Mortality was high, and even higher among the patients with valvular heart diseases, with negative psychological and social repercussions.
como parte dos requisitos para obtenção do grau de Doutor em Psicologia. Orientador-Prof.Dr.J.Tolentino Rosa SÃO PAULO 2006 hypothèse théorique de ce travail, la présence de refuges psychiques, en accord avec Steiner (1997), comme stratégie de survie psychique. Dans cette situation, nous avons en vue la prépondérance, la regression, de relations persecutoires entre objet, en vertue de l'extrême anxiété dépressive. Ainsi, dans ce refuge (berceau de la Fênix), le patient se préserve de la douleur de la perte (lutte pour la vie, pour le coeur qui sera retiré) et de l'entière destruction (devastation de la maladie, risque chirurgical et de la immunosuppresseur), arrivant à affronter le procéssus de transplantation cardiaque. Dans le cas contraire, le patient succombe au cadre dépressif.
Estudos anteriores demonstram que fatores psicológicos intervêm nos resultados de um transplante cardíaco. Diferem, em seus achados, em função dos paradigmas a que estão vinculados, que incluem ou não o campo intersubjetivo nos quais os fenômenos emergem. Nesta investigação objetivamos descrever o funcionamento mental de pacientes candidatos ao transplante, a partir de suas relações objetais inconscientes, delimitando uma vivência emocional comum nesta situação, bem como, buscamos averiguar se existem diferenças entre os pacientes, em função da realização ou não da cirurgia. Utilizou-se, como procedimento, o Teste de Relações Objetais de H. Phillipson (TRO), aplicado em 63 cardiopatas com indicação ao procedimento. O material clínico proveniente do acompanhamento psicológico destes pacientes também é utilizado para completarmos as observações. Os resultados apontam a presença de indicadores psicopatológicos, de acordo com a classificação de Grassano para depressão clínica em 60 casos. Em dois casos observaram-se indicadores para psicopatia e um caso para funcionamento psicótico, com repercussões negativas sobre o vínculo com o tratamento. Constataram-se diferenças estatisticamente significantes na performance dos pacientes frente às lâminas BG e C2, mas não podemos afirmar que as dificuldades de ajuste perceptual nestas lâminas, mais freqüentes entre aqueles que não fazem a cirurgia, seja fator de obstáculo ao procedimento. Sugerimos, como hipótese teórica deste trabalho, a presença de refúgios psíquicos, de acordo com Steiner como estratégia de sobrevivência psíquica, nesta situação, tendo em vista o predomínio, regressivo, de relações de objeto persecutórias, em virtude da extrema ansiedade depressiva. Assim, neste refúgio (ninho da Fênix), o paciente abriga-se da dor da perda (luto pela vida, pelo coração a ser retirado) e da aniquilação (devastação da doença, risco cirúrgico e da imunossupressão), conseguindo enfrentar o processo de transplante cardíaco. Caso contrário, o paciente sucumbe ao quadro depressivo. Descritores: transplante cardíaco; relações objetais; psicanálise; psicologia da saúde; intervenção terapêutica.
During the last years, the reported incidence of ABO 'auto-antibodies' has increased in patients receiving organs from minor ABO-unmatched donors. This feature has been ascribed to the production of isoantibodies by the immunocompetent B lymphocytes transferred with the organ. As was the case in a report by Bracey [ 11, most patients were receiving immunosuppressive therapy with Ciclosporin A (CS-A). It has been suggested that CS-A could play a primary role in the development of the aforementioned phenomenon [2]. In this setting, we wish to report the case of a patient who showed a 'auto'-anti-B antibody following a pancreas transplantation without receiving CS-A.The patient, a 32-year-old diabetic male, blood group B, received a pancreas from a group 0 cadaver donor. Preoperative screening of alloantibodies was negative, and 4 group B blood units were tested and found compatible at crossmatching. Immunosuppressive therapy was started the day of transplantation, consisting of azathioprine (3 mg/kg/day), prednisone (1 mg/kg/day in a tapering schedule), and antilymphocytic globulin (Lym-phoser8, Berna; 12 mg/kg/day). On the 1 1 th posttransplant day, graft failure due to vascular occlusion was diagnosed, requiring pancreatectomy. Crossmatching was now incompatible at the indirect antiglobulin phase with all the group B units tested, and the direct antiglobulin test was positive for IgG, but not for C3. An anti-B antibody could be identified in both eluate and patient's serum, showing a titer of 1/8 which remained unchanged after incubation with dithiothreitol. The hemoglobin level had dropped from 1 1 to 8 g/dl, but serum levels of both lactate dehydrogenase and haptoglobin were within normal limites. After surgery, the patient was transfused with 2 crossmatch-compatible group 0 blood units without adverse effects. Twenty days later, the direct antiglobulin test was negative, and no anti-B activity was observed in the serum.The present case, in addition to some others previously reported [3], reveals that 'auto'-anti-ABO antibodies could appear following minor ABO-unmatched grafts even in the absence of CS-A administration. This observation allows us to suggest that the hypothetical relationship between such a phenomenon and CS-A would be merely coincidental, since during recent years this drug has been used in most of the transplanted patients. References1 Bracey, A.W.: Anti-A of donor lymphocyte origin in three recipients of organs from the same donor. Vox Sang. 53: 18 1-1 83 (1987). 2 Mangal, A. K.; Growe, G. H.; Sinclair, M.; Stillwell, G. F.; Reeve, C. E.; Naiman, S. C.: Acquired hemolytic anemia due to 'auto'anti-A or 'auto'-anti-B induced by group 0 homograft in renal transplant recipients. Transfusion 24: 201-205 (1 984). 3 Lundgren, G.; Asaba, H.; Bergstrom, J.; Groth, C.G.; Magnusson, G.; Moller, E.; Strindberg, J.; Wehle, B.: Fulminating anti-A autoimmune haemolysis with anuria in a renal transplant recipient: a therapeutic role of plasma exchange. Clin. Nephrol. 16: 211-214 (1981).
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