Ergebnisse der gynäkolgischen Descensuschirurgie unter Verwendung des GYNECARE PROLIFT® prolenemesh am Krankenhaus Agatharied Der Descensus genitalis ist eine der häufigsten gutartigen Erkrankungen der Frau, im Jahr 2010 waren mehr als 316 Millionen Frauen weltweit betroffen. Es besteht ein Lebensrisiko von 11,1% für eine chirurgische Intervention für eine 80jährige Frau. Die Gründe liegen v. a. in der Anzahl vaginaler (operativer) Geburten, Adiopsitas, Z.n. Hysterektomie, Überalterung und chronisch erhöhter intraabdominaler Druck. Die klinische Symptomatik besteht aus den typischen Senkungssymptomen wie Fremdkörper- und Druckgefühl, Ulcerationen mit Blutung, Fluor, Infektionen und Schmerzen. Außerdem kann es zu anorectaler Dysfunktion und Störungen der Blasenspeicher- und entleerungsfunktion kommen. Auch werden häufig Störungen der Sexualfunktion beschrieben. Die anatomiegerechte Beckenbodendefektbehebung mittels Polypropylene-Kunststoffnetzen (GYNECARE PROLIFT® prolenemesh) über den vaginalen Zugang wird zunehmend, neben den klassischen Descensusoperationen, zur Rekonstruktion des weiblichen Beckenbodens verwendet. Anhand der prä- und postoperativen Anamnese und Untersuchung nach dem POP-Q Schema einschließlich intra- und postoperativer Veräufe sowie 4 etablierter Fragebögen (PFDI-20, PFIQ-7, PISQ-12 und PGI-C) zu subjektiven Einschränkungen durch den Descensus erfolgt die Evaluation des Erfolges der Netzimplantation und ein Vergleich mit Ergebnissen anderer Methoden der Descensuschirurgie. Ergebnisse: Netzspezifische Komplikationen wie Exposition in die Scheide, Erosion in Nachbarorgane, Schrumpfung der Netze mit Schmerzen, Auftreten einer De Novo Belastungsinkontinenz oder einer Dyspareunie wurden im vorliegenden Kollektiv deutlich seltener als in der Literatur verzeichnet. Die Netzimplantation war in 81,5% (Stadium 0 oder 1) erfolgreich, es kam in 18,5% zu einem Rezidiv. Je nach Literatur und betroffenem Kompartiment liegen die Rezidivraten nach Mesheinlage zwischen 3,5 und 46% und bei 2 bis 42,5% nach klassischen Descensusoperationen. In allen 4 Fragebögen wurde eine Verbesserung der Lebensqualität, der sexuellen Zufriedenheit und der Speicher- und Entleerungsfunktion von Blase und Darm verzeichnet, jedoch war die Netzimplantation gleichwertig mit den klassischen Senkungsoperationen. / Introduction: Descensus genitalis is one of women’s most frequent benign diseases. In 2010, more than 316 Million women world-wide were affected. There’s an 11.1 % risk for an 80 year-old woman to undergo surgery within her life span. Above all, reasons lie in the number of vaginal births (including surgical intervention), hysterectomy, adipositas, high age and elevated intraabdominal pressure. Typical clinical descensus symptoms include foreign body and pressure sensation, ulceration with bleeding, fluor, infections and pain. Furthermore, anorectal dysfunction, bladder storage and emptying problems. Sexual dysfunctions are also frequently described. Apart from the usual descensus operation for the reconstruction of the female pelvic floor, implementing polypropylene mesh (GYNECARE PROLIFT® prolenemesh) through vaginal access has increasingly become an alternative. Material and methods: Success of the mesh implantation was compared with results of other methods of descensus surgery, using pre- and post-operative medical history, examination based on the POP-Q scale including intra- and post-operative developments as well as on four established questionnaires (PFDI-20, PFIQ-7, PISQ-12 and PGI-C) describing subjective restrictions caused by the descensus. Results/discussion: Mesh-specific complications, such as exposition into the vagina, erosion into adjacent organs, painful shrinking of the mesh, de novo stress incontinence or a dyspareunia were detected much less frequently in the current cohort than described in literature. Mesh implantation was successful in 81.5 % (stage 0 or 1), a recrudescence occurred in 18.5 %. Depending on the respective literature and specific cohort, the rates for recrudescence after mesh implementation lie between 3.5 and 46 %, while they range between 2 and 42.5% after usual descensus surgery. Each of the four questionnaires reported improvement of life quality, of sexual satisfaction as well as better bowel and bladder storage and emptying ability. However, results of mesh implantation showed no significant difference to those of the conventional descensus surgery.

This study contains an investigation of the conditions of plausibility for the doctrine of God within the frame of reference of the modern era. This is done by means of a hermeneutic-dogmatic analysis and evaluation of the teology of Walter Kasper. The hypothesis is that Kasper does not succeed to accomodate legitimate material-dogmatic observations in his proposed structure for a doctrine on the trinity. The modern era is characterised by the demise of classical Western metaphysics and the emergence of an ontology of relation, accentuating the historicity of reality. This became clear in the turn towards subjectivity and radical autonomy, and resulted as ultimate consequence in an atheistic way of life and mode of thought. The static nature of the classical substance-orientated ontology, influenced the conceptual modelling of classical Western theology profoundly negative. With regard to the doctrine of God, thinking in terms of salvation history and within the context of ecclesiastic practice, liturgy and doxology, receded to the background, making room for highly abstract philosophical speculation. This resulted in the separation of the immanent and economic trinity and led to two separate tracts, de Deo uno and de Deo trino. This state of affairs has the implication that two modes of thought are operative, namely a more speculative, natural-theological and a salvation historical orientated mode of thought. Kasper maintains that this two modes of thought should be upheld on the condition that the analogy, as the method of natural theology, is broadened by the perspective of the historicity and event character of reality. Analogia entis (mode of thought) must be understood as analogia libertatis (mode of being). This “additional” perspective enables the formal integration of the mentioned tracts, de Deo uno and de Deo trino. In a material sense, this means turning the back on the traditional essentialistic concept of the trinity in favour of a personal, salvation-historical approach by developing de Deo uno as doctrine concerning God the Father. Taking the fundamental anthropological structure of unthematic directedness towards absolute freedom as piont of departure, Kasper arrives at a “description” of God’s essence as Absolute Person, as Absolute Freedom to love. In accordance with his emphasis on history, Kasper propagates the equal importance of assensus- and desensus-christology. He proposes a refounding of the New Testament Son of God-christology by means of an indirect christology, that implies a trinitarian context. The implicit relationality suggested in Kasper’s description of God’s essence - Absolute Freedom to love - is made explicit in the relation of unity between Father and Son, a relation that implies the unity of Father, Son and Holy Spirit in an indirect way. According to Kasper, God the Father must be understood as source and ground of this divine unity. Kasper hereby distances himself from the traditional essentialistic concept of the trinity in favour of the Orthodox point of view, although he upholds the filioque and understands the intertrinitarian processiones in terms of the Western “theologic”. Kasper maintains that these proposal is a concrete explication of Thomas by means of the insights of Richard of St Victor, encompassing the synthesis of the essentialistic and personal trinitarian traditions on a higher niveau. This claim of Kasper must be contradicted. In the first instance, due to the fact that the trinitarian relations are merely viewed in terms of origin, his concept of trinitarian unity is one-dimensional. It is a patrocentristic orientated unity of origin. An underdeveloped pneumatology is, secondly, the direct result of the above mentioned patrocentricity. Although Kasper highlights the communio nature of trinitarian unity and the personality of the Holy Spirit, these accents are not accounted for in the structure of his proposal. Thirdly, assensus- and desensus-christology does not receive equal attention. Assensus-christology is neglected. Our proposal in this regard is a trinitarian pneumatology, explicated from the departure point of the immanent trinitarian concretion of persons and the economic trinitarian creation of personhood. In this way, the intertrinitarian unity as well as the unity of immanent and economic trinity, becomes explicable as the same unity but in different configurations. At the same time, the personality of the Holy Spirit is not only mentioned, but accounted for. / Thesis (DD(Dogmatics and Christian Ethics))--University of Pretoria, 2005. / Dogmatics and Christian Ethics / unrestricted

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The purpose of the present dissertation is to study the elaborations of the initiation myth in contemporary Italian author Alessandro Baricco. The theoretical and methodological framework consists mainly of Mircea Eliade’s phenomenological theory of initiation. It is argued that the categories of space and time are interdepent in religious thought and should thus be studied as a unit, through the notion of the chronotope. The dissertation therefore proposes to introduce the concept of the chronotope of initiation as an operative tool, the intersection of the theories of Eliade and Mikhail Bakhtin, for the literary subgenre of the initiation novel. A hermeneutical analysis of the novels Oceano mare, Emmaus and Mr Gwyn demonstrates that the initiation myth is present in all three novels. The symbolism of death and rebirth is coherently enacted as a movement via the categories cosmos-chaos-cosmos, for which the author uses the symbolism of the earth to define cosmos (regularity and structure) and water symbolism for the regenerating chaos (dissolution and renewal). The different chapters of analysis accentuate the interaction of space and time within the different phases of the initiation pattern: the profane, the threshold, the sacred, the centre (the place where the actual ritual is enacted) and the return, which are all defined as chronotopes. The analysis shows that although the chronotope of initiation – the concept intending the fusion of the temporal event of ritual at the spatial centre – assumes different forms throughout the corpus, its function remains unmodified, with its purpose being the creation of ontological change. In its inherent structure, the chronotope of initiation unites antithetical spatial and temporal characteristics. Spatially it unites infinite and dissolving chaotic space with the constitutive envelope or sacred vertical centre, and temporally it brings together the ultimative ontological change at a fixed, historical moment with the eternal, sacred, time opened by ritual, representing the coincidentia oppositorum of the sacred. The analysis also shows that the so-called “portraits of the ineffable”, present in all three novels, reflect the same qualities. As immanent works of art, they function as thresholds into the infinite. From a chronological perspective, the dissertation shows a modification of the initiation pattern in Baricco’s writing: from the classical form in Oceano mare, via a more realistic application in Emmaus, to the most elaborate, meta-literary adaption in Mr Gwyn. Nevertheless, the use of the pattern and its thematic coherence reveals that Baricco consciously elaborates on the pattern to suit the contemporary context.

Le mystère du mal – faute et/ou malheur – est la limite la plus compacte à laquelle se heurte la réflexion humaine en général et la réflexion théologique en particulier. J'ai entrepris de lire sous cet angle la trilogie de Balthasar, qui est son œuvre centrale : il s'agit de voir comment un théologien contemporain du calibre de Balthasar affronte ce mystère, et en quels termes se présentent pour lui le désir humain et l'espoir chrétien de salut. L'approche de Balthasar est phénoménologique ; mais à ce propos deux précisions s'imposent. D'une part, cette phénoménologie est théologique : l'événement de Révélation est sans analogie ; on ne peut le ranger parmi les autres phénomènes. D'autre part, une telle phénoménologie se situe au pôle positif d'un « choix fondamental ». Ce choix, qui est un leitmotiv qu'on peut suivre à la trace dans toute la trilogie, décide de l'orientation de toute vie spirituelle : ou bien l'être humain, en présence de ce qui s'offre à sa conscience connaissante, tend à se développer, s'affirmer, s'approfondir, ou bien au contraire, il se laisse saisir et emporter par le mystère de ce qu'il lui est donné de percevoir. La réflexion théologique de Balthasar a comme axe principal la kénose divine : kénose intra-trinitaire (le dépouillement mutuel des personnes divines l'une envers l'autre) ; kénose de création (Dieu posant hors de lui des créatures capables de s'opposer à lui) ; kénose d'alliance (Dieu s'impliquant dans les aléas d'une alliance avec son peuple) ; kénose révélatrice (l'Incarnation, la Passion et la mort en Croix du Verbe divin). Le thème récurrent est celui de la « non-puissance » de Dieu, de la « non-figure » du Fils ensanglanté et mourant sur la Croix. La kénose du Fils incarné s'inscrit dans une logique visionnaire, répondant à un souci obsessif de Balthasar : le souci du « salut-pour-tous ». En effet, le Fils incarné subit l'abandon du Père, jusqu'à partager l'enfermement sans issue des réprouvés éventuels: la « Descente aux Enfers », c'est l'épreuve de la « non-puissance » extrême, seule capable de délivrer l'éventuel réprouvé sans faire violence au Libre Arbitre qui, selon la doctrine, définit la dignité de la personne humaine. La théologie négative, selon Balthasar, n'est pas l'arrêt de la raison humaine devant l'infini divin qui dépasse les limites de la conscience connaissante : pour Balthasar, c'est la contemplation du mystère inconcevable de la kénose divine, de l'inimaginable dépouillement divin dans la Passion du Fils et la Descente aux Enfers. La kénose du Fils incarné, ce n'est pas un acte distinct du Dieu tout-puissant, qui se séparerait de sa toute-puissance pour rejoindre le niveau de la condition humaine : le dépouillement, la non-puissance, c'est la définition même de Dieu dans la vie trinitaire. Selon Balthasar, la Passion, la mort, l'abandon du Christ jusque dans les ténèbres de la perdition révèlent Dieu tel qu'il est de toute éternité. Percevoir le divin dans la « non-figure » du Christ en croix, c'est recevoir le don du regard simple, c'est se tenir au pôle positif du « choix fondamental » : être emporté, ravi par le mystère qui se révèle. Ainsi se définit ce que Balthasar rappelle avec insistance : l'humilité de la théologie et de son langage: l'ouverture contemplative au mystère et le respect des failles de toute construction « théo-logique », failles par lesquelles se manifeste le mystère de l'indicible, qui bouscule nos habitudes et nos représentations.