1/8. Death in the home: the doctor's responsibility.The role physicians assume when patients die at home is nebulous and ill defined. Beyond the traditional function of providing comfort and condolence to family members, the physician's duties are directed toward how our society deals with the bureaucratic and legal aspects of death. statistics are maintained regarding the numbers of deaths in municipalities and states and the causes of death, and those numbers are used by individuals and organizations for a multitude of legal, medical, and political purposes. The state also has an obvious interest in uncovering and prosecuting crime. The physician has a vital part to play in providing essential medical information for those record-keeping, statistical, and legal purposes. physicians need to be mindful of the important functions being served when they are asked to complete death certificates and to report cases and provide information to the medical examiner. As with many other physician activities, the information we provide about our patients' deaths serves a singular societal need; thus, we should view that function not as a burden but as a vital aspect of the enriching and enobling work that is uniquely ours.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/8. Moving on: recovering from the death of a spouse.Grieving is a complex multidimensional process in response to loss. The grief work involved in coping with a loved one's death does not end when the loved one dies. Rather, the grief work continues through a series of recovery stages. Six stages of recovery--loss, protest, searching, despair, reorganization, and reinvestment--are illustrated and discussed using a case study that highlights a wife's recovery from the death of her husband. Recognition of the stages of grief recovery after a death are significant for health care professionals so that bereavement support may be provided throughout the entire recovery process.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/8. Donation after cardiac death: two case studies.Few transplant centers consider using lungs from cardiac death donors because of warm ischemic damage. In certain scenarios, the recovery and transplantation of lungs from cardiac death donors are appropriate. A young person with a severe neurologic and spinal cord injury, who is not brain dead and who is otherwise healthy, should be considered as a cardiac death donor. A protocol should be established with local lung transplant surgeons to facilitate the successful procurement of lungs from cardiac death donors. In addition, when patients present to hospital emergency rooms with nonsurvivable injuries either in cardiac arrest or with extremely labile vital signs, uncontrolled donation after cardiac death can be considered. It is important to obtain informed consent from the family and to suspend any previous do-not-resuscitate orders before initiating resuscitative efforts. If an organ procurement coordinator and team are within close proximity to the hospital, consideration should be given to uncontrolled donation after cardiac death.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/8. Postoperative death of a patient in apparent remission of malignant lymphoma after dissection for squamous cell carcinoma.A 67-year-old man in apparent remission of malignant lymphoma had squamous cell carcinoma of the left buccal mucosa. The patient underwent partial resection of the mandible, including the excision of the tumor. During the fourth postoperative night the patient suddenly became febrile and had a spiking fever for the next 5 days. His general condition deteriorated afterward, and acute aggravation of malignant lymphoma was suspected. On day 16 disseminated intravascular coagulation was indicated by a decreased platelet count of 3.8 x 10(4), a tendency toward bleeding, and multiple organ failure. The patient died 18 days postoperatively. We alert anesthesiologists and surgeons that surgically treating patients with malignant lymphoma who are receiving immunosuppressive drugs is precarious even though their disease is considered to be in apparent remission.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/8. Balancing losses and growth: a relational perspective on identity formation in the second half of life.psychoanalysis has so far only to a limited extent examined specifically grown-up and mature organizations of the self. The Freudian contributions mainly examine the impact of losses on the second half of life. The Eriksonian approaches put greater emphasis of possible gains and adaptation, while less attention is paid to inner, subjective life. In contrast, the Jungian and transpersonal views emphasize possible increase in inner freedom and a more relativistic, holistic, and possibly spiritual or "worldcentric" view on existence. Within a relational psychoanalytic perspective on identity formation in the second half of life, these possible changes may be described as a mature widening of potential space, using Winnicott's terms. Relationships also may be more based on "being" than "doing." A perspective incorporating potentials for increased experiential depth and creativity must include attention to actual losses and suffering, conflicts involved in letting go of certain ambitions, and lifelong themes that may be actualized.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/8. Mitochondrial tRNA(Ile) mutation in fatal cardiomyopathy.A patient with mitochondrial encephalomyopathy who died from progressive intractable cardiac failure at the age of 18 is reported. At the age of 4, he presented with short stature, but multiorgan disorders including deafness, focal glomerulosclerosis, epilepsy and dilated cardiomyopathy appeared later in his clinical course. Laboratory tests showed hyperlactatemia and hyperpyruvatemia. Histopathological findings demonstrated mitochondrial myopathy with ragged red fibers and focal cytochrome C oxidase-deficient fibers in skeletal and cardiac muscles. The activity of cytochrome C oxidase was 30% less than the control level in skeletal muscle. Sequencing of the entire mitochondrial tRNA genome revealed a novel point mutation in the tRNA(Ile) region (nt 4269). This A-to-G substitution was found in none of the 30 controls by screening using mispairing PCR and Ssp I digestion methods, suggesting that this new mutation was pathogenic in our case.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/8. Idiopathic Parkinson's disease and depression: a psychosomatic view.The link between idiopathic Parkinson's disease and depression is examined in the light of psychosomatic theory. A view of the condition is offered as a manifestation of chronic emotional disorder in an organic sense. Predisposition arises from bereavement and/or maternal failure in early emotional development.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
8/8. On the dynamics of dying.This study is concerned with dynamic processes that underly the rapid, degenerative changes associated with the "dying" stage of the multicellular organism's life cycle. The interaction between negative and positive feedback cycles is discussed: negative feedback cycles underly the superstability characteristic of health and illness. When negative feedback cycles fade in the dying phase of life, positive feedback cycles, previously held in check by the negative feedback cycles to which they had been coupled, rise explosively, driving physiologic variables from their normal values towards extremes. This results in the rapid downturn that we associate with dying--an accelerating disintegration terminating in death. A medical case history is analyzed.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |