Concomitant Systemic Diseases Research Articles

Endoscopy in the elderly patient

In the elderly who require endoscopy for diagnosis and /or intervention, the endoscopist should be aware of the special risks related to the presence of concomitant systemic diseases. This is especially pertinent in the use of sedatives and analgesics due to the altered physiological functions related to ageing. This can be further complicated by the fact that elderly patients are often prescribed multiple drugs, which makes for the possibility of serious drug interactions. Endoscopy is a minimally invasive technique that is safer than conventional surgery in many conditions. The endoscopist must take into consideration the important factors related to quality of life, as well as the wishes of the patients and their families. The endoscopist must be sympathetic to their wishes and realize when investigation and treatment are not appropriate.

Stereotactic Radiosurgery for Pituitary Tumors

Objective Report the clinical result of SRS for pituitary adenoma.Methods 18 selected pituitary tumors were treated with SRS between Aug 1994 to Aug 1998.The median tumor diameter was 10mm,median SRS target volum was 1.37mm\+3,median margine target dose was 20Gy.Results The median follow\|up period was 47 months,87.5% cases obtained clinical improvement and 78.5% obtained hormone level lowered,37.5% show reduction of tumor size,only 1 PRL\|producing adenoma received reoperation for tumor progression.Conclusion The most important advantage of SRS is low treatment morbidity,it offers an alternative option for patients who do not require decompression of the optic apparatus or more rapid normalization of their endocrine status or for patients who have failed prior microsurgery.SRS is suitable for the patients who are poor candidates for general anesthesia due to concomitant systemic medical diseases.

Prevalence of systemic and ocular diseases in age-related cataract patients

Cataract patients often display concomitant ocular and systemic diseases which may influence the decision between general and regional anesthesia. The aim of this study was to quantify co-morbidity of these patients and assess the influence of the two types of anesthesia an the anesthesiological risk on the frequency of intra- and post-operative complications and visual outcome. In this prospective study, in patients scheduled for cataract extraction at the University Eye Hospital and Clinic of Ulm (tertiary eye care center) all systemic and ocular diseases as well as intra- and postoperative complications were analyzed. The prevalence of the co-morbidity in our patients was compared to other studies including age-matched controls. The anesthesiological risk was quantified using the classification scheme of the American Society of Anesthesiologists (ASA). Eighty-eight patients with a mean age of 70.4 +/- 11.7 years were analyzed. Sixty-one% of patients displayed systemic as well as ocular co-morbidity. Only systemic or ocular comorbidity was present in 32% and 5% of patients, respectively. Two% of patients exhibited neither ocular nor systemic comorbidity. In 61% of patients the surgery was performed in regional anesthesia and in 39% in general anesthesia. The prevalence of systemic and ocular co-morbidity as found in our study was significantly higher as compared to that in the general population of the same age. Visual improvement and the frequency of intra- and postoperative complications were independent on type of anesthesia and anesthesiological risk. Patients who were scheduled at our institution for cataract surgery exhibited a high frequency of ocular as well as systemic co-morbidity. This can be interpreted in such a way that patients with a high level of co-morbidity are referred to tertiary eye care centers for cataract surgery.

A retrospective evaluation of 193 patients with oral lichen planus.

One hundred and ninety-three patients with oral lichen planus were evaluated retrospectively. Women outnumbered men by more than two to one. The mean age at lesion discovery was in the sixth decade. The buccal mucosa was the most common site of occurrence. There were concomitant systemic diseases in many of the patients. The ulcerative form was the most prevalent referred form. Therapies included observation and treatment with topical and systemic corticosteroids with and without anti-fungals and immunosuppressants. Areas of discussion include lesion location, chronicity, therapeutic modalities, malignant transformation, age, gender, symptomatology and systemic disease.

Supportive therapy in oral surgery

The adequate therapy revolving around the care of the oral surgical patient includes more than the skillful carrying out of a technical procedure. It includes specific systemic measures designated to increase the rapid return to a state of health. Among these measures the oral surgeon must consider adequate sedation and control of pain. He must be certain that his patient is properly hydrated and that nutrition is adequate for tissue healing. Concomitant systemic diseases which are likely to retard the patient's progress must be controlled. Close cooperation between oral surgeon and internist makes smoother, more rapid convalescence with enhanced security for the patient.