[Impact of a training workshop on residents and senior registrar skill in diagnosis and repair of anal sphincter and rectal mucosae obstetrical injuries]. / Impact d'un atelier de formation au diagnostic et à la réparation des lésions obstétricales du sphincter anal et de la muqueuse rectale sur les compétences des internes et chefs de clinique.

OBJECTIVE: To evaluate the impact of a training workshop on residents and senior registrar skill in repair of anal sphincter and rectal mucosae obstetrical injury. MATERIAL AND METHODS: Residents and senior registrar practical and theoretical knowledge were evaluated by a questionnaire sent, using AGOF (association des gynécologues-obstétriciens en formation) mailing list. This questionnaire includes questions about epidemiology, risk factors and sutures types. Scores were compared according to the participation or not at the workshop. RESULTS: There were 106 residents or senior registrar (48.4%) in the workshop group and 113 (51.6%) in the control group. Scores were significantly higher in the workshop group than in the control group for theoretical knowledge (4.1 vs. 3.7), practical knowledge (17.6 vs. 15.9) and global scores (21.7 vs. 19.7). There was no difference according to the participation before or after the third residency semester. Residents global scores were statistically higher in the workshop group compared to the control group (21.8 vs. 19.5) but there was no significant difference between the senior registrar of the two group. Participants in the workshop group estimate themselves significantly more efficient than in the control group concerning anal sphincter injury repair and rectal mucosae repair. CONCLUSION: A training workshop seems to improve the theoretical and practical skill. LEVEL OF EVIDENCE: 4.

[Vaginal flap for rectovaginal fistulae in Crohn's disease]. / Traitement des fistules recto-vaginales de la maladie de Crohn par lambeau d'avancement vaginal.

OBJECTIVES: To evaluate efficacy and functional results (sexual activity) of vaginal flap for rectovaginal fistula in Crohn's disease. PATIENTS AND METHODS: From May 2004 to March 2008, we proposed a vaginal flap in patients who had a rectovaginal fistula in Crohn's disease and for which rectal flap was technically impossible. Monitoring included a clinical examination at 1 month and every 3 months for 1 year, Perianal Disease Activity Index for sexual activity evaluation. Every year and in April 2009 the nursing team during a telephone interview filled a standardized questionnaire. RESULTS: We treated 5 patients. At 6 months, 4 of 5 patients were healed. At 7 months, 1 patient presented a new flare up of CD with reopening of the fistula. The other 3 patients were still healed at a median follow-up of 30.66 months (15 to 59). One patient presented dyspareunia during 3 months. DISCUSSION AND CONCLUSION: Vaginal flap is an effective technique that entails neither prolonged dyspareunia nor fecal incontinence. Stoma is not systematic.

[Frequency, persistence and recurrence of HPV lesions of the uterine cervix in HIV-seropositive women]. / Fréquence, persistance et récidive des lésions à HPV du col utérin chez les patientes séropositives pour le VIH.

OBJECTIVE: The aim of this study was to determine the frequency, persistence and risk of recurrence of human papillomavirus (HPV) lesions of the uterine cervix in human immunodeficiency virus (HIV)-infected women. PATIENTS AND METHODS: To determine the frequency of such lesions, we compared 148 HIV-positive patients with 4862 HIV-negative patients who had a cervical smear test in Toulouse university hospital. To determine the persistence and recurrence rate of the lesions, we prospectively followed 63 of the HIV-positive patients. Their follow-up was compared with that of 227 of the HIV-negative patients. RESULTS: Abnormal smears were much more frequent in HIV-positive patients (42 versus 5%, P<0.001). Persistence or aggravation of the lesions was also greater in HIV-positive patients (82 versus 43%, P<0.001). Lastly, the recurrence rate of dysplastic lesions after treatment was significantly higher in HIV-positive patients (64 versus 11%, P<0.001). DISCUSSION AND CONCLUSION: As the frequency, persistence and risk of recurrence of cervical HPV lesions are very high in HIV-positive women, close gynecological surveillance of these patients is indispensable. Surveillance must not be restricted to the uterine cervix because of the frequency of multifocal lesions: vagina, vulva, perineum and anus. It must also be adapted to the severity of immunodeficiency and the patient's history.

[How to manage biliary injuries caused by Dormia catherers?]. / Comment gérer les plaies biliaires induites par la sonde de Dormia?*

The authors report the complications of intraoperative biliary exploration, particulary for the utilisation of basket Dormia. If the biliary injury, in general, are an problem for the surgeon, the especific injury for the basket Dormia are underestimate. The authors makes, for theirs observations, an review of the literature and an clasification anatomical-clinic are propose for help therapy repair.