[Age-related peculiarities of regulating heart rhythm in dose-adjusted physical stress]. / Altersbesonderheiten der Regulation des Herzrhythmus bei dosierter körperlicher Belastung.

The authors examined the heart rate regulation by means of rhythmography during and after dynamic exercise in 90 normal subjects aged between 20 and 89 years and in 15 older man who went in for endurance training. It was shown that the quality of the regulation of the cardiac rhythm deteriorates in the course of aging. This is associated with the impairment of the vegetative influences on the sino-atrial node on aging. Physical endurance training contributes to the regulation of the cardiac rhythm in persons at older age.

[Changes in the renin-angiotensin-aldosterone system in elderly patients with chronic ischemic heart disease. 4. The renin-angiotensin-aldosterone system in elderly patients with ischemic heart disease and cardiovascular insufficiency]. / Veränderungen des Renin-Angiotensin-Aldosteron-Systems (RAAS) bei älteren Patienten mit chronischer ischämischer Herzkrankheit (IHK). 4. Mitteilung. Das Renin-Angiotensin-Aldosteron-System bei älteren IHK-Kranken mit Herz-Kreislauf-Insuffizienz.

The elderly chronic ischemic heart disease (IHK) patients with cardiac failure show a higher activation of the renin-angiotensin-aldosterone system compared to the younger patients. It was noted functional activity of the renin-angiotensin-aldosterone system increases with a progress of the disease (decompensation). Changes occur not only in the basal level of plasma reninactivity and circulating aldosterone concentration, but also the 24 hour rhythm to the side of an increased hormonal level during the evening hours, evidencing thus for disadaption of the renin-angiotensin-aldosterone system and its decreased reliability under conditions of habitual life activity. Administration of the converting enzyme inhibitor, Captopril, has confirmed a pathogenetic role of the renin-angiotensin-aldosterone system in the development of cardiac failure syndrome in the chronic IHK patients as well as verified a new approach in the treatment of this pathology.

[The oxygen transport function and energy metabolism of erythrocytes in human aging]. / Sauerstofftransportfunktion und Energieumsatz von Erythrozyten beim Altern des Menschen.

Age-related changes of hemoglobin affinity to oxygen and intraerythrocyte factors which determine it (pH, pCO2, rate of glycolysis, content of organic phosphates) were studied. The results obtained showed the decrease in aging of the affinity of hemoglobin to oxygen resultant from the decrease of pH of intraerythrocyte medium (Bohr effect), despite the inhibited energy metabolism and decreased content of organic phosphates in erythrocytes.

[The effect of propranolol on the functional condition of the central and autonomic nervous system in persons of various ages]. / Der Einfluss des Propranolols auf den funktionalen Zustand des zentralen und vegetativen Nervensystems bei Personen unterschiedlichen Alters.

The effect of propranolol (0.6 mg/kg b.w.) on the functional state of the central and vegetative nervous system was studied in 60 apparently healthy of different age by means of electroencephalography and spectral analysis of the cardiac rhythm. In the young subjects propranolol produced inhibitory effects on the central nervous system, while in the elderly and very elderly subjects it was predominantly an activating one. The elderly versus young subjects showed a more marked impairment of the sympathetic effects on the cardiac rhythm due to propranolol administration. It was a characteristic feature of propranolol action to display a disaccord between its effects on the central nervous system and vegetative control of the cardiac rhythm in the very elderly people.

[Age-related peculiarities of adrenergic regulation of the contractility and pump function of the heart]. / Alternsbesonderheiten der adrenergen Regulation der Kontraktionsfähigkeit und der Pumpfunktion des Herzens.

The pharmacodynamics of adrenaline were investigated with respect to the adrenergic regulation of the contractility, of the pumping function and of the systolic function of the heart, aiming at the examination of age particularities. The results show that the positively effect of adrenaline becomes less with increasing age. The arrhythmogenic effect of the preparation is described, just as its effect on blood pressure regulation. The results are discussed in detail.

[Peculiarities of the transitional process of heart rhythm in the active orthostasis test in healthy probands, elderly and of an advanced age]. / Besonderheiten des Ubergangsprozesses des Herzrhythmus beim aktiven Orthostase-Versuch bei gesunden Personen höheren und hohen Lebensalters.

To identify the age-related peculiarities of the transient state of the cardiac rhythm during the orthostatic test, 155 apparently healthy persons aged from 20 to 89 years were examined. The method of rhythmography was used to assess the amplitude and time characteristics of the transient processes. It was found that in aging the form of transient process undergoes a change, the amplitude of cardiac rhythm transient state is decreased, and its time characteristics duration is increased. The revealed age-associated changes seem to evidence for a worsening of the quality of cardiac rhythm regulation during the transient state in the orthostatic test.

[Changes in the renin-angiotensin-aldosterone system in the development of hypertension in aging. 2]. / Veränderung des Renin-Angiotensin-Aldosteron-Systems bei Entwicklung einer Hypertonie im Alter. 2. Mitteilung.

The change of the reactivity of the RAAS during physiological aging of the organism implies the variety of forms of the course of hypertension: The RAAS is involved in stage I of the development of the disease. The progress of the disease (stage III) results in the "decay" of the RAAS. A dependence of the activity of the RAAS on the clinical course and on the hemodynamic variant of hypertension in old age could detected.

[Change in the renin-angiotensin-aldosterone system in aging. 1]. / Veränderung des Renin-Angiotensin-Aldosteron-Systems während des Alterns. 1. Mitteilung.

Data are provided that testify to a changed reactivity of the RAAS in old age: Higher sensitivity of this system to the regulatory influences of the sympathico-adrenal and of the hypothalamus-hypophysis system as well as restriction of the functional facilities and reduction of reactivity. The obtained results indicate an aging-dependent reduction of the degree of reliability of the RAAS in stress situations.

[Use of placental suspensions in geriatric practice]. / Uber die Anwendung von Plazentasuspension in der geriatrischen Praxis.

A number of scientifically substantiated indications of the application of placental suspension in man of higher age, the positive results of the studies of the effectiveness of placental therapy on metabolic processes and physiological functions of the aging organism, and the experience won in the application of placental suspension in the complex therapy of some diseases frequently occurring at old age allow us to consider this kind of treatment an effective therapy and thus to recommend tissue therapy with a placental suspension for the introduction into geriatric practice.

[Characteristics of the electrocardiographic diagnosis in chronic cor pulmonale in the aged]. / Besonderheiten der elektrokardiographischen Diagnostik bei chronischem Cor pulmonale im Alter.

Detailed ECG analyses were made in 97 patients aged between 60 and 79 as well as in 64 younger patients (aged between 30 and 49) suffering from chronical cor pulmonale. Since typical ECG symptoms pointing to cor pulmonale occur less frequently in old age, an analysis scheme to facilitate diagnostics is suggested. The ECG criteria established by Widimsky to diagnose cor pulmonale are supposed to be hypothetical and, in particular, are not adequate for early stages of the clinical picture. Therefore, reference is made to the method by Dusanin , which postulates symptoms of dextrocardia and pulmonary hypertension as established assessment criteria. We recommend the consideration of seven ECG characteristics as a result of a thorough ECG analysis. These characteristics have been integrated in a diagnostical formula through mathematical processes.

[Principles of pharmacotherapy in geriatrics]. / Prinzipien der Pharmakotherapie in der Geriatrie.

This article examines the pharmacokinetics and pharmacodynamics of drugs under the aspects of senile changes in organs and systems in the neurohumoral regulation and in metabolism. It gives reasons for the inadequacy of polypharmacy in the treatment of elderly and old people and for the need of a strict individualization. The retarded reactivity of the organism of old people, their increased susceptibility and reduced tolerance of the effects of drugs necessitate smaller dosages of drugs in geriatrics in comparison with the generally usual dosages, especially at the beginning of treatment. The multitude of exogenous and endogenous changes in the organism, that go hand in hand with the process of aging, leads in old people to an increased susceptibility to more frequent and pronounced secondary effects caused by drugs. Of special importance in the prevention of a possible intoxication by drugs are, in the case of elderly people, the proper composition of food, the water balance and the electrolyte metabolism.

[Relation between lipid and carbohydrate metabolism in patients suffering from ischemic heart diseases in old age]. / Zusammenhang zwischen Lipid- und Kohlenhydratstoffwechsel bei Patienten mit ischämischer Herzkrankheit (IHK) im Alter.

The authors determined the levels of oral glucose tolerance, of serum insulin and of the serum lipids in 143 patients of advanced age suffering from ischaemic heart disease. They point out the importance of the relationship between disturbed lipid and carbohydrate metabolisms which cause coronary arteriosclerosis via hyperinsulinism.

[Characteristics of changes in lipid and carbohydrate metabolism, autoimmune reactions and hemocoagulation in elderly patients with atherosclerosis at various sites]. / Besonderheiten von Veränderungen des Lipid- und Kohlenhydratstoffwechsels, autoimmuner Reaktionen und der Hämokoagulation bei Patienten im höheren Lebensalter mit Atherosklerose unterschiedlicher Lokalisation.

Senile changes in the lipid and carbohydrate metabolisms as well as in the system of haemocoagulation are risk factors of the atherosclerotic process. Atherosclerosis in patients of advanced or old age assumes a general character and the incidence of the combined involvement of different vascular regions increases. The identification of the atherosclerotic process in patients of advances age is accompanied by an increase in the disturbances of the lipid and carbohydrate metabolisms in the immunological system and the system of haemocoagulation. There are differences in the degree of such metabolic disturbances in older patients which depend on the localization of the atherosclerotic process. The strongest disturbances of the lipid and carbohydrate metabolism and in the immune reactivity occur in connection with coronary and cerebral atherosclerosis. Less frequent are metabolic disturbances and impairments of the immune reactivity in the case of peripheral atherosclerosis obliterans. Obviously, it is not only general changes in the organism but also local factors that play an important part with regard to this type of localization of the process such as deteriorated trophism of the tissue, changes in the vascular wall. Although atherosclerosis is in general characterized by an increased haemocoagulation there exist differences depending on the various localizations of the vascular process.

[Prognosis of the probable morbidity rate in ischemic heart disease in patients over 50]. / Voraussagen über die Erkrankungswahrscheinlichkeit an ischämischer Herzkrankheit (IHK) nach dem 50. Lebensjahr.

A mathematic model on prognostic statements as to the development of the ischaemic heart disease from the 50th year of life has been developed. By applying the probit analysis it was possible to plot curves which contain statements on the probable morbidity rate with regard to the ischaemic heart disease. The probability of becoming affected by the ischaemic heart disease increases with advancing years both in men and women. It is highest for men between 50 and 59 years and for women between 60 and 75 years. Between 70 and 74 years the risk becoming affected by the ischaemic heart disease is 4 to 5 times higher than between 50 and 54 years.

[Peculiarities of neurohumoral regulation of stomach function in the human in later and advanced age]. / Besonderheiten der neurohumoralen Regulation der Magenfunktion bei Menschen höheren und hohen Alters.

The process of aging of the human organism is accompanied by certain changes in the regulation of the secretory activity of the stomach. This applies to the neural mechanisms of regulation just as much as to the humoral ones. Quite often such changes are opposed. The significance of cholinergic mechanisms is reduced whereas that of adrenergic mechanisms is growing; the nerve influences get increasingly weaker and the humoral influences comparatively greater; the effect of the central structures decreases and the influence of the intramural nervous apparatus increases. The changed responsiveness of secretory cells from the stomach with respect to regulatory factors calls for the development of mechanisms of adaptation to the new level of the correlation between the neural and humoral factors, which represents a senile evolution of the system of neurohumoral regulation. In our opinion the observed changes in the neurohumoral regulation of the secretory activity of the stomach constitute one of the chief causes of the peculiarities of the functional state of the secretory apparatus in man which develop in advanced age.

[The role of the kidneys in the pathogenesis of late-onset hypertension]. / Zur Rolle der Nieren in der Pathogenese der Späthypertonie.

The investigation of the functional activity of the kidneys in old hypertensives revealed that the changes in partial functions of the kidneys observed in hypertension tend to diminish the effectiveness of the mechanisms controlling arterial blood pressure. This means that this disorder of function constitutes an important link in the pathogenesis of hypertension. Mild and severe disturbances of renal function in old hypertensives can be regarded as evidence of the growing role of the kidneys in the pathogenesis of late-onset hypertension. They are attributable to pre-existing physiological changes taking place in the kidneys at advanced age and to the declining reliability of the kidneys in the homeostatic control of arterial blood pressure.

[Age-associated peculiarities of microcirculation system in skeletal muscles and their role in muscle work capacity in human aging (author's transl)]. / Die alternsbesonderheiten des Systems der Mikrozirkulation in den Skelettmuskeln und ihre Rolle in der Arbeitsfähigkeit des Muskels beim Altern des Menschen.

The muscle blood flow was investigated at rest (MBFR) and after physical load under ischemia conditions (maximal muscle blood flow--MMBF) in 87 practically healthy persons (45 women and 42 men) aged 20--90. The state of muscle blood flow was evaluated by means of the clearance of 133xenon injected into M. tibialis anterior. The data obtained showed a decrease of MBFR and MMBF in older people as compared with younger subjects. In realization of this phenomenon a decrease in muscle capillarisation and a reduction in reactivity of microcirculatory link of vascular system plays an increasingly greater role with aging. The reduction in muscle blood flow forms a circulatory component of the age-associated hypoxia. This fact results in a decrease of muscle blood flow and limits the functional capacity of skeletal muscle under conditions of activity.

[Age related changes in the pharmacodynamics and pharmacokinetics of digoxin (author's transl)]. / Altersabhängige Veränderungen der Pharmakodynamik und der Pharmakokinetik des Digoxins.

Studies have been carried out on some peculiarities of the pharmacodynamics and pharmaco-kinetics in clinically healthy elderly and aged persons. It has been demonstrated that an increase in the sensitivity of the myocardium to digitoxin, and a decrease of its excretion by the kidneys are factors promoting the development of glycoside intoxication in the aged.

[Peculiarities of the renin-angiotensin-aldosterone-system in elderly patients with ischaemic heart diseases (author's transl)]. / Die Besonderheiten des Renin-Angiotensin-Aldosteron-Systems bei Patienten im höheren Lebensalter mit ischämischer Herzkrankheit.

An investigation into the renin-angiotensin-aldosterone system (RAAS) in patients of advanced age with ischaemic heart disease (IHD) and different degrees of atherosclerotic cardiosclerosis by means of radioimmunoassay, which was used to determine the renin activity and the aldosterone concentration in the plasma, showed that there is in IHD an activation of the above regulatory system even under the conditions of relative rest. Furthermore, it was found out that the renin activity of the plasma was increased only in male patients with IHD, whereas the aldosterone concentration was increased both in males and females. These findings justify the hypothesis on the pathogenetic role played by changes in the RAAS in IHD in old age. The more severe disorders of the RAAS as seen in male patients with IHD explain to some extent the earlier onset and greater severity of IHD in men. For the treatment of hyperaldosteronism, which has been found to be associated with IHD in persons of advanced age, it is necessary to include into the therapeutic plan of patients with IHD, in particular males, competitive aldosterone antagonists as well as beta-adrenergic blocking agents.