By C. Lauritzen (auth.), Professor Dr. med. Dieter Platt (eds.)

Volume three of this sequence is anxious with geriatric points 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 - provided within the first volumes - are of significant value, particularly for surgical specified­ ties. There are loads 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 considered as a contraindication for sur­ gery, this day even older sufferers endure operations on aortic aneurysms, skip operations for coronary sclerosis, pulmonary resections, and abdominosacral resections of rectal carcinomas, for instance. Pre­ needful for winning surgical procedure at a complicated age is sweet pre- and postoperative care of multimorbid sufferers. Physiological adjustments of the lungs with getting older, the elevated frequency in pneumonia and pulmonary quite a few embolisms with age, and the lessen in receptors, to offer examples, confront anesthetists with problems. The maxim "in outdated age rather less" is additionally acceptable during this box. in simple terms superior experimental gerontological study, very likely achieving even into anesthesia, will supply aim information for anesthesia in aged sufferers. the surface is an organ that reports attribute qualitative and quantitative alterations in outdated age.

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Polymorphism and hyperchromasia of nuclei and abnormal mitoses are common. Stromal invasion or complete loss of stroma may be seen. In 15%- 20% of adenocarcinomas of the endometrium, squamous metaplasia may be identified. Such a tumor is termed an adenoacanthoma. Rarely, a clear cell carcinoma that resembles hypernephroma is found. In general, the more undifferentiated the pattern, the worse is the prognosis. a) Signs Endometrial cancer produces metrorrhagia in younger women and postmenopausal bleeding later in life.

3. Primary Malignant Ovarian Tumors Primary ovarian carcinoma accounts for about 15%-20% of all gynecologic cancer and approximately 5% of all malignant tumors in women. Recent statistics indicate a relative increase in incidence of ovarian carcinomas, compared with those of the cervix and endometrium. Mortality statistics indicate that death from ovarian cancer is exceeded only by that from cervical cancer. Of all women with this lesion, 76% are older than 45 years. The peak incidence occurs in the sixth and seventh decades.

The preparation can be changed and the dose adjusted, if necessary. Liver tests are only done if a special indication is found. c. LAURITZEN 16 11. Duration of Treatment The duration of treatment depends on the aim of the therapy. In women castrated early in life, the substitution lasts up to their fifties or even longer. , mostly for 2-3 years. When prophylaxis of osteoporosis is aimed at, the administration continues up to old age. On the whole, the treatment is given as long as is sensible and as long as no contraindications, severe side effects, or other grave problems occur.

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