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1. 10 major health diseases and
treatments in USA

2. S.NO Title Pg.No
1. Dealing with the ANAL FISTULA
2. Stapedectomy – The Middle Ear Surgery
3. Breast Biopsy – News & Technology
4. Information about Angiography
5. Otoscopy in small animal practice
6. Pelvic Examination - What is happening today?
Cervical Cancer – The Pap smear and HPV Test
7.
combination
8. Laparoscopy and Endometriosis
9. Research on Appendicectomy
10. Anal fissures and fistulae

3. 1. Dealing with the ANAL FISTULA
When cavities of the body get abnormally associated, a fistula is formed. An example of
such a condition would be colostomy where a passageway is connected between the
abdominal wall and the colon. Such a connection can also occur between the anus and
other parts of the body like the intestinal lining or the vagina or the outer skin surface.
Each of these may be termed as an anal fistula.
What are the symptoms?
A tunneling of the body cavity can be observed in this medical state. Due to this abscess
or pus may be formed near the anal canal. Lesions may also occur and in some cases,
these may be filled with body fluids like excretory material. In these cases, natural
healing is difficult and medical aid has to be sought for. The individual may also
experience pain in the lower abdomen and near the anus. Change in body temperature,
itching and general fatigue can be noticed in patients. However, severity may vary from
person to person and hence it is important to discuss any discomfort with your healthcare
expert. Nowadays, many online doctors are also available who can promptly help and
assist you.
Why does it occur?
The anal fistula can occur for various reasons like injury or digestive diseases. Injury due
to constipation or infection in the lining of the anus can lead to this medical state. Besides
this there are two diseases in which these types of fistulae mainly form – the first would
be the Crohn’s disease and the second includes Ulcerative colitis. Discharge with foul
odor and accumulation of pus are commonly noticed.
What are the tests and surgeries for cure?
Some of the tests which are used to treat and examine an anal fistula are – the Barium
enema test, colonoscopy or a sigmoidoscopy procedure. Sometimes, an upper endoscopic
procedure may be carried out. Further, the examinations that are used to understand
inflammatory bowel diseases can be used here, to study the fistula.

4. The main method to confirm the condition is Fistulogram test. Here, X-ray photography
of the affected area is carried out after a radiant dye is injected into the body. The exact
presence of the abnormality can be recorded by this method.
After the medical procedures, the patient can heal and restore a healthy living in a few
weeks. Appropriate medication must be taken. The diet plan should be followed as per
your healthcare expert’s advice along with a healthy lifestyle.
2. Stapedectomy – The Middle Ear Surgery
Stapedectomy is the surgical procedure for the removal of the innermost bone of the
middle ear. There are three bones in the middle ear – incus, malleus and stapes. The
stapes is the innermost bone and stapedectomy is the procedure to remove this bone and
replace it with prosthesis. The prosthesis is a small plastic tube surrounding a small
stainless steel wire. The history of this procedure dates back to 1956 as the first operation
was performed then.
Stapedectomy procedure needs to be to improve the movement of sound to the inner ear.
The hearing loss is caused progressively by a condition called otosclerosis, wherein the
spongy bones at the base of stapes hardens and it does not vibrate properly as the stapes
is fixed to the opening of the inner ear. Otosclerosis can also affect the bone that
surrounds the inner ear, the malleus and the incus. If this condition is ignored, it may also
result into total deafness of both the ears.

5. This surgery does not include any incisions on the outer body as it is performed inside the
ear canal. After administering the local or general anesthesia, the eardrum is folded
forward and the ear canal is opened. The surgeon views the inside of the canal with the
operating microscope to observe the structures in detail and evaluate the ossicles (bones
for hearing) to confirm the diagnosis for otosclerosis. Then the stapes is separated from
the incus so that the malleus and the incus can be moved independently when pressed. A
drill or laser may be used in cutting through the tendon and arch of that bone to be
removed from the middle ear.
The prosthesis is clipped to the incus bone by making a tiny opening by directing the
laser beam at the window which joins the middle and inner ear and poses as a platform
for the stapes bone. The hole in the window is later sealed by taking a piece of tissue
from behind the earlobe by incision. The eardrum is then repaired and replaced and held
there by an ointment or gelatin sponge. This whole procedure almost amounts to 1.5 to 2
hours. More information can be obtained by watching medical videos of stapedectomy
online.
This surgery should be opted for by those who have fixed stapes from otosclerosis and a
conductive hearing loss of at least 20 db. Those who cannot hear at all can benefit only if
the surgery improves their hearing to the extent that a hearing aid can be useful for them.
The success rate of this procedure is almost 90%.

6. 3. Breast Biopsy – News & Technology
Medical news about breast biopsy says that many unnecessary biopsies are done by the
surgeons and that figure amounts to 600,000 women. A study suggested that out of 1.6
million women who get biopsies done annually, around 600,000 get it done
unnecessarily. Most of the doctors suggest invasive surgery which is three times more
expensive. But the doctors reason that it has the best diagnostic accuracy.
A needle biopsy is done under local anesthesia, leaves a tiny scar and costs about $1,000
to $2,000. It rarely misses lesions. A surgical biopsy requires sedation and stitches, and
costs about $5,000 to $6,000. And it leaves a bigger scar. With about 90 percent of
abnormal mammograms turning out to be benign, the most minimally invasive approach
makes the most sense.
There are also new medical products and services in the market coming up for breast
biopsy procedure. There is a new and lesser-known technology ‘microbubbles’ combined
with ultrasound which can help patients with early stages of cancer in detecting
treatments and saving them from another breast surgery. To check the spread of cancer,
there is a sentinel lymph node biopsy but ultrasound cannot pick up those from the usual
nodes. A study says that microbubble contrast- enhanced ultrasound accurately identifies
the sentinel lymph node in 89% of the 80 patients studied. Mostly 35% of patients who
undergo sentinel lymph node excision biopsy will require additional surgery because
cancer has spread. Using microbubble contrast-enhanced ultrasound preoperatively
means that the cancer and cancer spread can be removed during one operation.
The current technology to identify the sentinel lymph nodes at the time of surgical
excision are blue dye and radioisotopes. However accurate it may be, this procedure has

7. allergic reactions and side-effects for some patients and the disposal of the radioisotopes
(radioactive waste) also becomes a problem.
Ultrasound is widely accessible and it is said that microbubble enhancement is a real time
examination which shows the bubbles trafficking through the breast lymphatics and into
the sentinel lymph node. The study conducted has confirmed that this technique can
accurately identify the sentinel lymph node, and it would be considered using this
imaging technology to determine if it can be combined with less invasive biopsy
techniques, avoiding the need for a surgical sentinel lymph node biopsy completely.
However, it has to be noted that the use of microbubbles is restricted in the United States
and is currently not approved for use with breast cancer patients.
Kenneth Haines at Docturs.com/dd has explained in detail about what is biopsy, Breast
biopsy procedure, indications and types like breast needle biopsy, fine needle aspiration
etc. for a better awareness about breast biopsy on the medical vertical Docturs.
4. Information about Angiography
Heart diseases are becoming so common today that the term angiography is no more a
medical jargon. Angiography is also known as arteriography and it is the imaging
technique to visualize the inside, particular the arteries, veins and heart chamber.
Docturs.com/dd offers detailed explanation on angiography procedure and its types and
risks.
The medical news about angiography is that the medical procedure was documented on
film by the patient himself who was being operated upon and it won the BT Northern

8. Ireland Press Photographer of the Year. The patient was given local anesthesia as he
needed to stay awake and follow doctor’s instructions like taking deep breaths, cough or
place their arms in various positions. Not exactly medical, but this trivia talks about the
use of anesthesia in the angiography procedure.
The angiography first started with corrective bypass surgeries which have now
progressed to the modern angioplasties and angiographies. Huge investments have been
made behind these procedures to derive minimally invasive and innovative methods for
the treatment of diseases. Angiography diagnoses cardiac diseases and reveals its
complexity and the need for further surgical requirements. It can either be coronary artery
bypass graft or modern angioplasties, requiring less time for operating and healing.
Angiography can be done for various parts of the body and hence they are of various
types like extremity angiography, retinal angiography, cerebral angiography, renal
angiography, coronary angiography, lymph angiography, pulmonary angiography. There
are also different techniques like CT angiography, MR angiography and catheter
angiography.
The catheter angiography is the most traditional kind of angiography, first to be
introduced and dominant since its introduction. It includes the passing of catheter in the
blood vessel leading to the desired area and injecting a contrast material for highlighting
the diseased portion. The most commonly used catheters are Flush Catheters, Access
Catheters, Sizing Catheters and others. MRA – Magnetic Resonance Angiography
includes producing detailed pictures with the effect of radio waves in strong magnetic
field. CTA – Computer Tomography Angiography uses X-rays and computerized
analysis to produce high quality and detailed images, being minimally invasive, less time
consuming and cost effective.
All these types of angiographies have their own pros and cons. The major drawback with
catheter angiography is that it is invasive and so it always has an element of risk involved
with it. Catheter angiography is painful and is very highly priced when compared to the
other techniques of angiography. But the major advantage of this technique is that it can
be used for all type of patients and for all body parts. MRA and CTA are both cost
effective and painless. Thus these two new techniques are increasingly becoming a threat
to traditional catheter angiography. Some of the drawbacks are that MRA cannot be used
where patients have some iron objects inside their bodies. This is because the magnetic
field may be disturbed due the presence of these objects and could result in blurred
images. The drawback with CTA is that it cannot take detailed images of completely
blocked and crowded vessels.
These methods have certain drawbacks that are undergoing further research for
overcoming them to help their markets grow drastically. Docturs.com/dd is a medical
vertical offering updates about all such studies and researches for better health awareness.
5. Otoscopy in small animal practice

9. Otoscopy is the medical procedure of viewing the inside of the ear lining with the help of
an instrument called otoscope or auriscope. But one might not know that this same
procedure also takes place in animals, also known as veterinary otoscopy.
Docturs.com/dd offers information on otoscopy and a detailed explanation of the
procedure.
The otoscopy procedure basically includes visual examination of the ear canal by
inserting the otoscope in the ear. This procedure is also carried out in animals by
veterinarians. The endoscopic examination most frequently carried out on small animals
is the inspection of the acoustic meatus, called otoscopy. This method is easily accessible
and is seen seldom in cats but the disease of the acoustic meatus is seen mostly in dogs.
Not only the diagnosis but the treatment can also be done, like the removal of foreign
bodies or therapeutic measures such as irrigation/aspiration via the examination sheath
with a 3-way stopcock adapter. In case of video-otoscopy, which is mainly prevalent
today, the treatment can be checked, stored in the patient file and therefore also displayed
for the animal owner when establishing a diagnosis.
Online doctors also inform about the latest technical development in the diagnosis and
management of chronic ear disease in dogs and cats. There are various ear clinics
available which use video-otoscopy. The technique of video-otoscopy utilizes magnified
camera lens to examine in depth, the middle ear, ear drum and ear canal. Foreign objects
and tumors in the ear canal, infection of middle ear or abnormalities of eardrum can also
be identified easily. Video otoscopy is also valuable in enabling the veterinarians to
accurately diagnose and treat chronic otitis in animals.

10. Acute and chronic otitis externa and otitis media are common disorders in dogs and cats.
Alongwith other diagnostic and therapeutic procedures, video-otoscope is also useful and
effective for the management of clinical cases. Video-otoscopy provides enhanced
illumination and magnification which helps to get more detailed information for
diagnosis and prognosis, improves efficiency of cleaning procedures, and decreases risks
of iatrogenic injury to the middle and inner ear structures. With the help of this technique,
the clinical cases have photographic documentation which enhances the medical record,
communication with colleagues, and client education. However, this technique also has
some cons like it does not replace other important diagnostic tests such as evaluation for
atopy, adverse food reactions, and immune-compromising disease. The treatment fails is
the primary cause is not found, irrespective of what technique is employed.
Docturs.com/dd is medical vertical offering important medical information and updates
for a better and healthy living.
6. Pelvic Examination - What is happening today?
Pelvic examination has been a routine for many women worldwide over the years. But
are they aware that this routine is becoming obsolete or that it is being done without
consent at many places. Women are also not aware about the new guidelines for the
pelvic exam and so Docturs.com/dd brings you all the latest information and updates for
a better medical awareness.
The previous guidelines stated that the patients should be informed when the medical
students perform a pelvic exam on the patient under anesthesia. The new guidelines go
further to ensure patient consent is explicit. It is true that many women are not aware
about a pelvic examination being performed on then, and some are not even informed

11. after the surgery. Though this is now forbidden in US, the practice is still carried out in
Canada.
According to the new rules, medical students must introduce themselves to all patients
they'll be caring for and identify their role as medical students. Patients undergoing
gynecologic surgery are required to be explained the role of a pelvic exams during the
procedure and know it may be performed by members of the surgical team, including
medical students. Consent must always be given voluntarily, non-discriminatory, and
must not be coerced, the rules state.
The pelvic examinations are getting obsolete according to the latest medical news as
there have been convincing arguments about why is not needed too often. The basic
reason for having a pelvic exam done is the early detection of ovarian and cervical
cancer, Chlamydia and for hormonal birth control, which can be inspected with cheaper
methods also. The bimanual exam or the ultrasounds or the blood tests do not help in
early detection of ovarian cancer and till a reliable method for early detection is not
found, it is better to educate the women about its symptoms like pelvic pain and bloating.
Chlamydia testing also has an option as a urine sample or a self-administered vaginal
swab works like a speculum exam and is also cheaper. Except for an IUD or a diaphragm,
there is no medical reason for a pelvic exam for prescribing oral contraceptives. During a
pelvic exam, a doctor collects cervical cells, which can be "co-tested" for pre-cancerous
cellular changes (via the Pap) and, in women between 30 and 65, for HPV. A large study
of 330,000 women determined that the three-year intervals for Pap/HPV co-testing is,
indeed, medically sound. This shows that very regular pelvic exams are not a must.
Docturs.com/dd is a medical vertical spreading awareness about health topics fir a better
and healthy living.
7. Cervical Cancer – The Pap smear and HPV Test combination
Many women in America are affected by cervical cancer. Nevertheless, there are equal or
greater numbers of women who are not affected by the disease but are still rigorously
tested. There is no doubt that the pap smear tests are recommended for all girls who have
crossed puberty, but the question that persists is whether such testing is frequently
required and whether our women and doctors are well-briefed about the same.
Cervical cancer is one of the diseases caused by a virus of the papillomavirus family of
viruses called the Human Papillomavirus. This virus has almost 200 types and generally
causes no symptoms in people. Some of the HPV viruses cause symptoms like warts
while others are responsible for cancers of the vagina, vulva or cervix in females.
However, one very important point is that this virus is very common in the surroundings
almost like common cold and in most cases the bodies of young girls destroy it and deal
with the infection quite effectively. It is only when the infection is harbored for more than
a year or so, that risks may be developed.

12. A doctor must hence be very careful in recommending tests and check-ups for a young
girl. If the girl’s body is tested positive for the presence of HPV, then following the
results extensive tests and treatments may be administered by the practicing medical
professional. But such treatments may result in weakening of the cervix rendering it
incapable of carrying forth a successful pregnancy and childbirth in future. Keeping in
mind such factors there are a few guidelines that healthcare experts have come up with –
1. Girls in the twenties bracket should be test for HPV only after a positive pap test
2. A combination of the Pap smear and HPV test should be done only on women
older than 30 years.
The Centers for Disease Control in the U.S. Department of Health And Human Services
has gone further to set one more thumb rule so that women can lead safer lives without
the risks of adverse effects of testing. This would bring us to the 3 point:
3. As listed on the official document issued by CDC “1 woman + 2 negative tests =
3 years” which means if the Pap Smear and HPV tests are negative for a woman,
then she can refrain form getting tested for cervical cancer for three whole years!
Such a proscription is medically proven by the fact that cervical cancer is a cancer that
grows very slowly. In most cases, women far from chances of developing a cancer are
repeatedly tested for it. Staying abreast with medical news and research is hence
important for doctors and patients alike. Moreover, the HPV test is not here to replace
Pap smear tests for cervical cancer as both are equally important. The latter is a
preliminary test while the former is a confirmatory test which can guide subsequent
treatment when needed.
8. Laparoscopy and Endometriosis

13. Laparoscopy also has other names and is alternatively known as MIS-minimally invasive
surgery, keyhole surgery or band-aid surgery and it is a modern surgical technique for
operating the abdomen by making relatively small incisions than the ones required in
laparotomy.
Laparoscopic surgeries consist of operating within the abdominal and pelvic cavities and
keyhole surgery uses images that are displayed on the monitor screens so that the surgical
elements are magnified. The keyhole surgery performed on chest or thoracic cavity is
called thoracoscopic surgery and both these, laparoscopic and thoracoscopic come under
the umbrella term endoscopy. The patient is at advantage under a laparoscopic surgery
than under an open surgery as the former includes smaller incisions and hemorrhaging,
less pain and less recovery period.
There are various kinds of laparoscopies and endometriosis is one of them. Endometriosis
laparoscopy is also a kind of laparoscopy which proves to be better than an ultrasound.
Though it helps in finding signs of endometriosis, sometimes it does not pick up some
nodules, which is an indication of problem. So the next action to be taken is an
endometriosis laparoscopy to know the actual condition and problem.
Laparoscopy is very useful in different fields of medicine and it works like an eye of the
doctor inside the body without being invasive. Laparoscopy is done through an
instrument called laparoscope which also has a tiny camera attached to it which can be
inserted in the body through tiny opening from incision. The laparoscope also has a light
which helps in exploratory services and other like gastric bypass. This helps in lessening
the recovery time for many patients.
Endometriosis laparoscopy includes making an incision in the belly button, administering
either general or local anesthesia. The laparoscope is inserted and carbon dioxide gas is

14. dispended in the abdominal cavity so that it inflates and doctors can have a better view of
the inside and also the others assisting him. Then there is exploration of all the suspected
areas of endometric growth.
Sometimes, laparoscopic surgeries are done to watch the existing condition of the
abdominal cavity and sometimes for the removal of the abnormal endometriosis growth.
Removal is also possible with less incisions but it can also happen that more incisions are
needed to remove tissues from the body for the purpose of biopsy. The incisions are
mostly made down the pubic area or the bikini area. The physician should always explore
all the possibilities for the optimum outcomes and help for the same can be also yaken
from online doctors.
9. Research on Appendicectomy
An appendicectomy, also known as appendectomy or appendisectomy, is the surgical
process for the removal of appendix. The surgery for appendicitis takes place when the
patient is suffering from severe appendicitis and mostly is an emergency procedure.
When the surgical facilities are absent, antibiotics are given intravenously and used to
delay or avoid the start of sepsis and so it is now known that many cases can be resolved
without any operation. There are some cases in which appendicitis resolves completely
and there is an inflammatory mass which forms around the appendix. This is a relative
contraindication to surgery. Appendicectomy procedure may be performed as a
minimally invasive surgery – laparoscopically or as an open surgery.
Appendix surgery can be done laparoscopically specially in children, for uncomplicated
appendicitis and less post-operative pain and a shorter hospital stay. On comparing the
recovery after laparoscopic appendectomy and open surgery in children, it was seen that
children had less pain with the former one. Standardized anesthetic technique and pain
management was used. The study endpoints were postoperative pain, need for rescue
analgesia, and length of hospital stay. Those with an open surgery developed a wound
infection later. The study concluded that laparoscopic appendectomy is better than open
surgery.
Also, treating acute appendicitis with antibiotics is not as effective as appendicectomy
has been the latest medical news. They found that peritonitis was significantly more
frequent in the antibiotic group than the appendicectomy group and it is hence concluded
that emergency appendectomy is the best option.

15. Appendectomy is the best option for acute appendicitis compared to the antibiotics as was
concluded by a research study. Though appendicitis could be cured by antibiotics, the
study was conducted and its endpoint was occurrence of post-intervention peritonitis
within 30 days of treatment initiation. The researchers found that 30-days post-
intervention, peritonitis was significantly more frequent in the antibiotic group (8%) than
in the appendisectomy group (2%). There is also a point to consider that antibiotic
resistance could be why treatment failed in some cases, and that a different antibiotic
could produce better results in those cases.
There have also been researches reporting evidence supporting the benefits of
appendectomy as a therapy for ulcerative proctitis. It found that 40% of patients
experienced a complete resolution of their symptoms after appendicectomy.
The researchers found no significant associations between the likelihood of symptom
resolution of ulcerative proctitis after appendectomy and age, gender, duration of
symptoms before appendectomy, appendiceal histology, or the presence of appendiceal
orifice inflammation. More information about surgery of appendix can be obtained by
watching video of surgery online, for a better awareness.
10. Anal fissures and fistulae
Anal fissures and fistulae are not very common but when they occur, they become a
painful and unpleasant condition. Rectal tearing is distressing and highly resistant to
treatment and everybody endures it at some point in their life. This tear in the lining of
the anus or the skin around it is called anal fissure. Fistulae are the abnormal channels
from the anus which open onto the skin surrounding the anus.
Anal fissure and fistula have no specific causes but constipation is commonly associated
with them. They are also associated with a number of conditions resulting in an
inflammatory digestive tract. These conditions may be Crohn’s disease or ulcerative

16. colitis or many more. Fistula is caused by collection of pus called abscess or infection, in
one of the glands near anus and it may also result in multiple anal fissures.
The fistula symptoms and complications for anal fissure may be sudden and severe pain
in the anus or the surrounding area. The pain may occur spontaneously or during or
shortly after the passage of a hard stool. The pain is recurring and sharp and gets worse
with a bowel movement. Due to this, the victims avoid opening the bowels which
worsens the constipation and so the fissure takes more time in healing. This condition is
also associated with ‘sentinel pile’, a haemorrhoid - a small vein from inside the anus
lying outside- which may bleed sometimes and leave a blood streak on toilet paper.
Anal fistula is generally associated with painful abscess, which may be dull and
throbbing, in or near the anus. The abscess has a pus discharge which may be blood-
stained. The fistula formation results in continuous seeping of pus or a thin, watery fluid
from the anus, which can also be blood-streaked. Large abscesses may also cause fever.
Fistula symptoms may also be loss of appetite, abdominal pain, vomiting, nausea,
diarrhea, fever and weight loss.
Anal fissure and fistula need care and treatment. The care to be taken is firstly having a
fiber rich diet with fruits and vegetables which prevents the fissures occurrence and
fastens the healing process. Medications are also used if healthy diet is not sufficient, for
controlling constipation, with over-the-counter medicines. Creams or ointments that
contain pain-killing local anesthetic agents are very useful at relieving the pain of anal
fissures. Relief of the pain reduces the spasm in the muscles of the anus, which often
prevents the fissure from healing.

17. Reference:
1. Anal Fistula :- http://docturs.com/dd/pg/groups/11182/anal-fistula/
2. Breast Biopsy :- http://docturs.com/dd/pg/groups/11280/breast-biopsy/
3. Stapedectomy:- http://docturs.com/dd/pg/groups/11314/stapedectomy/
4. Otoscopy :- http://docturs.com/dd/pg/groups/2512/otoscopy/
5. Pap Smear :- http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
6. Anal Fissure :- http://docturs.com/dd/pg/groups/11174/anal-fissure/
7. Appendectomy:- http://docturs.com/dd/pg/groups/11216/appendicectomy/
8. Laparoscopy :- http://docturs.com/dd/pg/groups/2408/laparoscopy-examination-
of-the-abdomen-and-pelvis/
9. Cervical Cancer:- http://docturs.com/dd/pg/groups/15901/cervical-cancer/
10. Pelvic Exam :- http://docturs.com/dd/pg/groups/2369/pelvic-examination/
11. Latest Medical News :- http://docturs.com/dd/
12. Angiography :- http://docturs.com/dd/pg/groups/2355/angiography/

18. Thank you