Principles of exercising in patients with chronic kidney disease, on dialysis and for kidney transplant recipients

Independent of the course of kidney disease, physical fitness decreases continuously with the progression of CRF. The reduced physical fitness of patients with CKD is characterized by the following: reduced flexibility, coordination disturbances, decreased muscular strength and endurance. Often CKD patients suffer from depression and loss of self-confidence. Thus, the goals are to improve the principal components of motor fitness, conditioning gymnastics, different forms of endurance training, breathing and relaxation exercises, and body experience. The training starts with an initial phase followed by a build-up phase and a maintenance phase. Each phase consists of a warm-up, the main phase, and a cool-down phase. The Borg's RPE-scale is recommended for controlling the training. Because of their specific treatment modalities, hemodialysis and peritoneal dialysis patients as well as transplantation patients should seek individual prescriptions. Large experience exists in out-center training programs in dialysis and transplantation patients. The importance of physical fitness to the somatic and psychosocial well-being is well-documented. It is therefore recommended to exercise continuously on an individual basis in order to counteract the reduction of physical fitness due to CKD. Each patient should feel encouraged to participate in an exercise training adjusted to the individual capacity.

[The diagnosis and treatment of epileptic pseudocrises]

We evaluated 30 patients with a tentative diagnosis of epilepsy who did not respond to anticonvulsant therapy. Crisis were induced through suggestion with simultaneous EEG recording. Pseudoseizures were revealed in 10 patients. A depressive syndrome was present in 5 and other psychiatric disorders in the rest. Psychiatric therapy was effective in suppressing seizures in 7 compliant patients. We feel that suggestive induction of crisis is an effective diagnostic tool for identification of pseudoseizures.

[The frequency variation--a parameter in the evaluation of heart rhythm]

The duration of the pulse period shows under physiological conditions a though slight variation, which is regarded as the expression of the vegetative regulation of the heart. When this "irregularity" of the duration of the pulse period decreases or increases, it has pathological significance. A calculation algorithm of this parameter called variation of frequency is given. When it is between 2.5 and 10%, i.e. the length of the duration of the pulse period varies by this sum by the mean value, this can be regarded as physiological. At a variation of frequency below 2.5% one speaks of cardiac automatism. It has the same significance as the omission of the vegetative regulation of the heart and thus shows a bad prognosis for the patient. When the variation of frequency is more than 10%, a disturbance of the cardiac rhythm (of various form) is to be derived. At the same time the condition of the criterion of untimeliness can again be formulated. According to this an untimely beginning of beating of the heart (an extrasystole) is existing then, when it begins in an interval of less than 0.9-fold of a normal RR-interval.

[The aging of intermitotic cells (author's transl)]

The aging of the cells depends on their mitotic activity, which is particularly evident in multicellular organisms. By way of histoautoradiography we studied the cell kinetics on a total of 244 Wistar rats aged 6 days, 6 weeks, 6, 12, 23 and 28 months respectively, with these studies being centred on the mucosa of the small intestine since this mucosa is one of those tissues with the highest cell metabolism. We succeeded in demonstrating that the regeneration rate of cells per hour in the crypts of the small intestine and the migration speed of the enterocytes differ in young and old individuals and that the intermitotic cells have age-dependent properties as well. In addition, we could prove that intermitotic cells too have a non-growth fraction which, at an advanced age, decreases only a little, although significantly in terms of statistics. For the easily vulnerable crypt epithelium it is a reserve capacity and can be included in the proliferating pool, if necessary.

The influence of diabetes mellitus and hypercorticism on the wound healing of experimental myocardial infarction in rats

In diabetic and glucocorticoid-treated rats myocardial infarction is produced by coronary artery ligation. After the ligation was performed the animals were given 3H-thymidine or 3H-proline at different times. The following parameters were determined: number of DNA- and tropocollagen-synthesizing connective-tissue cells both at the infarction border and infarction site; mean silver-grain density above the nuclei or cells; number of mitoses. The labelling and mitotic indices as well as the standard deviation (in percent) from the mean values were calculated. The following results were obtained: 1. The retarded formation of collagen fibres in diabetic animals is caused by a reduced number of tropocollagen-synthesizing fibroblasts and by a diminished synthesizing performance of the individual cells. 2. Glucocorticoids have a pronounced inhibitory effect on granulation-tissue formation, The 3H--thymidine indices are strikingly low. The synthesis of collagen precursors in the fibroblasts is reduced. The release of tropocollagen from the connective-tissue cells is slowed down.

The influence of hyperthyroidism and hypothyroidism on the wound healing of experimental myocardial infarction in the rat

In hyperthyroid and hypothyroid rats myocardial infarction was produced by coronary artery ligature. At different times following the ligature the animals were given 3H-thymidine or 3H-proline. The following parameters were determined: the number of DNA- and tropocollagen-synthesizing connective-tissue cells at the infarction border and at the infarction site; the mean silver-grain density above the nuclei or cells; the duration of one cell cycle; and the number of mitoses. The labelling and mitotic indices as well as the percentage of the standard deviation from the mean values were estimated. The following results were obtained: 1. In hyperthyroidism wound healing is accelerated. The number of DNA-synthesizing connective-tissue cells is increased. The cell-cycles are shorter. The release of tropocollagen by the fibroblasts takes place at a strikingly fast rate. 2. In hypothyroidism wound healing is delayed. The 3H-thymidine and mitotic indices are lowered. The release of tropocollagen is slowed down. The granulation tissue contains localized accumulations of mucopolysaccharides.

The influence of age on the wound healing of experimental myocardial infarction in rats

In 6-weeks-old, 5-months-old and 21-months-old rats myocardial infarction was induced by coronary artery ligature. After performing the ligature the animals were administered 3H-thymidine, 3H-proline or 35S-sulphate at different times. The following parameters were determined: number of DNA- and tropocollagen-synthesizing connective tissue cells at the infarction border and at the infarction site; mean silver grain density above the nuclei or cells; duration of a cycle; number of mitoses, and incorporation of radioactive sulphate at the infarction site. In addition, the labelling and mitotic indices as well as the percentage of the standard deviation from the mean values were estimated. The following results were obtained: 1. The rate of granulation tissue formation in the necrotic zone is determined by the mitotic activity of the cells. With advancing age the cell cycles are being prolonged which results in retardation of wound healing. 2. The disturbed DNA-replication in old age is not associated with a time shift in the occurrence of the mitotic and labelling peaks. 3. With advancing age the number of fibroblasts synthesizing collagen precursors decreases. There exists no age-dependence of the 3H-proline incorporation rate, of the intracellular transport, of the synthesis of collagen precursor and of the release of labelled tropocollagen. In all age-groups under study these processes last approximately 4 hours. 4. Collagen fibre formation is accompanied by an increased synthesis of acid mucopolysaccharides. In infarction callosities the content of acid mucopolysaccharides mostly is constant. 5. The proliferating endothelial cells have a pronounced metabolic activity and a markedly short generation time.