Tumors of the Oralfaucial Cavity in Children. A review of 156 patients

Se presenta un estudio retrospectivo de 156 pacientes (pac) con tumores que se manifestaron en la cavidad oral, con localización inicial en maxilares o partes blandas (se excluyeron los tumores de la cara sin compromiso bucal). La edad promedio fue 9 años y 6 meses (rango de 1 día a 17 años). El 62% se presentó en varones. La localización inicial de los tumores fue ósea y en partes blandas en el 50% de los casos respectivamente; 102 pacientes tuvieron lesiones benignas y 54 lesiones malignas. Los manifestaciones al ingreso fueron: tumor palpable o visible (43%), tumor + dolor (22%), dolor (13%) y otros como caída de dientes, parálisis, fiebre o asimetría facial (22%). La rutina de estudio comprendió radiografía panorámica de maxilar, centellografía ósea (gamma-cámara) con Tecnesio 99, tomografía axial computada (TAC) y resonancia nuclear magnética (RNM). Los pacientes fueron tratados en forma multidisciplinaria siendo la cirugía (punción aspiración con aguja fina, biopsia y/o resección) el procedimiento inicial en la mayoría de ellos. El manejo se realizó basándose en un algoritmo como muestra la (figura 1).We reviewed the findings of 156 patients (pat) with tumors involving the oral cavity representing lesions of bones and soft tissues (cases of tumors involving the face but without involvement of the oral cavity were excluded). Mean age was 9 years and 6 months (1d-17y); 62% presented in males. Bones (50%) and soft tissues (50%) were almost equally represented as the initial site. One hundred two patients presented benign tumors and 54 with malignancies. Symptoms and signs on admission were: palpable or obvious mass (43%), tumorassociated pain (22%), pain (13%), and other (spontaneous missing of teeth, paralysis, fever and facial asymmetry) (22%). Imagining studies included X-ray of the maxilla, bone scintiscan, CAT scan, and MRI. Patients were assisted by a multidisciplinary team being surgery (FNAB, biopsy, resection) the first procedure for most of the patients. This was followed by an algorhythm - designed approach (figure 1).Facultad de OdontologíaFacultad de Ciencias Médica

Anti-Mullerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study

Study questions: Can serum anti-Müllerian hormone (AMH) levels measured in female adolescents predict polycystic ovary syndrome (PCOS)-associated features in adolescence and early adulthood? Summary answer: AMH levels associated well with PCOS-associated features (such as testosterone levels and oligoamenorrhoea) in adolescence, but was not an ideal marker to predict PCOS-associated features in early adulthood. What is known already: Several studies have reported that there is a strong correlation between antral follicle count and serum AMH levels and that women with PCOS/PCO have significantly higher serum AMH levels than women with normal ovaries. Other studies have reported an association between AMH serum levels and hyperandrogenism in adolescence, but none has prospectively assessed AMH as a risk predictor for developing features of PCOS during adulthood. Study design, size, duration: A subset of 400 girls was selected from the prospective population-based Northern Finland Birth Cohort 1986 (n = 4567 at age 16 and n = 4503 at age 26). The population has been followed from 1986 to the present. Participants/material, setting, methods: At age 16, 400 girls (100 from each testosterone quartile: 50 with oligo- or amenorrhoea and 50 with a normal menstrual cycle) were selected at random from the cohort for AMH measurement. Metabolic parameters were also assessed at age 16 in all participants. Postal questionnaires enquired about oligo- or amenorrhoea, hirsutism, contraceptive use and reproductive health at ages 16 and 26. Main results and role of chance: There was a significant correlation between AMH and testosterone at age 16 (r = 0.36, P < 0.001). AMH levels at age 16 were significantly higher among girls with oligo- or amenorrhoea compared with girls with normal menstrual cycles (35.9 pmol/l [95% CI: 33.2;38.6] versus 27.7 pmol/l [95% CI: 25.0;30.4], P < 0.001). AMH at age 16 was higher in girls who developed hirsutism at age 26 compared with the non-hirsute group (31.4 pmol/l [95% CI 27.1;36.5] versus 25.8 pmol/l [95% CI 23.3;28.6], P = 0.036). AMH at age 16 was also higher in women with PCOS at age 26 compared with the non-PCOS subjects (38.1 pmol/l [95% CI 29.1;48.4] versus 30.2 pmol/l [95% CI 27.9;32.4], P = 0.044). The sensitivity and specificity of the AMH (cut-off 22.5 pmol/l) for predicting PCOS at age 26 was 85.7 and 37.5%, respectively. The addition of testosterone did not significantly improve the accuracy of the test. There was no significant correlation between AMH levels and metabolic indices at age 16. Implications, reasons for cauntion: AMH is related to oligo- or amenorrhoea in adolescence, but it is not a good marker for metabolic factors. The relatively low rate of participation in the questionnaire at age 26 may also have affected the results. AMH was measured in a subset of the whole cohort. AMH measurement is lacking international standardization and therefore the concentrations and cut-off points are method dependent. Wider implications for the findings: Using a high enough cut-off value of AMH to predict which adolescents are likely to develop PCOS in adulthood could help to manage the condition from an early age due to a good sensitivity. However, because of its low specificity, it is not an ideal diagnostic marker, and its routine use in clinical practice cannot, at present, be recommended