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Results of heart transplantation as therapy for end-stage cardiac diseases are encouraging not only because of actuarial survival curves but also because of the recovered quality of life for the heart transplant recipient. Although heart transplantation drastically improves the physical capacity of the patients, heart recipients still have a reduced maximal aerobic capacity compared to healthy people. Altered resting and exercise haemodynamics, due to cardiac denervation, are a common finding after orthotopic heart transplantation: increases in heart rate and stroke volume at exercise are first linked with the augmented venous return and later with the increased plasmatic nor-adrenaline level. Maximal heart rate and stroke volume are both reduced when compared to innervated heart. Reduced cardiac output response to exercise therefore results in early anaerobic metabolism, acidosis, hyperventilation and diminished physical capacity. In spite of an altered ventilatory adaptation to exercise, characterised by hyperpnoea in most transplant patients, ventilation is not the limiting factor for exercise in heart recipients without associated obstructive pulmonary disease. Endurance training restores lean tissue, decreases submaximal minute ventilation, increases peak work output, maximal ventilation and peak heart rate. Guidelines for prescribing exercise are not yet standardised due to the limited number of studies on a sufficient cohort of heart recipients. Nevertheless, recommendations similar to those used for persons with coronary heart disease, with modifications due to the denervated heart, seem to be used. The cardiocirculatory and pulmonary capacity of heart transplant recipients allow them to undertake endurance sports activities such as walking, jogging, cycling and swimming, and these should be encouraged.

There is a lack of information about renal responses in heart and kidney transplant patients after intense physical exercise. Eleven heart and ten kidney transplant recipients, as well as two control groups of healthy subjects, were given a maximum exercise test on a bicycle ergometer. One control group was also given a moderate load corresponding to the peak load of the kidney transplant group. Blood and urine samples were collected before and after exercise and assayed for lactate, creatinine, total protein, and albumin. The glomerular filtration rate remained stable at the end of exercise in the transplant patients, while there was a slight (17 %) decrease in the control group. Albumin excretion rates after maximum exercise attained a mean

The binding properties and pharmacological effects of pirenzepine were compared to those of atropine in isolated pancreatic acini and pancreatic membranes of rats. In the first preparation, pirenzepine and atropine blocked [N-methyl-3H]scopolamine ([3H]NMS) binding, pirenzepine being 110 times less potent than atropine (KD for pirenzepine 0.38 microM and for atropine 3.5 microM). A similar difference in potency was observed with respect to carbamylcholine stimulation of amylase secretion (IC50 for pirenzepine 4.5 microM and for atropine 30 nM) and calcium efflux (IC50 for pirenzepine 2.8 microM and for atropine 4 nM). Correspondingly, in rat pancreatic membranes, the KD values for pirenzepine and atropine were 250 and 1.5 nM, respectively. These data are compatible with the hypothesis that the in vitro antimuscarinic effect of pirenzepine on the rat pancreas is linked to the occupancy of a single homogeneous class of receptors with a low affinity for the antagonist.

There is a lack of information about renal responses in heart and kidney transplant patients after intense physical exercise. Eleven heart and ten kidney transplant recipients, as well as two control groups of healthy subjects, were given a maximum exercise test on a bicycle ergometer. One control group was also given a moderate load corresponding to the peak load of the kidney transplant group. Blood and urine samples were collected before and after exercise and assayed for lactate, creatinine, total protein, and albumin. The glomerular filtration rate remained stable at the end of exercise in the transplant patients, while there was a slight (17 %) decrease in the control group. Albumin excretion rates after maximum exercise attained a mean

Three minutes after the end of a negative dobutamine stress echocardiography (16 pg/kg/min), a severe ischemic episode appeared, with ST-segment elevation in inferior leads, suggesting a spasm on a normal right coronary artery. This episode was relieved by nitroglycerin. Close clinical and electrocardiographic monitoring during and shortly after a dobutamine stress echocardiography is mandatory.

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