Long-term assessment of a sanitary education and lumbar rehabilitation program for health care workers with chronic low back pain at the University Hospital of Lille.

A back school was established in 1992 at the University Hospital of Lille (France) for employees with low back pain. We report its medical and socioeconomic benefits with a mean time to follow-up of 4 years. Our retrospective study included 108 health care workers and provides objective data (absenteeism, use of health care) and subjective information (progression of pain and disorder, social and professional impact) before training and a mean of 4 years after training. We found that 92% of the participants were satisfied with the training and that back pain had regressed or resolved for 55% of them. Both the frequency and duration of pain had decreased significantly. Seventy percent continue to apply the advice they received in their everyday life. Dealing with the problems specific to professional activities contributed to reduce the strain experienced on the job by the health care workers and improved their satisfaction at work. Global absenteeism was reduced by 57.8%, whereas it was reduced by 33% for back pain alone 4 years after implementing this program. Our study provides evidence of the positive impact of this type of training on the way back pain is perceived and on everyday life. The assessment of the cost/efficiency ratio completes the list of durable benefits reported here.

[Anatomic bases of the surgical approach to the carpal tunnel. A propos of 50 dissections]. / Bases anatomiques de la voie d'abord chirurgicale du canal carpien. A propos de 50 dissections.

After a classic dissection of 50 wrists in black african cadavers, we have studied carpal tunnel anatomy for therapeutic deductions. By a wide anterior incision following the longitudinal axis of the third finger remounting the inferior third of the forearm we studied both the anatomical limits specially the transcarpal ligament, the volare carpal ligament and also median nerve and flexores digitorum tendons. We have observed in 2 cases an ectopic second lumbrical muscle inside the carpal tunnel; we found numerous variations of the collateral and terminal branches of median nerve; we concluded that it is difficult to definitively establish the cartography of the terminal branches of median nerve. However our anatomical observations allowed us to choose larger and more medial surgical approach of the carpal tunnel to avoid the following complications: incomplete section of the carpal ligament, damages of collateral branches of median nerve, dislocation of flexor tendons of index and middle fingers, ignorance of anomalous muscle.

[Radiculo-medullary arteries of vertebral origin. Various anatomic aspects from 30 injections-dissections]. / Les artères radiculo-médullaires d'origine vertébrale. Quelques aspects anatomiques à partir de 30 injections-dissections.

Among medullary arteries we have only examined those directly arising from the vertebral artery at the cervical level. This study is about thirty anatomical samples of cervical spine removed during necropsies; there are treated by injection-dissection method. The observed variations do not allow isolation of any artery for the cervical bulge, as possible most frequently at the lumbar bulge level. We observed variations as sometimes alternate pedicles right or left, as sometimes a symmetrical aspect finishing at the same medullar level. By injecting differently colored liquids, in the right and in the left, a side prevalence has sometimes been noted but real conclusions cannot be draw without isobar and simultaneous injections.

[Anatomic study of the anterior interventricular artery (Ramus interventricularis anterior). Apropos of 200 anatomical samples]. / Etude anatomique de l'artère interventriculaire antérieure (ramus interventricularis anterior) a propos de 200 pièces anatomiques.

The coronary system has been studied on the basis of 200 hearts taken during necropsies and treated by injection of a synthetic resin followed by corrosion. Sixty samples were used for the study of the L.A.D. and one hundred and fifty were used for studying intercoronary anastomosis on L.A.D. The study highlighted the following particularities: the left coronary is the most common origin of L.A.D. (90 per cent cases); the L.A.D. irrigates: all the left ventricle ventral wall, the right apical part of both ventricles and the upper portion of the interventricular septum; out of 92 anastomoses, 49 were located on the L.A.D. which could protect against ischemia.

[Docimological analysis of the anatomy test for the PCEMII final exam in Dakar]. / Analyse docimologique de l'épreuve d'anatomie à l'examen final du PCEMII à Dakar.

This docimological analysis is based on computer treatment of the results of the anatomy exam for the two sessions of July (159 candidates) and October (56 candidates) of the identification questions, discrimination questions, coupling (paining), grouping, association and diagram labelling. The results were appraised following certain parameters: the gross score revealed a rather low average score for the whole class (14.57 and 9.57 over 30): the low success rate in July and the average figure of October indicate, in general, either the difficulty of the questions for the students or a bad reception of the message; the bad discrimination index, since only 21% of the questions are of the discriminatory type. This finding pointed to a revision of 50 of the 68 questions of July and 53 of the 68 questions of October. On the whole, only 15 questions, over the two sessions, could have been kept unchanged for an eventual bank (stock of data): The correlation coefficient has showed a significant relation between success in the anatomy subject and success in the PCEM2 exam. This work has showed the possibilities that computers may offer in the teaching of anatomy and the evaluation of students. Besides, it emphasizes the importance of the anatomy grade in the PCEM2 exam. Finally, the mode evaluation used help exploring the various levels of the cognitive areas (memorization, interpretation of data, problem-solving) and to build up a bank of anatomy questions.

[Branches of the vertebral artery to the spinal cord]. / Les rameaux de l'artère vertébrale à destination médullaire.

On the cervical level, ramifications stemming directly from the vertebral artery are studied while nevertheless taking into account contributions from rising and deep cervical, and while sometimes even from the upper intercostal and/or the occipital, as well as anastomoses contracted from these various sources at the level of the neck. No bulging cervical artery exists, but the variations observed are frequent. Pedicles are rarely symmetrical and usually alternate between left and right sides. Two, differently coloured injections sometimes reveal a preponderance for one side rather than the other, but the injections must be able to be made at the same time and with an equal degree of precision if a formal conclusion is to be drawn from this.