Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study.

OBJECTIVE: The abdominal route of genitourinary fistula repair may be associated with longer term hospitalisation, hospital-associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3 months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair. DESIGN: Prospective cohort study. SETTING: Eleven health facilities in sub-Saharan Africa and Asia. POPULATION: The 1274 women with genitourinary fistula presenting for surgical repair services. METHODS: Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log-binomial and Poisson (log-link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding. MAIN OUTCOME MEASURES: Abdominal route of repair and fistula closure at 3 months following fistula repair surgery. RESULTS: Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico-uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12-114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05-1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route. CONCLUSIONS: Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.

[Neglected idiopathic congenital clubfoot : surgical treatment before 20 years old. Retrospective study of 40 feet]. / Pied bot varus equin congenital idiopatique neglige. Traitement chirurgical avant 20 ans a propos de 40 pieds colliges sur 7 ans.

From January 2000 to december 2006, 40 club foot have been collected to the service of the frequency of the inveterate equin varus club foot is 0.3%. The average age is 12.13 years with extremes of 3 years to 20 years. The masculine sex is predominate with sex ratio of 1.08. Most patients come from the farming zones either 86.2% of the sample with parents to 93.1% without level of instruction. The bilateral attack predominates in 55% of the cases. On the therapeutic plan, ours patients benefited from the surgical technique of postero medical soft tissue release and lateral ostestomy in one time. A case of skin necrosis has been noted in our set. The middle receding is of 49 months with extremes of 14 months to 84 months. Our results were satisfactory in 95% of the cases.

[The treatment of tibia open fractures by Hoffmann external fixation in Niamey. About 50 cases]. / Le fixateur externe de Hoffmann dans la prise en charge des fractures ouvertes de jambe a Niamey. A propos de 50 cas.

UNLABELLED: The authors present the results of a retrospective study performed during 12 months; about 50 open fractures of tibia, treated by Hoffmann external fixation entirely or partially. The mean age was 33 years (6 years to 60 years). Forty (80%) patients had sustained the fracture in road traffic. According to Cauchoix system: 30 (60%) tibia open fracture was type I, 8 (16%) type II, and type III 12 (24%). 20 patients treated by external fixation following by internal fixation (plate), 10 patients treated by external fixation following by cast; 20 patients treated by external fixation only. The mean bone healing time was 7.5 month COMPLICATIONS: infections 6%, non-union 5 patients. Hoffmann external fixation is an excellent and safe method for the management of tibial open fractures.

[Colonic pseudo-obstruction disclosing bladder calculi: report of 2 cases]. / Pseudo-obstruction colique, révélatrice d'un empierrement vésical: à propos de 2 cas.

The authors report two cases of acute intestinal obstruction caused by bladder calculi and insist on differential clinical diagnosis. Simple X ray and sonography seemed to be sufficient-for diagnosis of this extrinseque colique obstruction and management consisted of removal of the bladder stones The prognosis is excellent.

Le fixateur externe de Hoffmann dans la prise en charge des fractures ouvertes de jambe a Niamey; a propos de 50 cas

Introduction : Le fixateur demeure une indication en cas de fracture ouverte des os longs avec perte ou non de substances .Le fixateur externe de Hoffmann; grace au principe de l'osteotaxis presente plusieurs avantages dans la prise en charge des fractures ouvertes de jambe . But : le but de ce travail etait de montrer les avantages lies a l'usage du fixateur externe de Hoffmann dans la prise en charge de la fracture ouverte de jambe .Materiels et Methode : Sur une periode de 12 mois ; les auteurs ont collige 50 fractures ouvertes de jambe ; qui provenaient de la ville de Niamey et des districts sanitaires environ ants . Il s'agissait d'une etude retrospective menee de Septembre 2005 a Aout 2006. Ont ete inclus dans cette etude ; les patients qui ont ete admis aux urgences pour fracture ouverte de jambe ; traitee par le fixateur externe de Hoffmann ; en totalite ou en partie et qui ont ete operes dans la periode de l'etude . Les patients ont ete reparti en en trois groupes : -groupe 1 :le fixateur a ete utilise exclusivement jusqu'a la consolidation. -groupe 2 :le fixateur externe suivi de platre. -groupe 3 : le fixateur externe suivi d'une osteosynthese interne. Resultats : Il s'agissait de 45 hommes et de 5 femmes ;L'age moyen etait de 33ans (6 ans a 60ans). Les AVP constituaient la premiere cause de fractures ouvertes avec 40(80) cas. L'ouverture de type I de Cauchoix representait 30(60) cas ; le type II represente 8(16) ; et le type III 12(24.) ; Sur le plan therapeutique les patients ont ete classes en trois : groupe1 soit 20 cas le fixateur a ete utilise comme l'unique methode de traitement ; groupe II 20 cas chez lesquels le fixateur externe a ete remplace en cours de traitement par une osteosynthese interne ; groupe III chez lesquels le fixateur a ete remplace a mi-parcours par un platre cruro- pedieux soit 10 cas. Le delais moyen de consolidation etait de 7;5 mois .. 6d'infections et 5cas de pseudarthroses ont ete enregistrees. Conclusion : Le fixateur externe de Hoffmann demeure une solution therapeutique accessible dans le contexte de l'etude ; evite pas mal d'amputations; procure une fixation stable; autorise la chirurgie reparatrice et permet au moment propice la conversion en osteosynthese interne ou son remplacement par un appareil platre