Derrame pericárdico en un caso de linfohistiocitosis hemofagocítica secundaria a leishmaniasis / Pericardial effusion in a case of hemophagocytic lymphohistiocytosis secondary to leishmaniasis

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Hemangioma parotídeo neonatal: diagnóstico por resonancia magnética / Neonatal parotid gland hemangioma: magnetic resonance diagnosis

Se presenta el caso de un recién nacido de 27 días de vida con una masa parotídea unilateral, sin otros hallazgos. Tras descartar causas infecciosas e inflamatorias, se realizaron estudios de imagen (ecografía y resonancia magnética) para establecer el diagnóstico definitivo de hemangioma parotídeo. El hemangioma representa el 50% de las raras masas parotídeas presentes en la infancia. La ausencia de lesiones premonitorias en la piel suprayacente en el periodo neonatal dificulta su diagnóstico. La resonancia magnética es la técnica exploratoria de elección, pues permite realizar un diagnóstico preciso evitando procedimientos invasivos, como la biopsia(AU)

A case report is presented of a 27 days old newborn with unilateral parotid mass with no other findings. After discarding infectious and inflammatory causes, image studies by ecography and magnetic resonance were carried out to establish a definitive diagnosis of parotid haemangioma. Haemangioma represents 50% of rare parotid masses in infancy. Absence of premonitory lesions in overlying skin, during the neonatal period, makes diagnosis difficult. Magnetic resonance is the exploration of choice as it allows a precise diagnosis there by avoiding invasive procedures such as biopsy(AU)

Hernia diafragmática congénita de presentación tardía / Late-presenting congenital diaphragmatic hernia

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¿Detección de hipoacusia sólo en neonatos de riesgo? / Should hearing screening be performed only in at risk neonates?

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Sífilis congenital neonatal: la gran simuladora lo pone difícil / Congenital syphilis: the great mimicker makes it difficult

Se presenta un caso de sífilis congénita que se manifestó como un proceso respiratorio grave, hepatosplenomegalia y sepsis neonatal precoz. Los marcadores serológicos gestacionales STORCH eran negativos, auqneu, persistiendo la sospecha clínica de infección congénita, se repitió la serología, siendo, en ese momento, la prueba de la reagina rápida en plasma (RPR) positiva. Este caso presentó como única manifestación de la enfermedad sifilítica la aparición tardía de una descamación palmoplantar sobre un fondo eritematoso una vez establecido el diagnóstico e iniciado el tratamiento con penicilina G i.v., aunque ya había respondido clínicamente a la administración de ampicilina y gentamicina, pautada ante la sospecha inicial de sepsis neonatal precoz

We report a case of congenital that presented with severe respiratory compromise, hepatosplenomegaly and early neonatal sepsis. Although the STORCH gestational serological markers had been negative, since the clinical suspicion of congenital infection persisted, the serological test was repeated and was found to be positive for rapid plasma regain. The only sign of syphilis in this case was the late development of palmoplantar scaling over an erythematous background, which occurred after the diagnosis had been established and intravenous treatment with penicillin G had begun, although a clinical response ad already been achieved with ampicillin and gentamicin, administered because of the initial suspicion for early neonatal sepsis

Organización del cribado auditivo neonatal con otoemisiones en hospitales secundarios: factible, eficiente y efectivo / Hearing screening based on otoacoustic emissions in infants born in secondary-level hospitals: feasible, efficient and effective

Introducción: Las otoemisiones acústicas (OEA) son uno de los métodos empleados para el diagnóstico precoz de la hipoacusia en el neonato. En el Hospital «Francesc de Borja» se realiza una detección universal con buenos resultados, demostrando que este método es posible, efectivo y eficiente. Material y métodos: Todos los recién nacidos son sometidos a una determinación de OEA bilateral, realizada por todas las enfermeras, antes del alta en la maternidad. Si la prueba sale alterada, se remite a consultas externas para repetirla durante el primer mes de vida por una enfermera experta y, si sale alterada, se remite para efectuar potenciales evocados auditivos (PEA). Si éstos confirman la alteración, se remite a otorrinolaringología para valoración y tratamiento, si procede. Resultados: En 3 años, se ha realizado la prueba en la maternidad a un total de 3.309 recién nacidos, de 3.385 nacidos totales (97.75%). En el primer paso, un 4,05% de las pruebas salieron alteradas. De los remitidos a consultas externas, un 22,69% continúan con alteraciones en las pruebas. Al segundo paso, no acuden on 11,19% de los pacientes. El rendimiento global tras repetir la prueba en aquéllos con resultados alterados (2.0 paso) es: 99,18% normales y 0,82% alterados (que pasan a PEA). De los remitidos a PEA, el porcentaje de confirmación de hipoacusia es del 74% (0,5% del total). Discusión: Con el protocolo descrito, es factible la realización de cribado auditivo universal y sin necesidad de unidades especiales, lo que facilita su implantación. Como la tarea se reparte entre mucha gente, en su paso inicial. no representa una sobrecarga

At Hospital Francesc de Borja, we use otoacoustic emissions for hearing screening in all newborns with good results. Here we demonstrate that it is feasible, efficient and effective. Methods: In our center, all newborns are tested bilaterally for otoacoustic emissions prior to discharge from the nursery, where all the nurses are capable of performing the test. If anomalies are detected, the newborn is reevaluated in our outpatient clinic during the first month of life by a specialized nurse. If the alterations persist, auditory brain stem responses are measured. If the results confirm the presence of an anomaly, the infant is referred to an ear, nose and throat specialist for evaluation and, if appropriate, treatment. Results: Over a three-year period, we have performed the test in 3309 of the 3385 infants born in our center (97.75%). The first test, in the maternity ward, detected problems in 4.05%. The alterations persisted in 22.69% of those reevaluated in the outpatient clinic; 11.19% of this group failed to undergo the second test. Overali, 99.18% were found to be normal at this stage and the remaining 0.82% underwent measurement of auditory brain stem responses, which were abnormal in 74%, for an incidence of 0.5% among the total group. Comments: This protocol is a simple and feasible approach to universal hearing screening without specialized units, a circumstance that facilitates its introduction. As the first test is performed by many people, the saturation of the specialized unit is avoided

[Stimulation increase in evoked acoustic otoemissions]. / Aumento del estímulo en las otoemisiones acústicas evocadas.

OBJECTIVE: Evoked otoacoustic emissions (OEAE) are an excellent evaluation method of the hearing organ and are principally useful in newborn screening. During the performance of this technique, doubtful cases sometimes exist and they are customarily considered as failures of the test, increasing the group of children to be re-evaluated. The program IL088 has the possibility of increasing the stimulus intensity (gain). We applied this gain to all children with doubtful OEAE in attempts to give a pass or fail score. PATIENTS AND METHODS: The record of OEAE was accomplished with the system IL088 v3.5. It was applied to 70 ears of healthy newborns, a gain of +15 dB initially and/or +21 dB (if a pass score was not obtained). Some normal ears were included in this group as controls. Of the explored ears, 23 had a normal OEAE, 17 presented a doubtful response and in 30 cases the answers were negative (fail). RESULTS: This study demonstrates that in doubtful cases, the usefulness of increasing the gain is very high permitting that these cases accomplish pass criteria (15/17). In the ears with a lack of response there is an increased response, but it usually does not reach a passing level (6/30). In children with normal response the pass rate does not vary. CONCLUSIONS: The increase in gain in ears with a doubtful response offers a high a rentability, reducing the the initial failure rate of OEAE without altering the real failure rate or affecting those that initially pass allowing a reduction in the number of second evaluations.

[Evoked otoacoustic emissions in school children]. / Otoemisiones acústicas evocadas en escolares.

OBJECTIVE: The aim of this work was to determine the usefulness of evoked otoacoustic emissions (OEAE) as a screening method for the diagnosis of hearing loss in schoolchildren. PATIENTS AND METHODS: To this end and by using this method, we have studied 1,202 ears of 616 children in the 1st and 2nd grades of elementary school with a mean age of 6.2 years. The equipment employed was an Otodynamic Analyzer (ILO 88) by Otodynamics, Ltd and the program ILO 88, version 3.94. RESULTS: The results were OEAE positive in 1,041 ears (86.6% passed the test) and OEAE negative in 161 ears (13.4% failed the test). We have determined the percentiles of all the parameters of the test and of the responses in order to establish the normal values in this age group. CONCLUSIONS: The use of the OEAE for the detection of hearing loss should not be restricted to newborns. The OEAE can also be used as an auditive screening test in schoolchildren.

[Influence of the middle ear on the measurement of otoacoustic emissions]. / Influencia del oído medio en la prueba de otoemisiones acústicas.

OBJECTIVE: Otoacoustic emissions (OAEs) provide an objective, non-invasive measurement of cochlear function. OAEs have proven to have a high sensitivity and reasonable specificity for hearing impairment diagnosis, especially when used for infant screening. The lower specificity could be due to middle ear function and that this affects otoacoustic emissions. PATIENTS AND METHODS: We have carried out a study in 1,202 ears with a mean age of 6.2 years. Clinical otoscopy and OAE measurements were performed in all cases and tympanometry in those cases with a negative result in the recorded emissions. RESULTS: Statistical analysis of tympanogram type indicated significant association with tympanogram type B and the absence of OAEs, as well as with otoscopic findings of secretory otitis media. CONCLUSIONS: Middle ear function must be taken into consideration when OAEs are used in clinical application. The problem of low specificity is mainly due to the fact that middle ear function affects the presence or absence of emissions with normal cochlear function.

[Diagnosis of otitis media with effusion by acoustic reflectometry]. / Diagnóstico de otitis secretoria mediante reflexometría acústica.

OBJECTIVE: Acoustic reflectometry is a new technique based on a sonar that enables the diagnosis of middle ear effusion. Our objective was to assess its value and to know the cut-off figure for pathology. PATIENTS AND METHODS: In 586 children, from 1 month to 14 years of age, we performed bilateral otoscopy looking for signs of middle ear effusion. Afterwards, 3 measurements with the acoustic otoscope (ENT, Inc.) were taken and the results between the two methods compared. RESULTS: There was a significant association (p < 0.0001, Chi-squared) between results > 4 and middle ear effusion with a sensitivity of 84.2% and a specificity of 98.9%. CONCLUSIONS: Acoustic reflectometry has shown to be a very quick (< 10 seconds/ear), accurate and objective technique. It is painless and easy. It can be made in any child, without collaboration (crying or moving) and at any age.

[A critical analysis of school screenings. The performance of each type of examination]. / Análisis crítico de las revisiones escolares. Rendimiento de cada tipo de exploración.

The results of a student screening program performed by the Primary Care Team of Gandía on 359 children (180 males and 179 females) that attended 1. EGB are presented. We reviewed the following: vision, hearing, dentition, somatometry, immunization, and urological and traumatological problems. Children with pathologies were referred to specialists to confirm the diagnosis. Of these children, 78% had some form of pathology. The most frequent system involved was hearing, followed by dentition and vision. The correlation of these results with those of the specialists was good (> 50%). The best results were obtained on vision screening results (100% correlation and 2/3 of the problems formerly detected). Twenty-four percent of the children had caries and this was not of major concern to the families. The worst results were obtained in auditive screening. Because the primary care examination model is not generalized, school screening is still a good method to detect previously undiagnosed pathologies in children.

[Comparative study of tonal liminal audiometry and evoked otoacoustic emissions in school screening programs]. / Estudio comparativo entre audiometría tonal liminar y otoemisiones evocadas en las revisiones escolares.

Early diagnosis of deafness is an important objective during the pediatric age. This study compares two different audiological techniques, otoacoustic emissions (OEA) and tonal audiometry (AUD), to be used as screening methods in school revisions programmed for 6 years olds. The correlation between techniques is very good (97% of the positives and 92% of the negatives). The OEA method is objective and faster if the environmental noise is low; if not, AUD seems to be more reliable. At this age (6 years), the otoacoustic emissions have characteristics of the adult age.

[Comparative study of evoked otoacoustic emissions and auditory potentials of the brain stem in the neonatal period]. / Estudio comparativo entre otoemisiones provocadas y potenciales auditivos tronculares en el período neonatal.

Evoked otoacoustic emissions (EOAE) are a recently discovered technique that is related to a good audiological status. It is a quick, simple and harmless test that can be used in neonatal screening. We report and compare here the results from a series of neonates in which we have performed both, this test and a brainstem response (ABR) test. The correlation between techniques was good, especially in normal positive neonates where the correlation was 100%. However, EOAE only explores the cochlear status and will not detect retrocochlear pathologies.

[A new method for the measurement of the anatomical development of the muscle complex of the anus in children with anorectal malformations]. / Nuevo método de cuantificación del desarrollo anatómico del complejo muscular del ano en los niños con malformación anorrectal.

We present a new method for the measurement of the anorectal muscle complex. We studied 40 children with anorectal malformation (14 low and 16 high). Taking the perineal TAC with a rectal probe and quotient called "C": [formula: see text] A "C" value less than 0.31 indicates little development of the anus muscle complex. In 10/26 patients with high malformation, "C" was less than 0.31. All of these patients had fecal incontinence.