[Traumatologic risk in ambulatory cardiac rehabilitation groups to leisure time sports groups of healthy athletes]. / Risiko von Sportverletzungen in ambulanten Herzsportgruppen im Vergleich zu Freizeitsportgruppen Gesunder. Sportverletzungen in der ambulanten kardiologischen Rehabilitation.

INTRODUCTION: Rehabilitation in ambulatory heart groups has become well established in comprehensive cardiac care. The prevention of injuries is critical to the safety and efficiency of the program. METHODS: Questionnaires were mailed to the ambulatory heart groups in the state of Hessen, Germany and answered by 1935/13 000 (15 %) patients (65.9 +/- 7.6 years, 1504/1935 (77.7 %) men covering approximately 674,000 patient exercise hours. RESULTS: Seventy-eight of the 106 (73.6 %) injuries reported occurred during games encompassing 28/106 (26.4 %) strains, 24/106 (22.6 %) bruises, 17/106 (16.0 %) sprains, 11/106 (10.4 %) bone fractures, 6/106 (5.7 %) ruptured tendons, 8/106 (7.5 %) ruptured muscles, 3/106 (2.8 %) ruptured ligaments, and 9/106 (8.5 %) miscellaneous. The injury risk was neither related to the cardiovascular diagnosis, the prevalence of diabetes, body mass index, previous sport experience, duration of participation in rehabilitation programs, nor to the participant's age. Patients on anticoagulants or after cardiovascular surgery had no excess risk. Gender was the only independent predictor of injuries. In men the overall incidence of injuries was higher (97/1504 [6.4 %]) than in women (9/431 [2.1 %]), p < 0.0005) while the severity was higher in women (6/9 = 66.7 % vs. 22/97 = 22.7 % p < 0.001). The injuries were treated by elastic bandages or band-aids in 69/106 (65.1 %), by splinting in 4/106 (3.8 %), by local injections in 4/106 (3.8 %), by massages in 3/106 (2.8 %), and by others in 26/106 (24.5 %). Five of the 106 (4.7 %) injuries required hospitalization. CONCLUSION: The traumatologic risk in the rehabilitation of cardiovascular outpatients is associated with a low incidence of injuries.

Pericardectomy for chronic constrictive pericarditis: risks and outcome.

From 1970 to 1990, 71 consecutive patients (51 men and 20 women) had pericardectomy for chronic constrictive pericarditis. The mean age was 44.2 +/- 16.1 years. In the preoperative state 2.8% were in NYHA class I, 18.3% in II, 43.6% in III and 35.2% in IV. The operative approach was median sternotomy in 93% and left anterolateral thoracotomy in 7%. The early mortality rate (within 30 days after operation) was 5.6%. All four early deaths were female (P < 0.001), in the preoperative state the patients were classified as NYHA class IV (P < 0.01). These patients had a significantly higher preoperative mean right atrial pressure then survivors (21.5 +/- 8.5 mmHg vs 13.6 +/- 5.6 mmHg, P < 0.005). Follow-up was obtained for 65 patients (91.5%) and averaged 11 +/- 5.8 years (the longest period was 21.5 years). Actuarial survival at 5, 10, 15 and 20 years for all patients was 84.6% +/- 4.5%, 80.1% +/- 5.3%, 70.5% +/- 6.9% and 65.8% +/- 7.9%, respectively. In the preoperative state 10 of the 12 late deaths (83%) were classified NYHA class IV and the remaining ones class III. Of the 49 patients alive 23% belong to NYHA class I, 42% to II and 35% to III; none is in class IV. Negative predictors of survival were found to be preoperative NYHA class IV (P < 0.01), low-voltage electrocardiogram (ECG) (P < 0.01), ascites (P < 0.01), dyspnea at rest (P < 0.05) and hyperbilirubinemia (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)