[Fibromyalgia].

Purpose: We review the current knowledge about fibromyalgia, adding to the clinical aspects, the nosology, epidemiology and pathogenesis. The therapeutic and social management of these suffering patients are discussed.

Key Points: The limitations of the American College of Rheumatology classification criteria used as diagnostic criteria are discussed.

[The role for new evidence-based methods in patient care].

Are we going to change the way we practice medicine? There are two kinds of medical knowledge: one is impersonal and results from research based on scientific methodology and scientific reasoning; the other is personal and results from learning and apprenticeship with seniors and from individual experience. Evidence-based medicine (EBM) is a new approach to teaching the practice of medicine. Instead of using personal knowledge, intuition, unsystematic clinical experience, and pathophysiological reasoning, it stresses evidence from clinical research.

[Natural history of non specific neuralgias of the limbs. Exponential kinetics of the root pain recovery in sciatica and femoral neuralgia; uncertain kinetics for brachial neuralgia].

Very few studies are dedicated to the natural history of sciatica, and none to femoral neuralgia or brachial neuralgia natural course. Hence, the results of a collection of five studies on these topics appear worth being published. A rheumatology department.

[Enthesiopathy and bone disease during the course of inflammatory spondylarthropathies. Diagnostic and physiopathologic importance].

Our studies concerning enthesopathies during the course of spondylarthropathies show that enthesopathies are very frequent: 58% among 48 spondylarthropathies in a preliminary study. The comparison of the frequency of enthesopathies in spondylarthropathies (58%) and in Rheumatoid Arthritis (6.6%) show a highly significant difference.

Prediction of articular destruction in rheumatoid arthritis: disease activity markers revisited.

Objective: To assess the predictive value for joint damage progression of commonly used disease activity or process measures in rheumatoid arthritis (RA).

Methods: Seventy-two patients fulfilling the American Rheumatism Association criteria for RA were assessed twice yearly for 2 years. Primary outcome variables were progression of articular destruction, evaluated by Sharp's method, for 6, 12, 18, and 24 month periods.

Endosonographic features of pancreatic metastases.

Background: Pancreatic metastasis is a rare event. Surgical resection can provide long-term survival in selected cases. The aim of this study was to describe the endosonographic features of pancreatic metastases.

Osteonecrosis of the hip in renal transplant recipients. Changes in functional status and magnetic resonance imaging findings over three years in three hundred five patients.

Objective: to conduct a retrospective study of the appearance and course of magnetic resonance imaging abnormalities in avascular osteonecrosis of the femoral head in renal transplant recipients and of potential relations between these abnormalities and the functional outcome.

Patients And Methods: among 305 renal transplant recipients, patients with pain in the hips or knees underwent radiographs and magnetic resonance imaging studies of the hips and, if appropriate, of the knees. The mean time interval between these studies and transplantation was 8.

[Low back pain: critical analysis of the state of the art].

Despite Low Back Pain (LBP) major health impact, its nosology, etiology and natural history remain ill defined in most cases. The studies of our team explored the clinical and psychological features of non specific low back pain on unselected populations of patients. Our first study was conducted in a department of rheumatology.

Value of endoscopic ultrasonography in the diagnosis of common bile duct stones: comparison with surgical exploration and ERCP.

An accurate and safe preoperative method of imaging the common bile duct is essential for the proper diagnosis of calculous biliary tract disease, especially in the current era of laparoscopic cholecystectomy. The value of endoscopic ultrasonography in detecting common duct stones has been reported, albeit in small series. The aim of this retrospective study was to assess the accuracy of EUS in a large series of patients.

Reliability of three methods of radiologic assessment in patients with rheumatoid arthritis.

Rationale And Objectives: To assess the intraobserver reliability of three methods used frequently to evaluate joint destruction in rheumatoid arthritis: the Sharp method, the Larsen method, and the carpo:metacarpal ratio.

Methods: One observer analyzed twice within a 6-week interval 71 radiographs from patients with rheumatoid arthritis. Reliability was estimated by intraclass correlation coefficient (R) and by Altman-Bland graphical method.

Are classification criteria for spondylarthropathy useful as diagnostic criteria?

The authors used data from a study conducted under the auspices of the Société Française de Rhumatologie to evaluate the sensitivity and specificity of the individual items of two sets of criteria for spondylarthropathy. The study included 124 patients with spondylarthropathy and 1,964 controls. They found that the spondylarthropathy criteria with the highest sensitivities and specificities were useful not only for classifying patients but also for assisting in the diagnosis of spondylarthropathy.

Clinical and psychological classification of non-specific low-back pain. A new study in primary care practice.

This study aimed to explore the clinical and psychological features of non-specific low-back pain (LBP), and to evaluate a classification of patients based on the relationship between psychological disturbances and LBP clinical presentation. An unselected population of consecutive patients (n = 262) complaining of low-back pain to primary care physicians of the Epidemiology Team of the French Rheumatology Society, in October and November 1991, was studied. Measures included a standardized clinical evaluation of the back and a psychological assessment using the General Health Questionnaire.

[Digestive echo-endoscopy].

Since its introduction into clinical practice in 1980, echo-endoscopy has greatly contributed to improving our capacity to image the digestive tract and now plays a major role in management of digestive tract diseases. Echo-endoscopy is a second intention technique reserved for further investigation of lesions previously identified by endoscopy or other imaging techniques. All five layers of the wall and surroundings of the accessible structures (oesophagus, stomach, duodenum, rectum and colon) can be visualized.

Endoscopic ultrasonography in the staging and follow-up of epidermoid carcinoma of the anal canal.

Epidermoid (squamous cell) carcinomas of the anal canal are relatively rare, accounting for less than 3% of all malignant tumors affecting the large intestine. Radiation therapy alone or combined with chemotherapy is the treatment of choice. To be effective, this requires initially correct staging and accurate follow-up.

Inter- and intraobserver variability in the interpretation of computed tomography of the lumbar spine.

In order to assess the variability in interpreting lumbar CT-scans, two radiologists and two rheumatologists examined the same set of 40 CT-scans and evaluated the presence of primary abnormalities using pre-established criteria. Inter- and intraobserver concordance was assessed using kappa statistics. Interpretation of herniated nucleus pulposus appeared reliable in this study (interobserver and intraobserver kappa statistics approximately 0.

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

Objective: To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes.

Design: Inception cohort study.

Setting: Primary care.

Endoscopic ultrasonography in the local staging of primary gastric lymphoma.

Endoscopic ultrasonography (EUS) and endoscopy were prospectively performed and compared to the histopathologic findings of the resection specimens in 24 patients with primary gastric lymphoma (PGL). On EUS, three types of PGL could be differentiated, a superficial type (n = 10), an infiltrating type (n = 12) and a tumorous type (n = 2). In the correct assessment of surface extension of the tumors, endoscopy and EUS agreed in 37.

[French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire)].

Functional disability is one of the main components of low back pain (LBP)-associated morbidity and should be taken into account in the evaluation and care of patients. This article describes the French-language adaptation and validation of the Roland and Morris Disability Questionnaire. This self-administered questionnaire proved rapid, simple to use, reliable, valid, and sensitive to changes in clinical status, suggesting that its widespread use may be possible in settings ranging from epidemiological or clinical research to individual LBP patient evaluation in daily clinical practice.

[Progressive paraparesis, complication of acquired pagetic synostosis of the cervical vertebrae. 2 cases].

Two cases of pagetic cervical intervertebral synostosis with spinal cord compression are reported. Computed tomography and magnetic resonance imaging enabled detailed analysis of pagetic bone structure and relationships between the fused spinal segment and spinal cord. Few similar cases have been reported and most authors have advocated conservative therapy with calcitonin and/or diphosphonates, with surgery only in cases unresponsive to pharmacotherapy.