Gynecology ; Orthopaedics ; Anesthesiology ; Surgery ; Otorhinolaryngology ; Ophthalmology ; Dermatology
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Bibliographic Information
Gynecology ; Orthopaedics ; Anesthesiology ; Surgery ; Otorhinolaryngology ; Ophthalmology ; Dermatology
（Geriatrics, 3）
Springer, 1984
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Includes bibliographies and indexes
Description and Table of Contents
Description
Volume 3 of this series is concerned with geriatric aspects of surgical specialties: gynecology, orthopedics, general surgery, otorhinolaryn- gology, and ophthalmology. Closely associated with these specialties is anesthesiology. Dermatology has an intermediate position between surgical and nonsurgical fields. The peculiarities of physiological and pathological aging of otgans and the consequences for diagnosis and therapy - presented in the first two volumes - are of great significance, especially for surgical special- ties. There are a large number of pre-, intra-, and postoperative problems in multimorbid geriatric patients, e. g. , coronary insufficiency, brady- arrhythmias, hypertonia, and hypotonia. While as recently as the tum of the century the age of 65 years was viewed as a contraindication for sur- gery, today even older patients undergo operations on aortic aneurysms, bypass operations for coronary sclerosis, pulmonary resections, and abdominosacral resections of rectal carcinomas, for example. Pre- requisite for successful surgery at an advanced age is good pre- and postoperative care of multimorbid patients.
Physiological changes of the lungs with aging, the increased frequency in pneumonia and pulmonary just a few embolisms with age, and the decrease in receptors, to give examples, confront anesthetists with difficulties. The maxim "in old age a little less" is also applicable in this field. Only improved experimental gerontological research, possibly reaching even into anesthesia, will provide objective data for anesthesia in elderly patients. The skin is an organ that experiences characteristic qualitative and quantitative changes in old age.
Table of Contents
Gynecology.- Pre- and Postmenopause.- A. The Premenopause.- B. The Menopause.- I. Causes of the Climacteric.- II. Consequences of Estrogen Decrease.- III. Treatment.- 1. Indications.- 2. Contraindications.- 3. Preparations.- 4. Therapeutic Effectiveness.- 5. Dose.- a) Genital Atrophy.- b) Psychotropic Effects.- c) Osteoporosis.- d) The Skin.- 6. Side Effects.- 7. Costs.- 8. Risks.- a) Vascular Complications.- b) Mortality.- 9. Risk: Benefit Ratio.- 10. Controls.- 11. Duration of Treatment.- 12. Summary of Treatment Recommendations.- C. Cancers.- I. Cancer of the Vulva.- 1. Symptoms.- 2. Diagnosis.- 3. Staging.- 4. Treatment and Prognosis.- II. Cancer of the Vagina.- 1. Premalignant Lesions.- 2. Malignant Lesions.- a) Symptoms and Diagnosis.- b) Treatment.- 3. Secondary Cancer of the Vagina.- III. Cancer of the Cervix Uteri.- 1. Symptoms.- 2. Diagnosis.- 3. Staging.- 4. Treatment.- 5. Radiation Therapy.- 6. Cervical Stump Carcinoma.- 7. Results of Treatment.- 8. Recurrence.- IV. Cancer of the Corpus Uteri.- 1. Premalignant Changes in the Endometrium.- 2. Dysplasia of the Endometrium.- a) Treatment.- 3. Malignant Neoplasms of the Endometrium.- a) Signs.- b) Diagnosis.- c) Staging.- d) Recurrence.- e) Results of Treatment.- 4. Sarcoma of the Uterus.- V. Cancer of the Fallopian Tubes.- 1. Symptoms and Diagnosis.- 2. Treatment.- 3. Prognosis.- VI. Malignant Tumors of the Ovaries.- 1. Estrogen-Producing Ovarian Tumors.- 2. Arrhenoblastoma.- 3. Primary Malignant Ovarian Tumors.- 4. Metastatic Ovarian Carcinomas.- 5. Clinical Aspects.- a) Symptomatology.- b) Differential Diagnosis.- c) Treatment.- d) Prognosis.- e) Follow-up.- VII. Cancer of the Mammary Glands.- 1. Etiology.- 2. Morphology.- 3. Symptoms.- 4. Diagnosis.- 5. Therapy.- 6. Hormones.- 7. Cytostatic Therapy.- 8. Prognosis.- References.- Epidemiology: Some Aspects of the Climacteric Woman.- A. Introduction.- B. International Definitions of the Climacteric Period.- C. Age at Menopause.- D. Epidemiology: Duration of the Reproductive Stage (Climacteric menstrual patterns).- E. Genital Changes in the Postmenopausal Period.- F. Extragenital Symptoms and Complaints.- I. Influences on the Incidence of Complaints.- References.- Orthopaedics.- Orthopaedics in the Elderly.- A. Introduction.- B. Fractures Near the Hip: the Problem.- I. Social Status of the Patient.- II. The Clinical Manager.- III. Treatment.- IV. The Geriatric Orthopaedic Team.- V. Admission Procedures.- VI. Anaesthesia.- VII. Operation.- 1. Femoral Neck Fractures.- 2. Trochanteric Fractures.- 3. Sepsis.- 4. Bleeding and Haemostasis.- 5. Length of Operation.- 6. Transfusion.- VIII. Bedsores.- IX. The Bladder.- X. The Rectum.- XI. Acetabular Erosion.- XII. Medical Complications.- C. Fractures in General.- I. The Lower Limb.- 1. Fractures of the Femoral Shaft.- 2. Fractures of the Patella.- 3. Fractures of the Tibia.- 4. Fractures of the Ankle and Foot.- II. The Pelvis and Trunk.- 1. Pelvis.- 2. Spine.- III. The Arm.- 1. Neck of Humerus.- 2. Dislocation of the Shoulder.- 3. The Elbow.- 4. The Colles' Fracture.- D. Outpatient Management of Fractures in Elderly Patients.- E. Pathological Fractures and Metastatic Paraplegia.- F. Radiculography.- G. Scintigraphy.- I. Metastatic Deposits.- II. The Loose Prostesis.- III. Stress Fractures.- H. Computer Assisted Tomogfaphy.- J. Spinal Stenosis.- K. The Practical Management of Arthroplasties in the Elderly.- I. The Programme.- II. The Assessment Clinic.- III. Admission.- IV. Skin Preparation.- V. The Clean Air Theatre.- VI. The Operation.- VII. Physiotherapy in the Recovery Room.- VIII. Infection.- IX. Care After Operation.- L. Conclusion.- References.- Anesthesiology.- Anesthesia.- A. Introductory Remarks.- B. Changes of Aging: Anesthesiologic Aspects.- I. Cardiovascular System.- II. Respiratory System.- III. Brain.- IV. Other Organs.- V. Pharmacology.- 1. Pharmacokinetics.- 2. Pharmacodynamics.- C. Hazards of Anesthesia and Surgery.- I. Preoperative Status.- 1. Quantification of the Anestetic Risk.- 2. Prediction of Cardiovascular and Pulmonary Risks.- II. Surgical Procedure.- 1. Nature of the Operation.- 2. Repeat Operations.- 3. Duration of Anesthesia and Surgery.- 4. Elective vs Emergency Surgery.- III. Anesthesia.- D. Preoperative Management.- I. Diagnosis and Treatment of Preexisting Disease.- 1. Cardiovascular System.- 2. Preoperative Cardiac Therapy.- 3. Respiratory System.- 4. Fluid and Electrolyte Balance.- II. Premedication.- E. Anesthetic Management.- I. Regional Anesthesia.- II. General Anesthesia.- III. Monitoring.- F. Postoperative Care.- I. Circulatory Complications.- II. Respiratory Disorders.- References.- Surgery.- Gastrointestinal Surgery in the Elderly.- A. Introduction.- B. Hiatus Hernia and Reflux Oesophagitis.- C. Carcinoma of the Oesophagus.- D. Carcinoma of the Stomach.- E. Peptic Ulceration.- I. Gastric Ulceration.- II. Duodenal Ulceration.- F. Gallstones.- I. Cholelithiasis.- II. Choledocholithiasis.- III. Cholelithiasis and Choledocholithiasis.- IV. Complications of Gallstones.- 1. Acute Pancreatitis.- 2. Carcinoma of the Gallbladder.- G. Carcinoma of the Pancreas.- H. Carcinoma of the Periampullary Region.- J. Carcinoma of the Large Intestine.- Pulmonary and Oesophageal Surgery in the Elderly.- A. Pulmonary Surgery.- I. Introduction.- II. Carcinoma of the Bronchus.- 1. Pathology.- 2. Staging.- 3. Presentation.- a) Symptoms.- b) Febrile Chest Illness.- c) Unusual Manifestations.- d) Asymptomatic Lesions Discovered on Routine Chest Radiography.- 4. Diagnostic Investigations.- a) Radiology.- b) Cytology.- c) Bronchoscopy.- d) Mediastinoscopy.- e) Percutaneous Lung Biopsy.- f) Pleural Biopsy.- g) Exploratory Thoracotomy.- 5. Assessment.- a) General Condition.- b) Heart and Circulation.- c) Respiratory System.- d) Kidney.- e) Liver.- f) Metabolism.- g) Summary.- 6. Preoperative Treatment.- 7. Choice of Operation.- 8. Postoperative Management.- 9. Palliative Treatment.- 10. Summary.- III. Empyema.- 1. Treatment.- 2. Acute Empyema.- 3. Intercostal Drainage.- 4. Rib Resection and Drainage.- IV. Spontaneous Pneumothorax.- V. Emphysematous Cysts.- VI. Retrosternal Goitre.- VII. Chest Trauma.- B. Oesophageal Surgery.- I. Introduction.- 1. Assessment.- 2. Radiographic Examination.- 3. Endoscopy.- 4. Manometry and pH Studies.- II. Carcinoma of the Oesophagus.- 1. Pathology.- 2. Symptoms.- 3. Clinical Assessment.- 4. Preoperative Management.- 5. Treatment by Resection.- a) Carcinoma of the Cardia.- b) Carcinoma of the Lower Third of the Oesophagus.- c) Carcinoma of the Middle Third of the Oesophagus.- d) Carcinoma Above the Aortic Arch.- e) Transhiatal Oesophagectomy Without Thoractomy.- 6. Postcricoid Carcinoma.- 7. Postoperative Management.- 8. Nonresectable Carcinoma.- 9. Radiotherapy.- III. Hiatus Hernia and Gastro-Oesophageal Reflux.- 1. Management.- 2. Antireflux Fundoplication Operation.- IV. Strictures.- V. Neuromuscular Disorders of the Oesophagus.- VI. Pharyngeal Diverticulum.- 1. Operation.- VII. Intrathoracic Oesophageal Pulsion Diverticulum.- VIII. Achalasia of the Oesophagus.- 1. Preoperative Oesophagoscopy.- 2. Treatment.- 3. Preoperative Treatment.- IX. Diffuse Oesophageal Spasm.- X. Scleroderma.- References.- Otorhinolaryngology.- Otolaryngology in the Elderly.- A. Introduction.- B. Ear.- I. Inner Ear.- 1. Presbycusis.- a) Morphological Findings.- b) Impairment of Function.- c) Contributory Factors.- d) Consequences of Presbycusis.- e) Treatment.- 2. Vertigo in the Elderly.- II. External and Middle Ear.- C. Nose and Paranasal Sinuses.- I. External Nose.- II. Mucosa of Nose and Paranasal Sinuses.- III. Olfactory Impairment.- IV. Epistaxis.- D. Pharynx and Salivary Glands.- I. Mucosal Changes.- II. Loss of Taste.- III. Salivary Glands.- E. Larynx.- I. Morphological Findings.- 1. Macroscopic Changes.- 2. Histologic Findings.- a) Laryngeal Cartilages.- b) Mucosa.- c) Vocal Folds.- II. The Voice in Old Age.- F. Therapeutic Aspects.- I. Conservative Treatment.- II. Ear, Nose, and Throat Operations in the Elderly.- 1. General Aspects.- 2. Specialized Aspects.- G. Malignant Ear, Nose, and Throat Conditions in the Elderly.- H. Concluding Remarks.- References.- Ophthalmology.- Aging of the Eyelids.- A. Significance of the Lid in Vision.- B. Lid Changes Caused by Aging.- I. Senile Atrophy.- II. Senile Pigment Abnormalities.- III. Blepharochalasis.- IV. Bags Under the Eyes.- V. Fat Hernia.- VI. Senile Blepharophimosis.- VII. Seborrheic Dermatitis.- C. Anomalies in the Position of the Lids Caused by Aging.- I. Senile Ectropion.- II. Senile Entropion.- D. Motor Disorders of Lid Function Caused by Aging.- I. Senile Ptosis.- E. Tumors of the Lid.- I. Pseudocancerous Lesions.- II. Precancerous Lesions.- III. Squamous Cell Carcinoma.- IV. Sebaceous Gland Carcinoma.- V. Basal Cell Carcinoma.- References.- The Eye in the Aging Patient: Cornea.- A. Structure of the Cornea.- I. Epithelium.- II. Stroma.- III. Endothelium.- IV. Metabolism.- V. Physiology.- B. Senile Changes of the Cornea.- I. Clinically Visible Signs of Aging.- 1. Arcus Senilis.- 2. Increased Shagreen of the Aged Cornea.- 3. LineofStahli.- 4. White Limbus Girdle of Vogt.- 5. Cornea Guttata.- II. Clinical Changes Detectable by Special Techniques.- 1. Thickness of the Cornea.- 2. Sensitivity of the Cornea.- 3. Specular Microscopy of the Endothelium.- a) Number of Cells.- b) Cell Distribution.- 4. Swelling Properties of the Stroma.- 5. Regenerative Power of the Epithelium.- 6. The Endothelium in Old Donors.- III. Microscopic Changes in Old Age.- 1. Descemet's Membrane.- 2. Basement Membrane of the Epithelium.- 3. Collagen Fibrils.- IV. Biochemical Changes in Old Age.- 1. Collagen.- 2. Glycosaminoglycans.- 3. Lipids, Physical and Chemical Explanation of Arcus Senilis.- a) Lipid Spectra.- b) Precipitation of Lipoproteins.- c) Arcus Senilis and the Blood Level of Lipoproteins.- 4. Metabolism.- V. Diseases of the Cornea Not Specific for Old Age.- References.- Age-Related Changes In the Anterior Segment of the Eye.- A. Introduction.- B. Cornea.- I. Stroma.- II. Descemet's Membrane.- III. Corneal Endothelium.- C. Trabecular Meshwork.- I. Trabecular Beams.- II. Cribriform Layer.- III. Trabecular Cells.- D. Ciliary Body.- I. Ciliary Muscle.- II. Ciliary Processes.- III. Ciliary Epithelium.- IV. Zonular Apparatus and Internal Limiting Membrane.- E. Iris.- I. Anterior Border Layer.- II. Pigment Epithelium.- References.- Aqueous Humor and Vitreous Production.- A. Aqueous Humor.- I. Volume.- II. Composition.- III. Intraocular Pressure.- IV. Formation.- V. Outflow.- VI. Summary.- B. Vitreous.- I. Structure.- II. Composition.- 1. Sodium Hyaluronate.- 2. Collagen.- III. Basement Membranes.- IV. Posterior Vitreous Detachment.- V. Summary.- References.- The Eye in the Elderly: Lens.- A. Introduction.- B. Lens Structure.- I. History of Development.- II. Anatomy of the Lens.- III. Histology and Fine Structure of the Lens.- C. Growth of the Lens.- I. Lens Weight.- II. Lens Weight and Volume in Relation to Age.- III. Specific Weight of the Lens.- IV. Diameter of Equator: Lens Thickness.- V. Lens Volume/Eye Volume.- VI. Lens Biometry with Respect to Accommodation.- D. Nutritional Supply of the Lens.- I. Aqueous Humor Composition.- II. Changes of Aqueous Humor Composition by the Lens.- III. Changes of Lens Properties by Aqueous Humor.- IV. Aqueous Composition in Aphakic Eyes.- V. Aqueous Composition and Age.- VI. The Lens as Part of an Open Biologic System.- E. Light Transmission of the Lens.- I. Transparency for Visible and Ultraviolet Light.- II. Disturbances of Transparency.- III. Lens Fluorescence.- IV. Applications of Scheimpflug Photography.- 1. Lens Photography.- 2. Densitometric Image Analysis.- 3. Calculation of the Methodological Error.- F. The Lens and Aging.- I. Presbyopia.- II. Age Changes of Lens Transparency, Development of Lens Opacities.- III. Age Changes of Biochemical Lens Properties.- 1. Protein Metabolism.- a) Deamidation and Degradation.- b) Disulfide Bridges and Other Covalent Cross-Links.- c) Racemization of Aspartic Acid.- d) Nonenzymatic Glycosylation.- 2. Enzymes and Energy Metabolism.- IV. Age Changes of Lens Morphology.- G. Senile Cataract as a Result of Multifactorial Origin.- I. Surgical Therapy.- II. Drug Treatment of Lens Opacities.- References.- The Aging Retina.- A. Introduction.- B. A Dilemma.- C. Structural Changes in Homo sapiens.- I. Vasculature.- II. Changes in the Pigment Epithelium.- III. Outer Nuclear Layer and Photoreceptors.- D. Objective Indices of Retinal Function.- I. The Electro-retinogram.- II. The Electro-oculogram.- III. The Early Receptor Potential.- E. Subjective Information on the Senescent Retina.- I. Visual Resolution.- II. Dark Adaptation.- References.- Dermatology.- Physiologic and Pathologic Alterations in Old Skin.- A. Overview.- B. Age-Associated Changes in Normal Skin.- I. Morphologic and Histologic Changes.- II. Physiologic Changes.- III. Biochemical and Biophysical Changes.- C. Age-Associated Pathologic Processes in the Skin.- I. Decubitus Ulcers.- II. Xerosis.- III. Pruritus.- IV. Herpes Zoster.- V. Bullous Pemphigoid.- VI. Skin Cancer.- 1. Epidemiology.- 2. Possible Age-Associated Risk Factors.- 3. Prevention and Treatment of Skin Cancer in the Elderly.- VII. Dermatoheliosis (Sun-Induced Aging).- References.
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