Latin American formal consensus on the appropriate indications of extra-articular lateral procedures in primary anterior cruciate ligament reconstruction.

OBJECTIVES: To create a practice guideline for the appropriate indications of an extra-articular procedure in primary anterior cruciate ligament reconstruction (ACLR). METHODS: The formal consensus method described by the Haute Autorité de Santé was used. The Latin American Society of Arthroscopy, Articular Replacement, and Sports Injuries (SLARD) recruited three groups of experts on ACLR. Initially, the steering group, consisting of eight surgeons, performed a systematic review of the literature and elaborated on 192 scenarios for primary ACLR. The rating group, composed of 23 surgeons, rated each scenario in two rounds, with an in-between in-person meeting for discussion. Median scores and agreement levels were estimated to classify each scenario as inappropriate, uncertain or appropriate for adding anterolateral reconstruction. Finally, the lecture group, consisting of 10 surgeons, revised each stage of the method, results and interpretation. RESULTS: Of the scenarios, 11.97% were rated as appropriate for adding an extra-articular lateral procedure, 7.81% as inappropriate and 80.21% as uncertain. The key recommendations for the addition of extra-articular lateral techniques were as follows: it is appropriate when the patient is under 25 years of age, has high-grade physical examination findings, practises a pivoting sport and has hyperlaxity; meanwhile, it is inappropriate when the patient has low-grade physical examination findings, has normal laxity and does not practise a pivoting sport. CONCLUSIONS: The appropriate indications of extra-articular lateral procedures in primary ACLR were determined on the basis of the best available evidence and expert opinion following a formal consensus method. LEVEL OF EVIDENCE: V.

Disección aórtica aguda tipo A en gestante de 33 semanas afectada del síndrome de Marfan / Acute type A aortic dissection in a woman at 33 weeks of pregnancy with Marfan syndrome

La disección aórtica es una patología que se presenta raramente en mujeres jóvenes, pero cuando ocurre suele ocurrir con mayor frecuencia durante el embarazo, sobre todo en el tercer trimestre. El síndrome de Marfan, otras colagenopatías, la hipertensión crónica, el abuso de cocaína y la coartación de aorta son factores predisponentes a su aparición.Presentamos un caso de una gestante afectada del síndrome de Marfan que debutó en la semana 33 con una disección aórtica aguda que requirió una cesárea urgente previa al reemplazo de la aorta ascendente. Ambos, madre y recién nacidos, fueron dados de alta sin incidencias (AU)

Although aortic dissection is uncommon in young women, it occurs more frequently during pregnancy, especially in the last trimester. Predisposing factors for aortic dissection are Marfan syndrome and other collagen diseases, chronic hypertension, aortic coarctation and cocaine abuse.We report a case of acute aortic dissection in a woman in the 33rd week of pregnancy with Marfan syndrome. After cesarean section, the ascendant aorta was replaced. Both mother and infant were discharged in good physical health (AU)

Muerte fetal intraútero secundaria a corioamnionitis aguda por Listeria monocytogenes / Intrauterine fetal death due to acute Listeria monocytogenes corioamnionitis

La listeriosis es una infección poco frecuente que muestra una especial predilección por pacientes inmunodeprimidos, así como fetos, neonatos, ancianos y embarazadas. Se presenta un caso de una gestante de 25 semanas que desarrolló una corioamnionitis aguda por Listeria monocytogenes que provocó la muerte fetal intraútero

Listeriosis is an uncommon infection that occurs mainly in immunodepressed individuals, the elderly, fetuses, neonates, and pregnant women. We present the case of a 25-year-old pregnant woman with acute chorioamnionitis caused by Listeria monocytogenes, leading to intrauterine fetal death