[Potential use of the sauna in the long-term treatment of hypertensive cardiovascular circulation disorders--a comparison with kinesiotherapy]. / Möglichkeiten des Einsatzes der Sauna in der Langzeitbehandlung von hypertonen Herz-Kreislauf-Regulationsstörungen--ein Vergleich zur Kinesiotherapie.

The authors report about the long-term response (one and three years) of blood pressure and heart frequency under rest and load (50 W) in patients with hypertension, coronary heart disease, essential hypertension and after aortocoronary venous-bypass operation (ACVB) (n = 65) under regular visits (twice a week) to the Finnish sauna. In comparison, 68 hypertensive patients who took a regular kinesiotherapy (running and swimming) were studied. Besides the parameters of heart circulation mentioned above, peripheric microcirculation (M. tibialis anterior) by means of xenon-133 muscle clearance and central hemodynamics by means of LVEF (single probe with In 113) were studied in CHD-patients. Cardiac output at rest and under 50 W load was recorded in hypertensive patients. It was shown that regular balneotherapy had a positive effect on regulation of blood pressure and hemodynamics in patients with hypertension or CHD with hypertension, as had kinesiotherapy in hypertensive patients.

[Differential therapy of myocardial ischemia in females]. / Differentialtherapie der Myokardischämie bei Frauen.

Peripheral perfusion abnormalities are considered a possible reason for myocardial ischemia in the absence of visible coronary artery stenoses. In 85 women (age: 41-58 years, mean age: 46 +/- 8) with pathological exercise ECG (precordial mapping: 50 leads), hemodynamic studies were performed without medication, after sublingual nitroglycerin (NTG, 0.8 mg), sublingual Nifedipin (N, 30 mg), and intravenous Dipyridamol (D, 0.5 mg/kg). Eighteen women showed normal coronary arteries and a normal myocardial perfusion (group I), 21 an impaired perfusion due to coronary stenoses (Group II), and 46 women a reduced perfusion without visible changes (Group III). Reference methods were measurement of pulmonary artery pressure, 201-TI-scintigraphy, and coronary angiography. In group II, enddiastolic and endsystolic left ventricular volume (EDV, ESV) as well as enddiastolic pulmonary artery pressure (pAd) were increased, the ejection fraction (EF) was reduced, and cardiac output (CO) was normal. In group III, ESV, EDV, EF, and CO were significantly reduced, while pAd increased. In group II, N led to a normalization of ESV, EDV, EF, and pAd. In group III, NTG led to a reduction of pAd and EDV, and concomitantly to a further reduction of the already low CO. In both groups the reduction of ST-segment depressions after NTG was significant. N led to a moderate reduction of pAd and ST-segment depression, but to an increase of CO in both groups. D exhibited a comparable effect in group III. In group II an increase of ST-segment changes and of pAd with unchanged CO was observed. With regard to longterm treatment of women in group III, N and D seemed to be more efficacious than nitrates due to a beneficial effect on cardiac output.

[Unilateral catheterless determination of kidney function in hydronephrosis]. / Experimentelle Untersuchungen zur seitengetrennten katheterlosen Nierenfunktionsbestimmung bei Harnstauungsnieren.

Whereas the value of quantitative separate determination of kidney functioning is undisputed for most urological and nephrological problems, its value for the judgement of hydronephrotic kidneys is doubted by various working groups. Using 15 mongrel dogs, the nuclide excretion at certain times, various calculation intervals and the results of separate functional analysis of hydronephrotic and non-hydronephrotic kidneys were compared. Due to the early nuclide excretion with an advanced secretion peak it is no longer acceptable to use a 2-minute calculation interval for hydronephrotic kidneys in dogs. If the upper limit of the calculation interval is prior to the secretion peak, there will be no overestimation of the hydronephrotic kidneys.

[Ventilation and hemodynamics as control parameters of spa treatment]. / Ventilation und Hämodynamik als Kontrollparameter einer Kur.

Physical endurance training as practised at spas in the active treatment of hypertension will usually result in an increase in oxygen supply reserves and will also improve haemodynamics, so that it could help in objectively identifying the success of cardiovascular treatment. For this reason we conducted a bicycle ergometer load test in recumbent position in a group of 23 male hypertensives in stages I and II (age between 25 and 58 years) before and after a treatment course at a spa of 4 to 5 weeks' duration. The measurement parameters were ECG, blood pressure, cardiac output and the ventilatory parameters tidal volume, oxygen uptake, respiratory equivalent and respiratory quotient. Significant blood pressure reductions were seen if the load did not exceed 75 watts. The treatment course had a definite influence on cardiac output at rest and under stress. The treatment course achieves reduction and largely also normalisation of the tidal volume which is otherwise higher than in healthy persons. No influence is exercised on the respiratory equivalent. Reduction of the tidal volume and of the oxygen uptake, as well as reduction of the respiratory quotient after the treatment course can be interpreted as an improvement in the economy of the cardiovascular system. The ventilatory parameters are only conditionally suitable for arriving at an objective assessment of the curative effect of the treatment course.

[Experiences with running therapy in essential hypertension]. / Erfahrungen mit der Lauftherapie bei essentieller Hypertonie.

The authors report about a long-term study (three months) on blood pressure and heart rate at rest and during exercise (50 W) in hypertensive patients (WHO stadium I and I, n = 24) running twice a week. The control group were 15 healthy people who were running as well. In addition, the peripheral microcirculation (musculus tibialis anterior) was recorded by the Xenon-133 muscle clearance method and the cardiac output by means of radiocardiography (Indium 113m) as parameter of central hemodynamics. A positive influence of running on hypertension and hemodynamics, resulting in a significant decrease of systolic and diastolic blood pressure and a significant improvement of the peripheral microcirculation was registered. The measured values of blood pressure, heart rate and cardiac output show that there was no cardial risk caused by running at a velocity of 2 to 2.5 m/s.

[The effect of training on the physical fitness of patients with chronic kidney failure]. / Der Einfluss körperlichen Trainings auf die physische Leistungsfähigkeit chronisch niereninsuffizienter Patienten.

Apart from the specifically uraemically conditioned decreasing in vitality factors a physically inactivity which originates from the want of the patient or is iatrogenically induced, respectively is one of the causes for the decrease in physical vitality in patients with chronic renal insufficiency. 10 patients with chronic renal disease (serum creatinine 9.2 mg%) after an ergometric test were trained regularly twice a week for 30 minutes with a training intensity which corresponded to 80% of the load intensity. After a training duration of 15 weeks 9 of the 10 patients yielded a better result, in one female patient the bicycle-ergometric effect remained constant. The physical load capacity of the successfully trained 9 patients increased by 22.2 W from 80,5 W to 102.7 W. This corresponds to a 27.6% increase in vitality. After the end of the training the patients achieved a result which is higher than that of untrained patients with renal insufficiency in the same region of insufficiency. In comparison to healthy persons of the same age before the training the patients were to be loaded with 71% and after the training with 92% of the normal. The result of the training can also be read at a decrease of the heart rate and at a shortening of the recreation phase after constant load. The significant decrease of the systolic blood pressure on the 50 W-step indicates to a favourable influence of the RR-behaviour.

[New aspects in the diagnosis of ischemic heart disease in females]. / Neue Aspekte in der Diagnostik der ischämischen Herzkrankheit bei Frauen.

To investigate still uncertain aspects of the diagnosis of ischemic heart disease (IHD) in women, between 1969 and 1984, repeated exercise studies were performed in 706 asymptomatic women (between the ages of 17 and 63 years). On observation of pathologic ST-segment depression of more than 0.1 mV, the exercise study was repeated after administration of 0.8 mg nitroglycerin. Pathologic ST-segment depression was seen in 310 women (44%). In 217 patients (31%), nitroglycerin had no effect (NTG negative); in 93 women (13%), there was normalization of the ST-segment changes (NTG positive). Additionally, in selected subgroups of patients, pulmonary artery pressure was measured at rest and during exercise and ECG mapping performed (n = 114); radionuclide ventriculograms (n = 64) and 201-thallium scintigrams (n = 99) were obtained and coronary angiography (n = 85) was performed. In the NTG-negative women, ejection fraction, myocardial perfusion and coronary arteries were normal. NTG-positive women had lower mean ejection fractions but still within normal limits and indications of impaired myocardial perfusion. High-grade coronary stenoses were found in 25%. No patient with pathologic ST-segment depression had mitral valve prolapse. NTG-positive women had significantly more risk factors than NTG-negative women. In the former group, pulmonary artery pressure measurements showed pathologic exercise hemodynamics, only in 25% of whom IHD with significant stenosis was found to be the cause. For this condition, differential diagnostic considerations include cardiomyopathy or small vessel disease.

[The behavior of blood pressure and peripheral hemodynamics in regular exercise therapy in patients with essential hypertension (stages I and II) of various age groups]. / Zum Verhalten von Blutdruck und peripherer Hämodynamik unter regelmässiger Bewegungstherapie bei Patienten mit essentieller Hypertonie (Stadium I und II) unterschiedlicher Altersgruppen.

The authors report on the effect of a combined training programme decreasing blood pressure in male patients with essential hypertension (stage I and II) treated formerly not effectively with propranolol. Basis of the exercise treatment was the frequency of training which was established from the individual loading tests before the series of therapy. In three collectives of patients with hypertension of different age decreases of systolic as well as diastolic blood pressure could be ascertained statistically. With the help of the xenon-133 muscle clearance in most cases an improvement of the peripheral microcirculation could be proved. The mean functional vascular cross section (A) significantly increased under the training therapy.

[The behavior of central and peripheral hemodynamics in isometric and dynamic stress in hypertensive patients treatment with regular sauna therapy]. / Das Verhalten von zentraler und peripherer Hämodynamik unter isometrischer und dynamischer Belastung bei Hypertonikern unter regelmässiger Saunabehandlung.

Effective treatment of hypertension includes decrease of blood pressure at rest, dynamic and isometric exercise. Therefore, we investigated the hemodynamic changes by radiocardiography (central hemodynamic) and Xenon-133-muscle clearance (peripheral hemodynamic) before and after a sauna treatment during a period of 3 months. 46 hypertensive men (WHO I-II, aged 41 +/- 11 years) participated in the study. Systolic and diastolic blood pressure at rest and during dynamic exercise were decreased significantly (p < or = 0.01) by sauna therapy. Change of blood pressure at isometric exercise was not significant (from 157.5 +/- 16.5 mmHg to 155.0 +/- 15.4 mmHg). The changes of cardiac output and total peripheral resistance were also not significant. Half-time of muscle clearance decreased significantly (from 4.4 +/- 1.9 min to 3.2 +/- 1.2 min, p < or = 0.01) and functional cross-section A increased significantly (from 3.8 +/- 0.9 mm2.c to 4.4 +/- 0.9 mm2.c, p < or = 0.01) after the sauna therapy at dynamic exercise, but not at isometric exercise. These results show the changes between isometric and dynamic exercise, which can only be explained well by a study of peripheral hemodynamic. Contrary to dynamic exercise, sauna therapy did not significantly decrease blood pressure at isometric exercise.

[Effect of sauna and walking series on blood pressure, peripheral microcirculation and performance behavior in essential hypertension]. / Der Einfluss von Sauna- und Laufserien auf Blutdruck, periphere Mikrozirkulation und Leistungsverhalten bei essentieller Hypertonie.

On the basis of two groups with hypertension (stage I and II) pre-treated with propranolol the authors report on possibilities of the assessment of therapeutic effects in physical therapy series. The systolic and diastolic behaviour of blood pressure at rest and under load as well as the peripheral blood supply before and after the therapeutic effect of sauna bath and running series lasting several weeks were investigated according to the principle of staying power. The xenon-133 muscle clearance served as method for the recognition of the peripheral microcirculation. In the series of sauna bath hyperthermia as well as in the running treatment significant reductions of blood pressure at rest and statistically provable improvements of the peripheral haemodynamics were the result. In higher degrees of load the hypertensive position of regulation is not influenced by the therapeutic method described.

[Differing acute effects of propranolol on the hypertensive heart during exercise]. / Differente Akutwirkung von Propranolol auf das Hypertonieherz unter körperlicher Belastung.

Exercise investigations were performed in 39 male hypertensives (WHO stage I-III) to assess haemodynamics and cardiac function after intravenous application of 5 mg propranolol for the detection of latent heart failure. Radiocardiography was used to determine volumetric parameters such as LV end-diastolic volume and ejection fraction, and microcatheterization was employed to obtain the LV filling pressure via pressure measurement in the pulmonary artery (PA). The negative inotropic and chronotropic effects of propranolol on pump function and myocardial mechanics at rest were found to be minimal. During 50 watt exercise however, an increase of the diastolic PA pressure has been observed simultaneously with a diminution of cardiac output (stroke volume being constant). Thus, under acutely administered beta blockade, a general disturbance in the flow-pressure relation could be induced, being comparable to heart failure. Only in a few cases was the reduced contractility compensated by the Frank-Starling mechanism, but only if the mechanism did not participate in the regulation of pump function during the previous control investigation. In other cases a remarkable reduction of cardiac output and even stroke volume occurred, results which may be explained as a consequence of a reduced venous return (or pooling) connected with acutely induced vascular effects (beta-2 blockade).

[Hemodynamics of patients with essential hypertension in mild infrared hyperthermia]. / Untersuchungen zur Hämodynamik bei Patienten mit essentieller Hypertonic unter milder Infrarot-Hyperthermie (IRA-Therm II).

Hyperthermia therapy in hypertensive patients is been discussed as an effective treatment. The aim of this study was to control the behaviour of circulation in conditions of hyperthermia. A group of 6 males, 32-53 years old, suffering from essential hypertension stage I-II underwent a single whole body-irradiation with near infrared (IRA), lasting over one hour. The body temperature rises up to maximal 38.5 degrees C. Before, during and after treatment the blood pressure (BP), the heart rate (HR), the stroke volume (SV), the cardiac output (CO) and the ejection fraction - measured by radionuclide ventriculography - where estimated and the peripheral arterial mean pressure (Pm), the ejection resistance (AW) and the Total peripheral resistance (TpW) were calculated. During irradiations there was a significant decrease of BP, AW and TpW. HR, SV, CO and EF increased significantly. Due to IRA irradiations there was a change in microcirculation with the consequence of lowering the blood pressure. The concomitant stimulation of the heart was well compensated as shown by CO, SV and EF.

[Rehabilitation measures in patients following recovery in myocarditis and dilated cardiomyopathy]. / Rehabilitative Massnahmen bei Patienten nach abgeheilter Myokarditis und dilatativer Kardiomyopathie.

In the frame of the attendance to patients with specific myocardial diseases differences are found in contrast to groups of patients, in particular of older age. The complex diagnostic clarification, including myocardial biopsy, is recommended. Convalescent treatment is of priority. Because of the bad prognosis of patients with impaired left-ventricular function, in particular patients with normal or slightly impaired left-ventricular ejection fraction should be mobilised using complex rehabilitative measures (psychologist, welfare worker) only after some longer convalescent treatment. Decisions as to sanatorium treatment or on further special therapeutic principles have to be made individually.

[Use of nitrates in hypertension. Cardiac and peripheral effects before and during antihypertensive therapy at rest and during stress]. / Nitratanwendung bei Hypertonie. Kardiale und periphere Wirkungen vor und unter antihypertensiver Therapie in Ruhe und unter Belastung.

The acute effects of 1.6 mg glycerol trinitrate (2 x 0.8 mg) on the hemodynamic function were compared in 11 healthy subjects and 25 hypertensive patients (WHO stages I and II), at rest and during exercise. The nitrate testing was performed before the beginning of antihypertensive treatment, during nonmedical therapy, as well as under additional oral therapy with diisopropylamin. Right-heart-catheterization, echocardiography, radionuclide-ventriculography and venous occlusion plethysmography were performed. Nitroglycerin consistently led to a reduction of blood pressure in the systemic and pulmonary circulation both at rest and during exercise. There was a small decrease of peripheral arterial resistance (TPR) at rest and a more pronounced decrease of pulmonary arteriolar resistance (PAR) at rest and during exercise. The documented effects may be important with regard to combined antihypertensive treatment. In addition, the application of nitrates in hypertensive crises may be useful.

[Behavior of blood pressure and peripheral hemodynamics in interval therapy in untreated and propranolol-treated patients with arterial circulatory disorders of the lower extremities]. / Zum Verhalten von Blutdruck und peripherer Hämodynamik unter Intervallauftherapie bei unbehandelten und mit Propranolol behandelten Patienten mit arteriellen Durchblutungsstörungen der unteren Extremitäten.

Searching for a possibility of an effective therapy of disturbances of peripheral arterial blood supply (stage I and II), the authors examined a medicamentously untreated group of patients as well as a comparable group of patients which was pretreated with propranolol. The two groups of patients performed twice a week an interval run exercise. Under the three-month training therapy in the two groups significant systolic and diastolic blood pressure reductions as well as statistically ascertained shortenings of the xenon-133-half-value time under working conditions and enlargements of the average functional vascular cross section A appeared. The distance of the intermittent claudication and the standardized moving up and down test prolonged. An influence on the microcirculation caused by propranolol could not be proved. The results are discussed on the basis of literature.

[Treatment of experimental immune complex nephritis with indomethacin]. / Therapie der experimentellen Immunkomplexnephritis mit Indomethazin.

Functional, histological and immune-histological examination were performed in altogether 64 Wistar-rats, in order to control the effect of a therapy with 2 mg/kg per body weight indomethazine lasting 2 months at the model of an experimental immune complex nephritis. In 44 rats after presensibilisation an immune complex nephritis was performed by intraperitoneal injections with human serum albumin which were repeated three times a week. 24 glomerulonephritis animals and other 20 animals without glomerulonephritis were daily administered indomethazin through a tube probe, the remaining 20 animals with glomerulonephritis served as untreated control groups. The excretion function of the kidney was tested before the beginning of the experiment, 2 weeks after the beginning of the therapy and the regular serum injections, respectively, and before the end of the experiment by determination of the biological half-life period of 131J-hippuran. In every case one day before this the proteinuria during 24 hours was determined. At the end of the experiment the kidneys were examined histologically and immune-histologically. The results showed that indomethazin does not lead to a clear influence on the proteinuria in the immune complex nephritis of the rat. The excretion of 131J-hippuran was significantly restricted, whereas the histological and immune-histological preparations in the animals with foreign serum injections showed clear changes of the glomeruli in the sense of an early stage of the immune complex nephritis, however, they did not show any essential influence by indomethazin. That is, indomethazin had altogether no favourable effect on the immune complex nephritis of the rat.

[Quantitative kidney function scintigraphy (FSG) on separate sides in urogenital tuberculosis]. / Die quantitative seitengetrennte Funktionsszintigraphie (FSG) der Niere bei der Urogenitaltuberkulose.

Depending on degree and size of the changes the function of the tuberculous kidney is disturbed with different strength. With the help of the quantitative function scintigraphy by means of 131 J hippuran (sequence scintigraphy, ROI nephrography and side-separated clearance) 33 patients with urotuberculosis were examined and their course of the disease was observed. The greatest value has the function scintigraphy in progressed renal tuberculosis in the differential therapy (nephrectomy, organ-maintaining operation or conservative therapy) and control of the course.