Remedial actions are discussed at the end of the paper.

Summary: Idiopathic chilblain is a relatively common yet poorly recognized acrosyndrome. This literature review aims to better understand and draw attention to this disorder. Chilblain is a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather. It usually resolves spontaneously. The etiology is uncertain, but vasospasm seems to play a role in this abnormal reaction to cold. Diagnosis is most often based on clinical presentation, but a skin biopsy can be useful in dubious cases. In histology, dermal edema and an inflammatory infiltrate are usually present. A distribution of the infiltrate particularly around the eccrine gland is typical. Systemic symptoms and underlying autoimmune disease should be screened. Avoiding cold and keeping extremities warm is the first recommendation for management, as well as smoking cessation. Calcium channel blockers (in particular nifedipine) seems to be the treatment that has been most evaluated in chilblains. However, their effectiveness is not confirmed by all studies. Topical betamethasone is often used but its effect has not been confirmed by randomized clinical trials. Other treatments, such as pentoxifylline, hydrochloroquine and topical nitroglycerin have shown positive effects only in a reduced number of patients. Acupuncture seems to bring a benefit.

Background: The purpose of this study was to evaluate the perceptual (2D versus 3D view) and instrumental (classical versus robotic) impacts of robotic system on surgical skill acquisition and, in a second time, to determine whether skills were transferred between conventional laparoscopy and robotic system. Methods: 40 medical students without any surgical experience were randomized into four groups (classical laparoscopy with 3D-direct view or with 2D-indirect view, robotic system in 3D or in 2D) and repeated a complex motor task 6 times. Afterwards, they performed 2 trials with the same technique but in the other viewing condition (perceptive switch). Finally, subjects performed last three trials with the other technique (technical switch). Subjects impressions were surveyed by a questionnaire.Results: Our study showed better performance and improvement in 3D view than in 2D view whatever instrumental aspect. Participants reported less mastery, familiarity, self-confidence and more difficulty in classical laparoscopy with 2D indirect view than in the other conditions. Conclusions: Robotic surgery improves surgical performance and learning particularly by 3D view advantage.However, performances after switches emphasize the need to adapt and pursue training also with conventional laparoscopy in order to prevent risks in conversion procedure.