To survey the cardiovascular complications induced by cardiac monitoring exercise during 10 years of our cardiac rehabilitation (CR) clinic and report on the safety of monitoring exercise training for early hospital-based CR.
All cardiac patients who participated in our exercise program from January 2000 through December 2009 were recruited as study subjects. We stratified the exercise risks of cardiac events and conducted the monitoring exercise with individualized prescriptions. We measured all cardiac complications, including death, symptoms, abnormal hemodynamic responses, and electrocardiogram (ECG) abnormality during exercise training, for 10 years. A total of 975 patients (68% male; mean age, 58.9±10.6) were included in this study. Initial indications for CR were recent percutaneous transluminal coronary angioplasty (PTCA) (75%), post-cardiac surgery (coronary bypass graft, 13.2%), valvular surgery and other cardiac surgery (4.2%), and others (7.6%).
The study population underwent 13,934 patient-hours of monitoring exercise. No death, cardiac arrest or acute myocardial infarction (AMI) occurred during exercise (0/13,934 exercise-hours). Fifty-nine patients experienced 70 cardiovascular events during the 13,934 exercise-hours (1/199 exercise-hours); there were 17 cases of angina only (1/820 exercise-hours), 31 cases of ECG abnormalities only (1/449 exercise-hours), 12 cases of angina with ECG abnormalities (1/1,161 exercise-hours), and 10 cases of abnormal hemodynamic responses (1/1,393 exercise-hours).
Early hospital-based CR is safe enough that no death, cardiac arrest or AMI occurred during the 13,934 patient-hours of monitoring exercise. However, risk stratification for exercise-induced cardiovascular events, proper exercise prescriptions, and intensive ECG monitoring are required prior to initiation of the monitoring exercise.
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To compare the technical strengths and weaknesses between retrodiscal (RD) and conventional subpedicular (SP) approaches of transforaminal epidural block (TF-EPB).
Sixty-one patients with L5 radiculopathy who planned to undergo TF-EPB were consecutively enrolled as study subjects. Subjects were randomly assigned to one of two groups. For the RD approach, the positioning of the patient and the C-arm were similar to that for lumbar discography. We compared the pattern of dye spreads, the frequency of complications during the procedures, and the effect of the pain block 2 weeks after the procedure between the two groups.
For the RD group (n=24), the contrast dye diffused around the L5 and S1 nerve roots in 16 cases (67%), but it diffused around only the L5 root in 27 cases (73%) in the SP group (n=37) (p<0.05). Two weeks after the procedure, the visual analogue scale (VAS) decreased by the same amount in both groups (RD group: 3.1±1.6, SP group: 3.2±2.6). Symptoms of nerve root irritation occurred in 1 case of the RD group and in 10 cases of the SD group (p<0.05).
The RD approach was as efficient as the SP approach for temporary diagnostic relief and offered considerable advantages, such as lower nerve root irritation possible lower risk of vascular injection. Thus, it could be a useful technique when a herniated disc segment is stuck or when the foraminal stenosis is severe.
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Effect of Needle Tip Position on Contrast Media Dispersion Pattern in Transforaminal Epidural Injection Using Kambin’s Triangle Approach
To observe the prognostic influences of the cardiac rehabilitation (CR) program in Korean acute myocardial infarction (AMI) patients during the first year after an occurrence of the disease.
A total of 141 AMI patients who underwent percutaneous coronary intervention (PCI) were recruited consecutively for this study and divided into the CR group and the control group. The CR group completed the phase 2 CR program in the hospital for a period of 6-8 weeks and maintained self-exercise in their community by exercise prescription for a year after AMI. We performed a prospective comparison of the patients' demographic data, high sensitive C-reactive protein (hs-CRP) level after the 4-month CR program, and the rate of recurrence (AMI, re-hospitalization, positive coronary angiogram, needed revascularization procedure, or death) between the two groups.
Compared to the control group (0.33±0.48 mg/dl), the hs-CRP level was lower in the CR group (0.18±0.32 mg/dl) after 4 months of exercise. The recurrence rate was lower (10%, 7/69) in the CR group, compared to the control group (24%, 17/72, p<0.05). The number of disease-free days was larger in the CR group (354±38.34), compared to the control group (316±99.96, p<0.05). In a comparison of statistical methods used for testing the equality of two survivor distributions, the CR group showed a lower recurrence rate than the control group (p<0.05).
Participation in the CR program designed for AMI patients who underwent PCI-induced normalization of the serum hs-CRP level and lowering of the recurrence rate by 14% during the first year.
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