On the hyperreactivity of type A's.
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Adult↗
Biomedical subjects
W Langewitz
Publications and source records attributed to W Langewitz.
Reliability and validity of ambulatory blood pressure recording in children.
We investigate whether ambulatory BP (aBP) recording in children reflects situational variations and whether aBP depicts the impact of heightened cardiovascular reactivity under mental challenge, and gender on changes in BP. Results of 19 aBP protocols (2 to 7.30 p.m. after school; 30 min intervals) in 86 children, performed during 2 years of follow-up show that repetitive ambulatory blood pressure (aBP) recording reflects the great variability of environmental stimuli in children. Mean aBP is highly correlated with self-reported physical activity. Systolic aBP correlates with cardiovascular changes under mental arithmetic and - to a lesser degree - during bicycle exercise. Ambulatory BP recording is a sensitive method to detect the influence of hyperreactivity and gender on BP development in children at the age of 10-13 yrs.
Ambulatory Care↗
The influence of monotherapy with oxprenolol and nitrendipine on ambulatory blood pressure in hypertensives.
We investigated whether beta-blockers or calcium-antagonists might be preferred in baseline antihypertensive therapy. In middle-aged male patients with essential BP readings did not differ between patients on Oxprenolol or on Nitrendipine (average BP: 123 +/- 12/81 +/- 14 vs. 129 +/- 17/80 +/- 10 mmHg), when clinical casual BP was within the normotensive range. Average BP at work was lower than clinical casual BP taken at the same day (125 +/- 14/80 +/- 12 vs. 133 +/- 12/87 +/-13 mmHg). A linear dependency between SBP at work and level of self reported physical activity (F(3,413) = 7.6; p less than or equal to 0.001) and arousal was found (F(3,374) = 5.2; p less than or equal to 0.02). Patients on Oxprenolol consistently had lower SBP at a particular level of physical activity and at lower levels of arousal than patients on Nitrendipine. We conclude that both regimen were equally effective as baseline antihypertensive monotherapy.
Adult↗
Intermittent ambulatory blood pressure recordings in children. Methodological aspects and influence of family history on hypertension.
In 100 children of different school classes (10-12 years, participation rate ca. 50%) ambulatory blood pressure (BP) was recorded by a semi-automatic non-invasive device (Remler system). BP was measured every 1/2 h between 2 and 7.30 p.m. During each measurement the children protocolled their activity. These BP recordings were repeated five times at monthly intervals in 86 children. In the same children casual and near basal BP was determined. The mean ambulatory BP was 103/64 +/- 7/6 mm Hg. The average retest reliability of the monthly mean values was r = 0.57 for systolic and r = 0.45 for diastolic BP. The variability of BP (standard deviation) was not reproducible. Data recording failed in 32% of all single systolic and in 42% of all single diastolic BP measurements. These drop-outs were caused by inappropriate use rather than technical problems. There was a relationship between procolled activities and systolic BP. On average, ambulatory BP was lower than BP under standardized conditions. Under all conditions, children with hypertensive parents exhibited a 6 mm Hg higher systolic BP than children without a similar family history. No sex differences were found.
Ambulatory Care↗
Efficacy of nitrendipine as baseline antihypertensive therapy.
To determine whether calcium antagonists might be used alternatively to beta-blockers in antihypertensive therapy, we investigated if monotherapy with oxprenolol (160-320 mg/day) and nitrendipine (20-40 mg/day) were equally effective on clinical casual blood pressure (BP), ambulatory BP monitoring (Remler), and BP during mental challenge (video game). In a prospective randomized long-term study, 60 white male civil servants (mean +/- SD = 43 +/- 6 years) with mild essential hypertension only were treated for at least 4 months. Average BP before therapy was 149 +/- 11/97 +/- 11 mm Hg. The antihypertensive effect was not different between the two groups (19/14 versus 21/12 mm Hg). Both groups did not differ in BP at rest, in BP during mental challenge (141 +/- 7/109 +/- 5 versus 146 +/- 9/112 +/- 8 mm Hg, NS), and average ambulatory BP monitoring at work (122 +/- 12/81 +/- 17 versus 132 +/- 14/79 +/- 17 mm Hg, NS), which was identical with the clinical casual BP. Thus, nitrendipine can effectively be used in long-term baseline antihypertensive monotherapy.
Adult↗
[Cardiac rupture. Histological study of ruptured and non-ruptured myocardial infarcts].
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Aged↗
Cardiovascular reactivity during mental stress testing, the type A interview, and exercise testing in healthy male subjects.
We compared the blood pressure (BP) of 61 healthy male Ss during mental arithmetic plus noise, physical exercise testing and the Type A interview. A consistent association between personality characteristics and cardiovascular reactivity was not found. There was a consistent correlation between systolic BP reactivity during mental arithmetic and the Type A interview. Mental arithmetic and exercise testing correlated significantly for middle aged men. No correlation of BP was found between the Type A interview and exercise testing.
Adult↗
[Traffic noise and hypertension risk. Hypothalamus theory of essential hypertension. Second communication (author's transl)].
In connection with the Bonn Study on Traffic Noise, 56 males with healthy cardiovascular systems were selected at random from two areas with different traffic noise conditions. The blood pressure was measured under the influence of a 5 minute standardized stressor and a 30 minute exposure to traffic noise. The 17 subjects with hereditary tendency to hypertension reacted significantly under the influence of both stressors with more marked rises in systolic and diastolic blood pressures than the 35 subjects who denied a hereditary tendency. On the other hand, the different residential areas did not affect the blood pressures obtained experimentally. The results support the hypothalamus theory of essential hypertension through the decisive etiological factors. At the same time they form the basis of a working hypothesis for a prospective study. According to this it is expected that males with a hereditary tendency to hypertension who have been exposed to traffic noise for several years will be more likely to develop hypertension.
Adult↗
[Cardiac rupture: histological study of ruptured and non-ruptured myocardial infarcts (author's transl)].
178 myocardial infarcts with wall rupture and 116 without were studied histologically. Mean morphological age of the infarct was 3.7 in the ruptured and 2.9 days in the non-ruptured cases. 57.7% of patients had died within the first 24 hours from a non-ruptured infarct. Death rate within the first 24 hours after infarction was 57.7% among the non-ruptured cases, 25.8% among those with rupture. 23.1% of infarcts had ruptured between the third and fourth day. Only 5.1% of patients with non-ruptured infarcts had died on the third or fourth day. Transmural infarction was present in 71.7% of those that had ruptured. The ruptured channel in general ran through the middle of the necrotic-infarcted, leucocyte-infiltrated myocardium. Infarct recurrence was demonstrated in 20% of ruptured and 73% of non-ruptured infarcts. Morphological comparison indicated that transmural infarction and marked leucocytic reaction in a not previously infarct-damaged myocardium are the main causes for rupture in myocardial infarction.
Aged↗
[Actinomycosis of the liver (author's transl)].
A case report is given of a 61 year old female patient, who came to the hospital with chronic pain in the right upper abdominal quadrant, fever, chills, dyspnea, and general weakness. 4 days later she died in hemorrhagic shock after having had melena. At postmortem an actinomycotic abscess of the size of a childs head was found in the left lobe of the liver; in addition there was a highly differentiated leiomyosarcoma of the duodenum. Isolated visceral actinomycosis is rare; it should however be thought of when the causes of liver abscesses are being scrutinized. Diagnosis can be established only bacterioiogically or histologically.
Actinomycosis↗
[Hormonal and pharmacological modification of the ileocecal sphincter].
Ileocecal shincter (ICS) pressure was evaluated in response to hormonal and pharmacological stimuli in rabbits. The effect of exogeneous gastrin (pentagastrin) and glucagon, metoclopramide and neostigmin on the ICS pressure was studied. Gastrin, glucagon and metoclopramide increased the pressure whereas neostigmin lowered it. These results suggest that this junctional zone is not only a valve but a real shincter, which is affected by gastrointestinal hormones and pharmacological substances. Further examinations are necessary to study the role of the ICS after gastrointestinal surgery.
Animals↗
A between-subjects comparison of respiratory sinus arrhythmia and baroreceptor cardiac reflex sensitivity as non-invasive measures of tonic parasympathetic cardiac control.
Respiratory sinus arrhythmia (RSA) has been used as an index of parasympathetic cardiac control. However, recent psychophysiological research casts serious doubts upon the usefulness of RSA as an index of vagal influences upon the heart in psychophysiological as well as in clinical studies. It suggests the need to look for another measure. In this exploratory study we investigated whether the baroreflex sensitivity (BRS) could serve as an alternative tool to investigate between-subject tonic parasympathetic influences on the heart. In nine healthy subjects we examined the effects of intravenous atropine (0.03 mg/kg i.v.), intravenous metoprolol (10-15 mg i.v.), and of saline as a placebo condition upon RSA, BRS, and related cardiovascular and respiratory variables, both under resting and under mental task conditions. After parasympathetic blockade, RSA and BRS display values near zero, showing their vagal origin. After beta-adrenergic blockade, when heart period is predominantly under vagal control, RSA fails to predict heart period variability. Using BRS, however, it is possible to predict more than 97% of heart period variance during beta-blockade. Finally, both the vagal and beta-adrenergic blockade show that BRS is a better predictor of parasympathetic cardiac control during blood pressure increases than during blood pressure decreases.
Adult↗
Cardiovascular indices of peripheral and central sympathetic activation.
OBJECTIVE: A number of sympathetic nervous system (SNS) parameters have been used in cardiovascular psychophysiology. This study aimed to describe the pattern and redundancy of a set of SNS parameters during peripherally induced changes of cardiac sympathetic activation and reflex modulation of central SNS control. Preejection period (PEP) was assessed as a marker of peripheral sympathetic activation. Low-frequency blood pressure variability (BPV) was assessed as an estimate of central SNS control. METHODS: Peripheral beta-sympathetic stimulation and blockade were achieved with epinephrine and esmolol hydrochloride (beta1-blockade), respectively. Changes in central SNS output were induced by loading and unloading arterial baroreceptors with norepinephrine and nitroprusside sodium, respectively. This single-blinded, crossover study in 24 healthy men also included two placebo control periods. PEP was derived from impedance cardiography and adjusted individually for heart rate. BPV was calculated by power spectral analyses of beat-to-beat heart rate and systolic blood pressure (Finapres system) data. RESULTS: PEP decreased during epinephrine infusion (-40.1 +/- 3.8 ms, p <.0001) and increased during esmolol infusion (+6.6 +/- 3.5 ms, p =.05). PEP was shortened after central SNS activation by nitroprusside (-16.8 +/- 2.9 ms, p < 0.0001). Systolic BPV in the low-frequency range (0.07-0.14 Hz, Mayer waves) increased during nitroprusside infusion (+0.44 +/- 0.19 ln mm Hg(2), p =.03) and decreased during norepinephrine infusion (-0.67 +/- 0.13 ln mm Hg(2), p < 0.0001). Low-frequency BPV did not change significantly during epinephrine or esmolol infusion. CONCLUSIONS: Our data provide empirical evidence of separable peripheral and central sympathetic response components. The combined report of low-frequency BPV and PEP gives distinct information on both central SNS control and the level of sympathetic cardiac activation achieved.
Adrenergic alpha-Agonists↗
[The Patient Satisfaction Questionnaire: a suitable tool for quality control in the physician-patient relationship?].
The relationship between doctor and patient receives increasing interest in the public press and in scientific discussions. An increasing number of intervention studies aiming at an enhancement of doctor-patient communication is currently in action. This paper examines the potential of a patient satisfaction questionnaire (PSQ) to assess the need for such an intervention study or to identify those residents who would profit most from an intervention. We investigated a sequential sample of 257 outpatients at the Outpatient Clinic of a Medical University Clinic (137 men, 120 women, mean age 42 +/- 17 years) who were seen by eleven residents for the first time. We used the german translation of an american 14-item questionnaire. Typical psychosocial characteristics of the sample were also assessed. 73.2 percent of the patients are "satisfied" or "very satisfied" with various physician activities during the examination, the mean sum score of the PSQ is 60.1 +/- 7.1 points (range: 39-70 points; maximum score: 70 points). Residents reach a mean total score between 58 and 63 points. Neither in single items nor in the sum score was there any significant difference between residents. We found no differences in PSQ values attributable to sociodemographic variables. The results show that the PSQ is not able to identify those residents to whom intervention studies should be offered in order to enhance psychosocial skills. Its use as an evaluation tool seems also limited because patient satisfaction is very high already prior to an intervention.
Adolescent↗