually in a fallopian tube
How you prepare
Before you have a tubal ligation your health care provider will likely:
Review the risks and benefits of reversible and permanent methods of contraception
Ask about your reasons for choosing sterilization and discuss factors that could lead to
regret, such as a young age or marital discord
Explain the details of the procedure
Discuss the causes and probability of sterilization failure
Share information about tubal ligation reversal
Help you choose the best time to do the procedure, such as shortly after childbirth or in
combination with another abdominal surgical procedure, such as a C-section
If you're not having a tubal ligation shortly after childbirth or during a C-section, you should use
contraception for at least one month before the procedure and continue using contraception until
your next period to decrease the likelihood of pregnancy. Having the procedure done during your
period or during the days between your period and ovulation also reduces the chance of pregnancy
at the time of the procedure. Your health care provider may give you a sensitive pregnancy test on
the day of surgery to make sure you're not pregnant
What you can expect
Tubal ligation is usually done with a laparoscope a thin tube equipped with a camera lens and
light under short-acting general or regional anesthesia. It can be done while you're recovering
from vaginal childbirth (minilaparotomy) or during a C-section delivery. It can also be done as an
outpatient procedure (interval tubal ligation) separate from childbirth.
During the procedure
If you have a tubal ligation as an outpatient procedure, a needle is inserted through your navel and
your abdomen is inflated with gas (carbon dioxide or nitrous oxide). Then a small incision is made,
and the laparoscope is inserted into your abdomen. In some cases, your doctor may make a second
small incision to insert special grasping forceps. Using instruments passed through the abdominal
wall, your doctor seals the fallopian tubes by destroying segments of the tubes or blocking them
with plastic rings or clips.
If you have a tubal ligation after vaginal childbirth, your doctor will likely make a small incision under
your navel, providing easy access to your still enlarged uterus and fallopian tubes. If you have a tubal
ligation during a C-section, your health care provider will use the incision that was made to deliver
the baby.
After the procedure
If your abdomen was inflated with gas during the procedure, the gas will be withdrawn. You may be
allowed to go home several hours after the procedure. If you have the procedure in combination
with childbirth, the tubal ligation isn't likely to prolong your hospital stay.
Whether or not you have the tubal ligation in combination with childbirth, you'll need to rest for at
least a day after the procedure. You will have some discomfort at the incision site. You might also
experience:
Abdominal pain or cramping
Fatigue
Dizziness
Gassiness or bloating
Shoulder pain
Sore throat
You may take acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) for pain relief,
but avoid using aspirin, since it may promote bleeding. You may bathe 48 hours after the procedure,
but avoid straining or rubbing the incision for one week. Carefully dry the incision after bathing.
Avoid strenuous lifting and sex for one week. Resume your normal activities gradually as you begin
to feel better. Your stitches will dissolve and won't require removal. Make an appointment to see
your health care provider a week after the procedure to make sure you're healing properly.
Contact your health care provider immediately if you experience:
A temperature of 101 F (38.3 C) or greater
Fainting spells
Severe abdominal pain that's persistent or gets worse after 12 hours
Bleeding from your incision that's persistent or gets worse after 12 hours, despite use of
pressure and bandages
Discharge from your incision that's persistent or gets worse
If you think you're pregnant at any time after the tubal ligation, contact your health care provider
immediately.
Keep in mind that although tubal ligation reversal is possible, the procedure is complicated and not
guaranteed to be effective
Tubal ligation

In a tubal ligation, the fallopian tubes are cut or blocked to disrupt the path normally taken by eggs
from the ovaries.



Transurethral incision of the prostate (TUIP)
Definition
Transurethral incision of the prostate (TUIP) is a type of prostate surgery done to relieve moderate
to severe urinary symptoms caused by prostate enlargement, a condition known as benign prostatic
hyperplasia (BPH).
During TUIP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of
your penis and into the tube that carries urine from your bladder (urethra). The urethra is
surrounded by prostate tissue. The doctor cuts one or two small grooves in the area where the
prostate and the bladder are connected (bladder neck) in order to open up the urinary channel. This
allows urine to pass through more easily.
TUIP is one of the options for treating urinary symptoms caused by BPH. To determine whether TUIP
or another treatment is a good option for you, your doctor will consider how severe your symptoms
are, what other health problems you have, and the size and shape of your prostate.
Why it's done
TUIP is used to ease urinary symptoms caused by an enlarged prostate. Symptoms can include:
Frequent, urgent need to urinate
Difficulty starting urination
Slow (prolonged) urination
Increased frequency of urination at night (nocturia)
Stopping and starting again while urinating
The feeling you can't completely empty your bladder
Urinary tract infections
Although a number of procedures are available to treat BPH, TUIP is an option only when the
prostate gland is relatively small less than about 1 ounce (30 milliliters) in size. If you have a larger
prostate or you have severe urinary symptoms, a different procedure may be a better option.
Risks
Risks of TUIP can include:
Temporary difficulty urinating. You may have trouble urinating (urinary retention) for a
few days after the procedure. Until you can urinate on your own, you will need to have a
tube inserted through your penis to carry urine out of your bladder (urinary catheter).
Urinary tract infection. Urinary tract infections are a possible complication after any
enlarged prostate procedure. An infection is increasingly likely to occur the longer you
have a catheter in place and may require antibiotics or other treatment.
Difficulty holding urine. You may have trouble controlling urination (urinary
incontinence) right after surgery. Rarely, this is a long-term consequence of TUIP.
Dry orgasm. TUIP can cause retrograde ejaculation, which means semen released during
sexual climax (ejaculation) enters your bladder rather than exiting the penis. Retrograde
ejaculation isn't harmful and generally doesn't affect sexual pleasure. But it can interfere
with your ability to father a child.
Erectile dysfunction. The inability to keep or maintain an erection is a possible long-term
side effect, but is less common with TUIP than with open prostatectomy or with TURP.
Need for re-treatment. Some men who have TUIP later require follow-up treatment
with TURP or another prostate procedure. Treatment is needed either because
symptoms return over time or because they never adequately improve

How you prepare
Before the procedure, your doctor may want to do a test that uses a visual scope to look inside your
urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and
examine your urinary system. Your doctor may also want to do other tests, such as blood tests or
tests to measure urine flow.
Follow your doctor's instructions on what to do before your treatment. Here are some issues to
discuss with your doctor:
Your medications. Tell your doctor about any prescription or over-the-counter
medications or supplements you take. This is especially important if you take blood-
thinning medications, such as warfarin (Coumadin) or clopidogrel (Plavix), and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or
naproxen sodium (Aleve, others). Your surgeon may ask you to stop taking medications
that increase your risk of bleeding several days before the surgery.
Fasting before the procedure. Your doctor will likely ask you to not eat or drink anything
after midnight. On the morning of your procedure, take only the medications your
doctor tells you to with a small sip of water.
Arrangements after the procedure. You won't be able to drive yourself home after the
procedure. You may be able to go home the day of surgery, or you may need to stay in
the hospital overnight. Ask your doctor ahead of time when you can expect to go home.
Activity restrictions. You may not be able to work or do strenuous activity for several
weeks after surgery. Ask your doctor how much recovery time you may need

What you can expect
TUIP typically takes 20 to 30 minutes. You'll receive either a general anesthetic, which will put you to
sleep, or an anesthetic that blocks feeling from the waist down (spinal block).
During the procedure
Your doctor may put numbing gel inside your urethra and may numb the prostate area with an
injection given through your rectum.
Once the anesthetic is working, your doctor will insert a combined visual and surgical instrument
(resectoscope) into the tip of your penis and extend it to the prostate area. The resectoscope is
equipped with a lens or camera, a cutting device, and valves to release fluid to wash (irrigate) the
surgery area. The resectoscope is about 12 inches (30.5 centimeters) long and 1/2 inch (1
centimeter) in diameter. It has a light, valves for controlling irrigating fluid, and an electrical loop to
cut tissue and seal blood vessels. Irrigating fluid is used to lubricate the urethra and rinse away
blood.
Using the resectoscope, the doctor makes one or two incisions on the inner surface of the prostate
where the bladder joins the prostate (bladder neck).
After the procedure
You may be able to leave the hospital the day of the procedure, or you may need to stay overnight.
Talk to your doctor about what you can expect, and any precautions you need to take after you go
home.
You'll have a catheter in place that enters through the tip of your penis and goes into
your bladder to drain your urine into a collection bag. The catheter may be left in place
for one or two days. In some cases, a catheter is needed for a longer period of time. You
may urinate around the catheter, which is normal because your bladder may squeeze
more urine out than the catheter can accommodate. Your doctor may give you
disposable catheters you can insert on your own a few times a day until you can urinate
again.
Urination may be painful, or you may have a sense of urgency as urine passes over the
surgical area. You may also need to urinate more often than usual. Painful urination
generally improves in one to four weeks.
Expect some blood in your urine right after surgery. If you have clots or so much blood
in your urine you can't see through it, contact your doctor.
Your ability to resume sexual activity depends on how quickly you heal. Talk to your
doctor about when it's OK for you to have sex again. You'll likely be able to resume
sexual activity after a few weeks.
These steps can help you recover after your procedure.
Drink plenty of water to flush out the bladder.
Avoid constipation and straining during a bowel movement. Eat fiber-containing foods
and avoid foods that can cause constipation. Ask your doctor if you should take a
laxative, if you do become constipated.
Don't take blood-thinning medications until your doctor says it's OK.
Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your
doctor says it's OK

Results
In most men, TUIP improves the ability to urinate and eases related symptoms. It may be a few
weeks to months before you notice the full benefits of treatment.
Your doctor will want to have regular follow-up appointments to check the condition of your
prostate and to discuss any symptom changes.
If the procedure doesn't do enough to lessen your symptoms, you may need to consider additional
treatment steps. A number of men who undergo TUIP need a follow-up procedure to treat prostate
enlargement, particularly after several years have passed.
After TUIP, it's important to have a digital rectal exam once a year to check your prostate and screen
for prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an
appointment to see your doctor


SPECT scan
Definition
A single-photon emission computerized tomography (SPECT) scan lets your doctor analyze the
function of some of your internal organs. A SPECT scan is a type of nuclear imaging test, which
means it uses a radioactive substance and a special camera to create 3-D pictures.
While imaging tests like X-rays can show what the structures inside your body look like, a SPECT scan
produces images that show how your organs work. For instance, a SPECT scan can show how blood
flows to your heart or what areas of your brain are more active or less active
Why it's done
The most common uses of SPECT are to help diagnose or monitor brain disorders, heart problems
and bone disorders.
Brain disorders
SPECT can be helpful in determining which parts of the brain are being affected by:
Dementia
Clogged blood vessels
Seizures
Epilepsy
Head injuries
Heart problems
Because the radioactive tracer highlights areas of blood flow, SPECT can check for:
Clogged coronary arteries. If the arteries that feed the heart muscle become narrowed
or clogged, the portions of the heart muscle served by these arteries can become
damaged or even die.
Reduced pumping efficiency. SPECT can show how completely your heart chambers
empty during contractions.
Bone disorders
Areas of bone healing or cancer progression usually light up on SPECT scans, so this type of test is
being used more frequently to help diagnose hidden bone fractures. SPECT scans can also diagnose
and track the progression of cancer that has spread to the bones
Risks
For most people, SPECT scans are safe. If you receive an injection or infusion of radioactive tracer,
you may experience:
Bleeding, pain or swelling where the needle was inserted in your arm
Rarely, an allergic reaction to the radioactive tracer
Your health care team uses the lowest amount of radiation possible in order to perform the scan.
Talk to your doctor if you're concerned about your exposure to radiation during a SPECT scan.
Be sure to tell your doctor if youre pregnant or breast-feeding. The radioactive tracer used in a
SPECT scan may affect a developing fetus or nursing baby
How you prepare
How you prepare for a SPECT scan depends on your particular situation. Ask your health care team
whether you need to make any special preparations before your SPECT scan.
In general, you should:
Leave metallic jewelry at home
Inform the technologist if you're pregnant or breast-feeding
Bring a list of all the medications and supplements you take

What you can expect
During your SPECT scan
SPECT scans involve two steps: receiving a radioactive dye (called a tracer) and using a SPECT
machine to scan a specific area of your body.
Receiving a radioactive substance
You'll receive a radioactive substance through an intravenous (IV) infusion into a vein in your arm.
The tracer dose is very small, only a few drops, and you may feel a cold sensation as it enters your
body. You may be asked to lie quietly in a room for 15 minutes or more before your scan while your
body absorbs the radioactive tracer. In some cases, you may need to wait several hours between the
injection and your SPECT scan.
Your body's more active tissues will absorb more of the radioactive substance. For instance, during a
seizure, the area of your brain causing the seizure may retain more of the radioactive tracer, which
allows doctors to pinpoint the area of your brain causing your seizures.
Undergoing the SPECT scan
The SPECT machine is a large circular device containing a camera that detects the radioactive tracer
your body absorbs. During your scan, you lie on a table while the SPECT machine rotates around you.
The SPECT machine takes pictures of your internal organs and other structures. The pictures are sent
to a computer that uses the information to create 3-D images of your body.
How long your scan takes depends on the reason for your procedure.
After your SPECT scan
Most of the radioactive tracer leaves your body through your urine within a few hours after your
SPECT scan. Your doctor may instruct you to drink more fluids, such as juice or water, after your
SPECT scan to help flush the tracer from your body. Your body breaks down the remaining tracer
over the next day or two
Results
Your doctor analyzes the results of your SPECT scan. Pictures from your scan may show colors that
tell your doctor what areas of your body absorbed more of the radioactive tracer and which areas
absorbed less. For instance, a brain SPECT image might show a lighter color where brain cells are less
active and darker colors where brains cells are more active. Some SPECT images show shades of
gray, rather than colors.
Ask your health care team how long to expect to wait for your results
SPECT scan

During a SPECT scan, your health care team positions you on a table. Then the SPECT machine
rotates around you, taking pictures of internal organs and other structures highlighted by the
radioactive tracer in your body




Lumbar puncture (spinal tap)
Definition
Lumbar puncture (spinal tap) is performed in your lower back, in the lumbar region. During lumbar
puncture, a needle is inserted between two lumbar bones (vertebrae) to remove a sample of
cerebrospinal fluid the fluid that surrounds your brain and spinal cord to protect them from
injury.
A lumbar puncture can help diagnose serious infections, such as meningitis; disorders of the central
nervous system, such as Guillain-Barre syndrome and multiple sclerosis; or cancers of the brain or
spinal cord. Sometimes doctors use lumbar puncture to inject anesthetic medications or
chemotherapy drugs into the cerebrospinal fluid
Why it's done
Lumbar puncture may be done to:
Collect cerebrospinal fluid for laboratory analysis
Measure the pressure of your cerebrospinal fluid
Inject spinal anesthetics, chemotherapy drugs or other medications
Inject dye (myelography) or radioactive substances (cisternography) into cerebrospinal
fluid to make diagnostic images of the fluid's flow
Information gathered from a lumbar puncture can help diagnose:
Serious bacterial, fungal and viral infections, including meningitis, encephalitis and
syphilis
Bleeding around the brain (subarachnoid hemorrhage)
Certain cancers involving the brain or spinal cord
Certain inflammatory conditions of the nervous system, such as multiple sclerosis and
Guillain-Barre syndrome
Risks
Though lumbar puncture is generally recognized as safe, it does carry some risks. These include:
Post-lumbar puncture headache. About 40 percent of people who have undergone a
lumbar puncture develop a headache afterward due to a leak of fluid into nearby
tissues. The headache typically starts several hours up to two days after the procedure
and may be accompanied by nausea, vomiting and dizziness. Post-lumbar puncture
headaches can last from a few hours to a week or more.
Back discomfort or pain. You may feel pain or tenderness in your lower back after the
procedure. The pain might radiate down the back of your legs.
Bleeding. Bleeding may occur near the puncture site or, rarely, into the epidural space.
Brainstem herniation. Increased pressure within the skull (intracranial), due to a brain
tumor or other space-occupying lesion, can lead to compression of the brainstem after a
sample of cerebrospinal fluid is removed. A computerized tomography (CT) scan or MRI
prior to a lumbar puncture can be obtained to determine if there is evidence of
increased intracranial pressure. This complication is uncommon
How you prepare
Before your lumbar puncture, your doctor asks questions about your medical history, does a physical
exam, and orders blood tests to check if you have any bleeding or clotting disorders. Your doctor
may also recommend a CT scan to determine if you have any abnormal swelling in or around your
brain.
Tell your doctor if you're taking blood-thinning or other anticoagulant medications. Examples include
warfarin (Coumadin, Jantoven), clopidogrel (Plavix), and some over-the-counter pain relievers such
as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). Also, tell your doctor if you're
allergic to any medications, such as numbing medications (local anesthetics).
What you can expect
Lumbar puncture is usually done in an outpatient facility or a hospital. You're asked to change into a
hospital gown. Then, you lie on your side with your knees drawn up to your chest or sit, leaning
forward on a stable surface. These positions flex your back, widening the spaces between your
vertebrae and making it easier for your doctor to insert the needle. Your back is washed with
antiseptic soap or iodine and covered with a sterile sheet.
During the procedure
A local anesthetic is injected into your lower back to numb the puncture site before the
needle is inserted. The local anesthetic will sting briefly as it's injected.
A thin, hollow needle is inserted between the two lower vertebrae (lumbar region),
through the spinal membrane (dura) and into the spinal canal. You may feel pressure in
your back during this part of the procedure.
Once the needle is in place, you may be asked to change your position slightly.
The cerebrospinal fluid pressure is measured, a small amount of fluid is withdrawn, and
the pressure is measured again. If needed, a drug or substance is injected.
The needle is removed and the puncture site is covered with a bandage.
The procedure usually lasts about 45 minutes. Your doctor may suggest lying down after the
procedure.
After the procedure
Plan to rest. Don't participate in strenuous activities the day of your procedure. You may
return to work if your job doesn't require you to be physically active. Discuss your
activities with your doctor if you have questions.
Take a pain medication. A nonprescription, pain-relieving medication that contains
acetaminophen can help reduce headache or back pain

During a lumbar puncture (spinal tap) procedure, you typically lie on your side with your knees
drawn up to your chest. Then a needle is inserted into your spinal canal in your lower back to
collect cerebrospinal fluid for testing.
Results
The spinal fluid samples are sent to a laboratory for analysis. Lab technicians check for a number of
things when examining spinal fluid, including:
General appearance. Spinal fluid is normally clear and colorless. If it's cloudy, yellow or
pink in color, it may indicate infection.
Protein (total protein and the presence of certain proteins). Elevated levels of total
protein greater than 45 milligrams per deciliter (mg/dL) may indicate infection or
another inflammatory condition. Specific lab values may vary from medical facility to
medical facility.
White blood cells. Spinal fluid normally contains up to 5 mononuclear leukocytes (white
blood cells) per microliter. Increased numbers may indicate infection. Specific lab values
may vary from medical facility to medical facility.
Sugar (glucose). A low glucose level in spinal fluid may indicate infection or another
condition.
Microorganisms. The presence of bacteria, viruses, fungi or other microorganisms can
indicate infection.
Cancer cells. The presence of abnormal cells in spinal fluid such as tumor or immature
blood cells can indicate certain types of cancer.
Lab results are combined with information obtained during the test, such as spinal fluid pressure, to
help establish a possible diagnosis.
Your health care provider generally gives you the results within a few days, but it could take longer.
Ask your doctor when he or she expects to receive the results of your test.
Write down questions that you want to ask your doctor. Don't hesitate to ask questions or to speak
up when you don't understand something your doctor says. Questions you may want to ask include:
Based on the results, what are my next steps?
What kind of follow-up, if any, should I expect?
Are there any factors that might have affected the results of this test, and therefore may
have altered the results?
Will I need to repeat the test at some point?


Spirometry
Definition
Spirometry (spi-ROM-uh-tree) is a common office test used to diagnose asthma, chronic obstructive
pulmonary disease (COPD) and certain other conditions that affect breathing. Spirometry may also
be used periodically to check how well your lungs are working once you're being treated for a
chronic lung condition.
Spirometry measures how much air you can inhale and exhale. Spirometry also measures how fast
you can exhale. Spirometry values below average indicate your lungs aren't working as well as they
should
Why it's done
Your doctor may suggest a spirometry test if he or she suspects your symptoms are caused by a
chronic lung condition such as:
Asthma
Chronic obstructive pulmonary disease (COPD)
Chronic bronchitis
Emphysema
Pulmonary fibrosis
If you've already been diagnosed with a chronic lung disorder, spirometry may be used periodically
to check how well your medications are working and whether your symptoms are under control.
How you prepare
Follow your doctor's instructions about whether you should avoid use of inhaled breathing
medications or other medications before the test. Other steps to take include:
Wear loose clothing that won't interfere with your ability to take a deep breath.
Avoid eating a large meal before your test, so it will be easier to breathe.
What you can expect
When you go to take your test:
The nurse or technician will give you specific instructions about how to take the test.
Listen carefully and make sure you know exactly what to do. Doing the test incorrectly
will cause inaccurate results.
A clip will be placed on your nose to keep your nostrils closed.
The nurse or technician will have you take a deep breath and breathe out as hard as you
can for several seconds into a tube that's attached to a machine (spirometer). You may
feel short of breath or dizzy for a moment after you perform the test.
You'll need to take the test at least three times to make sure your results are accurate
and consistent.
If your doctor gives you an inhaled medication to open your lungs (bronchodilator) after your initial
test, you'll need to wait 15 minutes and then you'll have another set of measurements done. That
way your doctor can compare the results of the two measurements, to see whether the
bronchodilator improved your airflow. Each set of measurements usually takes less than 15 minutes
to complete
Results
Key spirometry measurements include:
Forced vital capacity (FVC). This is the largest amount of air that you can forcefully
exhale after breathing in as deeply as you can. A lower than normal FVC reading
indicates restricted breathing.
Forced expiratory volume (FEV-1). This is how much air you can force from your lungs in
one second. It's a good way to measure the severity of your breathing problems. Lower
FEV-1 readings indicate more significant obstruction.


Stool DNA test

Definition
The stool DNA test is a noninvasive laboratory test that identifies DNA changes in the cells of a stool
sample. The stool DNA test specifically looks for DNA alterations associated with colon polyps and
colon cancer.
The major goal of the stool DNA test is to detect whether DNA changes that indicate colon cancer or
precancerous polyps are present in the colon.
One stool DNA test (Cologuard) is approved for use the United States
Why it's done
Stool DNA testing is intended to screen healthy people with no symptoms for colon cancer or
precancerous polyps. The test also measures blood in the stool. Research shows the stool DNA test is
effective at detecting colon cancer and precancerous polyps.
How stool DNA testing works
The stool DNA test detects signature DNA changes in tumor cells that are found in the stool.
Because the lining of the colon is always shedding cells, including cells from the surface of polyps
and cancers, these markers are available in the stool. A stool DNA test can identify several of these
markers, indicating the presence of precancerous polyps or colon cancer.
Many different DNA changes may be present in colon cancer cells, so the stool DNA test looks for a
panel of DNA markers. Also, because DNA markers may be present in only tiny amounts in stool,
very sensitive laboratory methods are required
Risks
The stool DNA test is safe and poses no risks.
Limitations of the test may include:
A stool DNA test could lead to additional testing. If your stool DNA test shows DNA changes
that are associated with colon polyps or colon cancer, you'll likely undergo additional testing
to find the source.
Your doctor would likely recommend colonoscopy, which includes removal of polyps or
biopsy procedures to remove tissue samples for testing. If you undergo these additional
tests, but it's determined that you don't have cancer, you could be exposed to additional
risks for no reason.
A stool DNA test can't detect all cancers. It's possible that colon cancer or precancerous
polyps could go undetected during a stool DNA test. This might occur due to a technical
error or to insufficient quantity of your stool sample
How you prepare
Stool DNA testing requires little preparation. You can eat and drink normally before the test and
continue your current medications. There's also no need to undergo bowel preparation to clean out
or empty your colon before the test.
What you can expect
During a stool DNA test you collect a stool sample and submit it to your doctor's office or mail it to a
designated laboratory.
You'll receive a stool DNA test kit for collecting and submitting the stool sample. The kit includes a
container that attaches to the toilet and a preservative solution that is added to the stool sample
before sealing the container. The stool DNA test requires only one stool sample.
After the stool sample is collected, it can be returned to the doctor's office or sent by mail to the
laboratory.
Results
Stool DNA test results may include:
Negative result. A test is considered negative if DNA markers common to colon cancer or
precancerous polyps and signs of blood are not found in the stool.
Positive result. A test is considered positive if DNA markers common to colon cancer or
precancerous polyps or signs of blood are found in the stool sample. Additional evaluation,
such as a colonoscopy to examine the colon, may be recommended to determine the cause.



Stress test
Definition
A stress test, also called an exercise stress test, is used to gather information about how well your
heart works during physical activity. Because exercise makes your heart pump harder and faster
than it does during most daily activities, an exercise stress test can reveal problems within your
heart that might not be noticeable otherwise.
An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your
heart rhythm, blood pressure and breathing are monitored.
Your doctor may recommend an exercise stress test if he or she suspects you have coronary artery
disease or an irregular heart rhythm (arrhythmia). An exercise stress test may also be used to guide
your treatment if you've already been diagnosed with a heart condition
Why it's done
Your doctor may recommend an exercise stress test to:
Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that
supply your heart with blood, oxygen and nutrients. Coronary artery disease is a condition
that develops when these arteries become damaged or diseased usually due to a buildup
of deposits containing cholesterol called plaques. If you have symptoms such as shortness of
breath or chest pains with exertion, an exercise stress test can help determine if they're
related to coronary artery disease.
Diagnose heart rhythm problems (arrhythmias). Heart arrhythmias occur when the
electrical impulses that coordinate your heart rhythm don't function properly, causing your
heart to beat too fast, too slow or irregularly. If you have symptoms such as a racing
heartbeat, slow heartbeat or a fluttering in your chest, an exercise stress test can help
determine if they're related to an arrhythmia.
Guide treatment of heart disorders. If you've already been diagnosed with coronary artery
disease, arrhythmia, valvular heart disease or another heart condition, an exercise stress
test can help your doctor find out how well treatment is working to relieve your symptoms.
It may also be used to help establish the right treatment plan for you by showing how much
exercise your heart can handle.
In some cases, stress tests may be used to help determine the timing of cardiac surgery, such as
valve replacement. In some people with heart failure, results from a stress test may help the doctor
evaluate the need for heart transplantation or other advanced therapies.
Your doctor may recommend a procedure called a nuclear stress test if a routine exercise stress test
doesn't pinpoint the cause of your symptoms. A nuclear stress test is a similar procedure that
includes the use of radioactive dye and a special scanner to create images of your heart muscle.
Risks
An exercise stress test is generally safe, and complications are rare. But, as with any medical
procedure, it does carry a risk of complications.
Potential complications include:
Low blood pressure. Blood pressure may drop during or immediately after exercise and
cause dizziness. It usually goes away when you stop exercising.
Abnormal heart rhythms (arrhythmias). Arrhythmias brought on by an exercise stress test
usually go away shortly after you stop exercising.
Heart attack (myocardial infarction). Although very rare, it's possible that an exercise stress
test could provoke a heart attack.
How you prepare
You may be asked not to eat, drink or smoke for two hours or more before an exercise stress test.
You can take your medications as usual, unless your doctor tells you otherwise.
If you use an inhaler for asthma or other breathing problems, bring it with you to the test. Make sure
your doctor and the health care team member monitoring your stress test know that you use an
inhaler.
Wear or bring comfortable clothes with you to the exercise stress test.
What you can expect
When you arrive for your exercise stress test, your doctor asks you about your medical history and
how often you typically exercise. This helps determine the amount of exercise that's appropriate for
you during the stress test.
During an exercise stress test
Before you start the test, a member of your health care team places sticky patches (electrodes) on
your chest, legs and arms. The electrodes are connected by wires to an electrocardiogram (ECG or
EKG) machine. The electrocardiogram records the electrical signals that trigger your heartbeats. A
blood pressure cuff is placed on your arm to check your blood pressure during the exercise stress
test.
You then begin slowly walking on the treadmill or pedaling the stationary bike. As the test
progresses, the speed and incline of the treadmill increases. A railing is provided on the treadmill
that you can use for balance, but don't hang on to it, as that may skew the results of the test. On a
stationary bike, the resistance increases as the test progresses, making it harder to pedal. During the
test, you may be asked to breathe into a tube to measure the gases in your breath as you exhale.
The length of the test depends on your physical fitness and symptoms. The goal is to have your heart
work hard for about eight to 12 minutes in order to thoroughly monitor its function. You continue
exercising until your heart rate has reached a set target or until you develop symptoms that don't
allow you to continue. These signs and symptoms may include:
Moderate to severe chest pain
Severe shortness of breath
Abnormally high or low blood pressure
An abnormal heart rhythm
Dizziness
Certain changes in your electrocardiogram
A typical exercise stress test lasts 15 minutes or less. You may stop the test at any time if you're too
uncomfortable to continue exercising.
Depending on your medical history, your stress test may also include:
Medication to stimulate your heart. If you can't exercise long enough to increase your heart
rate, or if you're unable to exercise at all due to a medical condition such as arthritis, your
doctor may give you medication to increase your heart rate or increase blood flow to your
coronary arteries as a substitute for exercising.
Echocardiogram. An echocardiogram uses sound waves to produce images of your heart,
allowing your doctor to see how your heart is beating and pumping blood. In some cases,
you may have an echocardiogram before you exercise and after you're done. Your doctor
can use the images from the echocardiograms to help identify abnormalities in the heart
muscle and valves.
Nuclear stress test. Another stress test known as a nuclear stress test helps measure blood
flow to your heart muscle at rest and during exercise. It's similar to a routine exercise stress
test but with images in addition to an electrocardiogram. Trace amounts of radioactive
material such as thallium or a compound known as sestamibi (Cardiolite) are injected
into your bloodstream. Special cameras are used to detect areas in your heart that receive
less blood flow.
Computerized tomography (CT) and magnetic resonance imaging (MRI). In some cases,
your doctor may use these imaging technologies to visualize your heart under stress.
After an exercise stress test
After you stop exercising, you may be asked to stand still for several seconds and then lie down for
about five minutes with the monitors in place so that they can continue taking measurements as
your heart rate and breathing return to normal.
When your exercise stress test is complete, you may return to your normal activities for the
remainder of the day
Results
If the information gathered during your exercise stress test shows your heart function to be normal,
you may not need any further tests.
However, if the results are normal and your symptoms continue or become worse, your doctor may
recommend you have a nuclear stress test or another exercise stress test that includes an
echocardiogram before and after exercise. These tests are more accurate and provide more
information about your heart function, but they are also more expensive.
If the results of your exercise stress test suggest coronary artery disease or reveal an arrhythmia, the
information gathered during the test will be used to help your doctor develop a treatment plan. You
may need additional tests and evaluations, such as a coronary angiogram, depending on the
findings.
If the purpose of your exercise stress test was to guide treatment for a heart condition, your doctor
will use data from the test to establish or modify your treatment plan, as needed






Stroke telemedicine (telestroke)
Definition
In stroke telemedicine, also called telestroke, doctors who have advanced training in the nervous
system (neurologists) remotely evaluate people who've had acute strokes and make diagnoses and
treatment recommendations to emergency medicine doctors at other sites. Doctors communicate
using digital video cameras, Internet telecommunications, robotic telepresence, smartphones and
other technology.
Having a prompt neurological evaluation increases the possibility that you may receive clot-
dissolving therapies (thrombolytics) or other clot-retrieving procedures in time to reduce disability
and death resulting from stroke.
In stroke telemedicine (telestroke), at Mayo Clinic, your doctor and the neurologist trained in blood
vessel conditions (vascular neurologist) provide care in your home community and try to avoid the
need for transfer to another medical center. This focus on regional care often allows you to receive
quality stroke care in your community.
Stroke telemedicine operates on a hub-and-spoke system. A large urban medical center, generally
certified as a primary or comprehensive stroke center, usually serves as the primary medical center
(the hub). Remote locations, usually smaller regional rural or underserved hospitals, serve as the
spokes. Many regional hospitals don't have neurologists on call to recommend the most appropriate
care. In stroke telemedicine, a vascular neurologist at the hub consults with doctors and people
who've had acute strokes at the remote sites (spokes).
In telestroke, many people work together as a team, including a program manager, a clinical
coordinator, vascular neurologists, neurosurgeons and radiologists at the hub site, and emergency
medicine doctors and other staff at the spoke site. Radiology technicians, informational technology
staff, researchers, nurses, nurse practitioners and other staff also are important members of the
stroke telemedicine team.
Stroke telemedicine consultation
In a stroke telemedicine consultation, an emergency medicine doctor at your regional hospital (the
spoke) will examine you. If your doctor suspects an acute stroke, he or she will activate the stroke
telemedicine hotline at the hub hospital, which has a dedicated hotline and group paging system and
vascular neurologists on call 24 hours a day, 365 days a year. The hub's on-call vascular neurologist
usually responds within five minutes.
After you have a CT scan at the spoke hospital, the vascular neurologist at the hub performs a live,
real-time audiovisual consultation. The vascular neurologist may discuss your medical history and
review your test results. The vascular neurologist evaluates you, works with your doctor to
determine the most appropriate treatment and sends the treatment recommendation electronically
to the spoke hospital.
Having a prompt evaluation increases the possibility that clot-dissolving therapies (thrombolytics)
can be delivered in time to reduce stroke-related disability. To be effective, clot-dissolving therapies
must be given within three to four and a half hours after you experience stroke symptoms


Rh factor blood test
Definition
Rhesus (Rh) factor is an inherited trait that refers to a specific protein found on the surface of red
blood cells. If your blood has the protein, you're Rh positive the most common Rh factor. If your
blood lacks the protein, you're Rh negative.
Although Rh factor doesn't affect your health, it can affect pregnancy. Your pregnancy needs special
care if you're Rh negative and your baby's father is Rh positive.
If you're pregnant, your health care provider will recommend an Rh factor test during your first
prenatal visit. The Rh factor test is a basic blood test that indicates whether you're Rh positive or Rh
negative.
Why it's done
The Rh factor test is done during pregnancy to identify a woman's Rh factor. In some cases, the
baby's father might need an Rh factor test, too.
During pregnancy or, more likely, during delivery a small amount of your baby's blood could
come in contact with your blood. If you're Rh positive, Rh incompatibility isn't a concern. If you're Rh
negative and your baby is Rh positive, however, your body might produce Rh antibodies after
exposure to the baby's red blood cells.
Typically, the antibodies aren't a problem during the first pregnancy. The concern is with a
subsequent pregnancy with an Rh positive baby. In this case, your existing Rh antibodies might cross
the placenta and fight the baby's red blood cells. This could lead to life-threatening anemia a lack
of healthy red blood cells for the Rh positive baby.
If you're Rh negative, you might need to have another blood test an antibody screen during
your first trimester and again during week 28 of pregnancy. The antibody screen is used to detect
antibodies to Rh positive blood.
If you haven't started to produce Rh antibodies, you'll need an injection of a blood product called Rh
immune globulin. The immune globulin prevents your body from producing Rh antibodies during
your pregnancy.
If your baby is born Rh negative, no additional treatment is needed.
If your baby is born Rh positive, you'll need another injection shortly after delivery. You'll likely need
injections during any subsequent pregnancies and after the delivery of each Rh positive baby as well.
If you're Rh negative, you'll also need an Rh immune globulin injection after any situation in which
your blood could come into contact with Rh positive blood, including:
Miscarriage
Abortion
Ectopic pregnancy when a fertilized eggs implants somewhere outside the uterus, usually
in a fallopian tube
Molar pregnancy a noncancerous (benign) tumor that develops in the uterus
Amniocentesis a prenatal test in which a sample of the fluid that surrounds and protects a
baby in the uterus (amniotic fluid) is removed for testing or treatment
Chorionic villus sampling a prenatal test in which a sample of the wispy projections that
make up most of the placenta (chorionic villi) is removed for testing
Bleeding during pregnancy
Blunt trauma to the abdomen during pregnancy
Rotation of a baby in a breech position such as buttocks first before labor
If the antibody screen shows that you're already producing antibodies, an injection of Rh immune
globulin won't help. Your baby will be carefully monitored. If necessary, he or she might be given a
blood transfusion through the umbilical cord during pregnancy or immediately after delivery.
Mother's Rh
factor
Father's Rh
factor
Baby's Rh factor Precautions
Rh positive Rh positive Rh positive None
Rh negative Rh negative Rh negative None
Rh positive Rh negative Could be Rh
positive or Rh
negative
None
Rh negative Rh positive Could be Rh
positive or Rh
negative
Rh immune
globulin injections

What you can expect
An Rh factor test is a basic blood test. The blood sample is usually taken in a health care provider's
office typically during the first prenatal visit and sent to a lab for analysis.
No special preparation is necessary
Results
If you're Rh positive, no action is needed.
If you're Rh negative and the baby's father is Rh positive, there's a potential for your body to
produce antibodies that could harm your baby. Talk with your health care provider about scheduling
an Rh immune globulin injection during your pregnancy and make sure you remind your health care
team of your Rh status during labor.
Your reminders will help your health care team provide the best possible care during labor and
delivery




Rheumatoid factor
Definition
A rheumatoid factor test measures the amount of rheumatoid factor in your blood. Rheumatoid
factors are proteins produced by your immune system that can attack healthy tissue in your body.
High levels of rheumatoid factor in the blood are most often associated with autoimmune diseases,
such as rheumatoid arthritis and Sjogren's syndrome. But rheumatoid factor may be detected in
some healthy people, and people with autoimmune diseases sometimes have normal levels of
rheumatoid factor.
Why it's done
A rheumatoid factor test is one of a group of blood tests primarily used to help pinpoint a diagnosis
of rheumatoid arthritis. These other tests may include:
Anti-nuclear antibody (ANA)
Anti-cyclic citrullinated peptide (anti-CCP) antibodies
C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR, or sed rate)
The amount of rheumatoid factor in your blood may also help your doctor choose the treatment
approach that will work best for your situation.
What you can expect
During a rheumatoid factor test, a small sample of blood is drawn from a vein in your arm. This
typically takes just a few minutes. Your blood sample is sent to a laboratory for testing
Results
A positive rheumatoid factor test result indicates that a high level of rheumatoid factor was detected
in your blood. A higher level of rheumatoid factor in your blood is closely associated with
autoimmune disease, particularly rheumatoid arthritis. But a number of other diseases and
conditions can raise rheumatoid factor levels, including:
Cancer
Chronic infections
Cirrhosis
Inflammatory lung diseases, such as sarcoidosis
Mixed connective tissue disease
Scleroderma
Sjogren's syndrome
Systemic lupus erythematosus
Some healthy people have positive rheumatoid factor tests, though it's not clear why. And some
people who have rheumatoid arthritis will have low levels of rheumatoid factor in their blood

Quad screen
Definition
The quad screen also known as the quadruple marker test or simply the quad test is a prenatal
test that measures levels of four substances in a pregnant woman's blood:
Alpha-fetoprotein (AFP), a protein made by the developing baby
Human chorionic gonadotropin (HCG), a hormone made by the placenta
Estriol, a hormone made by the placenta and the baby's liver
Inhibin A, another hormone made by the placenta
Typically, the quad screen is done between weeks 15 and 20 of pregnancy the second trimester.
Results of the quad screen indicate your risk of carrying a baby who has certain chromosomal
conditions, such as Down syndrome. The alpha-fetoprotein part of the test can help detect neural
tube defects, such as spina bifida.
If your risk level is low, the quad screen can offer reassurance of a healthy pregnancy.
If your risk level is moderate or high, you might choose to follow the quad screen with another test
that's more definitive

Why it's done
The quad screen is done to evaluate your risk of carrying a baby who has any of the following
conditions:
Down syndrome (trisomy 21). Down syndrome is a genetic condition that causes lifelong
impairments in mental and social development, as well as various physical concerns.
Edwards syndrome (trisomy 18). Edwards syndrome is a genetic condition that causes
severe developmental delays. Edwards syndrome is often fatal by age 1.
Spina bifida. Spina bifida is a serious birth defect that occurs when the tissue surrounding a
baby's developing spinal cord doesn't close properly. Spina bifida can lead to severe physical
and mental disabilities.
Anencephaly. Anencephaly is an underdeveloped brain and an incomplete skull. A baby
born with anencephaly might be stillborn or survive only a few hours to days after birth.
Depending on the timing, your health care provider might recommend other prenatal screening
tests such as first trimester screening, which involves a blood test and an ultrasound exam in
addition to the quad screen or in place of the quad screen.
Remember, the quad screen is optional. Test results only indicate whether you have an increased
risk of carrying a baby who has Down syndrome, for example, not whether your baby actually has
the condition.
Before the screening, think about what the results mean to you. Consider whether the screening will
be worth any anxiety it might cause, or whether you'll handle your pregnancy differently depending
on the results.
You might also consider what level of risk would be enough for you to choose a more invasive
follow-up test.

Risks
The quad screen is a routine prenatal screening test. The test poses no risk of miscarriage or other
pregnancy complications
How you prepare
You don't need to do anything special to prepare for the quad screen. You can eat and drink
normally before the blood test
What you can expect
During the quad screen, a member of your health care team takes a sample of blood by inserting a
needle into a vein in your arm. The blood sample is sent to a lab for analysis. You can return to your
usual activities immediately.
Test results are typically available within a week.
Results
Your health care provider will use your age, race and the results of the quad screen to gauge your
risk of carrying a baby who has certain chromosomal conditions or neural tube defects. Other factors
such as your personal or family health history also might affect your risk.
Quad screen results are given as a probability, such as a 1 in 5,000 risk of carrying a baby who has
Down syndrome. Generally, the test is considered positive if the risk is 1 in 250 to 1 in 300.
Keep in mind that a positive quad screen simply means that levels of some or all of the substances
measured in your blood were outside the normal range. This can happen for various reasons,
including:
A miscalculation of how long you've been pregnant
A multiple pregnancy
In vitro fertilization
The presence of other medical conditions, such as diabetes
Smoking during pregnancy
If your test results are positive, your health care provider might recommend an ultrasound to verify
the baby's gestational age and confirm the number of babies. During the ultrasound, your health
care provider will also evaluate your baby's growth, study the placenta and identify possible
abnormalities.
The quad screen correctly identifies about 80 percent of women who are carrying a baby who has
Down syndrome. About 5 percent of women have a false-positive result, meaning that the test result
is positive but the baby doesn't actually have Down syndrome.
When you consider your test results, remember that the quad screen only indicates your overall risk
of carrying a baby who has certain chromosomal conditions or neural tube defects. A low-risk result
doesn't guarantee that your baby won't have one of these conditions. Likewise, a high-risk result
doesn't guarantee that your baby will be born with one of these conditions.
Often, positive test results are an invitation to consider secondary testing. For example:
Noninvasive prenatal testing. If you're at high risk of a chromosomal condition, you might
consider a new prenatal screening test that analyzes fetal DNA circulating within your blood.
This blood test evaluates your risk of carrying a baby who has Down syndrome, as well as
various other chromosomal conditions perhaps helping you avoid testing that's more
invasive.
Targeted ultrasound. If you're at high risk of a neural tube defect, your health care provider
might suggest a targeted ultrasound perhaps accompanied by amniocentesis. Ultrasound
isn't an effective screening tool for Down syndrome.
Chorionic villus sampling (CVS). CVS can be used to diagnose chromosomal conditions, such
as Down syndrome. During CVS, which is usually done during the first trimester, a sample of
tissue from the placenta is removed for testing. CVS poses a slight risk of miscarriage and
isn't useful in detecting neural tube defects, such as spina bifida.
Amniocentesis. Amniocentesis can be used to diagnose both chromosomal conditions, such
as Down syndrome, and neural tube defects, such as spina bifida. During amniocentesis,
which is usually done during the second trimester, a sample of amniotic fluid is removed
from the uterus for testing. Like CVS, amniocentesis poses a slight risk of miscarriage.
Your health care provider or a genetic counselor will help you understand your test results and what
the results mean for your pregnancy.

Pap smear
Definition
A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. A Pap smear
involves collecting cells from your cervix the lower, narrow end of your uterus that's at the top of
your vagina.
Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. A Pap smear
can also detect changes in your cervical cells that suggest cancer may develop in the future.
Detecting these abnormal cells early with a Pap smear is your first step in halting the possible
development of cervical cancer.
Why it's done
A Pap smear is used to screen for cervical cancer. The Pap smear is usually done in conjunction with
a pelvic exam. In women older than age 30, the Pap smear may be combined with a test for human
papillomavirus (HPV) a common sexually transmitted infection that can cause cervical cancer in
some women.
Who should have a Pap smear?
You and your doctor can decide when it's time for you to begin Pap smear testing and how often you
should have the test. In general, doctors recommend beginning Pap smear testing at age 21 and
then every two or three years. After age 30, Pap smears are generally recommended every three
years, or every five years when the Pap smear is combined with an HPV test.
If you have certain risk factors, your doctor may recommend more-frequent Pap smears, regardless
of your age. These risk factors include:
A diagnosis of cervical cancer or a Pap smear that showed precancerous cells
Exposure to diethylstilbestrol (DES) before birth
HIV infection
Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid
use
You and your doctor can discuss the benefits and risks of Pap smears and decide what's best for you
based on your risk factors.
What do medical organizations recommend?
A number of organizations have recommendations regarding when and how frequently a woman
should have Pap smears. These guidelines differ slightly because each organization takes different
factors into consideration. The guidelines are recommendations for you and your doctor to consider
and discuss.
In general, groups agree that you should have your first Pap smear at age 21:
The American Cancer Society (ACS) recommends having your first Pap smear at age 21.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends having your
first Pap smear at age 21.
The U.S. Preventive Services Task Force (USPSTF) recommends that women begin Pap smear
testing at age 21.
The Institute for Clinical Systems Improvement (ICSI) recommends that women begin Pap
smear testing at age 21.
Groups' guidelines differ for how often the tests should be done.
Age ACS ACOG USPSTF ICSI
21 -
29
Every 3 years Every 3 years Every 3 years Every 2
years
30
and
older
Every 3 years, or
every 5 years when
Pap smear is
combined with an
HPV test women
at high risk may need
to be screened more
often
Every 3 years, or
every 5 years when
Pap smear is
combined with an
HPV test women
at high risk may need
to be screened more
often
Every 3 years,
or every 5
years when
Pap smear is
combined with
an HPV test
Every 3
years if
you've had
3 negative
tests in a
row

Who can consider stopping Pap smears?
Discuss your screening options with your doctor. In certain situations a woman and her doctor may
decide to end Pap testing, such as:
After total hysterectomy. After a total hysterectomy surgical removal of the uterus
including the cervix ask your doctor if you need to continue having Pap smears. If your
hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you
may be able to discontinue routine Pap smears. But if your hysterectomy was for a
precancerous or cancerous condition of the cervix, your doctor may recommend continuing
routine Pap smears.
Older age. Groups agree that older women may consider stopping routine Pap tests. ACS
guidelines suggest a woman older than age 65 can stop having tests if she's had regular
screenings with normal results. USPSTF guidelines recommend against Pap testing for
women older than age 65 who have had routine Pap testing in the past and are not at high
risk of cervical cancer. ICSI guidelines recommend women ages 65 to 70 may consider
stopping Pap testing if their last three tests have been negative and they've had no
abnormal tests in 10 years. ACOG guidelines say that women older than age 65 can stop Pap
tests if they've had three consecutive negative Pap tests in the last 10 years, or two
consecutive negative Pap tests combined with negative HPV tests in the last 10 years, with
the most recent test performed within the past 5 years. Discuss your options with your
doctor and together you can decide what's best for you based on your risk factors. If you are
sexually active with multiple partners, your doctor may recommend continuing Pap smear
testing.
Risks
A Pap smear is a safe way to screen for cervical cancer. However, a Pap smear isn't foolproof. It's
possible to receive false-negative results meaning that the test indicates no abnormality, even
though you do have abnormal cells.
A false-negative result doesn't mean that a mistake was made. Factors that can cause a false-
negative result include:
An inadequate collection of cells
A small number of abnormal cells
Blood or inflammatory cells obscuring the abnormal cells
Although it's possible for abnormal cells to go undetected, time is on your side. Cervical cancer takes
several years to develop. And if one test doesn't detect the abnormal cells, the next test most likely
will.
How you prepare
To ensure that your Pap smear is most effective, follow these tips prior to your test:
Avoid intercourse, douching or using any vaginal medicines or spermicidal foams, creams or
jellies for two days before having a Pap smear, as these may wash away or obscure
abnormal cells.
Try not to schedule a Pap smear during your menstrual period. Although the test can be
done, it's best to avoid this time of your cycle, if possible
What you can expect
During the Pap smear
A Pap smear is performed in your doctor's office and takes only a few minutes. You may be asked to
undress completely or only from the waist down.
You'll lie down on your back on an exam table with your knees bent. Your heels rest in supports
called stirrups.
Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds
the walls of the vagina apart so that your doctor can easily see your cervix. Inserting the speculum
may cause a sensation of pressure in your pelvic area.
Then your doctor will take samples of your cervical cells using a soft brush or a flat scraping device
called a spatula. This usually doesn't hurt.
After the Pap smear
After your Pap smear, you can go about your day without restrictions.
Depending on the type of Pap test you're undergoing, your doctor transfers the cell sample collected
from your cervix into a container holding a special liquid to preserve the sample (liquid-based Pap
test) or onto a glass slide (conventional Pap test).
The samples are transferred to a laboratory where they're examined under a microscope to look for
characteristics in the cells that indicate cancer or a precancerous condition.
Ask your doctor about when you can expect the results of your Pap smear. In some cases, your
doctor will contact you only if something of concern is found or if it's determined that you need
further testing.

In a Pap test, your doctor uses a vaginal speculum to hold your vaginal walls apart. Next, he or she
collects a sample of cells from your cervix using a small cone-shaped brush or a cotton-tipped
swab and a tiny plastic spatula (1 and 2). Your doctor then smears the cells onto a glass slide (3) or
puts them into a bottle containing a solution to preserve the cells for examination under a
microscope.
Results
The Pap smear can alert your doctor to the presence of suspicious cells that need further testing.
Normal results
If only normal cervical cells were discovered during your Pap smear, you're said to have a negative
result. You won't need any further treatment or testing until you're due for your next Pap smear and
pelvic exam.
Abnormal results
If abnormal or unusual cells were discovered during your Pap smear, you're said to have a positive
result. A positive result doesn't mean you have cervical cancer. What a positive result means
depends on the type of cells discovered in your Pap smear.
Here are some terms your doctor might use and what your next course of action might be:
Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and
flat and grow on the surface of a healthy cervix. In the case of ASCUS, the Pap smear reveals
slightly abnormal squamous cells, but the changes don't clearly suggest that precancerous
cells are present. With the liquid-based test, your doctor can reanalyze the sample to check
for the presence of viruses known to promote the development of cancer, such as some
types of human papillomavirus (HPV). If no high-risk viruses are present, the abnormal cells
found as a result of the test aren't of great concern. If worrisome viruses are present, you'll
need further testing.
Squamous intraepithelial lesion. This term is used to indicate that the cells collected from
the Pap smear may be precancerous. If the changes are low grade, it means the size, shape
and other characteristics of the cells suggest that if a precancerous lesion is present, it's
likely to be years away from becoming a cancer. If the changes are high grade, there's a
greater chance that the lesion may develop into cancer much sooner. Additional diagnostic
testing is necessary.
Atypical glandular cells. Glandular cells produce mucus and grow in the opening of your
cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal,
but it's unclear whether they're cancerous. Further testing is needed to determine the
source of the abnormal cells and their significance.
Squamous cell cancer or adenocarcinoma cells. This result means the cells collected for the
Pap smear appear so abnormal that the pathologist is almost certain a cancer is present.
"Squamous cell cancer" refers to cancers arising in the flat surface cells of the vagina or
cervix. "Adenocarcinoma" refers to cancers arising in glandular cells. If such cells are found,
your doctor will recommend prompt evaluation.
If your Pap smear is abnormal, your doctor may perform a procedure called colposcopy using a
special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva.
Your doctor also may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue
sample is then sent to a laboratory for analysis and a definitive diagnosis


Peak flow meter
Definition
A peak flow meter is a portable, easy-to-use device that measures how well your lungs are working.
If you have asthma, your doctor may recommend that you use a peak flow meter to help track your
asthma control.
In addition to watching for worsening signs and symptoms, such as wheezing or coughing, you can
use a peak flow meter to help you decide when you need to act to keep your asthma under control.
Regular use of your peak flow meter can give you time to adjust your medication or take other steps
before your symptoms get worse. A peak flow meter can be useful for adults and children as young
as preschool age.

Why it's done
A peak flow meter allows you to measure day-to-day changes in your breathing. Using a peak flow
meter can help you:
Track the control of your asthma over time
Show how well your treatment is working
Recognize signs of a flare-up before symptoms appear
Know what steps to take when you have signs of an asthma flare-up
Decide when to call your doctor or get emergency care
How you prepare
Work with your doctor to make sure you get the right type of peak flow meter. Peak flow meters are
available over-the-counter and can be purchased at a pharmacy. There are several types of peak
flow meters available, and all of them work basically the same way: You blow a fast, hard breath into
a mouthpiece and record the resulting score. However, there are a few differences.
Meters designed for young children have a lower scale than do those designed for older
children, teens and adults. Some peak flow meters can be adjusted to work for either a
young child or an older child, teen or adult.
Basic peak flow meters are inexpensive, simple to use and give accurate readings that you
must record in a peak flow diary.
More expensive electronic peak flow meters record and track peak flow readings
automatically.
Using your peak flow meter
Here's the correct way to use a peak flow meter:
1. Move the marker to the bottom of the numbered scale, and connect the mouthpiece to the
peak flow meter (if it isn't already connected).
2. Stand up if you're able.
3. Take a deep breath, filling your lungs completely.
4. Place your lips tightly around the mouthpiece. Blow as hard and as fast as you can with a
single breath.
5. Note the final position of the marker. This is your peak flow rate.
6. Follow the steps above then blow into the peak flow meter two more times. Record the
highest reading of the three.
To get accurate readings, make sure you know how to use your peak flow meter properly. Ask your
doctor or other health care provider to watch you use it. It's also important to keep your peak flow
meter clean. Follow the manufacturer's instructions most peak flow meters require weekly
cleaning with warm water and a mild detergent.

What you can expect
To start, your doctor will want to get an idea of your peak flow measurements when you feel good
and have no asthma symptoms.
Measurements from a peak flow meter are called your peak flow rate. You'll record your daily peak
flow rate over a two- to three-week period. Your highest peak flow rate over this period is known as
your "personal best." Your personal best serves as a benchmark in your daily asthma management
plan.
When to check your peak flow
Your doctor will probably recommend using your peak flow meter once a day typically before you
take your regular asthma medication in the morning.
If your asthma is under control most of the time, your doctor may say it's OK to check your peak flow
every few days instead of every day. If your asthma isn't very well controlled, you may need to take
peak flow readings more than once a day.
In addition to regular peak flow monitoring, you may need to check your peak flow in these
situations:
You have asthma symptoms that wake you up at night.
You have increased symptoms during the day.
You have a cold, flu or other illness that affects your breathing.
You need to use quick-relief (rescue) medication, such as inhaled albuterol. (Check your peak
flow before you take rescue medication. Then check it again after 20 or 30 minutes.)
Tracking your readings
Record your peak flow rate in an asthma diary. Some people record their peak flow meter readings
by hand. But if you have an electronic personal health record, you may choose to enter your
information into the record using a computer or mobile device. This gives you the option of sharing
your data with your health care providers and family members. Some peak flow meters upload this
data automatically.
Results
Once you and your doctor have established your peak flow zones, you'll use a color-coded system
based on your symptoms and your peak flow. This system tells you what to do when you are in each
zone.
Green, yellow and red: Understanding your peak flow zones
Your doctor will use your personal best to set your peak flow zones. Each zone is determined by your
peak flow rate and symptoms. The color code for each zone reflects progressively more-severe
symptoms:
Green zone = stable
Your peak flow rate is 80 to 100 percent of your personal best, an indication that your
asthma is under control.
You probably have no asthma signs or symptoms.
Take your preventive medications as usual.
If you consistently stay within the green zone, your doctor may recommend reducing your
asthma medication.
Yellow zone = caution
Your peak flow rate is 50 to 80 percent of your personal best, an indication that your asthma
is getting worse.
You may have signs and symptoms such as coughing, wheezing or chest tightness - but your
peak flow rates may decrease before symptoms appear.
You may need to increase or change your asthma medication.
Red zone = danger
Your peak flow rate is less than 50 percent of your personal best, an indication of a medical
emergency.
You may have severe coughing, wheezing and shortness of breath. Stop whatever you're
doing and use a bronchodilator or other medication to open your airways.
Your asthma action plan will help you decide whether to call your doctor, take an oral
corticosteroid or seek emergency care.
Peak flow: Just one tool for asthma control
Using a peak flow meter can be an effective tool for managing your asthma but there are other
things you need to do:
Use an asthma action plan. An action plan is a simple but important part of managing your
asthma. It helps you keep track of which medications to take, when to take them and what
doses you need, based on whether you're in your green, yellow or red zone.
Meet with your doctor. Even if your asthma's under control, meet with your doctor on a
regular basis to review your action plan and revise it as needed. Asthma symptoms change
over time, which means your treatment may need to change, too.
Avoid your triggers. Pay attention to things that trigger your asthma symptoms or make
them worse and try to avoid them.
Make healthy choices. Taking steps to stay healthy for example, maintaining a healthy
weight, getting regular exercise and not smoking can make a big difference in reducing
your asthma symptoms.






Polysomnography (sleep study)
Definition
Polysomnography, also called a sleep study, is a test used to diagnose sleep disorders.
Polysomnography records your brain waves, the oxygen level in your blood, heart rate and
breathing, as well as eye and leg movements during the study.
Polysomnography usually is done at a sleep disorders unit within a hospital or at a sleep center.
You'll be asked to come to the sleep center in the evening for polysomnography so that the test can
record your nighttime sleep patterns.
In addition to helping diagnose sleep disorders, polysomnography may be used to help adjust your
treatment plan if you've already been diagnosed with a sleep disorder.

Why it's done
Polysomnography monitors your sleep stages and cycles to identify if or when your sleep patterns
are disrupted and why.
The normal process of falling asleep begins with a sleep stage called non-rapid eye movement
(NREM) sleep. During this stage, your brain waves, as recorded by electroencephalography (EEG),
slow down considerably. Your eyes don't move back and forth rapidly during NREM, in contrast to
later stages of sleep. After an hour or two of NREM sleep, your brain activity picks up again, and
rapid eye movement (REM) sleep begins. Most dreaming occurs during REM sleep.
You normally go through four to six sleep cycles a night, cycling between NREM and REM sleep in
about 90 minutes. Your REM stage usually lengthens with each cycle as the night progresses. Sleep
disorders can disturb this sleep process. Polysomnography monitors your sleep stages and cycles to
identify if or when your sleep patterns are disrupted.
Your doctor may recommend polysomnography if he or she suspects you have:
Sleep apnea or another sleep-related breathing disorder your breathing repeatedly stops
and starts during sleep.
Periodic limb movement disorder you involuntarily flex and extend your legs while
sleeping. This sleep disorder is sometimes associated with restless legs syndrome.
Narcolepsy you experience overwhelming daytime drowsiness and sudden attacks of
sleep.
REM sleep behavior disorder you act out dreams as you sleep.
Unusual behaviors during sleep you do unusual activities during sleep, such as walking,
moving around a lot or rhythmic movements.
Unexplained chronic insomnia you consistently have trouble falling asleep or staying
asleep.

Risks
Polysomnography is a noninvasive, painless test. Complications are rare. The most common side
effect is skin irritation caused by the adhesive used to attach test sensors to your skin.
How you prepare
Your doctor may ask you not to drink alcohol or eat or drink anything with caffeine during the
afternoon and evening before polysomnography. Alcohol and caffeine can change your sleep
patterns, and they may make symptoms of some sleep disorders worse.
What you can expect
During polysomnography
You arrive at the sleep center in the evening for polysomnography and stay overnight. You may bring
items you use for your bedtime routine, and you can sleep in your own nightclothes.
The room where polysomnography is done is similar to a hotel room, and it's dark and quiet during
the test. You don't share the room with anyone else. The room has a video camera, so the
polysomnography technologists monitoring you can see what's happening in the room when the
lights are out, and an audio system, so they can talk to you and hear you from their monitoring area
outside the room.
After you get ready for bed, one of the technologists places sensors on your scalp, temples, chest
and legs using a mild adhesive, such as glue or tape. The sensors are connected by wires to a
computer, but the wires are long enough to let you move normally in bed. A small clip also is placed
on your finger or ear to monitor the level of oxygen in your blood.
While you sleep, a technologist monitors your:
Brain waves
Eye movements
Heart rate
Breathing pattern
Blood oxygen level
Body position
Limb movement
Snoring and other noise you may make as you sleep
All of these measurements are recorded on a continuous graph.
Polysomnography technologists monitor you throughout the night. If you need assistance, you can
talk to them through the monitoring equipment. They can come into the room to detach the wires if
you need to get up during the night.
Although you probably won't fall asleep as easily or sleep as well at the sleep center as you do at
home, this usually doesn't affect the test results. A full night's sleep isn't required to obtain accurate
polysomnography results.
After polysomnography
In the morning, the sensors are removed, and you may leave the sleep center. You're given an
appointment for a follow-up visit with the doctor who recommended the test. You can return to
your usual activities after polysomnography.
Results
The measurements recorded during polysomnography provide a great deal of information about
your sleep patterns. For example:
Brain waves and eye movements during sleep can help your health care team assess your
sleep stages and identify disruptions in the stages that may occur due to sleep disorders
such as narcolepsy and REM sleep behavior disorder.
Heart and breathing rate changes and changes in blood oxygen that are abnormal during
sleep may suggest sleep apnea.
Frequent leg movements that disrupt your sleep may indicate periodic limb movement
disorder.
Unusual movements or behaviors during sleep may be signs of REM sleep behavior disorder
or another sleep disorder.
The information gathered during polysomnography is evaluated first by a polysomnography
technologist, who uses the data to chart your sleep stages and cycles. Then, that information is
reviewed by your sleep center doctor.
It may take up to two weeks to receive the results of polysomnography. At a follow-up appointment,
your doctor reviews the results with you and, based on the data gathered, discusses any treatment
or further evaluation that you may need.



Positron emission tomography (PET) scan
Definition
A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and
organs are functioning. A PET scan uses a radioactive drug (tracer) to show this activity.
The tracer may be injected, swallowed or inhaled, depending on which organ or tissue is being
studied by the PET scan. The tracer collects in areas of your body that have higher levels of chemical
activity, which often correspond to areas of disease. On a PET scan, these areas show up as bright
spots.
A PET scan is useful in revealing or evaluating several conditions, including some cancers, heart
disease and brain disorders
Why it's done
A PET scan is an effective way to examine the chemical activity in parts of your body. It may help
identify a variety of conditions, including some cancers, heart disease and brain disorders. The
pictures from a PET scan provide information different from that uncovered by other types of scans,
such as computerized tomography (CT) or magnetic resonance imaging (MRI). A PET scan or a
combined CT-PET scan enables your doctor to better diagnose your condition.
Cancer
Cancer cells show up as bright spots on PET scans because they have a higher metabolic rate than do
normal cells. PET scans may be useful in:
Detecting cancer
Revealing whether your cancer has spread
Checking whether a cancer treatment is working
Finding a cancer recurrence
PET scans must be interpreted carefully because noncancerous conditions can look like cancer, and
many types of cancer do not appear on PET scans. The types of cancer most likely to show up on PET
scans include:
Brain
Breast
Cervical
Colorectal
Esophageal
Head and neck
Lung
Lymphoma
Melanoma
Pancreatic
Prostate
Thyroid
Heart disease
PET scans can reveal areas of decreased blood flow in the heart. This information can help you and
your doctor decide, for example, whether you might benefit from a procedure to open clogged heart
arteries (angioplasty) or coronary artery bypass surgery.
Brain disorders
PET scans can be used to evaluate certain brain disorders, such as:
Tumors
Alzheimer's disease
Seizures
PET scan of the heart

This PET image shows an area of reduced blood flow from one of the arteries that feeds the heart.
This information may help doctors decide whether to suggest bypass surgery or angioplasty to
restore that blood flow.
PET scans of the brain for Alzheimer's disease

A PET scan can compare a normal brain (left) with one affected by Alzheimer's disease (right). An
increase in blue and green colors shows decreased brain metabolic activity due to Alzheimer's
disease.
Risks
For your PET scan, a radioactive drug (tracer) will be put into your body. The amount of radiation
you're exposed to is small, and the risk of negative effects from it is low. But the tracer might:
Cause a major allergic reaction, in rare instances
Expose your unborn baby to radiation if you are pregnant
Expose your child to radiation if you are breast-feeding
Talk with your doctor about the benefits and risks of a PET scan
How you prepare
Tell your doctor:
If you've ever had a bad allergic reaction
If you've been sick recently or you have another medical condition, such as diabetes
If you're taking any medications, vitamins or herbal supplements
If you're pregnant or think you might be pregnant
If you're breast-feeding
If you're afraid of enclosed spaces (claustrophobic)
Your doctor will give you detailed instructions on how to prepare for your scan. A general rule is to
avoid strenuous exercise for a couple of days before the study and to stop eating a few hours before
the scan.
What you can expect
The PET scanner is a large machine that looks a little like a giant doughnut standing upright, similar
to a computerized tomography (CT) machine. You'll need about two hours for the procedure, which
may be done on an outpatient basis (no overnight hospital stay). When you arrive for your scan, you
may be asked to:
Change into a hospital gown
Empty your bladder
Then you will be given a radioactive drug (tracer). You may receive the drug by injection or be asked
to inhale or swallow it, depending on the type of tracer being used. If the drug is injected, you may
briefly feel a cold sensation moving up your arm. You'll need to wait 30 to 60 minutes for the tracer
to be absorbed by your body.
During the PET scan
When you are ready, you'll lie on a narrow, padded table that slides into the scanner. During the
scan you'll need to lie very still so that the images aren't blurred. It takes about 30 minutes to
complete the test. The machine makes buzzing and clicking sounds.
The test is painless. If you're afraid of enclosed spaces, you may feel some anxiety while in the
scanner. Be sure to tell the nurse or technologist about any discomfort. He or she may give you a
drug to help you relax.
In some cases you may have a CT and PET scan in the same machine during the same appointment.
The CT scan will be done first and take about 10 minutes.
After the PET scan
After the test you can carry on with your day as usual, unless your doctor tells you otherwise. You'll
need to drink plenty of fluids to help flush the tracer from your body.


Results
Pictures from a PET scan display bright spots where the radioactive tracer collected. These spots
reveal higher levels of chemical activity and details about how your tissues and organs are
functioning. A doctor specially trained to interpret scan images (radiologist) will report the findings
to your doctor.
The radiologist may also compare your PET images with images from other tests you've undergone
recently, such as computerized tomography (CT) or magnetic resonance imaging (MRI). Or the
pictures may be combined to provide more detail about your condition

Prostate biopsy
Definition
A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The
prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports
sperm.
During a prostate biopsy, also called a core needle biopsy, a fine needle is used to collect a number
of tissue samples from your prostate gland. A prostate biopsy is performed by a doctor who
specializes in the urinary system and men's sex organs (urologist).
Your urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-
specific antigen (PSA) blood test or digital rectal exam (DRE), suggest you may have prostate cancer.
Following a prostate biopsy, tissue samples from the prostate biopsy are examined under a
microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is
evaluated to determine how quickly it's likely to grow and spread and to determine your best
treatment options.
Why it's done
A prostate biopsy is used to detect prostate cancer. Your doctor may recommend a prostate biopsy
if:
Results of a prostate-specific antigen (PSA) test are higher than normal for your age
Your doctor found lumps or other abnormalities during a digital rectal exam
You've had a previous biopsy that was normal, but you still have elevated PSA levels
A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous
Risks
Common risks associated with a prostate biopsy include:
Infection. The most common risk associated with a prostate biopsy is infection. Rarely, men
who have a prostate biopsy develop an infection of the urinary tract or prostate that
requires treatment with antibiotics.
Bleeding at the biopsy site. Rectal bleeding is common after a prostate biopsy. Don't start
taking any blood-thinning medications after your biopsy until your doctor says it's OK.
Blood in your semen. It's common to notice red or rust coloring in your semen after a
prostate biopsy. This indicates blood, and it's not a cause for concern. Blood in your semen
may persist for a few weeks after the biopsy.
Difficulty urinating. In some men, prostate biopsy can cause difficulty passing urine after the
procedure. Rarely, a temporary urinary catheter must be inserted.
How you prepare
To prepare you for your prostate biopsy, your urologist may have you:
Stop taking medication that can increase the risk of bleeding, such as warfarin (Coumadin),
aspirin, ibuprofen (Advil, Motrin, others), and certain herbal supplements for several days
before the procedure
Do a cleansing enema at home before your biopsy appointment
Take antibiotics 30 to 60 minutes before your prostate biopsy to help prevent infection
What you can expect
Types of prostate biopsy procedures
Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:
Passing the needle through the wall of the rectum. This is called a transrectal biopsy, and it
is the most common way of performing a prostate biopsy.
Collecting a tissue sample through the tip of the penis. This way of performing a prostate
biopsy is called a transurethral biopsy. A long, thin tube equipped with a camera is passed
through the opening (urethra) at the tip of the penis in order to access the prostate.
Inserting the needle through the area of skin between the anus and scrotum. This type of
prostate biopsy involves making a small cut in the area of skin (perineum) between the anus
and the scrotum. The doctor inserts the biopsy needle through the cut and into the prostate
to draw out a sample of tissue.
What to expect during transrectal prostate biopsy
In most cases, the urologist performs a transrectal prostate biopsy. For this procedure, your doctor
will start by having you lie on your side, with your knees pulled up to your chest. In some cases, you
may be asked to lie on your stomach.
After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into
your rectum. Transrectal ultrasonography is used to create images of your prostate using sound
waves. Your doctor will use the images to identify the area that needs to be numbed with an
anesthetic injection, if one is used. The ultrasound images are also used to guide the prostate biopsy
needle into place.
In most cases, an injection of a numbing medication is used to reduce the discomfort associated with
the prostate biopsy. A needle is used to inject the anesthetic at various points near the base of the
prostate.
Once the biopsy device is situated, your doctor will retrieve thin, cylindrical sections of tissue with a
hollow, spring-propelled needle. The procedure typically causes a very brief, uncomfortable
sensation each time the spring-loaded needle takes a sample. Your doctor may target a suspicious
area to biopsy or may take samples from several places in your prostate. In most cases, doctors will
take 10 to 12 tissue samples. The entire procedure usually takes about five to 10 minutes.
After the procedure
After a prostate biopsy, you'll probably need to take an antibiotic for a few days. You may feel slight
soreness and have some light bleeding from your rectum. You may have blood in your urine or stools
for a few days. You may also notice that your semen has a red or rust-colored tint caused by a small
amount of blood in your semen. This can last for several weeks.
Call your doctor if you have:
Prolonged or heavy bleeding
Pain that gets worse
Swelling near the biopsy area
Difficulty urinating
In rare cases, a prostate biopsy can lead to infection. If you have any signs of infection, call your
doctor. Signs and symptoms of infection include:
Fever
Pain when urinating
Discharge from your penis
Results
A doctor who specializes in diagnosing cancer and other tissue abnormalities (pathologist) will
evaluate the prostate biopsy samples. The pathologist can tell if the tissue removed is cancerous
and, if cancer is present, estimate how aggressive it is. The pathologist compiles the laboratory
findings in a pathology report that's given to your doctor. Your doctor will explain the findings to you
and, if you like, you can ask for a copy of your pathology report for future reference.
Your pathology report may include:
Information about your medical history. A pathology report may include a discussion of
your medical history and any other tests that prompted your doctor to recommend a
prostate biopsy.
A description of the biopsy sample. This section of the pathology report, sometimes called
the gross description, describes the biopsy sample in general. For instance, it may describe
the color and consistency of the prostate tissue collected by the needle biopsy procedure.
Or it may say how many samples were submitted for laboratory analysis.
A description of the cells. This section of the pathology report describes how the cells
appear under a microscope. Prostate cancer cells may be referred to as adenocarcinoma in a
pathology report. Sometimes the pathologist finds cells that appear abnormal but aren't
cancerous. Words used in pathology reports to describe these noncancerous conditions
include "prostatic intraepithelial neoplasia" and "atypical small acinar proliferation."

If the pathologist finds cancer, it's graded on a scale called the Gleason score. This scale
rates how different the cancer cells are from normal tissue. The lowest rating is 2, and the
highest is 10. Cancers with a high Gleason score are the most abnormal and are more likely
to grow and spread quickly.
The pathologist's diagnosis. This section of the pathology report lists the pathologist's
diagnosis. It may also include comments, such as whether other tests are recommended.




Prothrombin time test
Definition
A prothrombin time test measures how quickly your blood clots. Sometimes called a pro time test or
PT test, a prothrombin time test uses a sample of your blood.
Prothrombin is a protein produced by your liver that helps your blood to clot. When you bleed, a
series of chemicals (clotting factors) activate in a stepwise fashion. The end result is a clot which
stops the bleeding. One step in the process is prothrombin turning into another protein called
thrombin. The prothrombin time test measures how well the clotting process works and how long it
takes to occur.
Why it's done
If you take a blood-thinning medication such as warfarin to prevent clots from forming, your doctor
will recommend a prothrombin time test to monitor the medication's effectiveness. It can also be
ordered to:
Detect a bleeding disorder
Diagnose liver problems
Screen people having surgery for unrecognized bleeding problems
A variation of the prothrombin time test is part of a test series called model for end-stage liver
disease (MELD) used to assess the severity and priority of people waiting for liver transplants.
If your doctor suspects you may have liver problems, you may undergo additional testing to assess
the health of your liver, such as liver enzyme tests. If your doctor suspects you may have a bleeding
disorder, you may undergo additional clotting-function tests.
Risks
A prothrombin time test is safe. Because the test involves drawing blood from a vein in your arm,
you may experience soreness or bruising at the site from which your blood is drawn.
What you can expect
During the test
Prothrombin time testing is done using a blood sample. Usually, the blood is drawn through a small
needle inserted into a vein in the bend of your arm. You'll be asked to roll up your shirt sleeve if
you're wearing long sleeves. The person drawing the blood might tie a band around your upper arm
and ask you to make a fist. This causes your vein to stick out more, making it easier to insert the
needle. The needle is attached to a small tube, in which your blood is collected. All of this usually
takes just a few minutes.
You may feel a quick pain as the needle is inserted and experience some short-term discomfort at
the site after the needle is removed.
After the test
Once the needle is removed, you'll be given a piece of gauze and a bandage to cover the area where
the needle was inserted. You'll be asked to gently apply pressure to the area for a minute or so, to
help stop any bleeding.
Your blood will be sent to a laboratory for analysis. If the laboratory analysis is done on-site, you
could have your test results within hours. If your doctor sends your blood to an off-site laboratory, it
may take several days to receive the results.
Home testing
Home testing kits are available for people who have to take blood thinners for long periods and who
have been trained in taking blood samples and testing them.
Results
Prothrombin time test results can be presented in two ways:
Prothrombin time in seconds. Prothrombin time is usually measured in seconds the time
it takes for your blood to clot. This way of determining prothrombin time creates results that
will vary depending on the laboratory and the method used to test the blood, but a sample
range is approximately 10 to 14 seconds. A number higher than average means it takes
blood longer than usual to clot. A lower number means blood clots more quickly than
expected.
Prothrombin time as a ratio. For people taking the blood-thinning medication warfarin
(Coumadin), results are given as a number that represents a ratio called the international
normalized ratio (INR). The INR is a formula that adjusts for differences in the chemicals
used in different laboratories so that test results can be comparable.

An INR range of 2.0 to 3.0 is generally effective for people taking warfarin who need full
anticoagulation, but may need to be slightly higher in certain situations. If your INR is higher
than this range, that means your blood clots more slowly than desired. A lower INR means
your blood clots more quickly than desired. The INR is used only for people on oral
anticoagulant therapy. It's not useful in people whose PT is higher for other reasons.
What your results mean
Clotting too slowly
If your prothrombin time test reveals that your blood is clotting too slowly, this can be caused by:
Blood-thinning medications, such as warfarin (Coumadin), heparin
Liver problems
Inadequate levels of proteins (factors) that cause blood to clot
Vitamin K deficiency
Congenital factor deficiency
Presence of coagulation factor inhibitors
Clotting too fast
If your prothrombin time test reveals that your blood is clotting too fast, this can be caused by:
Supplements that contain vitamin K
High intake of foods that contain vitamin K, such as liver, broccoli, chickpeas, green tea, kale,
turnip greens and products that contain soybeans
Estrogen-containing medications, such as birth control pills and hormone replacement
therapy



PSA test
Definition
The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of
prostate-specific antigen (PSA) in your blood. PSA is a protein produced in the prostate, a small gland
that sits below a man's bladder. PSA is mostly found in semen, which also is produced in the
prostate. Small amounts of PSA ordinarily circulate in the blood.
The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer.
However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA
levels.
There is a lot of conflicting advice about PSA testing. Ultimately, whether you have a PSA test is
something you should decide after discussing it with your doctor, considering your risk factors and
weighing your personal preferences.

Why it's done
Prostate cancer is the most common nonskin cancer in men, and it's the second leading cause of
cancer-related death in men after lung cancer. Early detection may be an important tool in getting
appropriate and timely treatment.
Men with prostate cancer may have elevated levels of PSA. Many noncancerous conditions also can
increase a man's PSA level. Although the PSA test can detect high levels of PSA in the blood, the test
doesn't provide precise diagnostic information about the condition of the prostate.
The PSA test is only one tool used to screen for early signs of prostate cancer. Another common
screening test, usually done in addition to a PSA test, is a digital rectal exam. In this test, your doctor
inserts a lubricated, gloved finger into your rectum to reach the prostate. By feeling or pressing on
the prostate, the doctor may be able to judge whether it has abnormal lumps or hard areas.
Neither the PSA test nor the digital rectal exam provides enough information for your doctor to
diagnose prostate cancer. Abnormal results in these tests may lead your doctor to recommend a
prostate biopsy. During this procedure, samples of tissue are removed for laboratory examination. A
diagnosis of cancer is based on the biopsy results.
Other reasons for PSA tests
For men who have already been diagnosed with prostate cancer, the PSA test may be used to:
Help decide if and when to begin treatment
Judge the effectiveness of a treatment
Check for recurring cancer
What you can expect
A PSA test is done by examining a blood sample in a lab. A nurse or medical technician will use a
needle to draw blood from a vein, most likely in your arm.
Risks
Weighing the benefits, limitations and potential risks of the PSA test can help you make an informed
decision.
Benefits of the test
A PSA test may help detect prostate cancer at an early stage. Cancer is easier to treat and is more
likely to be cured if it's diagnosed in its early stages.
But to judge the benefit of the test, it's important to know if early detection and early treatment will
improve treatment outcomes and decrease the number of deaths from prostate cancer.
A key issue is the typical course of prostate cancer. Prostate cancer usually progresses slowly over
many years. Therefore, a man may have prostate cancer that never causes symptoms or becomes a
medical problem during his lifetime.
Limitations of the test
The limitations of PSA testing include:
PSA-raising factors. Besides cancer, other conditions that can raise PSA levels include an
enlarged prostate (benign prostatic hyperplasia, or BPH) and an inflamed or infected
prostate (prostatitis). Also, PSA levels normally increase with age.
PSA-lowering factors. Certain drugs used to treat BPH or urinary conditions may lower PSA
levels. Large doses of certain chemotherapy medications can also lower PSA levels.
Misleading results. The test doesn't always provide an accurate result. An elevated PSA level
doesn't necessarily mean you have cancer. And in some cases, a normal PSA level does not
completely rule out prostate cancer.
Over diagnosis. Studies have estimated that between 17 and 50 percent of men with
prostate cancer detected by PSA tests have tumors that wouldn't result in symptoms during
their lifetimes. These symptom-free tumors are considered over diagnoses identification
of cancer not likely to cause poor health or to present a risk to the man's life.
Potential risks
The potential risks of the PSA test are essentially related to the choices you make based on the test
results, such as the decision to undergo further testing and treatment for prostate cancer. The risks
include:
Biopsy issues. A biopsy is a procedure that carries its own risks, including pain, bleeding and
infection.
Psychological effects. False-positive test results high PSA levels but no cancer found with
biopsy can cause anxiety or distress. If you are diagnosed with prostate cancer, but it
appears to be a slow-growing tumor that doesn't result in illness, you may experience
significant anxiety just knowing it's there.
Recommendations
A number of major professional organizations and government agencies have weighed in on the
benefits and risks of PSA testing. The American Cancer Society, the American Urological Association,
the American College of Preventive Medicine, the Centers for Disease Control and Prevention, and
the U.S. Preventive Services Task Force all recognize the controversy surrounding screening with the
PSA test and the lack of firm evidence that screening can prevent deaths from prostate cancer.
Other points of agreement include:
Screening needs to be an individualized decision. All of the organizations recommend that
doctors discuss the benefits and risks of PSA testing with men at a certain age or in high-risk
groups. Doctors should help men make their own decisions about screening, based on age,
risk factors, life expectancy and personal preferences.
Older men may not need to be screened. Some organizations recommend that screening
isn't necessary for men age 75 and older or those who aren't expected to live more than 10
years. The American Cancer Society advises that this decision should be made on an
individual basis. It is very important, however, to keep in mind that decisions need to be
individualized and not assume that all prostate cancer screening must stop once a man is in
his 70s.
Men at high risk should discuss screening at an earlier age. Some groups recommend
earlier discussions for men in high-risk groups those with a family history of prostate
cancer and African-American men.
The American Cancer Society recommends that doctors provide information about prostate cancer
screening to men at average risk starting at age 50, while men at higher risk could benefit from this
information at age 40 or 45. The American Urological Association recommends that men consider
getting a baseline prostate cancer screening, including a PSA test and DRE, beginning at age 40.
The American Urological Association (AUA) recommends against PSA screening in men under age 40,
and it doesn't recommend screening between ages 40 and 54 for men at average risk. For men ages
55 to 69, the AUA recommends shared decision-making between men and their doctors about when
to begin screening. The AUA guidelines state that the greatest benefit of screening appears to be in
men ages 55 to 69, and it does not recommend routine screening beyond age 70.
The U.S. Preventive Services Task Force (USPSTF) recommends against PSA-based screening for men
who do not have symptoms that are highly suspicious for prostate cancer. The USPSTF states that
PSA testing in healthy men, regardless of age, offers no net benefit or that the harms outweigh the
benefits. This has been a very controversial point of view, and many experts in the field of prostate
cancer do not agree with the USPSTF recommendations.
Results
Results of PSA tests are reported as nanograms of PSA per milliliter of blood (ng/mL). There's no
specific cutoff point between a normal and abnormal PSA level. Your doctor might recommend a
prostate biopsy based on results of your PSA test and digital rectal exam, along with other factors.
Variations of the PSA test
Your doctor may use other ways of interpreting PSA results before making decisions about ordering
a biopsy to test for cancerous tissue. These other methods are intended to improve the accuracy of
the PSA test as a screening tool.
Researchers continue to investigate variations of the PSA test to determine whether they provide a
measurable benefit. Variations of the PSA test include:
PSA velocity. PSA velocity is the change in PSA levels over time. A rapid rise in PSA may
indicate the presence of cancer or an aggressive form of cancer.
Percentage of free PSA. PSA circulates in the blood in two forms either attached to
certain blood proteins or unattached (free). If you have a high PSA level but a low
percentage of free PSA, it may be more likely that you have prostate cancer. This test is
primarily used for men with a PSA level in the borderline range between 4 and 10. It is
especially useful when determining the need for re-biopsy rather than in an initial screening
state.
Talk to your doctor
Before getting a PSA test, talk to your doctor about the benefits and risks. If you decide that a PSA
test is right for you, ask your doctor:
When you will discuss the results
What kinds of recommendations he or she might make if the results are positive
How often you should repeat the test if the results are negative
Discussing these issues beforehand may make it easier for you to learn the results of your test and
make appropriate decisions afterward.


Needle biopsy
Definition
A needle biopsy is a procedure to obtain a sample of cells from your body for laboratory testing.
Common needle biopsy procedures include fine-needle aspiration and core needle biopsy. Needle
biopsy may be used to take tissue or fluid samples from muscles, bones and organs, such as the liver
or lungs
Why it's done
Your doctor may suggest a needle biopsy to help diagnose a medical condition or to rule out a
disease or condition. A needle biopsy may also be used to assess the progress of a treatment.
The sample from your needle biopsy may help your doctor determine what's causing:
A mass or lump. A needle biopsy may reveal whether a mass or lump is a cyst, an infection, a
benign tumor or cancer.
An infection. Analysis from a needle biopsy can help doctors determine what germs are
causing an infection so that the most effective medications can be used.
Inflammation. A needle biopsy sample may reveal what's causing inflammation and what
types of cells are involved.
You may also undergo imaging tests, such as a computerized tomography (CT) scan or an ultrasound,
before your needle biopsy. Sometimes these tests are also used during the needle biopsy procedure
to more accurately locate the area to be biopsied.
Risks
Needle biopsy carries a small risk of bleeding and infection at the site where the needle was
inserted. Some mild pain can be expected after needle biopsy, though it is usually controlled with
over-the-counter pain relievers or prescription medications.
Call your doctor if you experience:
Fever
Pain at the biopsy site that worsens or isn't helped by medications
Swelling at the biopsy site
Drainage from the biopsy site
Bleeding that doesn't stop with pressure or a bandage
How you prepare
Most needle biopsy procedures don't require any preparation on your part. However, you may be
asked to stop taking blood-thinning medications, such as warfarin (Coumadin) or aspirin, in the days
before your biopsy. Depending on what part of your body will be biopsied, your doctor may ask you
not to eat or drink before the procedure. Ask your doctor whether either applies to you.
Preparing for sedation or general anesthesia
In certain cases, you may receive intravenous (IV) sedatives or general anesthetics before your
needle biopsy. If this is the case, your doctor may ask that you fast the day before your procedure.
Tell your doctor about any medications you're taking, as you may need to stop taking certain
medications before undergoing anesthesia.
You won't be able to return to work immediately if your needle biopsy is done under IV sedation or
general anesthesia. Depending on your duties, you may be able to return to work in 24 hours. Talk to
your doctor about when it's safe to return to work.
Make arrangements or ask friends or family to:
Drive you home
Stay with you for 24 hours
Help with household chores for a day or two
What you can expect
During the needle biopsy
Your health care team will position you in a way that makes it easy for the doctor to access the area
where the needle will be inserted. You may be asked to lie flat on a table.
In certain cases, you may undergo imaging procedures, such as a CT scan or ultrasound. These allow
your doctor to see the target area and plan the best way to proceed. Imaging procedures are
sometimes done before your needle biopsy and sometimes performed during the biopsy. What type
of imaging you'll undergo, if any, will depend on what part of your body is being biopsied.
Your health care team will clean the area of your body where the needle will be inserted. An
anesthetic may be injected into the skin around the area to numb it. In some cases, you'll receive an
intravenous (IV) sedative or other medication to relax you during the procedure. Sometimes general
anesthesia is used during a needle biopsy. If this is the case, you'll receive medications through a
vein in your arm that will relax you and put you in a sleep-like state.
During the needle biopsy, the doctor guides a needle through your skin and into the area of interest.
A sample of cells is collected and the needle is withdrawn. This process may be repeated several
times until enough cells are collected.
Common types of needle biopsy techniques include:
Fine-needle aspiration. This type of needle biopsy uses a thin, hollow needle to draw cells
from your body.
Core needle biopsy. This type of needle biopsy uses a wider needle than does fine-needle
aspiration. The needle used during a core needle biopsy is a hollow tube that allows the
doctor to extract a core of tissue for testing.
You may experience mild discomfort during your needle biopsy, such as a sensation of pressure in
the area. Tell your health care team if you're feeling uncomfortable.
After the needle biopsy
Once your doctor has collected enough cells or tissue for analysis, your needle biopsy procedure is
complete. Your biopsy sample is sent to a laboratory for analysis. The results may be available in a
few days, though more technical tests may require more time. Ask your doctor how long you can
expect to wait.
Your health care team may apply a bandage over the area where the needle was inserted. You may
be asked to apply pressure to the bandage for several minutes to ensure there is minimal bleeding.
In most cases, you can leave when your needle biopsy procedure is completed. Whether you can
leave right away or whether you'll need to stay for observation depends on what part of your body
was biopsied. In some cases, your health care team may want to observe you for a few hours to
ensure you don't have complications from your biopsy. If you received an IV sedative or general
anesthetic, you'll be taken to a comfortable place to relax while the medication wears off.
Plan to take it easy for the rest of the day. Protect the area where you received the needle biopsy by
keeping the bandage in place for as long as instructed. You may feel some mild pain or discomfort in
the area, but this should resolve in a day or two
Results
Pathologists doctors who specialize in studying cells and tissue samples for signs of disease will
study the biopsy sample in the laboratory and make a diagnosis. Pathologists create a pathology
report for your doctor. Once your doctor receives the report, you will be contacted with the results.
You can request a copy of your pathology report from your doctor. Pathology reports are usually
filled with technical terms, so you may find it helpful to have your doctor review the report with you.
Your pathology report may include:
A description of the biopsy sample. This section of the pathology report, sometimes called
the gross description, describes the biopsy sample in general. For instance, it may describe
the color and consistency of the tissues or fluid collected by the needle biopsy procedure. Or
it may say how many slides were submitted for laboratory analysis.
A description of the cells. This section of the pathology report describes how the cells
appear under a microscope. This section may include how many cells and what types of cells
were seen. Information on special dyes that were used to study the cells in order to gather
more information about the diagnosis and the best treatments also may be included.
The pathologist's diagnosis. This section of the pathology report lists the pathologist's
diagnosis. It may also include comments, such as whether other tests are recommended.
The results of your needle biopsy will determine the next steps in your medical care. Talk with your
doctor about what your results mean for you.


Nitric oxide test for asthma
Definition
An exhaled nitric oxide (eNO) test can help with the diagnosis and treatment of asthma. It measures
the level of nitric oxide gas in an exhaled sample of your breath. This sample is collected by having
you breathe into the mouthpiece of a machine that performs the measurement.
Why it's done
The diagnosis of asthma is usually made using your medical history, a physical exam, and certain
tests to see how well your lungs are working, such as peak flow measurement and spirometry tests.
You may sometimes need tests that may trigger and then treat mild asthma symptoms. These tests
are called challenge tests.
Even after these tests, the diagnosis of asthma may still be uncertain, or there may be questions
about the best treatment. That's where the exhaled nitric oxide test may be helpful. Nitric oxide is
produced throughout the body, including in the lungs, to fight inflammation and relax constricted
muscles. High levels of exhaled nitric oxide in your breath can mean that your airways are inflamed
one sign of asthma.
Nitric oxide testing is also done to help predict whether or not steroid medications (which decrease
inflammation) are likely to be helpful for your asthma. If you've already been diagnosed with asthma
and treated with one of the steroid medications, your doctor may use an exhaled nitric oxide test
during office visits to help determine whether your asthma is under control.
Exhaled nitric oxide testing may not be necessary or provide useful information for everyone who
has asthma. In addition, it may not be available in all hospitals or doctor's offices
How you prepare
Check ahead of time to see whether nitric oxide testing is covered by your insurance.
To make sure test results are accurate, you will need to avoid the following for at least two hours
before you take the test:
Using an asthma inhaler
Eating and drinking
Exercising
Using tobacco, toothpaste or mouthwash
What you can expect
To do this test, you'll be seated. Your doctor will have you put in a mouthpiece attached with a tube
that leads to an electronic measurement device. Next, you'll breathe in for two or three seconds
until your lungs are filled with air. Your doctor will then have you exhale steadily so that the air flows
out of your lungs at a steady rate. Your doctor may have you watch a computer monitor that
registers how much you're breathing out so that you can maintain a steady exhalation. You'll need to
repeat the test a few times to confirm your results. The entire test generally takes five minutes or
less.
Results
Higher than normal levels of exhaled nitric oxide generally mean your airways are inflamed a sign
of asthma.
Levels under about 20 parts per billion in children and under about 25 parts per billion in
adults are considered normal.
More than 35 parts per billion in children and 50 parts per billion in adults may signal airway
inflammation caused by asthma.
Nitric oxide test results can vary widely from person to person. When interpreting test results, your
doctor will consider a number of other factors. These may include:
Your asthma signs and symptoms
Results of other tests, such as peak flow tests or spirometry tests
Past nitric oxide test results
Medications you take
Whether you have a cold or the flu
Whether you have hay fever or other allergies
Whether or not you smoke
Your age

Noninvasive prenatal testing
Definition
Noninvasive prenatal testing (NIPT), also known as noninvasive prenatal diagnosis (NIPD), is a
screening method for detecting certain specific chromosomal abnormalities in a developing baby.
Noninvasive prenatal testing is a sophisticated blood test that examines fetal DNA in the maternal
bloodstream to determine whether your baby is at risk of Down syndrome, extra sequences of
chromosome 13 (trisomy 13), extra sequences of chromosome 18 (trisomy 18) or a sex chromosome
abnormality, such as Turner syndrome. The testing can also be used to determine a baby's sex and
rhesus (Rh) blood type.
Currently, noninvasive prenatal testing is only available for women who have certain risk factors.
Noninvasive prenatal testing might help you avoid other tests that might put your pregnancy at risk.
Your health care provider or a genetic counselor will discuss whether noninvasive prenatal testing
might benefit you and how to interpret the results.
Why it's done
Noninvasive prenatal testing is much more sensitive and specific than traditional first and second
trimester screening. As a result, noninvasive testing can often help women who have certain risk
factors avoid invasive testing, such as:
Amniocentesis. During this procedure, a small sample of the fluid that surrounds and
protects the baby during pregnancy (amniotic fluid) is removed from the uterus for testing.
Chorionic villus sampling (CVS). During CVS, a small sample of the wispy projections that are
part of the developing placenta (chorionic villi) are removed from the placenta for testing.
Amniocentesis and CVS both carry a slight risk of miscarriage.
Your health care provider might recommend noninvasive prenatal testing first if:
You have risk factors for having a baby who has a chromosomal condition. Noninvasive
prenatal testing can determine whether your baby is at risk of a chromosomal condition.
Risk factors might include older maternal age or having previously given birth to a baby who
has Down syndrome, trisomy 13 or trisomy 18. Your health care provider also might
recommend noninvasive prenatal testing if you've gotten worrisome results from another
prenatal screening test.
You're a carrier of an X-linked recessive disorder. X-linked recessive disorders, such as
Duchenne's muscular dystrophy or a blood-clotting disorder (hemophilia), typically affect
only males. Noninvasive prenatal testing can determine the sex of your baby earlier than an
ultrasound. While noninvasive prenatal testing can determine your baby's sex, it won't
determine if your baby has the disorder. Depending on your test results, a genetic counselor
can help you understand the next steps.
You have an Rh negative blood type. Noninvasive prenatal testing can determine your baby's
Rh factor. If you're Rh negative and your baby is Rh positive, you might produce Rh
antibodies after exposure to your baby's red blood cells. This is called becoming sensitized.
(This is typically not a concern during a first pregnancy, but can be a concern during
subsequent pregnancies.)
While noninvasive prenatal testing is currently recommended for women at high risk of carrying a
baby who has a chromosomal abnormality, research is under way to see how it might be helpful for
other women. Research is also being done to see what other chromosomal abnormalities and
genetic conditions can be detected through this type of testing.
Risks
Noninvasive prenatal testing poses no physical risks for you or your baby.
While noninvasive prenatal testing might cause anxiety, it might help you avoid the need for more
invasive tests, treatment or monitoring during your pregnancy.
Keep in mind, however, that noninvasive prenatal testing doesn't screen for all chromosomal or
genetic conditions.
How you prepare
If you're interested in noninvasive prenatal testing, talk to your health care provider about its
availability. Also, consider checking to see if your health insurance covers the cost of noninvasive
prenatal testing.
Before you undergo noninvasive prenatal testing, your health care provider or a genetic counselor
will explain the possible results and what they might mean for you and your baby. Be sure to discuss
any questions or concerns you have about the testing process.
What you can expect
Noninvasive prenatal testing can be done as early as week 10 of pregnancy.
During noninvasive prenatal testing a maternal blood sample is taken and sent to a lab. The lab
analyzes the maternal and fetal DNA in the blood sample. A higher than expected ratio of
chromosome 21 sequences indicates, for example, the likely presence of trisomy 21 in the baby.
Trisomy 21 is the most common cause of Down syndrome.
Typically, test results are available within two weeks.
Results
Your health care provider or a genetic counselor will explain the results of noninvasive prenatal
testing. For example:
Chromosomal conditions. If the test results are normal, you might not need further testing.
However, if results indicate the likelihood that your baby has a chromosomal abnormality,
amniocentesis or CVS will be offered. Further testing using the sample from amniocentesis
or CVS can be used to confirm the diagnosis.
Fetal sex. If you're the carrier of an X-linked recessive disorder and the test results indicate
that you're carrying a girl, you might not need further testing. If the test results indicate that
you're carrying a boy, amniocentesis or CVS will be offered. These tests can be used to
diagnose a genetic condition.
Rh factor. If you're Rh negative and the test results indicate that your baby is Rh negative,
you won't need medication to prevent your body from producing Rh antibodies during your
pregnancy. If the test results indicate that your baby is Rh positive and you've previously
become sensitized, your baby will be carefully monitored.
Chromosomal abnormalities can't be corrected. If your baby is diagnosed with a chromosomal
abnormality, you'll need to decide whether to continue with your pregnancy or what steps to take to
care for your baby during pregnancy and after he or she is born. Your health care provider or a
genetic counselor can help answer any questions you might have.
Keep in mind that regardless of the results of noninvasive prenatal testing, if you have risk factors
that suggest your baby might be at increased risk of a chromosomal condition you have the option
of undergoing amniocentesis or CVS.


Nuclear stress test
Definition
A nuclear stress test measures blood flow to your heart muscle both at rest and during stress on the
heart. It's performed similarly to a routine exercise stress test, but provides images that can show
areas of low blood flow through the heart and areas of damaged heart muscle.
A nuclear stress test usually involves taking two sets of images of your heart one set during an
exercise stress test while you're exercising on a treadmill or stationary bike, or with medication that
stresses your heart, and another set while you're at rest. A nuclear stress test is used to gather
information about how well your heart works during physical activity and at rest.
You may be given a nuclear stress test if your doctor suspects you have coronary artery disease or
another heart problem, or if an exercise stress test alone wasn't enough to pinpoint the cause of
symptoms such as chest pain or shortness of breath. A nuclear stress test may also be recommended
in order to guide your treatment if you've already been diagnosed with a heart condition.
Why it's done
Your doctor may recommend a nuclear stress test to:
Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that
supply your heart with blood, oxygen and nutrients. Coronary artery disease is a condition
that develops when these arteries become damaged or diseased usually due to a buildup
of deposits called plaques. If you have symptoms such as shortness of breath or chest pains,
a nuclear stress test can help determine if they are related to coronary artery disease.
Look at the size and shape of your heart. The images from a nuclear stress test can show
your doctor if your heart is enlarged and can measure the pumping function (ejection
fraction) of your heart.
Guide treatment of heart disorders. If you've already been diagnosed with coronary artery
disease, arrhythmia or another heart condition, a nuclear stress test can help your doctor
find out how well treatment is working to relieve your symptoms. It may also be used to
help establish the right treatment plan for you by determining how much exercise your
heart can handle

Risks
A nuclear stress test is generally safe, and complications are rare. But, as with any medical
procedure, it does carry a risk of complications.
Potential complications include:
Allergic reaction. It's possible you could be allergic to the radioactive dye that's injected into
a vein in your hand or arm during a nuclear stress test.
Low blood pressure. Blood pressure may drop during or immediately after exercise and
cause dizziness. It usually goes away when you stop exercising.
Abnormal heart rhythms (arrhythmias). Arrhythmias brought on by an exercise stress test
usually go away shortly after you stop exercising. Life-threatening arrhythmias are rare and
usually occur in individuals with severe heart disease.
Heart attack (myocardial infarction). Although very rare, it's possible that a nuclear stress
test could cause a heart attack.
Flushing sensation or chest pain. These symptoms can occur when you are given a
medication to stress your heart if you're unable to exercise adequately. These symptoms are
usually brief, but tell your doctor if you experience them.
How you prepare
You may be asked not to eat, drink or smoke for two hours before a nuclear stress test. You can take
your medications as usual, unless your doctor tells you not to.
If you use an inhaler for asthma or other breathing problems, bring it with you to the test. Make sure
your doctor and the health care team member monitoring your stress test know that you use an
inhaler.
Wear or bring comfortable clothes with you to the exercise stress test.
What you can expect
When you arrive for your nuclear stress test, your doctor asks you about your medical history and
how often you typically exercise. This helps determine the amount of exercise that's appropriate for
you during the stress test.
During a nuclear stress test
Before you start the test, a member of your health care team places sticky patches (electrodes) on
your chest, legs and arms. The electrodes are connected by wires to an electrocardiogram (ECG or
EKG) machine. The electrocardiogram records the electrical signals that trigger your heartbeats. A
blood pressure cuff is placed on your arm to check your blood pressure during the test.
If you're unable to exercise adequately, you may be injected with a medication that increases blood
flow to your heart muscle simulating exercise for the test.
You then begin walking on the treadmill or pedaling the stationary bike slowly. As the test
progresses, the speed and incline of the treadmill increases. A railing is provided on the treadmill
that you can use for balance, but don't hang on to it tightly, as that may skew the results of the test.
On a stationary bike, the resistance increases as the test progresses, making it harder to pedal.
The length of the test depends on your physical fitness and symptoms. The goal is to have your heart
work hard for about eight to 12 minutes in order to thoroughly monitor its function. You continue
exercising until your heart rate has reached a set target, you develop symptoms that don't allow you
to continue or warning signs are detected by those monitoring your test, including:
Moderate to severe chest pain
Severe shortness of breath
Abnormally high or low blood pressure
An abnormal heart rhythm
Dizziness
You may stop the test at any time if you are too uncomfortable to continue exercising.
Injection of dye
Once you've reached your maximum level of exercise, a radioactive dye called thallium or sestamibi
(Cardiolite) is injected into your bloodstream through an intravenous (IV) line, usually in your hand
or arm. This substance mixes with your blood and travels to your heart. A special scanner similar to
an X-ray machine which detects the radioactive material in your heart creates images of your
heart muscle. Inadequate blood flow to any part of your heart will show up as a light spot on the
images because not as much of the radioactive dye is getting there.
After exercising, you'll be asked to rest for two to four hours. During this time, you shouldn't eat or
drink anything or do any strenuous activities. After this time, you'll have a second set of images
taken of your heart while you lie on an examination table. Again, a technician will inject radioactive
dye through an IV and will take images of your heart. This second set of images will let your doctor
compare the blood flow through your heart while you're exercising and at rest.
After a nuclear stress test
When your nuclear stress test is complete, you may return to your normal activities for the
remainder of the day.

Results
Your doctor will discuss the results of your nuclear stress test with you. Your results could show:
Normal blood flow during exercise and rest. If the information gathered during your nuclear
stress test shows your heart function to be normal during both exercise and rest, it's unlikely
you have coronary artery disease. You may not need any further tests.
Normal blood flow during rest but not exercise. This means that part of your heart muscle
isn't receiving enough blood when you're exercising or doing other strenuous activity. This
may mean you have one or more blocked arteries (coronary artery disease).
Low blood flow during rest and exercise. This means that part of your heart isn't getting
enough blood flow at all times, which could be due to severe coronary artery disease or
previous heart attack.
Lack of radioactive dye in parts of your heart. Areas of your heart that don't show the
radioactive dye are areas that have damaged tissue (scar tissue) from a heart attack.
If your test results show you don't have enough blood flow through your heart, you may need to
undergo coronary angiography a test to look directly at the blood vessels supplying your heart. If
you have severe blockages, you may need a coronary intervention (balloon angioplasty and stent
placement) or open-heart surgery (coronary artery bypass).

Magnetic resonance elastography
Definition
Magnetic resonance elastography (MRE) is a new way to image the body. It works by combining MRI
imaging with sound waves to create a visual map (elastogram) showing the stiffness of body tissues.
MRE is used to detect hardening of the liver caused by many kinds of chronic liver disease. MRE also
has potential as a noninvasive way to diagnose diseases in other parts of the body.
MRE was invented at Mayo Clinic. The test is available there and at various other centers. It's usually
done as part of a conventional MRI exam.
Why it's done
MRE measures the stiffness of liver tissue in people with known or suspected liver disease. Liver
disease can result in scarring of the liver (fibrosis), which increases the stiffness of liver tissue.
Often, people with liver fibrosis don't experience any signs or symptoms. But untreated liver fibrosis
may progress to cirrhosis, which can be fatal. If diagnosed, liver fibrosis often can be treated to halt
progression and sometimes to reverse the condition.
Studies have shown that MRE is highly accurate at ruling out liver fibrosis. If you have liver fibrosis,
MRE can help your doctor gauge the severity of your liver disease, guide treatment decisions and
assess your response to treatment.
The traditional test for liver fibrosis uses a needle to extract a sample (biopsy) of liver tissue. MRE
offers several advantages:
It's noninvasive and generally safer and more comfortable than biopsy is.
It assesses the entire liver, not just the portion of liver tissue that is biopsied or imaged by
other noninvasive tests.
It can detect fibrosis at an earlier stage than can other imaging methods.
It's effective in people who are obese or who have fluid accumulation in the abdomen
(ascites).
Risks
The presence of metal in your body may be a safety hazard or affect a portion of the MRE image.
Before receiving an MRE, tell the technologist if you have any metal or electronic devices in your
body, such as:
Metallic joint prostheses
Artificial heart valves
An implantable heart defibrillator
A pacemaker
Metal clips
Cochlear implants
A bullet, shrapnel or any other type of metal fragment
Before you schedule an MRE, tell your doctor if you think you're pregnant. The effects of magnetic
fields on fetuses aren't well-understood. Your doctor may recommend choosing an alternative exam
or postponing the MRE.
How you prepare
Before an MRE exam, eat normally and continue to take your usual medications, unless otherwise
instructed. You will be asked to change into a gown and to remove:
Jewelry
Hairpins
Eyeglasses
Watches
Wigs
Dentures
Hearing aids
Underwire bras

What you can expect
MRE is usually done as part of a conventional MRI examination. A standard MRI liver examination
takes 30 to 45 minutes. The MRE portion of the test takes less than five minutes.
In MRE, a small pad is placed on the surface of your body. The pad emits low-frequency vibrations
that pass through your liver. The speed at which the vibrations pass through the liver is measured.
Vibrations travel faster through stiff tissue.
Results
After the MRE procedure, a computer program creates a color-coded map showing the stiffness in
your liver tissue.
A doctor specially trained to interpret MRE (radiologist) will analyze the images from your scan and
report the findings to your doctor. Your doctor will discuss any important findings and next steps
with you.

MRI
Definition
Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to
create detailed images of the organs and tissues within your body.
Most MRI machines are large, tube-shaped magnets. When you lie inside an MRI machine, the
magnetic field temporarily realigns hydrogen atoms in your body. Radio waves cause these aligned
atoms to produce very faint signals, which are used to create cross-sectional MRI images like
slices in a loaf of bread.
The MRI machine can also be used to produce 3-D images that may be viewed from many different
angles.
Why it's done
MRI is a noninvasive way for your doctor to examine your organs, tissues and skeletal system. It
produces high-resolution images that help diagnose a variety of problems.
MRI of the brain and spinal cord
MRI is the most frequently used imaging test of the brain and spinal cord. It's often performed to
help diagnose:
Aneurysms
Disorders of the eye and inner ear
Multiple sclerosis
Spinal cord injuries
Stroke
Tumors
Functional MRI of the brain (fMRI) can be used to identify important language and movement
control areas in the brain in people who are being considered for brain surgery.

MRI of the heart and blood vessels
An MRI that focuses on the heart or blood vessels can assess:
The size and function of the heart's chambers
Thickness and movement of the walls of the heart
The extent of damage caused by heart attack or heart disease
Structural problems in the aorta, such as aneurysms or dissections
Inflammation or blockages in the blood vessels

MRI of other internal organs
An MRI may be used to check for tumors or other abnormalities of many organs in the body,
including the:
Liver
Kidneys
Spleen
Pancreas
Uterus
Ovaries
Prostate
Testicles

MRI of bones and joints
MRI may be used to help evaluate:
Joint disorders, such as arthritis
Joint abnormalities caused by traumatic or repetitive injuries
Disk abnormalities in the spine
Bone infections
Tumors of the bones and soft tissues

MRI of the breasts
MRI may be used in addition to mammography to detect breast cancer, particularly in women who
have dense breast tissue or who may be at high risk of the disease.

Risks
The presence of metal in your body may be a safety hazard or affect a portion of the MRI image.
Before receiving an MRI, tell the technologist if you have any metal or electronic devices in your
body, such as:
Metallic joint prostheses
Artificial heart valves
An implantable heart defibrillator
A pacemaker
Metal clips
Cochlear implants
A bullet, shrapnel or any other type of metal fragment
Before you schedule an MRI, tell your doctor if you think you're pregnant. The effects of magnetic
fields on fetuses aren't well understood. Your doctor may recommend choosing an alternative exam
or postponing the MRI.
It's also important to discuss any kidney or liver problems with your doctor and the technologist,
because problems with these organs may limit the use of injected contrast agents during your scan.
How you prepare
Before an MRI exam, eat normally and continue to take your usual medications, unless otherwise
instructed. You will be asked to change into a gown and to remove:
Jewelry
Hairpins
Eyeglasses
Watches
Wigs
Dentures
Hearing aids
Underwire bras
What you can expect
During the test
The MRI machine looks like a tube that has both ends open. You lie down on a movable table that
slides into the opening of the tube. A technologist monitors you from another room. You can talk
with the person by microphone.
The MRI machine creates a strong magnetic field around you, and radio waves are directed at your
body. The procedure is painless. You don't feel the magnetic field or radio waves, and there are no
moving parts around you.
During the MRI scan, the internal part of the magnet produces repetitive tapping, thumping and
other noises. Earplugs or music may be provided to help block the noise. If you are worried about
feeling claustrophobic inside the MRI machine, talk to your doctor beforehand. You may receive a
sedative before the scan.
In some cases, a contrast material, typically gadolinium, may be injected through an intravenous (IV)
line into a vein in your hand or arm. The contrast material enhances the appearance of certain
details. The material used for MRIs is less likely to cause an allergic reaction than the material used
for CT scans.
An MRI can last up to an hour or more. You must hold very still because movement can blur the
resulting images.
During a functional MRI, you may be asked to perform a number of small tasks such as tapping
your thumb against your fingers, rubbing a block of sandpaper or answering simple questions. This
helps pinpoint the portions of your brain that control these actions.
After the test
If you haven't been sedated, you may resume your usual activities immediately after the scan.
Results
A doctor specially trained to interpret MRIs (radiologist) will analyze the images from your scan and
report the findings to your doctor. Your doctor will discuss any important findings and next steps
with you.


Mammogram
Definition
A mammogram is an X-ray image of your breast used to screen for breast cancer. Mammograms play
a key role in early breast cancer detection and help decrease breast cancer deaths.
During a mammogram, your breasts are compressed between two firm surfaces to spread out the
breast tissue. Then an X-ray captures black-and-white images of your breasts that are displayed on a
computer screen and examined by a doctor who looks for signs of cancer.
A mammogram can be used either for screening or for diagnostic purposes. How often you should
have a mammogram depends on your age and your risk of breast cancer.
Why it's done
Mammography is X-ray imaging of your breasts designed to detect tumors and other abnormalities.
Mammography can be used either for screening or for diagnostic purposes in evaluating a breast
lump:
Screening mammography. Screening mammography is used to detect breast changes in
women who have no signs or symptoms or observable breast abnormalities. The goal is to
detect cancer before clinical signs are noticeable.
Diagnostic mammography. Diagnostic mammography is used to investigate suspicious
breast changes, such as a breast lump, breast pain, an unusual skin appearance, nipple
thickening or nipple discharge. It's also used to evaluate abnormal findings on a screening
mammogram. A diagnostic mammogram includes additional mammogram images.
When to begin screening mammography
Experts and medical organizations don't agree on when women should begin regular mammograms
or how often the tests should be performed. Talk with your doctor about your risk factors, your
preferences, and the benefits and risks of screening. Together, you can decide what screening
mammography schedule is best for you.
Some general guidelines for when to begin screening mammography include:
Women with an average risk of breast cancer. Many women begin mammograms at age 40
and have them every one to two years. Professional groups differ on their
recommendations, with most, including the American Cancer Society, advising women with
an average risk to begin mammograms at age 40 and the U.S. Preventive Services Task Force
recommending women wait until age 50 to begin regular mammograms.
Women with a high risk of breast cancer. Women with a high risk of breast cancer may
benefit by beginning screening mammograms before age 40. Talk to your doctor for an
individualized program. Your risk factors, such as a family history of breast cancer, may lead
your doctor to recommend magnetic resonance imaging (MRI) in combination with
mammograms.
Risks
Risks and limitations of mammograms include:
Mammograms expose you to low-dose radiation. The dose is very low, though, and for
most women the benefits of regular mammograms outweigh the risks posed by this amount
of radiation.
Mammograms aren't always accurate. The accuracy of the procedure depends in part on
the technique used and the experience and skill of the radiologist. Other factors such as
your age and breast density may result in false-negative or false-positive mammograms.
Mammograms in younger women can be difficult to interpret. The breasts of younger
women contain more glands and ligaments than do those of older women, resulting in
dense breast tissue that can obscure signs of cancer. With age, breast tissue becomes fattier
and has fewer glands, making it easier to interpret and detect changes on mammograms.
Having a mammogram may lead to additional testing. Among women of all ages, about 10
percent of mammograms require additional testing, including additional imaging tests such
as ultrasound, and a procedure (biopsy) to remove a sample of breast tissue for laboratory
testing. However, most abnormal findings detected on mammograms aren't cancer. If you're
told that your mammogram is abnormal, ask the radiologist to compare your current
mammogram with any previous mammograms.
Screening mammography can't detect all cancers. Some cancers detected by physical
examination may not be seen on the mammogram. A cancer may be too small or may be in
an area that is difficult to view by mammography, such as your armpit. Mammograms can
miss 1 in 5 cancers in women.
Not all of the tumors found by mammography can be cured. Certain types of cancers are
aggressive, grow rapidly and spread early to other parts of your body.
How you prepare
To prepare for your mammogram:
Choose a certified mammogram facility. Ask whether the mammogram facility is certified
by the Food and Drug Administration. This certification will ensure that the facility meets
certain standards.
Schedule the test for a time when your breasts are least likely to be tender. If you haven't
gone through menopause, that's usually during the week after your menstrual period. Your
breasts are most likely to be tender the week before and the week during your period.
Bring your prior mammogram images. If you're going to a new facility for your
mammogram, gather any prior mammograms and bring them with you to your appointment
so that the radiologist can compare them with your new images.
Don't use deodorant before your mammogram. Avoid using deodorants, antiperspirants,
powders, lotions, creams or perfumes under your arms or on your breasts. Metallic particles
in powders and deodorants could be visible on your mammogram and cause confusion.
Consider an over-the-counter pain medication if you find that having a mammogram is
uncomfortable. Taking an over-the-counter pain medication, such as aspirin, acetaminophen
(Tylenol, others) or ibuprofen (Advil, Motrin IB, others), about an hour before your
mammogram might ease the discomfort of the test.
What you can expect
During the test
At the testing facility, you're given a gown and asked to remove neck jewelry and clothing from the
waist up. To make this easier, wear a two-piece outfit that day.
For the procedure itself, you stand in front of an X-ray machine specially designed for
mammography. The technician places one of your breasts on a platform and raises or lowers the
platform to match your height. The technician helps you position your head, arms and torso to allow
an unobstructed view of your breast.
Your breast is gradually pressed against the platform by a clear plastic plate. Pressure is applied for a
few seconds to spread out the breast tissue. The pressure isn't harmful, but you may find it
uncomfortable or even painful. If you have too much discomfort, tell the technician.
Your breast must be compressed to even out its thickness and permit the X-rays to penetrate the
breast tissue. The pressure also holds your breast still to decrease blurring from movement and
minimizes the dose of radiation needed. During the brief X-ray exposure, you'll be asked to stand still
and hold your breath.
After the test
After images are made of both your breasts, you may be asked to wait while the technician checks
the quality of the images. If the views are inadequate for technical reasons, you may have to repeat
part of the test. The entire procedure usually takes less than 30 minutes. Afterward, you may dress
and resume normal activity.
In the United State, federal law requires mammogram facilities to send your results within 30 days,
but you can usually expect to receive your results sooner. Ask the technician what you can expect.
Breast calcifications

Calcifications are small calcium deposits in the breast that show up as white spots on a
mammogram. Large, round, well-defined calcifications (left column) are more likely to be
noncancerous (benign). Tight clusters of tiny, irregularly shaped calcifications (right column) may
indicate cancer.

Results
Mammography produces mammograms black-and-white images of your breast tissue. Most
mammograms are digital images that appear on a computer screen. A radiologist interprets the
images and sends a written report of the findings to your doctor.
The radiologist looks for evidence of cancer or noncancerous (benign) conditions that may require
further testing, follow-up or treatment.
Possible findings include:
Calcium deposits (calcifications) in ducts and other tissues
Masses or lumps
Distorted tissues
Dense areas appearing in only one breast or one specific area on the mammogram
New dense area that has appeared since your last mammogram
Calcifications can be the result of cell secretions, cell debris, inflammation and trauma, among other
causes. Tiny, irregular deposits called microcalcifications may be associated with cancer. Larger,
coarser areas of calcification may be caused by aging or by a benign condition such as fibroadenoma,
a common noncancerous tumor of the breast. Most breast calcifications are benign, but if
calcifications appear worrisome, the radiologist might order additional diagnostic images with
magnification.
Dense areas indicate tissue that is more glandular than fatty, which can make calcifications and
masses more difficult to identify or differentiate from normal glandular tissue. Dense areas can also
represent cancer. Distorted areas suggest tumors that may have invaded neighboring tissues.
If the radiologist notes areas of concern on your mammogram, further testing may include
additional mammograms known as compression or magnification views, as well as ultrasound
imaging or a procedure (biopsy) to remove a sample of breast tissue for laboratory testing. Some
situations require the use of diagnostic magnetic resonance imaging (MRI) in areas where the
current imaging with mammography or ultrasound is negative and it's not clear what's causing a
breast change or abnormality.







Microalbumin test
Definition
A urine microalbumin test is a test to detect very small levels of a blood protein (albumin) in your
urine. A microalbumin test is used to detect early signs of kidney damage in people who have a risk
of kidney disease.
Healthy kidneys filter waste from your blood and keep the healthy components, such as proteins like
albumin. Kidney damage can cause proteins to leak through your kidneys and leave your body in
your urine. Albumin (al-BYOO-min) is one of the first proteins to leak when kidneys become
damaged.
Microalbumin tests are recommended for people with an increased risk of kidney disease, such as
those with type 1 diabetes, type 2 diabetes or high blood pressure.
Why it's done
Your doctor may recommend a urine microalbumin test to detect early signs of kidney damage.
Treatment for early kidney damage may prevent or delay more advanced kidney disease.
How often you need microalbumin tests depends on any underlying conditions and your risk of
kidney damage. For example:
Type 1 diabetes. If you have type 1 diabetes, your doctor may recommend a microalbumin
test once a year beginning five years after your diagnosis.
Type 2 diabetes. If you have type 2 diabetes, your doctor may recommend a microalbumin
test once a year beginning immediately after your diagnosis.
High blood pressure. If you have high blood pressure, your doctor may recommend regular
microalbumin tests. Discuss with your doctor how often to repeat this test.
If your urinary microalbumin level is elevated, your doctor may recommend more frequent testing.
How you prepare
The microalbumin test is a simple urine test. You can eat and drink normally before the test.
What you can expect
During the microalbumin test, you simply need to provide a fresh urine sample. This may be done in
several ways:
24-hour urine test. Your doctor may ask you to collect all of your urine in a special container
over a 24-hour period and submit it for analysis.
Timed urine test. Your doctor may ask you to provide a urine sample first thing in the
morning or after a four-hour period of not urinating.
Random urine test. A random urine test can be taken at any time. But to improve accuracy
of the results, it's often combined with a urine test for creatinine a waste product usually
filtered by the kidneys.
The urine sample is sent to a lab for analysis. After you provide the urine sample, you can return to
your usual activities immediately.
Results
Results of the microalbumin test are measured as milligrams (mg) of protein leakage over 24 hours.
Generally:
Less than 30 mg is normal
Thirty to 300 mg indicates early kidney disease (microalbuminuria)
More than 300 mg indicates more advanced kidney disease (macroalbuminuria)
Discuss your test result with your doctor and what it means for your health. If your urinary
microalbumin level is higher than normal, your doctor may recommend repeating the test.
Several factors can cause higher than expected urinary microalbumin results, such as:
Blood in your urine (hematuria)
Certain medications
Fever
Recent vigorous exercise
Urinary tract infection
Other kidney diseases

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