[Hydrotherapy and thermotherapy in the treatment of functional disorders]. / Hydro-Thermotherapie bringt Körper, Seele und Geist in Einklang. Erspart die Sauna den Psychaiater?

The modern interpretation of functional disorders classifies them as somatoform autonomic functional disorders that are associated with the vegetative nervous system. This places them within the responsibility of psychosomatic, psychotherapeutic medicine or psychiatry. In consequence, other forms of treatment with an impact on the vegetative system are being underestimated, such as hydrotherapy and thermotherapy, the efficacy of which depends on the fact that thermoregulation predominates over the regulation of numerous other organ systems. In the present article, the effectiveness of this therapeutic approach is discussed.

Oxidative stress in chronic lymphoedema.

BACKGROUND: Chronic lymphoedema is one of the most frequent and debilitating complications after surgical and radiological tumour treatment. Prevention and therapy of lymphoedema is therefore an important problem of the rehabilitation of those patients. AIM: To investigate whether chronic lymphoedema results in increased oxidative stress. DESIGN: Prospective case-control study. METHODS: We obtained venous blood samples from patients (n=38) with chronic lymphoedema and determined biomarkers of prooxidative reactions and of antioxidative defense system in the erythrocytes or blood plasma: reduced and oxidized glutathione (GSH and GSSG), and lipid peroxidation products such as malondialdehyde (MDA) and 4-hydroxynonenal (HNE). Healthy volunteers (n=90) and patients who had undergone surgical and/or radiotherapeutic treatment of tumours without consequent lymphoedema (n=20) acted as controls. RESULTS: The blood of patients with chronic lymphoedema contained lower concentrations of GSH and higher levels of GSSG and of MDA and HNE, compared with the control group. MDA was increased by about three-fold in the serum of the lymphoedema patients. Accelerated free radical formation and lipid peroxidation processes were further demonstrated by the liberation of MDA and HNE into the blood serum after manual lymph drainage. DISCUSSION: Our data demonstrate enhanced formation of reactive oxygen species (ROS) and accelerated lipid peroxidation processes in chronic lymphoedematous tissue. The strengthening of antioxidative defense mechanisms could be useful in the therapy of chronic lymphoedema.

Improved antioxidative protection in winter swimmers.

Adaptation to oxidative stress is an improved ability to resist the damaging effects of reactive oxygen species, resulting from pre-exposure to a lower dose. Changes in uric acid and glutathione levels during ice-bathing suggest that the intensive voluntary short-term cold exposure of winter swimming produces oxidative stress. We investigated whether the repeated oxidative stress in winter swimmers results in improved antioxidative adaptation. We obtained venous blood samples from winter swimmers and determined important components of the antioxidative defense system in the erythrocytes or blood plasma: reduced and oxidized glutathione (GSH and GSSG), and the activities of superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (Cat). The control group consisted of healthy people who had never participated in winter swimming. The baseline concentration of GSH and the activities of erythrocytic SOD and Cat, were higher in winter swimmers. We interpret this as an adaptative response to repeated oxidative stress, and postulate it as a new basic molecular mechanism of increased tolerance to environmental stress.

[Adjuvant therapy in lymphedema]. / Adjuvante Therapie beim Lymphödem.

Therapy of first choice in chronic lymphedema is the complex physical drainage therapy. Complementary measures serve the prevention of erysipelas, the treatment of secondary tissue damage and additionally existing diseases in the lymphedematous area. Some measures of physical medicine and drugs are discussed. Antioxidative therapy as a new principle is presented. It is used to decrease secondary tissue damage by free radicals and to prevent possible damage far from the lymphedematous area.

Influence of Allium sativum on oxidative stress status - a clinical investigation.

The influence of daily application of coated garlic powder tablets (900 mg with an alliin content of 1.3% and an allicin content of 0.6%) on serum levels of malondialdehyde (MDA) and concentrations of reduced (GSH) and oxidized (GSSG) glutathione was investigated. 25 healthy volunteers were treated with garlic tablets for 2 months. After the 2 months' treatment a reduction of initial serum MDA level was observed. Application of Allium sativum reduced the MDA level by about 60% of the initial value. The MDA reducing effect was found in all age groups. In two age groups (younger than 30 years and older than 40 years) different initial values (higher values in elderly) but almost the equal MDA-levels after the treatment were found. The GSH concentration in circulating human erythrocytes showed a significant increase after the 2 month period of application of Allium sativum tablets, while the GSSG concentration showed no significant changes during the whole period of investigation. Thus a significantly decreasing trend of the GSSG: total glutathione ratio was measured.

[Increased formation of free radicals in chronic lymphedema]. / Verstärkte Bildung freier Radikale beim chronischen Lymphödem.

The erythrocytic glutathione concentration in patients with lymphatic edema was around 20% lower than that of healthy volunteers. In addition, there was a drastic increase in the plasma malondialdehyde concentration. These changes indicate vigorous generation and activity of free radicals in lymphatic edematous tissue.

Uric acid and glutathione levels during short-term whole body cold exposure.

Ten healthy subjects who swim regularly in ice-cold water during the winter (winter swimming), were evaluated before and after this short-term whole body exposure. A drastic decrease in plasma uric acid concentration was observed during and following the exposure to the cold stimulus. We hypothesize that the uric acid decrease can be caused by its consumption after formation of oxygen radicals. In addition, the erythrocytic level of oxidized glutathione and the ratio of oxidized glutathione/total glutathione also increased following cold exposure, which supports this hypothesis. Furthermore, the baseline concentration of reduced glutathione was increased and the concentration of oxidized glutathione was decreased in the erythrocytes of winter swimmers as compared to those of nonwinter swimmers. This can be viewed as an adaptation to repeated oxidative stress, and is postulated as mechanism for body hardening. Hardening is the exposure to a natural, e.g., thermal stimulus, resulting in an increased tolerance to stress, e.g., diseases. Exposure to repeated intensive short-term cold stimuli is often applied in hydrotherapy, which is used in physical medicine for hardening.

[Fitness by cold stimulation of various intensity: effects on metabolism of purines and free radicals]. / Abhärtung durch Kaltreize unterschiedlicher Intensität: Wirkungen auf den Purin- und Radikalmetabolismus.

Whole-body cold stimuli lead to a dosage-depended decrease of uric acid level in blood plasma. This could be observed in own studies on winter-swimming and cold shower application and in studies on patients treated by cold-chamber-therapy. This uric acid decrease is due to an accelerated oxygen radical formation during cold exposition rather than to an inhibition of purine metabolism. The acute oxidative loading due to cold exposure and the long-term antioxidative adaptation may be interpreted as a new molecular mechanism resulting in body hardening.

Changes in the glutathione system of erythrocytes due to enhanced formation of oxygen free radicals during short-term whole body cold stimulus.

The red cell glutathione levels of 10 healthy volunteers who are accustomed to winter-swimming were measured before and after this short-term whole body exposition to hypothermic environment. From the increases of the erythrocytic level of oxidized glutathione (GSSG) and of GSSG: total glutathione ratio an extensive formation of oxygen free radicals during and following the exposition to the intensive cold stimulus was concluded. That is in accordance with the finding on the drastic decrease of the concentration of uric acid as an important radical scavenger of the human blood plasma. Furthermore, the initial erythrocytic concentrations of reduced glutathione (GSH) and GSSG of subjects accustomed to winter-swimming were compared with those of healthy control persons who are not accustomed to regular winter-swimming. The markedly increased concentration of GSH and the reduced GSSG:total glutathione ratio in the erythrocytes of winter-swimmers reflect the adaptation to a regular oxidative stress. This antioxidative adaptation is postulated as a new basic mechanism of the hardening by exposition to an intensive short-term cold stimulus often applied within the hydrotherapy.

[Diagnosis and clinical relevance of microcirculation disorders in progressive scleroderma]. / Diagnostik und klinische Relevanz von Mikrozirkulationsstörungen bei der progressiven Sklerodermie.

Microcirculation in the hands of patients with progressive systemic sclerosis shows some peculiarities. For diagnostic purposes functional thermography and the acrale rewarming test may be used. Typical features of progressive systemic sclerosis are a general hypothermia of the hands and localized hypothermic areas and refractory hyperthermic areas. In the acrale rewarming test reactive vasodilatation after cold stimuli is often not inducible and the significantly retarded rewarming shows a marked local restrict dependence. The significance of these facts for a more intensive physical therapy is discussed.

[Possibilities for the success of radon treatment of patients with progressive scleroderma]. / Erfolgsaussichten von Radonkuren bei Patienten mit progressiver Sklerodermie.

Physiotherapy and spa-therapy occupy a high value in the treatment of the progressive sclerodermia. On the basis of 59 radon cures at Bad Brambach in patients with this disease is shown that a success of the cure lasting for a long time is to be expected particularly in patients with a relatively bad initial situation. Above all an amelioration of the subjective condition as well as the movability of the joints is achieved. The necessity of repeated cures at an interval of 1 to 2 years is discussed in selected patients. No evidence can be rendered concerning a possibly specific radon effect.