[Congenital mucocele of the ventral face of the tongue]. / Mucocèle congénitale de la face ventrale de la langue.

BACKGROUND: Congenital cystic lesions of the oral cavity are an extremely rare occurrence. Their prenatal diagnosis is essential since they can impede respiratory and swallowing functions. We describe a case that was detected prenatally and discuss its management. CASE REPORT: A 21-year-old primigravida patient who was 23 weeks pregnant was referred to our obstetrics and gynecology center after fetal ultrasonography showed a cystic lesion of the oral cavity. She had no family history of any congenital anomalies. Ultrasonography showed a male fetus with an anechoic mass measuring 21×11 mm encompassing the entire oral cavity, evoking either a mucocele or a cystic hygroma. Magnetic resonance imaging (MRI) showed a fetus with a wide-open mouth, due to a well-demarcated protruding cystic mass with no solid component, suggestive of a mucocele. A prenatal sonographically guided percutaneous needle aspiration of mucous fluid was performed at 33 gestational weeks. Although the mucocele decreased significantly in size, it nevertheless continued to expand progressively. After an uncomplicated pregnancy, the patient had spontaneous onset of labor at 39 weeks of gestation. An iterative aspiration was performed in the same manner in utero, resulting in a complete collapse of the mucocele. If needed, intubation could be considered. A 3030-g male was born by vaginal delivery, without respiratory distress. Clinical examination showed the extremely opened mouth and confirmed the presence of a large cystic mass approximately 4 cm in diameter, of sublingual origin and encompassing the entire oral cavity. The continuous protrusion of the tongue was responsible for the infant's inability to close the mouth and be breastfed. After insertion of a feeding tube, the newborn had maxillofacial surgery consisting in marsupialization of the cyst at 2 days of age. The mucocele decreased in size and the postoperative course was uneventful. No recurrence was observed at 6 months' follow-up. DISCUSSION AND CONCLUSION: Congenital mucoceles of the tongue are very rare benign lesions of the oral cavity, resulting from extravasation or retention of mucus from minor salivary glands. Their prevalence is unknown and, to our knowledge, less than ten cases of prenatal diagnosis have been previously reported. Such cystic lesions can cause respiratory distress and swallowing disorders in newborns. They are usually suspected on ultrasonography. MRI highlights the nature of the lesion and its locoregional connections with muscles and blood vessels. It provides a good analysis of the soft tissues and can distinguish between the muscles of the tongue and the pathologic mass. However, the use of CT has been reported when the diagnosis was made after childbirth or in adulthood. Given the risks of interference of the lesion with respiratory and swallowing functions, intrauterine decompression of the mucocele can be an option to prevent respiratory distress at birth and the need for neonatal intubation. Mucoceles provide somewhat confusing and disturbing ultrasonographic appearances, which can be stressful for the medical team and parents. Prenatal diagnosis and early surgical intervention (marsupialization, complete excision of the cyst or the salivary gland) can prevent risks of breathing distress and breastfeeding problems. Therefore, this strategy is essential to offer fast and satisfactory management of this rare but anxiety-producing congenital situation.

[A more and more painful intrauterine device where it is not enough to see the wires to exclude malposition!]. / Un stérilet qui fait de plus en plus mal où il ne suffit pas d'en voir les fils pour exclure une malposition !

We report a case of a 30-year-old woman with an intrauterine device (IUD) improperly inserted deep within the myometrium, with a muscularis layer injury of the recto-sigmoid colon resulting of a uterine perforation and presented as abdomino-pelvic pain and dyspareunia. The ultrasonographic control of the IUD after the insertion (performed seven months before) was not checked. Cervical examination showed the strings of the IUD. The ultrasonographic exploration identified an intra-myometrial IUD with fundus perforation of the uterus. A laparoscopic exploration permitting the removal of the IUD revealed an insertion through the bowel wall. The lessons to draw of about this case report are discussed through a brief review of the literature.

[Imperforate hymen: one diagnosis can hide another]. / Imperforation hyménéale : un diagnostic peut en cacher un autre.

INTRODUCTION: A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management. CASE REPORT: An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later. CONCLUSION: In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.

Seguridad clínica de la Dexmedetomidina en el tratamiento del dolor neuropático

Se define dolor neuropático, como aquel causado por una lesión primaria o disfunción en el sistema nervioso. Métodos: Estudio prospectivo, ensayo terapéutico, no aliatorizado, con grupos paralelos y comparativos. Se seleccionaron 40 pacientes (n=40), adultos, con diagnóstico clínico de dolor neuropático, agrupados en: Grupo A: Veinte pacientes (n=20), se les administró 70 mg de lidocaína al 1% más 5 mg de Levobupivacaína. Grupo B: Veinte pacientes (n=20), se les administró 70 mg de lidocaína al 1% más 5 mg de Levobupivacaína más Dexmedetomidine a la dosis de 0.3 microgramos/kg/dosis. A ambos grupos de pacientes se les realizó bloqueos simpáticos y periféricos de acuerdo a la patología y localización del dolor neuropático. Al minuto y cinco minutos de realizado el bloqueo se registro la presencia o no de efectos adversos, reportados espontáneamente y a través de preguntas abiertas. Resultados: El 42.5% de los pacientes negó efectos adversos; es mayor el porcentaje de pacientes que no tuvo ningún efecto adverso en el grupo B, que recibió Dexmedetomidina (50%) que en el grupo A (35%). Conclusión: Por lo que se concluye, que además de su acción sedante la dexmedetomidina, no produce depresión respiratoria y son más fáciles de manejar los pacientes. Además las variaciones de la frecuencia cardiaca y la tensión arterial fueron predecibles y estables, presentan menos ansiedad y resulta ser bien tolerado.

Neuropathic pain is defined as that which is caused by either a primary injury or dysfunction in the nervous system. Methods: We conducted a prospective, non-randomized, parallel group, comparative clinical trial, where adult patients (n=40) with a clinical diagnosis of neuropathic pain were screened and selected for admission in the trial. Patients were divided into two groups: Group A patients, n=20, were administered lidocaine 1%, 70 mg and levobupivacaine 5 mg, both locally; Group B patients, n= 20, were locally administered lidocaine 1%, 70 mg, levobupivacaine 5 mg, and dexmedetomidine at 3 mg/kg/dose. Sympathetic and peripheral blocks were made to each patient, according to the specific clinical picture and neuropathic pain localization. Pre-block-assessed parameters were again determined 1 and 5 minutes after finalizing the anesthetic procedure. Adverse events, either spontaneously reported or obtained through open questions, were also determined. Results: Tolerability assessment resulted in 42.5% of overall patients not reporting treatment-related adverse events, and again when comparing both groups, those receiving dexmedetomidine reported adverse events less frequently (50%) than Group A patients (35%). Conclusions: We conclude that, besides its sedative properties, dexmedetomidine together with local anesthetics showed excellent analgesia-enhancing effects, with the additional benefit of a favorable side-effect profile, lacking respiratory-depressant actions and improving overall patient management. In addition, patients receiving dexmedetomidine showed changes in heart rate and blood pressure that were both predictable and stable during and after the anesthetic procedures, while the patient achieved anxiolysis, improving his tolerance to the procedure itself.