Use of autologous bone marrow cells concentrate enriched with platelet-fibrin on extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty.

Allografts techniques remain the best reconstructive strategy for chronic extensor mechanism lesions after total knee arthroplasty (3) but outcomes depend strictly on the host tissue-allograft junctions healing. The purpose of this study is to evaluate if modern techniques of adding autologous bone marrow cells concentrate enriched with platelet-rich fibrin, provide better healing of the allograft. We present the case of an 86 years old patient affected by patellar tendon rupture after TKA. A whole extensor mechanism allograft was performed adding a bone marrow cells concentrate enriched with platelet-rich fibrin on the host tissue-allograft junctions. Preoperatively and at each follow-up the value of Knee Society Score and radiographic consolidation signs were recorded. Radiographic controls showed clear signs of consolidation already at 1 months follow-up and a solid fusion at 3 months. This case report describes a valid method to improve healing using a tissue-construct engineered with stem cells and growth factors.

[Trauma of the liver and hepatic pedicle]. / Le lesioni multifunzionali del fegato.

Traumatic injuries of the liver and hepatic pedicle secondary to blunt abdominal trauma are unusual and often associated with injuries of other abdominal and/or thoracic organs. These lead the patient to an emergency operation for hemorrhagic shock. The diagnosis of trauma severity and hepatic pedicle involvement is made intraoperatively. Often only one anatomical structure of the hepatic pedicle is involved, whereas involvement of two or all three anatomical structures is rare and associated with a bad prognosis. The management of these injuries still remain one of the most challenging scenario in trauma surgery. The overall experience is not significant. Clear treatment guidelines or management algorithms have not yet been established, in part due to the complexity, severity and variability of these injuries and to the lack of large series with these rare events. Three cases of associated liver and hepatic pedicle injuries treated in our unit are reported.

[Bouveret's syndrome]. / La sindrome di Bouveret.

Bouveret's syndrome is represented by an intestinal occlusion due to a gallstone passed through a cholecysto-duodenal fistula and impacted in the duodenum. The authors report a case of this rare syndrome and discuss the optimal surgical approach.

Prevalencia de Parto Vaginal en Pacientes con Cesárea Previa / Prevalence of Vaginal Birth in Patients With Prior Cesarean Section

RESUMEN Introducción:El manejo de la gestante con una cesárea previa es aún controversial, no existiendo hasta el momento un criterio universal y uniforme acerca de la mejor conducta a seguir en estos casos. Muchas son las variables que se manejan en la atención del final de la gestación, por esto, no existiendo una normativa a la hora de indicar una operación cesárea, los criterios van a depender tanto del servicio donde se maneje como de las causas que se consideren para indicarla. Objetivo:El objetivo de este estudio fue evaluar la prevalencia de partos vaginales posteriores a una cesárea e investigar las causas en casos de una cesárea iterativa. Se incluyeron pacientes con antecedentes de una cesárea previa en el Servicio de Gineco-obstetricia del Hospital Materno Infantil San Pablo. Material y Métodos:Diseño observacional descriptivo restrospectivo de corte transverso. Fueron revisadas 289 fichas médicas de pacientes con cesárea previa de un total de 2999 nacimientos que hubieron en el año 2009. Resultados:El 88,3% culminaron en una cesárea iterativa siendo la causa más frecuente la sospecha de alteración del bienestar fetal (23%). Conclusión:La prevalencia de parto vaginal en pacientes con cesárea previa fue 12%.

ABSTRACT Introduction: The management of pregnant women with a previous cesarean is still controversial, since at present there is not a universal and uniform about the best approach to follow in these cases. There are many variables that are handled in the care of late pregnancy, so there are no regulations to indicate when a Caesarean section, the criteria will depend on both the service which is handled as the reasons to be considered for identify. Objetive:The aim of this study was to assess the prevalence of vaginal births after cesarean section and investigate the causes in cases of repeat cesarean section. Patients with a history of previous cesarean section in our department. Materials and Methods:Restrospective observational desig of transverse section. Were reviewed 289 patients (9.6%) with previous caesarean section a total of 2999 births there were in 2009. Results: 88.3% culminating in a repeat cesarean section being the most common cause of suspicion of impaired fetal well-being (23%). Conclusion:The prevalence of vaginal birth in patients with prior cesarean section was 12%.