The cardiac filling pressure following exercise and thermal stress.

Under heat stress, a decrease of the central venous pressure (CVP) was regularly observed, raising the question of whether this reaction is a limiting factor for the circulation. In animal experiments it could be shown, however, that despite a lowered CVP, which depended on the elevated body temperatures, a high cardiac output (CO), as well as an elevated stroke volume could be maintained. A low CVP went hand in hand with a low total peripheral resistance. It was argued that under these circumstances the low CVP was not limiting because the intrinsic factors of the heart (sympathetic stimulation) were capable of maintaining a high CO. In human experiments the lowered CVP had to be seen in relation to the degree of dehydration. Regardless of whether the plasma volume remained constant, as in exercise, or declined, as in thermal stress (sauna), the CVP followed the volume depletion of the vascular and extravascular space, and it might well be that under these circumstances CVP is limiting. In this case, however, the altered CVP must be seen first as a monitor for the fluid deficit and not as a factor controlling cardiac function.

[Results of comparative studies of Strömbeck and Skoog breast reduction-plasty]. / Ergebnisse vergleichender Untersuchungen bei der Mammareduktionsplastik nach Strömbeck und Skoog.

Long-term results in reduction mammaplasty can be evaluated at the earliest after one year. Criticism about the result induced us to apply more often the technique of Skoog beside the procedure of Strömbeck. A follow-up study of 110 patients could be done. Objective parameters were considered as well as subjective factors. Special attention was paid to diagnosis of cancer after mammaplasty.

[Vitamin C in a long-term trial is without effect on experimental carcinogenesis]. / Vitamin C im Langzeitversuch ohne Einfluss auf die experimentelle Carcinogenese.

This long-term study deals with the effect of ascorbic acid on chemically induced carcinogenesis of the small intestine in rats. Carcinoma was induced in 27 animals by application of N-Ethyl-N'-nitro-N-nitrosoguanidine (ENNG) alone in the drinking water (120 mg/1). The average survival time was 238 ( 40) days. The addition of large amounts of ascorbic acid to the food (3 g/100 g food) did not suppress the development of tumors. On the contrary, a significant reduction in the survival time was seen. All animals receiving ENNG and ascorbic acid only lived 207 ( 45) days on average. Neither histological type of tumor spread was influenced by the use of ascorbic acid. Giving ascorbic acid alone had no effect on the survival time and did not lead to changes in the tissue of the small intestine.

[Colitis cystica profunda]. / Colitis cystica profunda.

The rare disease of colitis cystica profunda is characterized histopathologically by epithelial coated cysts with mucous content within the submucosa of the large intestine or rectum. The clinical picture, showing loss of blood and mucus as well as the macroscopic appearance can lead to confusion with rectal cancer. This misinterpretation can be supported by the histologic picture of small biopsies and frozen sections. Transanal disc excision as definite therapy will allow extensive histologic examination and will prevent false treatment, for example proctectomy, in case of localization close to anal orifice.

Extracellular fluid volume and central circulation after long lasting exercise and dehydration in conscious dogs.

Two aspects of the recovery period after endurance exercise were investigated: a) the fluid distribution between the intra- and extravascular parts of the extracellular fluid volume (ECFV) induced by exercise dehydration, b) the cardiovascular response pattern [blood pressure (BP), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR), and central venous pressure (CVP)] to the heat load which results from the preceding exercise. Seven conscious dogs performed endurance exercise in a cool environment (16 degrees C) on a horizontal treadmill till 4% of the body weight was lost. It was found that about 70% of the total fluid loss of the body came from intracellular water. During exercise sodium and chloride concentrations rose by 6 mMol and 7 mMol respectively (P less than 0.005) and remained elevated throughout the early recovery period indicating a fluid loss of about 100-200 ml out of the ECFV. Direct measurements of the ECFV as sulfate space confirmed these values. Since the plasma volume remained unchanged, this fluid loss was carried totally by the interstitial fluid volume. Immediately after exercise body temperature was elevated by 1.5 degrees C and returned towards control within 90 min. Cardiac output was above control level for 2 h after the end of exercise, at first due to an increased HR and thereafter to an elevated stroke volume (SV) (P less than 0.02). CVP and TPR were below control levels for at least 2 h (P less than 0.01). A linear correlation was found between CVP and TPR. A close correlation existed between the body temperature and the cardiovascular parameters. It can be concluded that even long after exercise the cardiovascular system has to serve thermoregulatory needs.