Little communication between company doctors and private physicians with respect to hindrances to return to work after prolonged absence from work because of low back pain]

OBJECTIVE: To determine occurrence and reasons of contact between company doctors and treating physicians with respect to patients absent with low back pain for three months. DESIGN: Prospective cohort study. METHOD: A cohort of employees who were absent for 3 months with back pain were selected according to defined criteria. A questionnaire about medical status and communication with treating physicians was sent to their company doctors. RESULTS: The company doctors of 300 of 467 employees participated. In 19% of the employees the company doctor contacted the curative sector (56 contacts had taken place, 14 were planned). The contact consisted almost always of exchange of information and less frequently of co-operation towards a mutual policy. In almost 50% of the cases the company doctors regarded the clinical waiting period, length of treatment and opinion of the curative sector as disincentives to return to work. Psychosocial factors such as psychological problems, work-related motivation, private problems and a conflict between employer and employee all were mentioned less frequently. Although contacts were slightly more frequent when psychosocial factors, treatment or opinion of the curative sector inhibited return to work, only disincentives such as work-related motivation, motivation to return to work and the waiting period were significantly associated with the contact frequency. CONCLUSION: The communication rate between company doctors and the curative sector in employees long absent with back pain is low. Communication consists of exchange of information rather than co-operation towards a mutual policy. Although according to many company doctors the curative sector plays an inhibitive role in return to work, they do not communicate accordingly.     

Intraspinal synovial cysts: MR imaging

Juxtaarticular intraspinal synovial cysts are unusual lesions of the spine associated with facet arthropathy. These lesions can cause radicular symptoms and may masquerade clinically as other, more common entities. Synovial cysts have been detected at myelography and have been well characterized at computed tomography as posterolateral epidural masses, typically at L4-5. Six synovial cysts of the lumbar spine were demonstrated on magnetic resonance (MR) images. The signal-intensity patterns of these lesions are variable. MR imaging can be used to document the presence of hemorrhage within the cyst, which may relate to the exacerbation of symptoms. Air-filled synovial cysts may be difficult to detect and distinguish from facet arthropathy.     

PRETREATMENT WITH PARACETAMOL INHIBITS METABOLISM OF ENFLURANE IN RATS

We studied the interaction between paracetamol (acetaminophenU.S.P.) and enflurane. Sixteen rats were assigned to four groups(n=4) to receive: paracetamol 7.5 mg/100 g body weight; paracetamolplus 1% enflurane; 1% enflurane alone, or no treatment (controls).Animals were killed 6 h later. A second series of 16 were treatedidentically, but were killed after 24 h. Measurements were madeof fluoride concentrations in serum, liver and urine (indicatorsof biotransformation of enflurane), paracetamol concentrationsin urine, pathological changes in liver samples, and concentrationsof the enzymes aspartate aminotransferase (AST) and alanineaminotransferase (ALT) in serum. Pretreatment with paracetamolsignificantly decreased urinary fluoride at 6 and 24 h afterexposure to enflurane, but decreased fluoride concentrationsin serum and liver only at 6 h after exposure to enflurane.Paracetamol concentrations in urine did not change after exposureto enflurane. Exposure to paracetamol alone increased AST andALT. At 24 h after exposure to enflurane, serum concentrationsof enzymes in rats pretreated with paracetamol were similarto those of control rats. Pretreatment with paracetamol maytherefore inhibit metabolism of enflurane. Although no hepaticdamage was observed, the increased in AST and AL T suggestedsubclinical liver damage in rats given only paracetamol.     

Strangulation in child abuse: CT diagnosis

The central nervous system is commonly affected in child abuse. Between April 1985 and July 1986 three infants were identified in whom the primary mode of injury had been strangulation. In each case computed tomography (CT) demonstrated a large cerebral infarction confined to vascular territories associated with small subdural hematomas. There was no history or visible evidence of significant head trauma. Autopsy of one infant confirmed the presence of a hemispheric infarct, thin subdural hematoma, and an area of subintimal hemorrhage in the carotid artery ipsilateral to the infarct. The remaining two patients survived with residual hemiparesis. CT findings of a large cerebral infarction with an associated subdural hematoma in an infant without a history of a significant trauma should suggest the possibility of child abuse and may be the primary manifestation of abuse in some patients.