By Dr. M. Loebe, V. Theodoridis, R. Hetzer (auth.), W. Albert M.D., A. Bittner M.D., Prof. Dr. R. Hetzer (eds.)
Advances in center surgical procedure were notable within the final 15 years. In end-stage middle sickness, techniques at the moment are played in many instances which have been in basic terms experimental one or twenty years in the past. center transplantation has develop into a well-established method. in keeping with the Gen eral Registry of the foreign Society of middle and Lung Transplantation. 40,738 middle transplantations have been played in the course of the finish of 1997 with survival charges of seventy eight % at twelve months, sixty five % at 5 years, and forty two % at ten years. The development during this box has been because of severe efforts in knowing and modulating immune responses to the trans planted center, to problematic healing ideas to constrain infections, and to stronger out-patient care. therefore, center transplantation is built-in into the amenities of the wellbeing and fitness care platforms, the regimen of physicians, and the notice of sufferers. The ensuing bring up in capability organ recipients has now not been met, although, by way of an identical raise of accessible donor organs. This expanding discrepancy has compelled the technical development and scientific evalua tion of mechanical circulatory help structures as an alternative for remedy of severely sick sufferers with a failing middle. in the beginning, those help units have been basically used to keep up adequate circulate in post-cardiotomy center failure till myocardial functionality had recov ered. because the overdue Eighties, their fundamental use has been that of bridging sufferers with middle failure until eventually an appropriate organ is accessible in order that middle transplantation might be performed.
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Extra resources for Quality of Life and Psychosomatics: In Mechanical Circulation • The Heart Transplantation
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According to their transactional stress-solving concept, Lazarus and Folkman (24) define coping as ' ... ' Coping is focusing aimrelated on processes in the domains of acting, thinking and emotions, their feed-back, 31 32 W. Albert, A. Bittner, R. Hetzer and subsequent consequences. The defense-concept is based on psychoanalytic theories focusing on unconscious solving-mechanisms between reality, internal demands, and ego-competencies. ' We combined expert-rating questionnaires of both approaches in expecting severe individual crises during MCS with reactions determined by defense-mechanisms and time periods, which are more adequate described by coping-mechanisms.
What importance does it have now It has lost its vitality. Now a 'replacement heart' stands beside the bed, a duplication results with an internal and external life center which has to form a union, a union between living and dead matter. - Eventually the patients experience the existential threat as chronically indeterminate; the time of heart transplantation is incalculable. Only consolation can be offered, and hope has to be preserved. - Waiting for a donor organ evokes strong desires as one anticipates, even longs for, the death of other people, which are connected with feelings of guilt and fear of punishment.
Cumulative frequencies of defense mechanisms (KBAM) during stabilization period on BV AD umulative frequency I. 2. 3. 4. 5. 6. 7. 9. 10. II. ' oj logical exp/mullion. suppression: ojJears or illoccepw"'e impulses aITcet-i lati n di placement of aggres ion to other objects projection: ascribillg OWIl illlolerable impulses (0 others turning aggre ion toward elf introjection 26 21 20 19 I 15 11 8 8 6 4 Observations The description of the psychiatric and psychic disorders and reactions during BY AD illustrates a great diagnostic variety, but with assignment to phenomenologic categories alone, many qualitative aspects of the observed processes in the therapeutic approach are not sufficiently depicted.
