[Psychological and somatic aspects of living liver donors: preoperative assessment and postoperative course]. / Psychische und somatische Aspekte der Leberlebendspende: Präoperative Evaluation und postoperativer Verlauf.

BACKGROUND AND OBJECTIVE: Living donor liver transplantation (LDLT) has been gaining importance in the treatment of end-stage liver disease in adults as a partial solution to the growing organ shortage. Thus far, only few empirical studies have been published on the situation of donors who are faced with the risk of medical complications after resection of the right hepatic lobe. PATIENTS AND METHODS: 87 potential donors were preoperatively assessed in the years 2000 and 2001 at the Charité Berlin. 41 potential donors were excluded, 46 donors (31 women, 15 men, mean age 41 [19 - 67] years) underwent liver surgery and were re-assessed 6 months after the operation. The frequency of postoperative complications and the course of psychosocial parameters were investigated. Donors' moods were analysed with the Berlin Mood Questionnaire, the physical complaints were assessed with the Giessen Complaint Questionnaire. The preoperative interviews of 20 potential donors were analysed according the current social qualitative research methods. RESULTS: In 11 % (n = 10) of potential donors transplantation was not recommended for psychosocial reasons because they showed a marked ambivalence towards the operation. After operation, 22 % (n = 12) of donors had postoperative complications. Most relevant single causes of severe impairment were temporary and reversible biliary leakages from the cutting edge. There were no long- term complications. 26 % (n = 10) of donors showed postoperative high values for anxious depression and physical complaints. CONCLUSIONS: The resection of the right hepatic lobe holds promise of a good psychosocial outcome for most donors, irrespective of donation-related complications. The psychosocial impairment and physical complaints of some donors after transplantation are yet not clearly understood. Further psychosocial studies will be necessary to develop criteria for an evidence based medical care of living donors.

Willingness to donate: an interview study before liver transplantation.

OBJECTIVES: The introduction of the living donation in organ transplantation introduces important new psychological conflicts and ethical questions in the transplantation process. Operation related risks, as well as dependencies in the family structure, generate considerable pressure on potential donors. The aim of the study was to reconstruct the determinants of willingness to donate before transplantation. METHODS: Evaluation of 20 taped and transcribed interviews oriented to current approaches in qualitative interview research. The approach used is based on grounded theory, qualitative content analysis, and the concept of the ideal type. RESULTS: Before surgery, "openly motivated" donors push for an operation, leaving no room for ambivalence in the evaluation process. They idealise the relationship with the recipient, and link their donation with the individual-partly in subconscious expectations and wishes. In contrast, "openly ambivalent" donors formulate their anxieties and express arguments against donation. CONCLUSIONS: Statements that claim ambivalence towards donation or utterance of arguments against donation indicate earlier coercion. Before transplantation, potential donors should have the opportunity to discuss their emotional situation to help their decision making process.

Quality of life of living donors before and after living donor liver transplantation.

Living donor liver transplantation (LDLT) is becoming an established method for treatment of terminal liver disease in adults. After resection of the right hepatic lobe, postoperative complications can arise in healthy donors, and even individual cases of death have been recorded. There remains, however, little research on the psychosocial aspects in living donors before and after LDLT. Using the WHOQOL questionnaire, this prospective study investigates the quality of life (QoL) in a sample of 28 living donors, including the relationship between postoperative complications and QoL before and 6 months after donation. Before LDLT, the donor QoL is high, above that of the general healthy population. After LDLT, a significant reduction in the QoL appears in the areas of "physical health" and "living conditions." Nevertheless, the QoL remains above the level of the general population. Only two donors showed general QoL values below those of the general population. The postoperative complications had no significant influence on the QoL after transplantation. The high QoL of donors following LDLT indicates a positive psychosocial outcome for the majority of donors, irrespective of donation-related complications. Additional psychosocial studies will be necessary to disclose predictors for an unfavorable psychosocial outcome following LDLT.

[Morphe and function - Kurt Goldstein's understanding of the Babinski phenomenon]. / Morphe und Funktion - Kurt Goldsteins Verständnis des Babinski-Phänomens.

Viewed in terms of the theory of science and medicine, one of the striking features characterizing the period extending from the end of the 19 (th) century to the first third of the 20 (th) century was the formulation of concepts of etiopathogenesis. Existing theories on the morphe and structure of human cells, tissues, and organs were enlarged by models focusing on the function of these elements and structures of the organism. This enlargement of etiopathogenic concepts, including biperspective observation, occurred in the fields of internal medicine (Gustav von Bergmann), psychiatry (Erwin Straus), and neurology (Kurt Goldstein). In the light of Goldsteins's understanding of the Babinski phenomenon, the present paper seeks to show what fundamental questions spring from a theory of the human organism that takes into account both morphe and structure and function. Studies of historical models of this kind are both meaningful and justified in that they include constructs and guiding theoretical principles (like, for instance, biperspective access to the patient and his/her disease) which are of immediate relevance in addressing problems with which psychosomatics and medicine are challenged today.

[Kurt Goldstein's understanding of amnesic aphasia and its underlying disorder - an early model of the pensée opératoire of the French psychosomatic school?]. / Kurt Goldsteins Verständnis der amnestischen Aphasie und der Grundstörung - ein frühes Modell der Pensée opératoire der französischen psychosomatischen Schule?

Kurt Goldstein's understanding of amnesic aphasia in some regards anticipated the model of the pensée opératoire, a concept developed during the 60's and 70's by the French psychoanalytical school of psychosomatics. Goldstein interpreted amnesic aphasia within the framework of a "basic disorder". Closely following the philosopher Ernst Cassirer, Goldstein described amnesic aphasia as an expression of a general alteration following localized or generalised brain damage. Due to various historical events (world war, fascism, the holocaust) as well as developments during the 20(th) century (dominance of the English language in many areas of science), these connections were forgotten or were no longer recognised as such. Without wanting to determine the extent to which the concept of pensée opératoire possesses validity, one can interpret Goldstein's reflections on aphasia as a heretofore unreceived preliminary model of the psychosomatic concept of the French School.

On the theory of individual health.

On top of elaborate methods and approaches in research, diagnostics, and therapy, medicine is in need of a theory of its own thought and action; without theoretical reflection and referentiality, action becomes blind (and thus costly) and thought takes on a monotonous and circular character. Take the concept of health. The field of medicine, more and more taking its cues from evidence-based medicine (EBM), is onesidedly oriented to concepts of health which are based on notions of standard values for large populations or-in the shadow of the genome project-see health as the outcome of an intact genome, often turning a blind eye to the individual aspects of health. With an eye in particular to Friedrich Nietzsche's philosophy, the present paper looks into some continental European theories of individual health, seeking to determine to what extent they can contribute to reducing medicine's theory deficit and what consequences this may have for research, diagnostics, and therapy.

[Narcissism inventory-90 (NI-90). Empirically-based reduction and identification of items sensitive for change--a questionnaire particularly suited for measuring self-regulatory parameters]. / Narzissmusinventar-90 (NI-90). Empiriegeleitete Itemreduktion und Identifikation veränderungssensitiver Items des Narzissmusinventars zur Messung selbstregulativer Parameter.

By analysing Narcissism Inventories [1] gathered by the admission from 639 consecutive in-patients, as well as a related sample of inventories gathered from 397 consecutive patients (7/93-7/96) by admission and discharge, we examined the possibility of reducing the number of items of the Narcissism Inventory without losing significant information. This examination shows that reducing the inventory to a total of 5 items per scale is reasonable, without a relevant loss of metric quality in the item-reduced scales. In addition, items particularly sensitive to change could be identified and pointedly kept in the new, reduced scales. Through the deliberate selection of these items, it was possible to produce an empirically-guided short-version of the Narcissism Inventory, suited particularly for the examination of clinical process and regulatory parameters. With persistence of the original 18 scales proposed by the authors of the original test, a reduction to a total of 90 items results. The name "Narcissism Inventory-90 (NI-90)" is, therefore, suggested for this new version.

Patients' expressions of complaints as a predictor of the course of acute hepatitis A.

OBJECTIVE: Physical complaints, emotional states, liver, and immune parameters were investigated as possible indicators of the course of hepatitis A. METHODS: Forty-seven patients with hepatitis A were studied by means of the Giessen-Complaint-Inventory (GBB) and the Berlin Mood Questionnaire (BSF), as well as by taking into account their typical liver parameters and the following immune parameters: alphaInterferon (alphaIFN), soluble Interleukin 2 receptor (sIL-2R), Interleukin 6 (IL-6), Interleukin 1 receptor antagonist (IL-1Ra), and Immunoglobulin M or G (IgM, IgG). Two hundred twenty-nine medical students and a representative German sample (n = 1557, Braehler et al.) served as controls. RESULTS: We found that the initial degree of change in permeability of the liver cells, complaints about abdominal symptoms, and extent of depressive mood were able to predict the length of hospital stay. Patients with the initial, more pronounced liver damage, as well as patients who articulated less subjective impairment proved to have a longer course of illness. Those patients who needed a significantly longer time for recovery report, at admission, very few complaints-fewer than even the normal population. We were not, however, able to demonstrate a significant difference in the investigated immune parameters. CONCLUSION: A certain denial tendency seems to be harmful with respect to the recovery process and the immunological competence in the course of hepatitis A.

"They don't leave you on your own:" a qualitative study of the home care of chronically ill children.

Learning to cope with a chronic illness is a process often demanding professional help that extends beyond the time spent in the hospital. Using interviews, this qualitative study describes the subjective experiences of five families with children who are chronically ill and the experiences of the two head nurses at External Care Services (EPD) in Berlin, Germany, an institution focused exclusively on home care for children. The positive experiences expressed by parents reflect the patient-oriented understanding of caring developed by the EPD, which strives for the qualified instruction of families and the building of caring relationships. As a result of the care offered by the EPD, many children are spared the repeated hospitalizations that so hinder the normalization of family life and impede family health.

Severe anorexia nervosa associated with osteoporotic-linked femural neck fracture and pulmonary tuberculosis: a case report.

We report a case study of a 38-year-old woman who had been suffering from anorexia nervosa (AN) since the age of 26. Before admittance to our clinic, she weighed 23.8 kg (at a height of 164 cm, 8.8 body mass index [BMI]) but still carried out strenuous physical activities. After good psychotherapeutic response and weight gain (34.4 kg), she accidentally fell and broke her femoral neck-favored as it was by osteoporosis. The X-ray taken before dynamic hip screw implantation coincidentally showed signs of pulmonary tuberculosis (TB), which could then be proven by computed tomography (CT) scans and cultures from a bronchoscopy. Other than lack of appetite and loss of weight, which we attributed to AN, there were no other clinical or biochemical indicators which could have pointed to an earlier TB diagnosis. As a result, the need for screening procedures is discussed. The manifestation of TB during the first weight gain after 12 years of severe malnutrition, during which there were no serious infections, seems to endorse former observations that AN patients appear to be "resistant" to some extent against infectious diseases, a "protection" which may be lost with convalescence and weight gain.

["A small piece of normal life". A qualitative study on health care for chronically ill children in home care]. / "Ein Stückchen normales Leben". Eine qualitative Studie über die Gesundheitspflege bei chronisch kranken Kindern in der häuslichen Pflege.

This qualitative study deals with the subjective experiences of families with chronically-ill children and with experiences of the External Care Services (EPD) in Berlin, who exclusively conduct home-care for children. Learning to cope with chronic illness is a process that often demands professional help that extends beyond the time spent in hospital. Essential for the analysis performed here are the systemic positions put forward by v. Uexküll, Wesiack (psychosomatic medicine) and Friedemann (nursing science) who stress the connection between health and relationship. The parents' positive experiences reflect the patient-oriented understanding of health-care developed by the takes in the families in many respects. Without the care offered by the EPD some children would have been torn out of their family environment due to hospitalizations. This would have resulted in the damaging of the family health.

Determinants of the quality of life of patients with diabetes under intensified insulin therapy.

OBJECTIVE: The concept of quality of life (QOL) is understood as a multidimensional construct made up of physiological, psychological, and social aspects, but their particular weightings for the global QOL are rarely investigated. We examined 1) the general QOL of patients with diabetes, 2) the significance of the individual QOL aspects for the overall assessment of QOL, and 3) the modulating function of coping mechanism and particular personality traits. RESEARCH DESIGN AND METHODS: A total of 116 diabetes patients under intensified insulin therapy were studied, as were 107 patients with inflammatory bowel disease, 66 patients with chronic hepatitis C, and 229 students who served as control subjects. The examination was based on eight standardized QOL and personality questionnaires (354 items) and assessed by means of linear structural regression models (AMOS 3.6). RESULTS: The QOL of diabetes patients appears to be higher than the QOL of other chronically ill patients. Social, psychological, and physical aspects contribute to the overall QOL, although physical complaints receive a comparatively low weighting. Coping behavior and particular personality traits covary with all QOL aspects, giving these variables greater significance for the QOL than the existence of secondary illnesses. CONCLUSIONS: The hypothesis that the various factors involved in the multidimensional construct QOL receive different weightings was confirmed, making a simple summary score for the general QOL appear unjustifiable. In addition, all aspects that are commonly understood as parameters of QOL are influenced by external factors, such as coping behavior, based on individual personality characteristics.