By C. Lauritzen (auth.), Professor Dr. med. Dieter Platt (eds.)
Volume three of this sequence is worried with geriatric features of surgical specialties: gynecology, orthopedics, basic surgical procedure, otorhinolaryn gology, and ophthalmology. heavily linked to those specialties is anesthesiology. Dermatology has an intermediate place among surgical and nonsurgical fields. The peculiarities of physiological and pathological getting older of otgans and the results for prognosis and treatment - awarded within the first volumes - are of serious value, specifically for surgical targeted ties. There are a lot of pre-, intra-, and postoperative difficulties in multimorbid geriatric sufferers, e. g. , coronary insufficiency, brady arrhythmias, hypertonia, and hypotonia. whereas as lately because the tum of the century the age of sixty five years was once seen as a contraindication for sur gery, this present day even older sufferers suffer operations on aortic aneurysms, skip operations for coronary sclerosis, pulmonary resections, and abdominosacral resections of rectal carcinomas, for instance. Pre needful for profitable surgical procedure at a sophisticated age is sweet pre- and postoperative care of multimorbid sufferers. Physiological alterations of the lungs with getting older, the elevated frequency in pneumonia and pulmonary quite a few embolisms with age, and the reduce in receptors, to provide examples, confront anesthetists with problems. The maxim "in outdated age rather less" can also be acceptable during this box. purely stronger experimental gerontological learn, almost certainly achieving even into anesthesia, will offer goal info for anesthesia in aged sufferers. the surface is an organ that reviews attribute qualitative and quantitative alterations in previous age.
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Extra resources for Geriatrics 3: Gynecology · Orthopaedics · Anesthesiology · Surgery · Otorhinolaryngology · Ophthalmology · Dermatology
Palpable lymph nodes fixed to the skin suggest metastases. Proctoscopy may reveal involvement of adjacent rectum. Prolapse of the urethra or a paraurethral cyst is occasionally mistaken for vulval cancer. A primary luetic lesion in older women or lymphopathia venereum may also simulate vulval carcinoma. Biopsy provides the diagnosis in these case. 3. Staging The Cancer Committee of the International Federation of Gynecology and Obstetrics (FIGO) proposed a classification according to the TNM system, where T stands for primary tumor, N for lymph nodes, and M for metastases.
Thus, cancer of the vulva metastasizes early to the adjacent lymph nodes in the groin, which not infrequently undergo ulceration (Fig. 8). 18 C. LAURITZEN Fig. 8. Regional lymphatics and lymph nodes of the vulva. The lymph channels of the vulva drain into the superficial deep inguinal lymph nodes, to Cloquet's node in the femoral ring, and to the hypogastric and iliac lymph nodes (BELLER et al. 1974) 1. Symptoms Vulval cancer often causes no signs or symptoms. Pruritus and pain on urination or defecation are related to ulcerations.
Stages Ib, IIa, and lIb may be treated by radical surgery, primary irradiation, or a combination of both. A properly performed radical hysterectomy entails removal of the uterus with an extended vaginal cuff (about one-third of the vagina), the parametria, and deep lymph node dissection. 5. Radiation Therapy This form of treatment involves the insertion of radium. According to the inverse square law, the radiation effect will decline very rapidly with distance from the inserted radium. Therefore, additional external radiation is required, mostly in the form of 60CO irridation.