Angelini, A

Favretto, D

Fedrigo, M

Paradiso, B

Thiene, G

English

Paradiso B

Fedrigo M

Favretto D

Angelini A

Thiene G

Archivio istituzionale della ricerca - Università di Padova

T. Greenhalgh et al. / New Horizons in Clinical Case Reports 1 (2017) 1–284Unexpected in utero exposure to psychotropicmedicationsBeatrice Paradiso 1, Marny Fedrigo 1, Donata Favretton,2,Annalisa Angelini 1, Gaetano Thiene 11 Cardiopathology Unit, Department of Cardiological, Thoracic andVascular Sciences, School of Medicine, University Hospital, Padua,Italy2 Legal Medicine and Toxicology, Department of Cardiological, Thoracicand Vascular Sciences, School of Medicine, University Hospital, Padua,ItalyIntroduction: Pregnancies in the world each year involve womenwho have or who will develop psychiatric illness during the preg-nancy. Psychotropics in gestation could produce adverse perinatal andpostnatal outcomes, however counseling these women to discontinuemedication presents new risks associated with untreated or inade-quately treated mental illness, such as poor prenatal care, inadequatenutrition, and increased alcohol and tobacco use. The single adminis-tration at a higher dosage over multiple medications, active pharma-ceutical compounds with fewer metabolites and higher protein bind-ing are preferred. Nevertheless all psychotropic medications cross theplacenta, are present in amniotic ﬂuid, and can enter breast milk.Case description: The FDA, the Australian Drug Evaluation Committeeand Micromedex have categorized medications according to risk duringpregnancy. Based on these classiﬁcations Benzodiazepines, have beendemonstrated possibly teratogenic however they are still used for treatinganxiety, panic, seizures and insomnia. International Pharmacopoeiareported an increased risk of intrauterine growth retardation, hypotonia,bradycardia, respiratory depression, low Apgar and preterm delivery forfetal plasma drug concentrations equivalent to the therapeutic range ofmaternal prescription. Very few data are published on sudden intrauter-ine death (SIUD) for intrauterine exposure to psychotropic medication.We describe a SIUD correlated with unexpected toxic plasmatic fetalconcentration of Lorazepam.Results and conclusions: The pregnant manifested anxiety, panicattack and deﬁciency of emotional transport for the fetus. She was treatedwith Lorazepam evening dose of 2mg from 24 to 40 gestational weeks,according to therapeutic range prescription, when suddenly and unex-pectedly fetus died in utero just before the delivery. We evaluated thematernal and fetal pharmacological plasmatic concentration and observeda fetal plasmatic level of Lorazepam of 330mcg/l greater the toxic cutoff of45mcg/l, suggested by Micromedex to cause "ﬂoppy infant" syndrome. Byautoptic diagnosis we hypothesized neuropathological signs of suddencardiac arrest in health fetus.Take-home message: We propose that the monitoring of thematernal plasma levels of benzodiazepines during pregnancy andassessment of the concentration umbilical cord at birth, have to becorrelated with the fetal vital signs. Nevertheless, it is difﬁcult to deﬁnethe metabolic fate of drugs in utero. Each of the major metabolicpathways can be promoted by placental and/or fetal enzymes and themetabolite concentration in the fetus does not ineludibly reﬂect theability of the fetus to metabolize drugs. For this reason it has to bestrictly evaluated the toxicological etiopathogenesis of some cases ofSIUD and still birth.http://dx.doi.org/10.1016/j.nhccr.2017.06.142Marcus Gunn Syndrome and implications for Oraland Maxillofacial surgery (OMFS)Claire Grahamn,1, Nathalie Gallichan 1, Katharine Fleming 2,Kathryn Taylorn,11 Liverpool Dental School, Liverpool, UK2 Countess of Chester Hospital, Chester, UKIntroduction: Marcus Gunn Syndrome, also known as Jaw Wink Syn-drome or trigemino-oculomotor synkinesis, was ﬁrst reported in 1883. Ittypically presents at birth with unilateral ptosis and eyelid elevation onjaw opening. Pathophysiology is explained by an oculofacial synkinesis.There is an aberrant connection of the oculomotor nerve and the man-dibular branch of the trigeminal nerve resulting in eyelid elevation onmouth opening. The typically congenital syndrome is exceptionally rare. Itis often diagnosed in infancy with complete ophthalmic examination andptosis evaluation. This syndrome does not often require surgical inter-vention but it may still have an impact in clinical management.Case description: A 32-year-old male presented in the OMFS out-patient clinic in Countess of Chester Hospital for extraction of his lowerthird molars. His past medical history included a known diagnosis ofMarcus Gunn Syndrome but he was otherwise ﬁt and well. He had restingptosis of the left and elevation of the left eyelid on jaw protrusion.Results and conclusions: Third molars were removed uneventfullyunder local anesthesia and no further treatment was required. Literaturesuggests that patients with Marcus Gunn Syndrome may have an atypicaloculocardiac reﬂex during their surgical procedure and patients are atincreased risk of malignant hypothermia. In this case, the procedure wasperformed under local anesthesia but this condition may impact on sur-gical planning if general anesthesia was to be considered.http://dx.doi.org/10.1016/j.nhccr.2017.06.143Rash or infection? An uncommon case of fever withskin lesionsGaël Villanueva-CharbonneaunCentre hospitalier afﬁlié universitaire régional de Trois-Rivières,Trois-Rivières, Québec, CanadaIntroduction: Acute generalised exanthematous pustulosis (AGEP) is rareform of late hypersensitivity syndrome that can be sometimes mistaken as askin infection. The differential diagnosis of infectious pustular lesion is largebut it can also appear in the setting of a complete non-infectious estate.Case description: We present a 40-year-old woman from a French-Canadian background who developed pustular lesions all over her body inthe setting of fever, weakness and headache. She was previously affectedby an Henoch–Schönlein purpura and developed secondary chronicinfectious leg skin lesions.Result and conclusion: Two months before the apparition of thepustules, she was treated by many different antibiotics (cephalexin,

“Unexpected in utero exposure to psychotropic medications”

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\u201cUnexpected in utero exposure to psychotropic medications\u201d

\u201cUnexpected in utero exposure to psychotropic medications\u201d

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