[The preoperative consultation].
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Biomedical subjects
Publications and source records attributed to W Walcher.
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In a retrospective study to evaluate the sexuality of patients after radical surgery for cervical cancer, we interviewed with a standardized questionnaire 87 women who had undergone radical abdominal (N = 76) or radical vaginal (N = 11) hysterectomy between 1971 and 1985. Apart from employment and partnership, we assessed sexual behaviour as reflected by frequency of coitus, libido, and orgasm. The patients were questioned about each aspect preoperatively before knowing the diagnosis, post-operatively after the immediate effects of surgery had passed, and at the time of the interview. 6.6% of the women could be considered invalids. There was a clear decrease in frequency of coitus and an anxiety-related decrease of libido. However, the number of patients without sexual activity was not statistically different from that in an age-matched group of women who did not undergo surgery. 4.5% of partnerships broke up as an immediate consequence of the surgery. Only 20% of the patients felt they had been adequately informed of possible sexual consequences of treatment by the surgeon.
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Amitriptyline and mianserin were compared in a double-blind trial. Most of the depressive symptoms were influenced by both drugs, though quantitative and qualitative differences became evident. Amitriptyline predominantly influenced anxiety, despair and suicidal tendencies, while mianserin was particularly effective in psychomotor inhibition and the reduction of vegitative complaints. Mianserin did not show anticholinergic side effects.
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An increase in the developments of somatised illness and the mixture of nosological forms together with a growing tendency towards chronicity are evident in a looming change in the style of depressive psychoses. Vegetative vital emotions remain the leading symptoms of larvate depression. A lasting effect cannot be achieved by means of conventional somatic or sedative treatment. An adequate thymoleptic medication suitable for the main symptoms, incorporating socio- and psychotherapeutic methods for the contributary neurotic determinants, can however achieve an involution of the somatic and emotional symptoms of the vital irritation. For recurrent and increasingly chronic developments a long-term treatment with lithium salts proves successful.
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