Geriatrics 3

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. LineofStähli.- 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.