SUMMARYA preliminary study of 12 male patients (mean age, 47.8 years) with coronary heart disease (six with angina pectoris and six with prior myocardial infarction but without angina) was conducted according to a common protocol in Seattle, Washington, and Louvain, Belgium. Maximal oxygen intake (V02 max) and hemodynamic studies at rest and at two or three levels of submaximal exercise in the upright position were obtained before and after a 3-month physical training program that involved three sessions of 45 min/week. "V02 max" increased 22.5% (P < 0.0001) with physical training. Changes in maximal heart rate occurred in the patients with angina (+8.4%) but not in those without angina (+0.8%). At rest and at each submaximal exercise, heart rate, mean blood pressure, and cardiac output decreased after training, whereas stroke volume was unchanged and arterio-mixed venous oxygen (A-Vo0) difference increased.The pressure-rate product and the left ventricular work decreased after training. The classic posttraining bradyeardia was compensated not by a higher stroke volume but by an increased A-Vo,0 difference which resulted from both a higher arterial oxygen content and an increased peripheral oxygen extraction. The latter was more apparent when exercises of the same relative intensity were compared.Thus, benefits with physical training in coronary patients result at submaximal exercise level from enhanced arterial oxygen content and peripheral extraction and secondarily from lower hemodynamic stress on ischemic myocardium. Increased maximal A-V02 difference probably explains most of the increase in "VO9 max" with physical training in coronary patients not limited by angina pectoris. Additional Indexing WordsMaximal oxygen intake Arterial oxygen content Cardiac output Peripheral oxygen extraction Pressure-rate product PHYSICAL training is now recommended in the rehabilitation of ambulatory patients with coronary heart disease as there is

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Statistical Normothermia Hypothermia significance ATIII (%) 103,4 Ϯ 12,54 82,7 Ϯ 20,78 P Ͻ 0,05 PC (%) 70,1 Ϯ 7,51 53,1 Ϯ 7,34 P Ͻ 0,01 PLG (%) 14,5 Ϯ 0,52 17,3 Ϯ 2,45 P Ͻ 0,01 ␣ 2 -APL (%) 97 Ϯ 9,63 83,7 Ϯ 13,94 P Ͻ 0,05Conclusions: This study suggests that even though the hypothermia period was relatively short, haemostatic mechanism was impaired. Our data indicate an increased thrombotic and fibrinolytic tendency. Major trauma and abdominal surgery are related to hypothermia, usually of a duration longer than 60 minutes. Coagulation defects are relatively early effects of hypothermia; they should be either prevented or corrected promptly, well before standard laboratory tests or clinical signs indicate the disorder.Background and Goal of Study: Snapshot on hip fracture to measure the incidence and the predictive risk factors for clinical venous thromboembolic events (VTE), to describe the use of antithrombotic prophylaxis and to measure mortality and its predictive risk factors after 6 months. Materials and Methods: Prospective, multicenter (n ϭ 525) epidemiological study. Inclusion of operated hip fracture patients between October 1st and November 30, 2002. VTE were assessed by a critical events committee. Risk factors were isolated using a logistic regression. Odds Ratio -CI 95%. Results and Discussions: 7019 patients were included among which 6860 (97.7%) were analysed: age 81 Ϯ 12 (76% women, 63% Ͼ 80 yr), history of cardio-vascular disease 63%, history of deep vein thrombosis (DVT) or pulmonary embolism (PE) 6.4%. Surgery was performed with general anaesthesia 56%, (among which regional ϩ general 7%) and regional 44%. A low molecular weight heparin (LMWH) treatment was initiated pre-operatively in 51% of the patients. The median prophylaxis duration was 6 weeks. At 3 months, 75 symptomatic and confirmed DVTs and 15 PEs were reported in 85 patients (global rate 1.3% (CI 1.1%-1.6%). Fatal PE rate was 0.3%. Positive predictive risk factors: history of DVT or PE (OR 2.5 (1.6-4.0)), interval between the induction of anaesthesia and arrival in the recovery room greater than 2 hrs (OR 2.2 (1.4-3.4)). The LMWH treatment was beneficial (OR 0.3 (0.1-0.8)). After 6 months, 1066 patients died (14,7%) among which 366 died during the first month. The main causes were cardiac (31%), neurological (20%) pulmonary infections (8%), other causes (38%) and 49 (4.1%) deaths were declared as possible or definite PE. Major bleeding occurred in 86 (1.2%) patients (16 deaths). The main mortality predictive risk factors were: age, gender, reduced preoperative autonomy and cognitive functions, and complications requiring a re-hospitalisation. The use of regional anaesthesia (peripheral blocks 99%) combined with general anaesthesia was beneficial (OR 0.6 (0.4-0.9)). Conclusion(s):This very large study demonstrates that LMWH prophylaxis is applied widely after hip fracture in France and provides a high level of efficacy and safety. However the high death rate should lead to a major change in the care of these patients.*p Ͻ 0.05 betwee...