[Adherence to Phase III Cardiac Rehabilitation Programs: A Prospective, Randomized Comparison between a Conventionally Conducted Program and a Tai Chi-Based Program]. / Adhärenz in Herzgruppen: Ein prospektiver, randomisierter Vergleich einer konventionell durchgeführten Herzgruppe zu einer Tai-Chi-Herzgruppe.

INTRODUCTION: In patients with cardiac diseases, lifestyle changes such as an increase in physical activity are recommended to prevent further cardiac events. In Germany this is possible by attending outpatient heart groups. A problem inherent in these programs is the lack of adherence since more than two thirds of patients stop attending cardiac rehabilitation programs after six months. An alternative to the conventional implementation of heart groups is Tai Chi, which was found to improve adherence to cardiac rehabilitation programs in international studies. METHODS: Patients were randomly assigned to a conventional heart group or a heart group with Tai Chi exercises. At the beginning of the study, a medical history was taken and physical and instrumental tests were carried out, including an assessment of anxiety/depression (HADS questionnaire) and physical well-being (SD-12). Follow-up tests were performed every three months. RESULTS: Patients were 62.6 ±â€Š8.5 years old, the mean BMI was 28.6 ±â€Š62 kg/m(2), and the proportion of women was 29.8 %. The groups were different in terms of age (conventional heart group: 65.0 ±â€Š7.5; Tai Chi group: 59.9 ±â€Š8.9 years). Therefore, age-adjusted analyses were performed in addition to the planned analyses. Regarding the primary endpoint of the study, there was no difference between the groups. After twelve months, 50 % of subjects were active in the Tai Chi group and 48 % in the conventional heart group (odds ratio 0.92, p = 0.891). After adjustment for age by logistic regression, the odds ratio was 0.47 (p = 0.285). Furthermore, both the participation period in weeks (Tai Chi group: 43.3 ±â€Š26.0; conventional group: 45.5 ±â€Š24.2, p = 0.766) and the participation rate (Tai Chi group: 66.8 ±â€Š19.2 % Tai Chi, conventional group: 76.3 ±â€Š16.5 %, p = 0.074) did not differ between the two groups. A further analysis showed a non-significant trend for improvement of anxiety, depression and physical well-being in the Tai Chi group compared with the conventional group. CONCLUSION: The insight gained in international studies regarding a better adherence to Tai Chi-guided prevention programs was not transferable to heart group participants from Germany. However, there was a trend regarding a better mental condition in the Tai Chi group.

High-dose intravenous penicillin G does not prevent further progression in early neurological manifestation of Lyme borreliosis.

We report two cases of Lyme borreliosis (LB) with erythema migrans (EM) and simultaneous meningopolyneuritis with radicular pain and lymphocytic pleocytosis in the cerebrospinal fluid (CSF). EM and pain disappeared completely under high-dose penicillin G therapy within few a days. Pathological findings in CSF improved. Nevertheless, during and after therapy, neurological signs of LB developed: cranial nerve palsies as well as paresis of extremity muscles with radicular distribution.

Hemodynamic effects of nisoldipine in chronic congestive heart failure.

The hemodynamic effects of 10 and 20 mg isobutyl methyl 1,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-3,5-pyridinecarboxylate (nisoldipine, Bay k 5552) p.o. were studied in 15 patients with chronic congestive heart failure due to ischemic heart disease or cardiomyopathy. The dose of 10 mg elicited only a decrease of pulmonary wedge pressure during exercise, all other parameters remained unaffected. After 20 mg nisoldipine arterial blood pressure was reduced already at rest. During exercise, arterial as well as pulmonary artery and wedge pressures were significantly reduced. Heart rate remained unaffected and cardiac index increased slightly. It is concluded, that nisoldipine improves the hemodynamic situation in chronic congestive heart failure by simultaneously reducing cardiac pre- and afterload.