[Comparative evaluation of different physical load tests in patients who have had a myocardial infarct]. / Sravnitel'naia otsenka razlichnykh prob s fizicheskoi nagruzkoi u bol'nykh, perenesshikh infarkt miokarda

A comparative analysis of the results of exercise tests conducted in 2 groups of patients following myocardial infarction was done on the basis of data from the A.L. Myasnikov Institute of Cardiology, USSR Acad. Med. Sci., and the research group of medical rehabilitation of the Humboldt University, Berlin. Continuous and interrupted step-wisely growing bicycle exercises in sitting position were compared. The duration of each step comprised 5 min with pedalling at 60 rpm. With continuous tests every step increase the workload by 25 W. With stepwise tests in half of the patients the work load was increasing by 25 W every step, in the other half--by 16.7 W, the pause between the steps lasting 10 min. It was found that the main parameters of both types of tests did not differ in the two centers, as shown by statistical processing; an identical threshold capacity of the workload, equal elevations of the arterial pressure and heart contractions rate at the peak of the test were obtained. No differences were revealed in the criteria of test interruption with both types of examinations in the two centers. A slight tendency towards a greater elevation of the heart contractions rate and systolic arterial pressure was noted with continuous tests, in contrast to the step-wise. This results in a greater variance of the workability parameters when comparing the results. Therefore it seems preferable to conduct one type of tests--the continuous one.

[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.

[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 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.

[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.

[On the significance of combined kinesitherapy for the rehabilitation of ageing people with essential hypertension (author's transl)]. / Zur Bedeutung der kombinierten Bewegungstherapie für die Rehabilitation der alternden Menschen mit essentieller Hypertonie.

Proceeding from their investigations the authors have formulated the following questions: 1. How do ageing people with essential hypertension tolerate sauna treatment (hyperthermia)? 2. What is the optimum thermal load for effective antihypertensive treatment? 3. What is the optimum interval, i.e. how many sauna baths are recommended per week? 4. Does an anti-hypertensive combination therapy consisting of sauna baths and jogging produce the same or even better results in aged hypertensives than sauna treatment on its own?

[Studies on central and peripheral hemodynamics using radiocardiography and Xenon-133 muscle clearance in patients with essential hypertension]. / Untersuchungen zur zentralen und peripheren Hämodynamik mit Hilfe der Radiokardiographie und der Xenon-133-Muskelclearance bei Patienten mit essentieller Hypertonie.

Examination of 80 patients with essential hypertension revealed a significant correlation between the tonus of peripheral muscular arterioles on the one hand, and the stage and duration of hypertension and age of the patients, on the other hand. The correlation between arteriolar tonus and indicators of cardiac pump function was less marked. The results confirmed the close relationship between changes of peripheral blood bed and development of hypertension. The use of 133Xe half-period for measuring the peripheral arteriolar tonus proved a simple, but informative method adding an important indicator of peripheral haemodynamics to the results of haemodynamic examination.

[Value of nuclear medicine procedures in evaluating the hemodynamics in physical medicine and cardiac rehabilitation]. / Die Bedeutung nuklearmedizinischer Verfahren zur Beurteilung der Hämodynamik in der physikalischen Medizin und kardialen Rehabilitation.

This is a report on the application and importance of nuclear-medical procedures in physical therapy and rehabilitation. In particular, attention is focused on the parameters of peripheric haemodynamics (T1/2 and -A) and of the left ventricular ejection fraction. The authors aim at demonstrating their own results gained during the last 10 years in different groups of patients suffering from cardiovascular diseases at rest and under load. The results are critically estimated, including the relevant literature, and conclusions are drawn for clinical practice.

[A-wave in calibrated apex cardiogram in hypertension. Studies during rest and after exertion]. / Die a-Welle im kalibrierten Apexkardiogramm bei Hypertonikern. Untersuchungen in Ruhe und nach Belastung.

Apexcardiographic examinations were carried out of 86 hypertensive patients without clinically manifest heart failure. The amplitude of the wave a (or the per cent fraction of the wave a of the total amplitude) and the maximal rate of wave rise, df/dta were statistically significantly higher in the hypertensive patients than in normal subjects. The findings are interpreted as a manifestation of an increased left ventricular rigidity and of an increased atrial contractility in hypertensive patients. No correlation was found between the apexcardiographic indicators checked and the indicators of the cardiac pump function. In 46 hypertensive patients, in addition, a dynamic exercise test was performed (50 W for 6 min); 1 minute after cessation of exercise an apexcardiogram was recorded. An increase in the a/T quotient (greater than or equal to 5%) was found in 20; a decrease (=5%), in 10; and no change (less than +/- 5%), in 16 hypertensive patients. The postexercise apexcardiographic changes had no correlations with haemodynamic changes occurring during exercise.

[Effect of a 3-month-interval running exercise in combination with vasodilative therapy on microcirculation of the lower leg in peripheral arterial circulation disorders (stage I and II)]. / Die Wirkung einer dreimonatigen Intervallaufübung in Kombination mit einer Vasodilatantien-Therapie auf die Mikrozirkulation im Unterschenkel bei peripheren arteriellen Durchblutungsstörungen (Stadium I und II).

The authors report results of a three-month-interval running exercise under continuous vasodilatory therapy (Radecol and Jupal) in cases of peripheral arterial blood disturbances (stage I and II). Apart from control examination with the whipping test, the ultra-sound-Doppler method, phlebemphraxis-plethysmography, the paper reports above all the effects of interval running on the peripheral microcirculation of the working muscles which were determined by means of Xenon-133-clearance-half-life. Independent of the type of drug therapy used, significant (1 per cent) improvements of peripheral haemodynamics were found regarding the therapeutic regime presented.

[Experiences with the application of physiotherapy in peripheral arterial circulatory disorders of the lower extremities (stage I and IIa) under ambulatory conditions]. / Erfahrungen mit dem Einsatz der Physiotherapie bei peripheren arteriellen Durchblutungsstörungen der unteren Extremitäten (Stadium I und IIa) unter ambulanten Bedingungen.

In a comparative study the authors report on results of series of physical therapy in disturbances of the peripheral arterial blood supply. Examined were the behaviour of blood pressure, the painless walking distance and the peripheral microcirculation with the xenon-133-muscle clearance method before and after treatments lasting 10 to 12 weeks with combined exercises consisting of gymnastics and walking according to the interval principle (twice a week), with sauna visits twice a week as well as before and after diadynamic series of the current. In all therapy groups an improvement of the peripheral haemodynamics could be statistically ascertained. The distance of the intermittent claudication prolonged particularly in the group with interval walking. In the walking group and in the sauna group the values of the systolic blood pressure were significantly reduced. Side-effects were not observed. Therapy effects of the series of physical therapy described are best to be proved by the xenon-133 muscle clearance.

[Swim therapy in elderly patients with essential hypertension treated with beta receptor blockers]. / Schwimmtherapie bei älteren Patienten mit essentieller Hypertonie unter Behandlung mit beta-Rezeptorenblockern.

It is reported on the behaviour of blood pressure and heart rate at rest as well as on the peripheral microcirculation of the working musculature after physical conditioning in older patients with essential arterial hypertension (stage I and II). The patients with hypertension conditioned in 4 groups (twice a week swimming or once a week swimming and run each with and without propranolol) showed systolic and diastolic decrease of blood pressure with the exception of some patients. The heart rate at rest was significantly reduced only in the groups with swimming twice a week with and without beta-blockers. By means of the xenon-133-half-life period with the exception of the run-swimming group in all groups could be proved significant improvements of the peripheral microcirculation after the therapy, in contrast to the time before therapy. Value and limits of the training treatment described for the influence on the factor of risk arterial hypertension at old age are discussed.

[Use of walking and sauna therapy in the rehabilitation of hypertensive patients with ischemic heart disease following aortocoronary venous bypass operation with special reference to hemodynamics]. / Der Einsatz der Lauf- und Saunatherapie zur Rehabilitation von hypertonen IHK-Patienten nach aortokoronarer Venenbypassoperation (ACVB) unter besonderer Berücksichtigung der Hämodynamik.

Rehabilitation results are reported concerning the behavior of blood pressure and heart rate, peripheral and central hemodynamics, after resting and during exercise and physical conditioning by running as training and sauna, respectively, in hypertensive patients with IHD after aortocoronary venous bypass (ACVB) surgery. Bicycle ergometric examinations an xenon wash-out (for the determination of the mean functional vessel cross section A) were performed in 43 male untrained patients before and after physical therapy. The left ventricular ejection fraction (EF) at rest was also determined in these patients. Significant increases in the ejection fraction at rest (on average by 7-8%) could be demonstrated in both therapy groups. The group average value for peripheral microcirculation improved only in the sauna group. Blood pressure after resting and on exercise was not influenced. Results are discussed on the basis of the literature and practical conclusions drawn.