Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients.

BACKGROUND: Previous studies have demonstrated that in patients with coronary artery disease (CAD) upward deflection of the heart rate (HR) performance curve can be observed and that this upward deflection and the degree of the deflection are correlated with a diminished stress dependent left ventricular function. Magnesium supplementation improves endothelial function, exercise tolerance, and exercise induced chest pain in patients with CAD. PURPOSE: We studied the effects of oral magnesium therapy on exercise dependent HR as related to exercise tolerance and resting myocardial function in patients with CAD. METHODS: In a double blind controlled trial, 53 male patients with stable CAD were randomised to either oral magnesium 15 mmol twice daily (n = 28, age 61+/-9 years, height 171+/-7 cm, body weight 79+/-10 kg, previous myocardial infarction, n = 7) or placebo (n = 25, age 58+/-10 years, height 172+/-6 cm, body weight 79+/-10 kg, previous myocardial infarction, n = 6) for 6 months. Maximal oxygen uptake (VO2max), the degree and direction of the deflection of the HR performance curve described as factor k<0 (upward deflection), and the left ventricular ejection fraction (LVEF) were the outcomes measured. RESULTS: Magnesium therapy for 6 months significantly increased intracellular magnesium levels (32.7+/-2.5 v 35.6+/-2.1 mEq/l, p<0.001) compared to placebo (33.1+/-3.1.9 v 33.8+/-2.0 mEq/l, NS), VO2max (28.3+/-6.2 v 30.6+/-7.1 ml/kg/min, p<0.001; 29.3+/-5.4 v 29.6+/-5.2 ml/kg/min, NS), factor k (-0.298+/-0.242 v -0.208+/-0.260, p<0.05; -0.269+/-0.336 v -0.272+/-0.335, NS), and LVEF (58+/-11 v 67+/-10%, p<0.001; 55+/-11 v 54+/-12%, NS). CONCLUSION: The present study supports the intake of oral magnesium and its favourable effects on exercise tolerance and left ventricular function during rest and exercise in stable CAD patients.

Change in left atrial and ventricular dimensions during and immediately after exercise.

PURPOSE: The aim of this study was to evaluate differences in the left atrial (LAD), total ventricular end-diastolic (TEDD), end-systolic diameters (TESD), and left ventricular shortening fraction (SF) compared with heart rate (HR) and systolic blood pressure (SBP) during exercise and recovery. METHODS: Healthy young male (N = 15) and female (N = 16) subjects performed an incremental cycle ergometer test in upright position, and three phases of energy supply were defined by means of blood lactate concentration (LA) and respiratory gas exchange variables (I: aerobic; II: aerobic-anaerobic transition; III: anaerobic). Subjects were required to rest their arms on a steering bar and to lean their upper body forward; two dimensional (2-D) echocardiograms were obtained over the left parasternal area at rest (R), at the end of each phase, immediately within 15 s post, and 6 min after exercise (6 min). By using VINGMED's "Anatomical M-Mode," it was possible to extract M-Mode Sweeps from stored 2-D-Loops and perform the M-Mode measurement. RESULTS: In contrast to the significant decrease in TEDD and TESD from III to 15 s up to resting values and the significant increase in SF from III to 15 s, the moderate decrease in HR immediately post exercise (15 s) was not significant. The SBP showed a significantly decrease from III to 15 s; in contrast to TEDD, TESD, and SF, the values at 15 s were comparable with the values at II. For LAD, significant increase during exercise and a decrease during recovery were observed. Sex-specific differences of changes in measured variables could not be found. CONCLUSION: We concluded that post exercise measurement of left ventricular and atrial dimensions or SF were not valid to describe heart function at maximal exercise although immediately post exercise HR was near maximal level.

Parasympathetic receptor blockade and the heart rate performance curve.

Parasympathetic receptor blockade and the heart rate performance curve. Med. Sci Sports Sci., Vol. 30. No. 2, pp. 229-233, 1998. The aim of the present study was to investigate the influence of parasympathetic receptor blockade on the heart rate performance curve (HRPC). Twenty healthy male subjects performed a first cycle ergometer test (F), showing a HRPC deflection of varying degree and direction. Subjects then in random order performed two additional cycle ergometer tests, one with atropine (A) and the other with placebo (P). Two lactate turn points (LTP1, and LTP2) were determined by means of linear regression turn point analysis. The degree and direction of the deflection of the HRPC was calculated mathematically as factor kHR (kHR>0 = downsloping of HPRC; kHR<0 = upsloping of HRPC). In comparison with that in F and P, HR in A was significantly higher at rest, LTP1, LTP2, and during recovery, but not at Power(max). An upsloping deflection of the HRPC was seen in only five cases in F and P, whereas in A 10 cases were observed (P < 0.05). In A, kHR was significantly lower than in F and P. A significant correlation for kHR was found among F, P, and A. Independent from parasympathetic receptor blockade and the HR at Power(max), the HR at LTP2 was lower in cases with negative kHR (upsloping). In A as well as in P a significant correlation was observed between kHR and HR at LTP2. The individual time course of HRPC is reproducible and may be independent of parasympathetic activity.

The heart rate turn point reliability and methodological aspects.

PURPOSE: The aim of the study was to test protocol variations on the heart rate performance curve (HRPC) and the heart rate turn point (HRTP) according to Conconi et al. (1996). Respiratory gas exchange variables were used to define three phases of energy supply (I, II, III). METHODS: Eighteen healthy young male subjects performed 4 tests (T1-T4). T1: initial speed of 6 km x h(-1) followed by increments of 0.6 km x h(-1) every 60 s. Subjects were than randomized for the next three tests. T2: initial speed 5.6 km x h(-1) followed by increments of 0.2 km x h(-1) every 20 s; T3: similar to T2, in the second half of phase III acceleration (S) was increased. T4: like T2, at the beginning of phase III, S was increased. No differences were found in the degree of the deflection of the HRPC expressed as factor kHR between T1 (0.228 +/- 0.225) and T2 (0.248 +/- 0.231) but a significant increase was found in T3 (0.533 +/- 0.248) and T4 (0.770 +/- 0.258). RESULTS: The modifications of the protocol (T3 and T4) systematically influenced the deflection of the HRPC, but kHR was highly reproducible in all tests. Eleven subjects showed degrees of deflection in the HRPC in all tests. There were no significant differences for S, HR, and VO2 at the HRTP. An HRTP was not found in seven subjects in neither T1 or T2; however, in T3 and T4, these seven subjects showed a deflection of HRPC resulting from the protocol. The HRTP was found to be dependent on the start of the acceleration in phase III. In cases with a linear time course in the HRPC in T1 and T2, in T3 an HRTP was found at 15.6 km x h(-1) and in T4 at 13.6 km x h(-1) , respectively. CONCLUSION: The Conconi test protocol with an accelerated increase in S in the final phase of the test has a major influence on the occurrence of the HRTP in cases of near linear HRPC.

The heart rate performance curve and left ventricular function during exercise in patients after myocardial infarction.

PURPOSE: The aim of the study was to investigate the heart rate turn point (HRTP) in the time course of the heart rate performance curve (HRPC) in patients after myocardial infarction, and the relationship between the HRTP, the left ventricular function, and the second lactate turn point (LTP2). METHODS: We studied the degree and the direction of the HRPC and the left ventricular ejection fraction (LVEF) in 49 male patients 57 +/- 8 d after their first posterior wall infarction (MI). An incremental cycle ergometer test was performed and three phases of energy supply were defined (I: aerobic; II: aerobic-anaerobic transition; III: anaerobic) via blood lactate LA concentration. HRTP and LVEF-turn points (LVEFTP) were assessed by linear turn point analysis. The degree and direction of the deflection of HRPC were described as factor k (k > 0.1: downward deflection; -0.1 < k < 0.1: linear time curse; k < -0.1: upward deflection). The LVEF was determined by RNA. The difference between Pmax and LTP2 was calculated for LVEF (delta LVEF). RESULTS: An HRTP could be found in 44 and a LVEFTP in 47 cases. The HRTP occurred at 85 +/- 17 Watt (W), which correlated (r = 0.95; P < 0.001) with the LTP2 (84 +/- 17 W) and the LVEFTP (84 +/- 17 W, r = 0.93; P < 0.001). From LTP2 to Pmax a significant decrease in LVEF was found. There was a correlation between the percentage of HRmax at the HRTP and k (r = 0.70), as well as delta LVEF (r = 0.56). CONCLUSIONS: To prevent myocardial overloading, it seems to be useful to determine the HRTP, which indicate the workload where LVEF decreases.

A physiological profile of tennis match play.

PURPOSE: The aim of this investigation was to examine physiological demands of single match play in tennis. METHODS: 20 players performed 10 matches of 50 min. Respiratory gas exchange measures (RGEM) and heart rates (HR) were measured using two portable systems. Lactate concentration was determined after each game. The average oxygen uptake (VO2) of 270 games was 29.1 +/- 5.6 mL.kg-1.min-1 (51.1 +/- 10.9% of VO2max). Average VO2 for a game ranged from 10.4 to 47.8 mL.kg-1.min-1 (20.4 and 86.8% of VO2max). Average lactate concentration (LA) was 2.07 +/- 0.9 mmol.L-1 (ranging from 0.7 to 5.2 mmol.L-1). Furthermore, we monitored the duration of rallies (DR), the effective playing time (EPT), and the stroke frequency (SF). The average values of 270 games were DR: 6.4 +/- 4.1 s, EPT: 29.3 +/- 12.1%, SF: 42.6 +/- 9.6 shots.min-1. RESULTS: Multiple regression revealed that the DR was the most promising variable for the determination of VO2 in match play (r = 0.54). The body surface area (BSA) and EPT were also entered into the calculation model. In games of two defensive players, VO2 was significantly higher than in games with at least one offensive player. CONCLUSION: Our results suggest that energy demands of tennis matches are significantly influenced by DR. The highest average VO2 of a game of 47.8 mL.kg-1.min-1 may be regarded as a guide to assess endurance capacity required to sustain high-intensity periods of tennis matches compared with average VO2 of 29.1 mL.kg-1.min-1 for the 270 games. Our results suggest that proper conditioning is advisable especially for players who prefer to play from the baseline.

Left ventricular function in response to the transition from aerobic to anaerobic metabolism.

The purpose of this investigation was to study myocardial function at rest, during three phases of energy supply, and during recovery. Radionuclide angiography was performed during the aerobic phase (phase I, rest-first lactate increase), the aerobic-anaerobic transition phase (phase II, first lactate increase-second lactate increase), the anaerobic phase (phase III, second lactate increase-maximal work performance (Pmax)), and during recovery. Thirty-eight male patients (59 +/- 7 d after myocardial infarction) were compared with 19 healthy control subjects and 21 sport students of comparable age. Left ventricular ejection fraction (LVEF) increased from rest to phase I and from phase I to phase II in sports students and control subjects. During phase III, LVEF did not change significantly in sports students, but it decreased significantly in control subjects. This is in contrast to the patients, who showed an increase of LVEF from resting values (47 +/- 3%) to phase I (50 +/- 1%), no change during phase II (51 +/- 2%), and a decrease to resting values (45 +/- 2) during phase III. All subjects showed an increase in stroke volume (SV) during phase I and II, reaching a maximum at phase II. This was evidenced by an improvement of the systolic function with a constant left ventricular end-diastolic volume (EDV) in control subjects and sports students. In contrast, an improved SV in patients was achieved through an increase in EDV and a less distinct increase in the left ventricular end-systolic volume (ESV). Maximal LVEF values were measured during the first 90 s of recovery in all subjects. Values during recovery are not representative of load dependent myocardial function. This increase in LVEF does not cause an increase in cardiac output but is a consequence of changes in the EDV and ESV, which decrease again immediately after the end of exercise performance.

Do blood cells mimic gene expression profile alterations known to occur in muscular adaptation to endurance training?

Exercise is known to upregulate mRNA synthesis for carnitine palmitoyl transferase1 (CPT1) and possibly also other mitochondrial carnitine acyltransferases in muscle tissue. The aim of this study was to test whether such an adaptation of oxidative metabolism in skeletal muscle is a systemic process and consequently, also affects other cells. Messenger RNA levels of five genes [carnitine palmitoyl transferases 1 and 2 (CPT1 and CPT2), carnitine acetyltransferase (CRAT), carnitine palmitoyltransferase 2 (CPT2), microsomal carnitine palmitoyltransferase (GRP58) and organic cation transporter (OCTN2)] were determined with quantitative real time polymerase chain reaction (PCR) in blood cells and in muscle biopsy samples from six cross country skiers before and 6 months after a high volume/low intensity exercise training, when training had elicited a significantly slower rate of lactate accumulation. Quantitative real time PCR showed that levels of mRNA in blood cells correlated significantly (CPT1B: P< 0.001) with those in muscle tissue from the same donors. After 6-months training, there was a 15-fold upregulation of CPT1B mRNA, a six to ninefold increase of CRAT mRNA, of CPT2 mRNA, GRP58 mRNA, and of OCTN2 mRNA. The observation of a concordant stimulation of CPT1, CPT2, CRAT, GRP58 and OCTN2 transcription in blood cells and muscle tissue after 6-month-endurance training leads the hypothesis of a common stimulation mechanism other than direct mechanical stress or local chemical environment, but rather humoral factors.

Histological and histochemical studies of the effect of a devitalizing preparation on the cervix uteri.

Solcogyn is a new acid preparation for the treatment of benign changes in the portio uteri. Histological and histochemical investigations of the treated cervix in patients scheduled for hysterectomy revealed a differential effect of this acid mixture in that ectocervical squamous epithelium was scarcely affected, while ectopic and endocervical cylindrical epithelium and the subepithelial stroma were devitalized by in vivo fixation. The maximum depth of penetration of the fixative effect was 2.5 mm. The treated cervical ectopies and transformation zones re-epithelialized within 3-4 weeks. The comparatively slight but sufficiently deep devitalization of affected tissue explains the clinical advantages observed with this preparation as compared to thermocoagulation and cryotherapy.

[Clinical course and radiotherapy of primary vaginal cancer (362 cases)]. / Zur Klinik und Radiotherapie des primären Vaginalkarzinoms (362 Fälle).

362 cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynaecology, Vienna, from 1950 to 1977. As method of choice an individually dosed, fractioned and protracted radium-telecobalt therapy was employed. An overall 5-years' survival rate of 39.8% could be achieved, a value which is above the average reported in world literature. Comparing the last period analysed in the present study (1971 to 1977) with another period 20 years earlier (1951-1956), the following differences can be observed: the fraction of stages III and IV rose markedly from 57.2% to 68.7%; associated with this change was an increase of the percentage of older patients (greater than 60a) from 53.6% to 70.7%. These two developments had an impact on the survival rate: in the total population, it was 39.8% as compared to 32% for the period from 1971 to 1977. The 5-year-survival rate in stage I (n = 60) was 75%, in stage II (n = 95) 45.3%, in stage III (n = 145) 30.3% and in stage IV (n = 62) 19.3%. The incidence of rectovaginal or vesico-vaginal fistulas amounted to 8%. The importance of gynaecological screening for old age patients is emphasized being the only possibility for reducing the high percentage of progressed stages.

Radiotherapy of primary carcinoma of the vagina: management and results of different therapy schemes.

Three hundred and sixty-two cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynecology, Vienna, from 1950 to 1977. As the method of choice an individually dosed, fractioned, and protracted radium-telecobalt therapy was employed. Comparing the last period analyzed (1971-1977) with another period 20 years earlier (1951-1956), a marked increase of advanced stages and older patients can be observed. These changes are reflected in the 5-year remission rate: in the total population it was 39.8%, as compared to 32% for the period from 1971 to 1977. For a group of 99 patients, who were treated between 1971 and 1977, the therapeutic effect of different therapy schemes is reported. The benefit of teletherapy is remarkable for advanced states, whereas for stages I and II an intrauterine application may be of importance. The complication rate amounted to 8% recto- or vesicovaginal fistulas and 41% and 43% cystitis and proctitis. The central importance of gynecological screening, especially for older women, is emphasized.

[Effect of brachytherapy and teletherapy on treatment results in primary vaginal cancer]. / Zum Einfluss von Brachy- und Teletherapie auf das Behandlungsergebnis beim primären Vaginalkarzinom.

From 1971 to 1977 99 cases of primary carcinoma of the vagina were treated at the Radiotherapy Department of the I. University Clinic for Gynecology and Obstetrics in Vienna. Radiotherapy was adapted individually as far as possible due to the different localisations and extensions of this tumor and to the vicinity of bladder and rectum, two very radiation-sensitive organs. Basically a three-phased scheme of treatment was intended: primarily a focal irradiation of the tumor by plaque-application, then combined intra-uterine and intra-vaginal radium insertion, followed by a vaginal cylinder. Thus the vaginal tissue is charged with about 32 Gy in a depth of 0,5 cm, the tumor itself with about 100 Gy. Percutaneous telecobalt irradiation was applied additionally following the method prescribed for carcinoma of the cervix uteri. A vulvo-perineal irradiation field was applied supplementarily , if the tumor was localised in the lower third of the vagina. 5-year overall remission rate amounted to 32% for the years 1971 to 1977; hence it was somewhat lower than for the total time observed (1950 to 1977), which was 39,8%. This could be explained by the sharp increase of very old patients and of progressed stages. For separate stages, the following 5-year healing rates were observed: stage I: 78%; stage II: 48%; stage III: 24% and stage IV: 19%. Recto-vaginal or vesico-vaginal fistulas occurred in 8% of the cases; less severe complications, such as cystitis or proctitis, were found in 41 and 43%, respectively. The effect of percutaneous telecobalt irradiation on the healing rate was marked in progressed cases, especially. Only 1 patient of 15 (7%), who were not treated by teletherapy, reached 5-year remission , as compared to 14 of 52 (27%), who received teletherapy. Stages I and II did not show a comparable difference. Intrauterine brachytherapy was of more importance for remission rate in early stages: 11 of 16 (69%) patients with stages I and II, who were treated with intrauterine curietherapy, survived 5 years or more; of those who did not have intrauterine insertion, only 6 of 15 (40%) reached 5-year remission . For stages III and IV, intrauterine curietherapy did not markedly change the healing rate.

Metabolic and cardiorespiratory reactions in tennis-players in laboratory testing and under sport-specific conditions.

Metabolic and cardiorespiratory reactions were investigated during a sport-specific incremental field test (FT) for tennis and compared with a treadmill step test (TT) in a group of 13 trained male tennis players. In both the FT and the TT lactate acid (La), heart rate and oxygen uptake (VO2) were measured. VO2 was determined using a portable telemetric system (K2, Cosmed, Italy). Aerobic- (AT) and anaerobic threshold (ANT) at a blood lactate concentration of 2 mmol/l and at 4 mmol/l respectively was indicated to characterize the endurance capacity of the athletes. In both FT and TT, minimum value of lactate equivalent (LE(min)), measured in every exercise test, was also registered. At AT and ANT values for HR (AT: p < 0.001; ANT: p < 0.001) and VO2 (AT: p < 0.001; ANT: p < 0.001) were significantly higher in FT than in TT at submaximal loads. At LE(min) only higher values for HR (p < 0.05) were registered in FT. In contrast to maximum range significantly higher values for VO2 (p < 0.001) could be seen in TT (there were no significant differences for HR). Comparing maximum lactate (La(max)) subjects reached a higher lactate (p < 0.05) in TT. A particular aim of our investigation was to characterize the individual cardiopulmonal and metabolic adaptation of tennis players, considering sport-specific criteria. As a result, differences in cardiorespiratory and metabolic adaptations could be determined between laboratory TT and FT. This finding seems to point to the fact that, using field testing in addition to laboratory exercise testing, makes a better judgement of aerobic and anaerobic endurance under sport-specific conditions possible. Furthermore, it was important for us to put data, determined in the field test into practice, using the given pattern of the field test as an element of training. This kind of training has the advantage of combining an individually intensity-controlled specific endurance training for tennis with a training of technical skills.

Catecholamine excretion and heart rate as factors of psychophysical stress in table tennis.

Table tennis, like tennis, squash and badminton, is a racket sport. All these sports have in common a rapid succession of mostly short-term maximal or submaximal efforts and short recovery phases. The goal of this paper is to investigate the psychophysical stress in table tennis by means of the stress hormones epinephrine and norepinephrine. The catecholamines were determined from urine samples. 16 Austrian top-level table tennis players were examined. There were 8 female and 8 male players in this group. The catecholamine excretion at rest (R), training (TR), practice competition (PC), competition (C) and treadmill ergometry (TE) are indicated in ng/min of collecting time. When the group is divided according to sex, we find marked differences in the catecholamine release. While the epinephrine excretion during and after training and practice competition is basically the same, it is lower during and after treadmill ergometry and higher after competition. The same result was found with respect to norepinephrine excretion. The ratio between norepinephrine and epinephrine was 4:1 at rest and during and after treadmill ergometry, 6:1 during and after training, 5:1 during and after the practice competition and 2:1 during and after the competition. The investigation showed that a table tennis competition puts high stress on the player. The mental component should therefore receive much more importance in order to keep the stress low.

Comparison of laboratory and "on-court" endurance testing in tennis.

Treadmill testing (TT) commonly used in endurance testing is often not sport-specific. Therefore a field test (FT) for tennis players was developed. The purpose was 1) to compare metabolic and cardiorespiratory response between TT and FT and 2) to assess tennis stroke ratings during FT. In both tests ventilatory variables (VO2, VE, VT, Bf, VE x VO2(-1)), heart rate (HR), and lactate (LA) were measured. For both tests an "individual anaerobic threshold" (IAT) was calculated. The comparison of TT and FT yielded significant differences in cardiorespiratory and metabolic response. LA and VE were significantly higher in TT compared to FT at VO2 of 35, 40, and 45 ml x kg(-1) x min(-1). There were statistical differences between IAT resulting from both tests (TT vs. FT): HR (165+/-16, 175+/-11, p<0.001), VO2 (44.4+/-4.3, 47.8+/-4.8, p<0.05), LA (3.1+/-0.5, 2.5+/-0.4, p < 0.001), VE (97.0+/-15.6, 89.1+/-14.9, p < 0.05), VT (2.66+/-0.34, 2.34+/-0.47, p<0.05), VE/VO2 (27.9+/-3.9, 23.9+/-2.9, p<0.01). High correlation was found between stroke ratings and the national ranking of the players. We concluded that 1) metabolic, ventilatory, and cardiorespiratory demands of TT vs. FT were (semi)sport-specific and significantly different and 2) that the stroke rating in our study was a good predictor for tournament performance (r = 0.94). This type of stroke rating can be implemented in a FT.

Measurement of maximal power output in isokinetic and non-isokinetic cycling. A comparison of two methods.

The main goal of the study was to compare maximal power output and power output at different pedalling frequencies obtained during isokinetic all-out tests with maximal power output obtained during a single all-out sprint (against the same braking force for every subject). Sixty healthy male subjects participated in the study. The ergometer system used in this study has three operating modes: the isokinetic mode (maintaining pedal crank velocity constant at a present level), a revolution dependent mode and a revolution independent mode. In all three operating modes the effective forces are monitored by means of strain gauge. All subjects performed a single all-out sprint against a braking force of 20 Newton and an all-out isokinetic cycling test consisting of ten 10 s bouts of maximal cycling at speeds ranging from 50 rpm to 140 rpm. In both tests, irrespective of which test mode was used, the mean power for a complete crank revolution showed parabolic relationships to crank velocity. For the isokinetic test, the subjects showed a peak power (IsoWpeak) of 15.3+/-1.7 W/kg corresponding to an optimal velocity of 115+/-8.6 rpm. For the force-velocity test NonisoWpeak (the highest power obtained at any time during the test) was 14.4+/-1.9 W/kg and was achieved at a pedalling rate of 127+/-14 rpm. IsoWpeak was significantly higher than NonisoWpeak (p<0.001) but there were no significant differences between NonisoWpeak and IsoWmax (maximal mean power for each full crank revolution) for the revolutions from 90 rpm to 140 rpm. Though, NonisoWpeak and IsoWpeak are significantly different, there was a strong relationship between NonisoWpeak and IsoWpeak (r = 0.7158, p<0.001). There was also a strong relationship between NonisoWpeak and IsoWmax for the revolutions from 50 rpm to 120 rpm (p<0.001) and at 130 rpm (p<0.01).

[Amount and intensity of physical exercise in primary prevention]. / Umfänge und Intensität körperlicher Aktivität in der Primärprävention.

Numerous epidemiological studies have demonstrated an inverse relation between physical activity and physical "fitness" on one hand and premature death and the risk of chronic disease on the other hand. However, most of these studies showed crucial methodological and statistical differences, a fact which caused a lack of consensus of dose and intensity of physical activities for "health benefits". The optimal amount of physical activity to decrease mortality is in literature stated to range between 1,000 and 3,500 motoric kcal per week. Only a few data exist concerning the optimal intensity of preventive physical activities. There is some indication that only "vigorous" but not "non-vigorous" physical activities are associated with decreased mortality. Previous investigations suggest that a "threshold-intensity" (e.g. of at least 6 MET of "conditioning physical activity") is needed to produce an adequate preventive effect. On the other hand it has been documented, that "physical fitness" (endurance capacity) is a decisive factor for a decreased mortality. Therefore it may be assumed, that physical activities are only efficient for health benefits, if they also result in increased physical fitness. Following from this assumption the quality and quantity of training in primary prevention has to be adjusted to the individual requirements (performance, age, gender, health) of men.

[Treatment of breast cancer at the 1st Gynecology Clinic at the University of Vienna]. / Die Behandlung des Mammakarzinoms an der I. Universitäts-Frauenklinik Wien.

Since 1979 diagnosis, operative therapy and postoperative treatment and follow-up is performed at the Ist University-Clinic of Obstetrics and Gynecology in Vienna. This management brought a close cooperation with radiologists and other oncotherapists. A standard operation method, in our case a modified radical mastectomy with a complete dissection of the axilla after radioisotope marking of the axillary lymph nodes enables us to perform a randomised prospective study of adjuvant therapy. Though the observation time is relatively short, first results show, that metastases or local recurrences were observed only in the non-treated control group. That leads in our opinion to the cautious conclusion, that any form of adjuvant therapy is of therapeutic value. Which form of adjuvant therapy should be qualified best cannot be decided yet because of the too short follow-up period.

[Results of the first Austrian multicenter ovarian cancer study: prospective randomized comparison of sequential chemotherapy (adriamycin/cisplatin--vincristine/cyclophosphamide--methotrexate) with 2 standard protocols (adriamycin/cyclophosphamide or adriamycin/cisplatin) in stage III and IV patients]. / Ergebnisse der ersten multizentrischen osterreichischen Ovarialkarzinomstudie: Prospektiv randomisierter Vergleich einer sequentiellen Chemotherapie (Adriamycin/Cisplatin--Vincristin/Cyclophosphamid--Methotrexat) mit 2 Standard-Schemata (Adriamycin/Cyclophosphamid oder Adriamycin/Cisplatin) bei Patientinnen der Stadien III und IV.

From June 1980 to December 1982 164 patients with ovarian cancer stage III and IV were randomized into the three-legged Austrian Ovarian Cancer Study. A new polychemotherapy, known as the "changing-scheme" (adriamycin/cisplatinum--vincristine/cyclophosphamide--high dose methotrexate), developed in Vienna, was compared with adriamycin/cyclophosphamide and adriamycin/cisplatinum. The risk factors were stratified by means of special computer-assisted randomization. The first study evaluation in 1982 showed a significant advantage for the changing-scheme with regard to recurrence-free interval and survival (Mantel test: p less than 0.01, Breslow test: p less than 0.03). No difference was found between the combinations of adriamycin/cyclophosphamide and adriamycin/cisplatinum. At the second study evaluation in June 1984 the differences previously observed were no longe present to the same significant extent. The changing-scheme continued to be superior for the subgroups of patients with highly differentiated tumors, without ascites, with larger postoperative tumor burden and with liver metastases. The use of this therapy is be recommended for women with advanced ovarian cancer, especially in consideration of the much lower toxicity caused by the less frequent cisplatinum administrations as compared to the adriamycin/cisplatinum combination.