Odontogenic tumors in children and adolescents : a 15-year retrospective study in Argentina

There are few studies on bucco-maxillary lesions in children and adolescents, and reports on odontogenic tumors (OT) are scanty. Comparison among the available data is difficult due to differences in the criteria used in each study. The aim of the present work was to perform a retrospective study of OT in patients aged up to 20 years diagnosed at a center specialized in histopathologic diagnosis of oral diseases. All cases diagnosed with OT between 1990 and 2004 were retrieved from the Service archives. The 153 retrieved cases accounted for 7% of total biopsies performed during that period, and to 78.4% of tumors of the jaws. Mean age of the whole population was 12.7 years and the male to female ratio was 2:1. The most frequent tumor types were Odontoma, (50.9%), Ameloblastoma (18.3%) and Myxoma (8.5%), and the most infrequent was Calcifying Epithelial Odontogenic Tumor (1.3%). According to our results, OT cannot be considered infrequent. They are the prevalent tumors of the jaws in the age group studied herein

Pericoronal Follicles of Asymptomatic Impacted Teeth: A Radiographic, Histomorphologic, and Immunohistochemical Study

Objective. To associate radiographic and histopathological features of pericoronal follicles (PFs) of asymptomatic impacted teeth and evaluate cell proliferation and apoptosis in the epithelium. Study Design. Epithelium and mesenchyme of radiographically normal (NPF ≤ 2.5 mm) and hyperplastic (HPF 2.6 to 5 mm) PF (n = 140) were studied histologically. Cell proliferation (PI) and epithelial apoptosis were evaluated by Ki-67 and bcl-2 expression in 14 NPFs and 10 dentigerous cysts (DCs). Results. Radiographically, 127 were NPFs and 13 were HPFs; 87.8% of total PFs exhibited epithelium on the surface. Reduced enamel epithelium was observed in 78 (61.4%) NPFs and 6 (46.2%) HPFs, squamous metaplasia in 17 (13.4%) NPFs and 4 (30.8%) HPFs, and cystic epithelium in 15 (11.8%) NPFs and 3 (23%) HPFs. Mean PI was 1.97 ± 1.25 and 7.97 ± 1.74 in the epithelial component of NPF and DC, respectively; bcl-2 positive expression was observed in 9 (64.3%) NPFs and 7 (70%) DCs. Conclusion. The scant epithelial remnant proliferation could imply low risk for development of odontogenic pathologies in the absence of an additional stimulus

El Rol del Diagnóstico por imágenes en la Histiocitosis a Células de Langerhans (Granuloma Eosinofílico con Manifestación Bucal)

Fil: FERNÁNDEZ, LIDIA R. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Radiología; Argentina.Fil: PILONI, MARÍA JULIA. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Anatomía Patológica; Argentina.Fil: KESZLER, ALICIA. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Anatomía Patológica; Argentina.Las Histiocitosis de Células de Langerhans incluyen a la Enfermedad de Letterer Siwe, Hand Schüller Christian y al Granuloma Eosinofilico (GE); forma crónica más común y menos severa con expresión única y múltiple que afecta particularmente a los huesos, incluidos los maxilares, y/o partes blandas como la mucosa. En 33 casos de GE se evaluaron los datos clínicos y las imágenes radiográficas disponibles, aspectos histomorfológicos y expresión inmunohistoquímica. En los maxilares la forma monostótica fue la mas frecuente (68%) con mayor incidencia en la mandíbula. El sexo masculino fue tres veces más afectado que el femenino y el rango de edad entre 2 y 60 años, con picos de frecuencia en la 1ra y 4ta década de vida. El 50% de los casos fueron lesiones intraóseas uni o multiloculares. El 50% restante correspondió a lesiones en reborde alveolar con imagen símil lesión periodontal, excavada y de diente flotante (25%,15% y 10% respectivamente). Dado que sus características histológicas y/o radiográficas no son siempre patognomónicas es relevante la acción interdisciplinaria para su diagnóstico de certeza, elección terapéutica y valoración pronóstica

Ameloblastoma desmoplásico : diagnóstico precoz : presentación de un caso clínico

Fil: BLASCO, FABIÁN. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.Fil: VERDÚ, SERGIO. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Clínica Estomatológica; Argentina.Fil: NALLI, GABRIELA. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Clínica Estomatológica; Argentina.Fil: GIANNUNZIO, GRACIELA. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.Fil: MAURIÑO, NÉSTOR. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.Fil: LANFRANCHI TIZEIRA, HÉCTOR. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Clínica Estomatológica; Argentina.Fil: KESZLER, ALICIA. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; Argentina.El ameloblastoma es una neoplasia benigna, localmente invasora, originada a partir de restos de epitelio odontogénico o del revestimiento epitelial de un quiste dentígero. Es la neoplasia odontogénica más frecuente de la mandíbula. Actualmente la OMS (2005) reconoce cuatro tipos de ameloblastomas: el sólido multiquístico, el periférico o extraóseo, el desmoplásico y el uniquístico. El tipo desmoplásico es poco frecuente y presenta características clínicas, radiográficas e histológicas distintivas, aunque su comportamiento es similar al del tipo sólido-multiquístico, por lo que el tratamiento quirúrgico recomendado no varía. Se presenta un caso clínico donde el diagnóstico precoz fue fundamental para realizar un tratamiento conservador, rápido y con mínimas consecuencias estéticas y psicológicas para el paciente

Associations between salivary gland histopathologic diagnoses and phenotypic features of Sjögren's syndrome among 1,726 registry participants

OBJECTIVES: The Sjögren’s International Collaborative Clinical Alliance (SICCA) is an ongoing NIH-funded registry whose cohort ranges from those with symptoms of possible Sjögren’s syndrome (SS) to those with obvious disease. Using this database we examined associations between labial salivary gland (LSG) histopathology and other phenotypic features of SS. METHODS: LSG biopsy specimens from SICCA participants underwent protocol-directed histopathological assessments. Among 1726 LSG specimens exhibiting any pattern of sialadenitis, we compared biopsy diagnoses against concurrent salivary, ocular and serological assessments. RESULTS: LSG specimens included 61% with focal lymphocytic sialadenitis, (FLS; 66% of which had focus scores [FS] ≥ 1 per 4 mm(2)) and 38% with non-specific or sclerosing chronic sialadenitis (NS/SCS). FS ≥ 1 was strongly associated with positive serum anti-SS-A/-B, rheumatoid factor and the ocular component of SS, but not with symptoms of dry mouth or eyes. Those with positive anti-SS-A/-B were 9 times more likely to have a FS ≥ 1 (95% CI: 7.4; 11.9) than FS<1 or another pattern, while those with unstimulated whole salivary flow < 0.1 ml/min were only 2 times more likely to have a FS ≥ 1 (95% CI:1.7; 2.8) than FS<1 or another pattern, while controlling for other phenotypic features of SS. CONCLUSIONS: Distinguishing FLS from NS/SCS is essential in assessing LSG biopsies, before determining FS. A diagnosis of FLS with FS ≥ 1 per 4 mm(2), as compared to FLS with FS< 1 or with NS/SCS, was strongly associated with the ocular and serological components of SS and reflects SS autoimmunity

Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm

ObjectiveTo determine the impact of policy changes for pulse oximetry oxygen saturation (SpO2) alarm limits on neonatal mortality and morbidity among infants born very preterm.Study designThis was a retrospective cohort study of infants born very preterm in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants were classified based on treatment at a hospital with an SpO2 alarm policy change and study epoch (before vs after policy change). We used a generalized linear mixed model to determine the effect of hospital group and epoch on the primary outcomes of mortality and severe retinopathy of prematurity (ROP) and secondary outcomes of necrotizing enterocolitis, bronchopulmonary dysplasia, and any ROP.ResultsThere were 3809 infants in 10 hospitals with an SpO2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO2 alarm settings. Mortality was lower in hospitals without a policy change (aOR 0.63; 95% CI 0.50-0.80) but did not differ between epochs in policy change hospitals. The odds of bronchopulmonary dysplasia were greater for hospitals with a policy change (aOR 1.65; 95% CI 1.36-2.00) but did not differ for hospitals without a policy change. Severe ROP and necrotizing enterocolitis did not differ between epochs for either group. The adjusted odds of any ROP were lower in recent years in both hospital groups.ConclusionsChanging SpO2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. ClinicalTrials.gov: NCT00233324