Interest of the Ergo-Kit(®) for the clinical practice of the occupational physician. A study of 149 patients recruited in a rehabilitation program.

OBJECTIVE: Functional capacity evaluation is commonly used to assess the abilities of patients to perform some tasks. Ergo-Kit(®) is a validated tool assessing both functional capacities of patients and workplace demands. The objective of this study was to evaluate the relevance of the Ergo-Kit(®) data for occupational physicians during the return-to-work process. METHODS: A retrospective and monocenter study was conducted on all patients included in a rehabilitation program and assessed with the Ergo-Kit(®) tool between 2005 and 2014. Workplace demands and patients' functional capacities were evaluated and confronted. Self-beliefs and perceived disability were also assessed and compared to the functional capacity evaluation. RESULTS: One hundred and forty-nine working-age patients (85 men, 64 women; 39±12 years) suffering from musculoskeletal disorders or other diseases were included. Main causes of mismatch between workplace demands and functional capacities were manual handling of loads, postures with arms away from the body and repetitive motions at work; sitting posture was correlated with a lesser physical workload; and Oswestry score was correlated with functional capacities evaluated by the Ergo-Kit(®). CONCLUSION: Ergo-Kit(®) is a relevant tool to assess the multidimensional aspects of workplace demands and functional capacities. It could be very helpful for occupational physicians to manage return-to-work.

Social functioning and self-esteem in young people with disabilities participating in adapted competitive sport.

AIMS: The aim of this study was to investigate social functioning quality of life and self-esteem in young people with disabilities taking part in adapted competitive sport. METHOD: A sample of 496 athletes (mean age 16 years 4 months, range: 9 years to 20 years 9 months) was obtained from the 540 participants (91.8%) involved in a French national championship. The main outcome measurements were a social functioning inventory (PedsQL 4.0 social functioning) and a self-esteem inventory in physical areas (physical self inventory 6 PSI-6). RESULTS: The mean PedsQL SF score was 74.6 (SD: 17.7). Comparisons of PedsQL SF according to gender, age, self mobility and training revealed no significant differences between the groups. PedsQL SF was weakly but significantly correlated with all subscales of the PSI-6 in the total population. PSI-6 scores were significantly different between boys and girls, with better self-esteem for boys on general self-esteem (7.7 vs. 6.9, P=0.018), physical condition (6.8 vs. 6.0, P=0.023) and attractive body subscores (6.5 vs. 5.1, P<0.001). CONCLUSION: Social functioning scores were significantly higher in this population than in the samples of young people with disabilities available in the literature. Interactions between self-concept, social functioning quality of life and participation in adapted sport activities require further studies.

Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation.

Several surgical treatment modalities have been described in cases of isolated or multiple ovarian endometriotic cysts. The aim of this preliminary study was to investigate and test the efficacy of ethanol sclerotherapy (EST) for recurrent endometriotic cysts, before ovarian stimulation in infertile patients with an adequate ovarian status. In the setting of a prospective comparative study, EST was proposed to 31 infertile patients with recurrence of ovarian endometriomas before inclusion in assisted reproduction cycles. Reproductive outcome was compared with that of patients who had previous laparoscopic cystectomy for recurrent endometriomas. The mean size of endometriomas treated with sclerotherapy was 38.6 +/- 11.2 mm in diameter. Ovarian cysts recurred in 12.9% of cases; at a mean time of 10 months after EST. Ovarian reserve and ovarian response to stimulation were better in the EST group than in the control group. Consequently, clinical and cumulative pregnancy rates of the study group were higher than those of the control group (48.3% versus 19.2%, P = 0.04; and 55.2% versus 26.9%, P = 0.03, respectively). Ethanol sclerotherapy may be a good alternative to surgical management of recurrent endometriotic cysts before assisted reproductive treatment. It could be advised for selected infertile patients.

Return to work of 87 severely impaired low back pain patients two years after a program of intensive functional rehabilitation.

UNLABELLED: Return to work is the main long-term objective of rehabilitation programs for patients with chronic low back pain (LBP). OBJECTIVES: Evaluation of work status and number of sick leaves in 87 severely impaired LBP patients 2 years after a functional restoration program. PATIENTS AND METHODS: Open prospective study. POPULATION: 87 chronic LBP patients. INTERVENTION: multidisciplinary functional restoration program. Ergonomic advice on the workplace was performed for 53 patients. OUTCOME: work status and number of sick leaves due to LBP. RESULTS: The characteristics of the 26 patients lost to follow-up did not differ significantly from the rest of the population before the program. In the 61 remaining patients, 48 (78%) were at work at 2 years, 43 full-time and 22 at the same job. Nineteen worked in a different environment. Sick leaves were reduced by 60% compared to the 2 years prior to the program: 128 days (+/-200 days) versus 329 days (+/-179 days); p<0.005. CONCLUSION: Sick leaves remained significantly reduced and the number of workers who were at work significantly increased at 2 years after an intensive program.

[Symposium on the indications of surgery in chronic upper limb pain]. / Table ronde sur la place de la chirurgie dans les douleurs chroniques du membre supérieur.

Chronic pain is a true disease with neuromuscular and psychosocial features. It affects the individual as a whole. The consultation should not be limited to a physical approach and the clinician should not shelter behind useless investigations. It is necessary to listen to the patient, to seek elements of catastrophism and hypervigilance, to unmask a strategy of avoidance, and to evaluate the socioprofessional context. Psychosocial factors are the determinant ones in chronicisation of the pain and therefore are the ones that have to be addressed in the process of treatment and professional reintegration. The place of surgery is limited to the treatment of a trigger point (starting factor) and only when it is actually causing real symptoms and when surgical treatment will lead to regression of all the symptoms. On the whole though, the signs are never localised and we find a diffuse hypersensitivity with secondary dysfunction of the whole upper limb, functional exclusion, features of deconditioning, and all in an unfavourable psychosocial context. Thus, the assessment must be multidisciplinary and ideally the treatment should be managed in a centre of rehabilitation.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE: Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS: A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS: Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the study's follow-up period. CONCLUSION: The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

[Prospective study of the outcome at one year of patients with chronic low back pain in a program of intensive functional restoration and ergonomic intervention. Factors predicting their return to work]. / Etude du devenir à un an de lombalgiques chroniques inclus dans un programme associant reconditionnement à l'effort et action ergonomique. Recherche de facteurs prédictifs de retour et de maintien au travail.

OBJECTIVES: Evaluation of 1-year outcome after patients with chronic low back pain participated in an intensive functional restoration program associated with an ergonomic intervention on the workplace. Study of the factors predicts a return to work. METHODS: Prospective study of a cohort of 87 patients face major difficulties due to low back pain at work. Patients who visited a multidisciplinary clinic were included. Parameters, evaluating physical and psychological status, quality of life, presence at work, length of sick leaves, were determined before and after the program and at 6 and 12 months' followup. The correlation between these parameters and presence at work at 1 year was studied. RESULTS: A total of 86 patients completed the program; three were lost to followup at 1 year. Ergonomic interventions were tried in 53 patients. All parameters were improved at the end of the program and remained significantly improved at 12 months. A total of 90% of the patients returned to work at the end of the program, whereas only 17% were at work before; 72% were at work in 1 year. The number of sick leave days decreased by 60%. The Dallas index at the beginning and the end of the program, the number of sick leave days before the program and score on the item "feels able to work" correlated with the presence at work in 1 year. There was no correlation between presence at work and physical parameters. CONCLUSION: This study shows the effect of the program and determines factors predictive of successful return to work for patients with chronic low back pain. Further data are necessary to discuss the specific effect of ergonomic interventions.

Lower limb proximal amputation for a tumour: a retrospective study of 12 patients.

OBJECTIVE: To analyse survival, prosthetic fitting and functional status after trans-femoral amputation or hip disarticulation for a primitive tumour. METHODS: Retrospective study of all patients admitted since 1985. RESULTS: Mean age at amputation was 55. Causes of amputation were osteosarcoma in 50%. Eight (8) patients had initial conservative surgery. Local recurrence was never observed. Nine (9) developed metastasis and required further hospitalisation. Fifty percent (50%) of patients died. Inpatient rehabilitation started 14 days after amputation (7-27), and was of a mean duration of 32 days. Prosthetic fitting was performed 13 days after admission (7 days when a liner was used). Further improvement of the prosthesis was performed in 10 patients. Among the patients who died, 5 had gone home, 4 were wearing their prosthesis all day long and 2 walked indoors with no additional support at discharge. Three (3) patients lived less than 2 months at home. Among the patients who did survive, all went home, 5 were wearing their prosthesis all day long and 2 walked indoors without aid at discharge. Two (2) patients practised sport and 4 drove. All the patients who were active have gone back to work. CONCLUSIONS: Gain due to prosthesis provision is undebatable. Good functional results can be obtained with adapted materials. Initial problems due to the synchronisation of treatments are resolved with multidisciplinary care. All patients should have a rapid and short hospitalisation in a rehabilitation unit and receive a first, simple prosthesis that can be further adapted.

[Heparin induced thrombocytopenia: case report with acute thrombotic complications and literature review]. / Thrombopénie induite par l'héparine : présentation d'une observation avec complications thrombotiques graves et revue de la littérature.

PURPOSE: Review of the frequency, clinical and biological features and treatment of type II heparin-induced thrombocyopenia. METHODS: Case report and literature review. RESULTS: A 65 years old woman received as antithrombotic prophylaxis low molecular weight heparin (LMWH) after prosthetic knee replacement. Day 8, asymptomatic deep vein thrombosis was discovered after systematic echodoppler examination. Curative anticoagulation was started with LMWH. A fall in the platelet count (17 G/L) was noted day 12. Danaparoid was immediately introduced and heparin discontinued. However, day 16 a massive pulmonary embolism occurred which required transfer to an intensive care unit. Danaparoid was changed for lepirudin the same day. It took longer than three weeks for platelet count to return to normal value after heparin discontinuation. The suspicion of heparin-induced thrombocyopenia was confirmed by specific tests. DISCUSSION: HIT type II are rare but life-threatening and thrombosis events are the most frequent complications. The diagnosis is a high probability proved by both clinical and biological patterns. The treatment consists in alternative thrombin inhibitors such as danaparoid and lepirudin. The platelet count usually requires less than ten days to recover normal values after heparin withdrawal. Cases in which the delay to a normal platelet count exceeds 3 weeks have been reported specially after LMWH therapy. CONCLUSION: Type II HIT are rare but life-threatening events can occur. The platelet count check-up during heparin therapy must be systematic.

[Total inverted shoulder prosthesis and rotator cuff insufficiency: evaluation and determination of anatomical parameters predictive of good functional outcome in 21 shoulders]. / Prothèse totale inversée de l'épaule et insuffisance de la coiffe des rotateurs: évaluation et approche de paramètres anatomiques prédictifs d'une bonne fonctionnalité à propos de 21 cas.

OBJECTIVE: Evaluation of the functional results of the Delta 3 inverted shoulder prosthesis and determination of a radio-anatomical index predictive of best functional outcome. PATIENTS AND METHODS: Retrospective analysis of 19 patients (21 shoulders). Clinical (pain, satisfaction, amplitudes, Constant index) and radiological (acromio-epiphyseal distance) evaluation at a mean follow up of 13.6 months. RESULTS: Outcomes concerning pain, quality of life and Constant index were good and similar to other series. Few complications were observed. An increase of the acromio-epiphyseal distance of 33 to 50% compared to the non operated side is associated with a good functional result. CONCLUSION: Our results confirm those of other series and show that Delta 3 inverted prosthesis is an efficient therapeutic alternative in arthropathy with rotator cuff tears. Rehabilitation is fairly short and easy. The increase of the acromio-epiphyseal distance determines the tension of the deltoid muscle and could predict a favorable outcome.

The European strategy on endocrine disrupters: progress to date and EU/US cooperation.

The European Commission has been active in the field of endocrine disrupters since 1995. Its first actions were to fund research projects through the Fourth Framework Programme for Research and Development covering various aspects of the issue (identification of endocrine disrupters, environmental and human health impacts). This involvement in research has continued through the Fifth Framework Programme and increased to this day. The publication of a specific call for proposals on endocrine disrupters on May 31, 2001 bears witness to these efforts. In parallel, the policy profile of the issue quickly rose and led to the adoption of the Community Strategy on Endocrine Disrupters (COM (1999)706 final) in 1999. This strategy identifies actions short, medium and long term and is supported by the European Parliament and the European Council. Its short-term actions focus on the establishment of a list of substances for further evaluation of their role in endocrine disruption and on the use of existing legislation to control the risk; the medium-term actions focus on the identification and assessment of endocrine disrupters as well as on further research to better understand the ED phenomenon, and the long-term actions focus on legislative actions to protect human health and the environment. These European developments have gone hand in hand with international cooperation with the USA on research (in the frame of the EC/US S&T cooperation agreement), with the WHO on health issues and with the OECD on screening and testing issues.

[Treatment of Paget's disease with 1-ethane-1-hydroxy-1-diphosphonate]. / Le traitement de la maladie de Paget par l'éthane-1, hydroxy-1, 1-diphosphonate (EHDP).

The authors treated 11 patients suffering from severe and/or quickly developing Paget's disease (3 of whom had leontiasis ossea), using etidronate (E.H.D.P.) at doses of 7 to 15 mg.kg/day for a period of 6 months. The patients were followed up for 18 months, on average. The following were the conclusions of the investigation: E.H.D.P. is an effective treatment of Paget's disease: the decrease in hydroxyprolinuria was greater and more durable than that of the alcalin phosphatases; a variation between these two values even seems to appear under treatment. However, although some patients responded very well to the treatment, others were less responsive; at the dosages used, E.H.D.P. reduced the scanning hyperfixation of the active pagetic areas in 6 patients: it likewise more or less markedly reduced hyperosteoclastosis, with no apparent increase in the osteoid volume; two patients suffering from upper maxillary disease regressed clinically (dentures had become too large); headache and hypacusia were not modified; the response to the treatment seems to depend on three factors: the activity of the patient, the dosage used, and an individual factor which may be linked to the severity of the osteoidosis.

[Report of a case of Gaucher's disease in adult]. / Une observation de maladie de Gaucher de l'adulte.

The authors report a case of Gaucher's disease in an adult. This is a rare disease due to the accumulation of a glucoceramide in the reticulo-endothelial cells and may remain for long clinically symptomless, as in this case. The diagnosis suggested by the biological disturbance, viz. moderate thrombopenia, hypergammaglobulinemia, increase in SGPT, was conformed by the presence of Gaucher's cells in the liver and in the bone marrow, and by the existence of an intraleukocytic glucosidase deficiency. The authors recall the clinical forms of this disease, and recent clinical trials.