Involvement and Autonomy of Minors in Medical Settings: Perceptions of Children Undergoing Surgery and Parents.

Informed consent presupposes competence and represents a formal decision by an informed person who has the legal capacity to accept medical action or participate in research. Our aim was to analyze the perceptions of minors and their parents about the age at which they consider that a minor is competent for making health decisions. A descriptive observational study was carried out in 302 minors between 12 and 17 years of age undergoing elective surgery, and 302 parents (range 30 to 62 years). Two semistructured questionnaires were designed, one for the minors and the other, for the parents. A total of 20.1% of minors and 31.1% of parents believe that patients should not make decisions related to their health until they are 18 years old. A total of 74.9% of the minors surveyed consider that from 16 years of age, the minor is empowered to make decisions. In parents, this percentage is 60%. In the pediatric setting, each case and situation must be examined individually to determine if the minor meets the condition of maturity to decide. The ideal is to promote the minor's participation in decision-making, giving them the opportunity to participate in the process in a manner appropriate to their capacity.

Absceso mastoideo como presentación de colesteatoma congénito en preescolar ¿cuál es el origen? / Mastoid abscess as congenital cholesteatoma presentation in a child what is the origin?

Resumen El colesteatoma congénito es una entidad que puede manifestarse con una amplia variedad de síntomas o ser silente durante largo tiempo y constituir un hallazgo incidental. Una vez diagnosticada es importante valorar su extensión y el compromiso de estructuras adyacentes, para lograr una adecuada planificación quirúrgica, eliminando la enfermedad y manteniendo la mejor funcionalidad posible. Se presenta un caso de colesteatoma congénito infantil.

Abstract Congenital cholesteatoma is an entity that can manifest with a wide variety of symptoms or be silent for a long time and constitute an incidental finding. Once diagnosed, it is important to assess the extension to apply the most efficient treatment, eliminating the disease and providing functionality if possible. A case of congenital cholesteatoma in a child is presented.

[Prevalence of auditory neuropathy: prospective study in a tertiary-care center]. / Prevalencia de la neuropatía auditiva: estudio prospectivo en un hospital de tercer nivel.

OBJECTIVE: The primary goal of this study is to determine the frequency of onset of this disorder in our infant population. Its clinical importance is due, among other reasons, to the fact that idiopathic cases constitute false negatives in the auditory screening programmes based on the performance of otoacoustic emissions to all newborn children and brainstem auditory evoked response only to those presenting these risk factors, for which reason another goal is to establish the prevalence of these pure cases and the diagnostic delay they cause. PATIENTS AND METHOD: Prospective study of all newborn children at the Virgen de la Arrixaca Mother and Child Hospital (Murcia, Spain) in the period between June 1, 2000 and June 30, 2006. RESULTS: Our screening programme, with a coverage of 95.68 %, detected 114 patients with unilateral or bilateral sensorineural hearing loss, with 6 presenting hearing loss attributable to auditory neuropathy. CONCLUSIONS: The estimated prevalence of auditory neuropathy in our infant population turned out to be 1406 for every 10 000 children, ie 5.26 % of all sensorineural hearing loss diagnosed. Another significant finding was the delay in diagnosis, since the mean age at the moment of diagnosis was of 11.5 months, mainly due to idiopathic cases not detected during neonatal screening. Two clear conclusions can be inferred from these data: a) auditory neuropathy does not constitute an extraordinarily rare disorder, and b) idiopathic cases constitute false negatives in the universal auditory screening programmes based on the performance of otoacoustic emissions, which habitually leads to a delay in diagnosis and treatment.

Prevalencia de la neuropatía auditiva: estudio prospectivo en un hospital de tercer nivel / Prevalence of auditory neuropathy: prospective study in a tertiary-care center

Objetivo: El objetivo principal de este estudio es determinar la frecuencia de aparición de este trastorno en nuestra población infantil. Su importancia clínica se debe, entre otros motivos, a que sus casos idiopáticos son falsos negativos de los programas de cribado auditivo basados en la realización de otoemisiones acústicas a todos los recién nacidos y potenciales evocados auditivos de tronco cerebral sólo de los que presentan dichos factores de riesgo, por lo que otro objetivo es la prevalencia de estos casos puros y el retraso diagnóstico que ocasionan. Pacientes y método: Estudio prospectivo de todos los recién nacidos del Hospital Materno-Infantil Virgen de la Arrixaca (Murcia) en el período comprendido entre el 1 de junio del 2000 y el 30 de junio del 2006. Resultados: Nuestro programa de cribado, con un índice de cobertura del 95,68 %, detectó a 114 niños con hipoacusia neurosensorial unilateral o bilateral, de los que 6 presentaron una hipoacusia neurosensorial atribuible a la neuropatía auditiva. Conclusiones: La prevalencia estimada de la neuropatía auditiva en nuestra población infantil resultó ser de 1,406 cada 10.000 niños, es decir, un 5,26 % de todas las hipoacusias neurosensoriales diagnosticadas. Otro dato relevante es el retraso diagnóstico, ya que la media de edad al momento del diagnóstico fue de 11,5 meses, fundamentalmente por los casos idiopáticos que pasaron el cribado neonatal. De estos datos podemos deducir 2 claras conclusiones: a) la neuropatía auditiva no es un trastorno extraordinariamente raro, y b) los casos idiopáticos son falsos negativos de los programas de cribado auditivo universal basados en la realización de otoemisiones acústicas, lo que habitualmente conduce a un retraso diagnóstico y, por lo tanto, terapéutico

Objective: The primary goal of this study is to determine the frequency of onset of this disorder in our infant population. Its clinical importance is due, among other reasons, to the fact that idiopathic cases constitute false negatives in the auditory screening programmes based on the performance of otoacoustic emissions to all newborn children and brainstem auditory evoked response only to those presenting these risk factors, for which reason another goal is to establish the prevalence of these pure cases and the diagnostic delay they cause. Patients and method: Prospective study of all newborn children at the Virgen de la Arrixaca Mother and Child Hospital (Murcia, Spain) in the period between June 1, 2000 and June 30, 2006. Results: Our screening programme, with a coverage of 95.68 %, detected 114 patients with unilateral or bilateral sensorineural hearing loss, with 6 presenting hearing loss attributable to auditory neuropathy. Conclusions: The estimated prevalence of auditory neuropathy in our infant population turned out to be 1406 for every 10 000 children, ie 5.26 % of all sensorineural hearing loss diagnosed. Another significant finding was the delay in diagnosis, since the mean age at the moment of diagnosis was of 11.5 months, mainly due to idiopathic cases not detected during neonatal screening. Two clear conclusions can be inferred from these data: a) auditory neuropathy does not constitute an extraordinarily rare disorder, and b) idiopathic cases constitute false negatives in the universal auditory screening programmes based on the performance of otoacoustic emissions, which habitually leads to a delay in diagnosis and treatment

[Lemierre's syndrome. An unusual variant]. / Síndrome de Lemierre. Caso poco habitual.

Lemierre's syndrome or postanginal septicaemia is described in the literature as an unusual complication of oropharyngeal infection. In most cases the syndrome is caused by Fusobacterium necrophorum. This disease usually occurs in young healthy individuals with an oropharyngeal infection, implying high fever, cervical tumefaction, and cervical pain, frequently associated with septic lung embolization. This case report is an unusual variant of this disease in a 12-year-old patient whose site of primary infection was the middle ear.

Síndrome de Lemierre. Caso poco habitual / Lemierre's syndrome. An unusual variant

El síndrome de Lemierre, o sepsis postanginosa, se ha descrito como una rara complicación de infecciones de la cavidad orofaríngea. Su etiología, en la mayoría de las ocasiones, se debe a Fusobacterium necrophorum. La clínica ocurre generalmente en pacientes jóvenes y sanos que, en el curso de una faringoamigadalitis, presentan dolor cervical y fiebre alta debido a la trombosis de la vena yugular interna, frecuentemente en relación con embolias pulmonares sépticas. El caso presentado es poco habitual, dentro de la rareza de este síndrome, ya que se produce en una niña de 12 años en el curso de una otitis media aguda

Lemierre's syndrome or postanginal septicaemia is described in the literature as an unusual complication of oropharyngeal infection. In most cases the syndrome is caused by Fusobacterium necrophorum. This disease usually occurs in young healthy individuals with an oropharyngeal infection, implying high fever, cervical tumefaction, and cervical pain, frequently associated with septic lung embolization. This case report is an unusual variant of this disease in a 12-year-old patient whose site of primary infection was the middle ear

Rotura de cánula de plata en niño traqueostomizado. A propósito de un caso de cuerpo extraño traqueal / No disponible

En este artículo presentamos un caso de rotura de cánulade plata en un niño portador de la misma de forma permanentey revisamos con la literatura existente, las posiblescausas de estas roturas y como evitarlas en lo posible

In this article, we present a case of fractured silvertracheostomy tube in a child who carries it in a permanentway and we will review with the existing literature, thepossible causes of these fractures and how to avoid them ifpossible