Effects of a five-week intensive and multidisciplinary spine-specific functional restoration program in chronic low back pain patients with or without surgery.

OBJECTIVE: Evaluating the efficacy of an intensive, dynamic and multidisciplinary spine-specific functional restoration program in patients with chronic low back pain with or without surgery. METHODS: One hundred and forty-four subjects with chronic low back pain included in the retrospective study and divided into two groups: patients who had spine surgery (GI, n=81) and patients who did not have surgery (GC, n=37). The two groups followed the same functional restoration program (175 hours). All the subjects were evaluated before (T0) and after (T5wks) rehabilitation care based on physical, functional, psychological and professional parameters. RESULTS: All outcome measures were significantly improved for all subjects at the end of the study, regardless of the group. Eighty-one percent of patients returned to work. The surgery group obtained better results at the end of the program for pain and back muscle isometric endurance measures. CONCLUSIONS: The effects of the intensive program were validated; nevertheless, spine surgery seems to have a positive impact on some physical parameters of this spine-specific functional restoration program.

[Does exercise therapy for chronic lower-back pain require daily isokinetic reinforcement of the trunk muscles?]. / Le réentraînement à l'effort de la lombalgie chronique nécessite-t-il un renforcement musculaire isocinétique quotidien du tronc?

OBJECTIVE: The goal of this study was to determine the benefits of a functional retraining programme (with or without daily isokinetic reinforcement of the trunk muscles) in patients with lower-back pain. METHOD: Two groups of 30 patients took part in the study. The control group (CG) underwent a four-week reconditioning program in a day hospital, whereas a second interventional group (IG) additionally performed daily isokinetic training of the trunk muscles. Three evaluations were carried out: before hospitalization (T1), immediately after hospitalization (T2) and three months postrehabilitation (T3). RESULTS: We observed an improvement in each parameter after rehabilitation, regardless of the group. A decrease in the DALLAS scores revealed a reduced impact of lower-back pain on the patients' lives. Pain experienced fell by 24%, analgesic treatment was significantly decreased (CG: -53%; IG: -56%), muscle endurance was improved (quadriceps: +30%, abdominal muscles: +20%, paraspinal muscles: +23%, quadratus lumborum: +33%) and the patients were more supple, as revealed by a decrease in the finger-to-ground distance (at T1, CG: 12.9+/-6.1cm; IG: 13.6+/-5.5 cm at T1; CG: 2.2+/-5.4 cm; IG: 2.8+/-5.1cm at T2). The sole difference for CG and IG at T2 resulted from an improvement in the performance of the trunk extensor muscles, which was significantly greater in the IG (CG: +14%; IG: +20%). Three months after rehabilitation, the benefits were still present for the two groups and, indeed, were even greater for certain parameters. CONCLUSION: Regardless of the protocol, the patients improved in both physical and psychological terms and these improvements were maintained over a short period, at least. Our results confirmed that one functional recovery programme is not superior to another for patients with lower-back pain.

[Streptococcus intermedius Lemierre syndrome: an unusual association]. / Syndrome de Lemierre dû à Streptococcus intermedius: une association inhabituelle.

BACKGROUND: Lemierre's syndrome is a potentially severe though uncommon entity consisting in septic emboli from an internal jugular vein thrombus after oropharyngeal infection. CASE REPORT: A 21-year-old man initially treated for acute pharnygeal infection developed fever and lower chest pain related to multiple pulmonary abscesses. The diagnosis of Lemierre's syndrome was retained due to the association of extensive thrombus formation in the internal jugular vein and Streptococcus intermedius septicemia. DISCUSSION: Lemierre's syndrome is a classical entity whose frequency is probably underestimated. The causal agent is not always an anaerobic germ. Use of anticoagulants is controversial.

[Lung disease induced by isotretinoin]. / Pneumopathie induite par l'isotrétinoïne.

A young man without any past history of note had taken isotretinoin for disfiguring acne before the summer season. He presented with a severe bilateral pneumonia, associated with dyspnoea two months after the start of treatment. On the pulmonary radiography there was a bilateral ground glass appearance which was worse on the right. The elevated level of eosinophils (54% in 564,000 cells/ml) in the alveolar lavage lead to a diagnosis of allergic pneumonia. The rapidly favourable outcome following the cessation of the medication and with the addition of corticosteroids seemed to us a supplementary argument in favour of a diagnosis of eosinophilic pneumonia, due to isotretinoin which seemed the primary initiating factor.

[Reliability of transcutaneous PO2 measurements and ear oximetry at different levels of exercise]. / Fiabilité de la PO2 transcutanée et de l'oxymétrie par pince d'oreille à différents niveaux d'exercice.

Measurement of transcutaneous PO2 (PtcO2) and of the saturation of hemoglobin by ear oximetry (StcO2) are two non-invasive methods which can be used when performing exercise tests in patients with respiratory failure. To evaluate their reliability, we have compared 18 patients recording the PtcO2 (Radiometer electrode TCM1) and of StcO2 (Biox II A) with arterial samples using a radial artery catheter at rest and at a level corresponding to 50% of the maximal predicted effort and at maximal power (Wmax) obtained at the time of a triangular exercise (increasing the charge at 15 watts/min). The PtcO2 was significantly lower than the PaO2 at rest and on exercise: the variation between PaO2 and PtcO2 was 1.85 kPa at rest (confidence interval -0.25 to 3.96 kPa) but decreased with exercise reaching 1.22 kPa at the last level of exercise (confidence interval -1.2 to 3.65 kPa). The relative raising of PtcO2 in relation to the PaO2 masks a fall in the observed PaO2 on average for the entire group (the PaO2 falls from 9.49 kPa to 8.62 kPa whereas the PtcO2 only falls from 7.64 kPa to 7.39 kPa). The mean StcO2 does not differ from th SaO2 at rest as on exercise. However, the confidence interval of the scatters between SaO2 and StcO2 increase considerably at maximal power: whereas it ranges between -5.5 and 3.5% at rest and in the middle range effort, and is between -13.4 and 11.1% at the last stage.(ABSTRACT TRUNCATED AT 250 WORDS)