[Thoracic outlet syndrome]. / Le syndrome du défilé cervico-thoraco-brachial.

BACKGROUND: The thoracic outlet syndrome (TOS) is recognized as a cause of upper limb pain. It is often under-diagnosed and its frequency under-estimated by rheumatologists. AIM: To report the diagnostic problems related to TOC though a literature review. METHODS: A narrative review of literature RESULTS: The diagnosis of TOS is difficult because of intricacy of vascular and neurological symptoms. It requires provocative tests, electrophysiological investigations and Doppler ultrasonography. A good anatomical knowledge is mandatory in order to clarify the mechanisms and the location of the lesions which depend on sophisticated imaging exams. It is also recommended to exclude all other causes of upper limb pain, as well as peripheral nerve compression syndromes, which can coexist with TOS. CONCLUSION: Diagnosis and treatment of the TOS involves rheumatologists, neurologists, physiatrists, orthopedic surgeons,vascular surgeons, thoracic surgeons, neurosurgeons and sometimes psychiatrists who have to cooperate in order to prevent severe functional after-effects.

[Rheumatologic manifestations of sarcoidosis]. / Les manifestations rhumatologiques de la sarcoidose.

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It has various clinical features. The most commonly affected organs are the lung, the lymph nodes, the eyes and the skin. Involvement of the musculoskeletal system is far less common and may be inaugural. Articular involvement is dominated by Lofgren syndrome and acute polyarthritis. Abarticular manifestations are often confounded with arthritis. Bone locations are dominated by sarcoidosis dactylitis and osteolysis. Muscular involvement is often unknown and can appear as 3 clinical features: spread form, myositique form or pseudotumoral form. Calcium balance disturbances are dominated by hypercalcemia which is often asymptomatique, but sometimes it reveal the sarcoidosis. Treatment of rheumatologic disorders often involves non steroidal antiinflammatory drugs, corticosteroids and methotrexate. Biological therapies such as the anti-TNFa and the anti-CD20 were showed to be effective in some case reports of severe and refractory disease.

[The value of intraoperative frozen section in surgical management of thyroid nodules. Report of 409 cases]. / La valeur de l'examen extemporané dans la chirurgie des nodules thyroïdiens. A propos de 409 cas.

OBJECTIVE: The purpose of this study was to assess the value of intraoperative frozen section diagnosis in thyroid surgery and determine its limitations. METHODS: This retrospective study examined the results of 409 frozen sections of thyroid specimens analyzed over the 4-year period and their correlations with the final histological examination. RESULTS: In our series, frozen section diagnosis was concordant with subsequent histopathological examination in 96.6% of cases, discordant in 3.4%. All discordances were due to false-negative diagnoses. Non-false-positive result was found. The global specificity of frozen section analysis for all histological subtypes was 100% and its sensitivity was 68.2%. CONCLUSION: The frozen section evaluation of thyroid neoplasm is highly accurate and specific. A high degree of specificity with an acceptable sensitivity is requested. However, the frozen section examination has still some limits in the diagnosis of microfollicular lesions.

[Accuracy of frozen section diagnosis: an analysis of 1695 consecutive cases]. / Fiabilite de l'examen extemporane: analyse de 1695 examens consecutifs.

BACKGROUND: The intraoperative frozen section is a well established procedure for rapid diagnosis that helps in making therapeutic decisions. AIM: Assessment of the accuracy of frozen section diagnosis and analysis of the causes of its discordance. METHODS: A retrospective review of 1695 surgical specimens performed in 1207 patients between January 2002 and April 2005. Frozen section results were compared with the final diagnoses in paraffin sections. RESULTS: The frozen section diagnosis was benign in 84.2%, malignant in 10.2% and borderline in 0.4% of all cases. The frozen section result was deffered to permanent section in 5.2%. The sensitivity, specificity, positive and negative predictive values were 84.6%, 99.8%, 98.2% and 97.8% respectively. Overall diagnostic agreement was 97.5% (Kappa=0.88). Frozen section diagnosis was incorrect in 2.5% of cases. Most of the discrepancies were false negative cases frequently due to sampling errors and misinterpretation. False positive cases were always related with misinterpretation. CONCLUSION: The frozen section evaluation is highly accurate and reliable. However, the surgeon and the pathologist must be aware of its limitations.