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We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.

Proposed and interim European quality specifications for imprecision and inaccuracy have been compared with the US CLIA total error criteria for proficiency testing (PT). To assess the relative demands of separate imprecision and inaccuracy specifications vs total error criteria, we derived the imprecision and inaccuracy that would be allowable if a testing process were to provide 90% assurance of achieving the analytical quality required by CLIA PT criteria. Charts of operating specifications (OPSpecs charts) were prepared for commonly used single-rule and multi-rule quality control procedures with 2 and 4 control measurements per run. Of the 23 tests studied, the proposed European specifications for imprecision and inaccuracy were more demanding than the CLIA requirements for 12 tests (albumin, alkaline phosphatase, amylase, calcium, chloride, creatinine, lactate dehydrogenase, lithium, magnesium, total protein, sodium, and thyroxine). The CLIA total error criteria were more demanding than the proposed European specifications for nine tests (alanine aminotransferase, aspartate aminotransferase, total bilirubin, cholesterol, creatine kinase, iron, triglycerides, uric acid, and urea nitrogen). Two tests (glucose, potassium) showed different requirements at different decision levels. Manufacturers and laboratory analysts need to compare these different quality specifications on a test-by-test basis to guide the development, selection, evaluation, and control of laboratory measurement procedures.

This study demonstrates the value of local quality control for surgical instruments. This is of importance in an increasingly hazard-conscious environment, where there are concerns over instrument sterilisation, surgical glove puncture and the potential for transmission of blood-borne and prion diseases.

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