Ear, nose, & throat journal
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Surgical outcomes of patients aged 65 and older depend in part on the patient's physiologic status and coexisting disease and whether the surgery is elective or urgent. As our overall population continues to grow older, more elderly patients with head and neck cancers are being scheduled for surgery. ⋯ Likewise, thorough planning for perioperative management is imperative to reduce morbidity and mortality. Because pharmacokinetics and pharmacodynamics are different in older patients than in younger patients, the administration of anesthesia must be adjusted accordingly.
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Patients older than 65 years who develop acoustic neuromas have the same signs and symptoms as younger patients. Age limits beyond which surgery for acoustic neuroma is currently not recommended are unreasonable. ⋯ The patient's general medical condition, life expectancy, and factors other than chronological age should be considered when surgery is being contemplated. Acoustic neuroma surgery for the older patient can provide gratifying results and should not be withheld strictly on the basis of age.
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Case Reports
Rheumatoid pannus of the cervical spine: a case report of an unusual cause of dysphagia.
Dysphagia as an initial complaint in rheumatoid arthritis is rare. We describe the case of a 69-year-old woman with rheumatoid arthritis who presented with a 2-day history of acute dysphagia. ⋯ Although the otolaryngologic manifestations of rheumatoid arthritis usually relate to synovial involvement of the temporomandibular and cricoarytenoid joints, our case establishes that a rheumatoid pannus on the anterior cervical spine can cause dysphagia. We believe that this may be the first reported case of this clinical entity.
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Viagra, an oral drug taken one hour prior to sexual activity, improves erectile function in the majority of men with erectile dysfunction who receive it. It is not an aphrodisiac and therefore will not work without sexual stimulation. ⋯ Patients with heart disease, suspected heart disease and risk factors for heart disease should discuss with their physicians the safety of resuming sexual activity. A cardiac work-up, including exercise treadmill testing, should be considered in appropriate patients.