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OBJECTIVE: To present the methods for clinical evaluation of sexual maturation in adolescents. METHODS: Bibliographic review concerning the practice of pubertal staging. RESULTS: The assessment of sexual maturation is an essential step in the comprehensive health care of adolescents, allowing for the evaluation of their developmental stage. In addition, this assessment allows establishing a correlation between different pubertal events, following up diseases, and interpreting laboratory tests appropriately. Pubertal stage is assessed by the examination of breasts and pubic hair in females, and genitals and pubic hair in males. A new photographic standard for pubertal staging and a new method for clinical measurement of testicular volume are presented. CONCLUSIONS: The assessment of sexual maturation is an important feature in the health care of adolescent patients and must be included in the clinical practice of pediatricians involved in adolescent medicine.

Objective: The purpose of this review is to offer updating on recent changes in the schedule of active immunization routine in adolescence., Methods: This review covers specialized medical literature between 1985 and 1996, and follows the recommendations of American Academy of Pediatrics and Advisory Committee on Immunization Practices., Results: Active immunization in adolescents has been changed in the few last years. New vaccines have been licensed (varicella, hepatitis A), while some old ones have been recommended for routine use (hepatitis B) or as a booster dose (MMR, tuberculosis) at adolescence. This paper reviews these vaccines and the last recommendations concerning their use in adolescents. Special indications of some other vaccines (antiinfluenza, antipneumococcus, etc.) are also mentioned., Conclusions: The most recent modifications in the schedule of pediatric immunization routine must be considered in the planning and execution of a comprehensive adolescent health care delivery.

Purpose: Measurement of the testis is a more readily available method of estimating spermatogenesis. Doubt remains about the best instrument for measuring testicular volume. Lack of bias or accuracy of instruments has received too much emphasis in some studies, while to our knowledge no one has yet appropriately compared reliability statistically. We propose a simple new method for measuring testicular size based on visual comparison with graphic models, and describe the reliability and bias of this and 4 traditional methods., Materials and Methods: Measurements of 42 adolescent testes were made in a certain sequence: graphic method, dimensional measurement, Prader orchidometer, ring orchidometer and ultrasound with ultrasound assumed to be the standard. Statistical analysis was based on the linear structural model., Results: Statistical tests indicated that all 5 methods are equally reliable (R > 0.9). Although they are not equally accurate, actual testicular size can be calculated using each of these 5 methods and the equations of the linear structural model., Conclusions: The new graphic method proposed in this study is as reliable as other well-known methods for measuring testicular size. Actual testicular volume can be estimated without bias and with equal reliability from any of the 5 methods using the equations of the linear structural model. This statistical approach is more relevant than the sole comparison of lack of bias or accuracy, which has been the main concern of previous studies.

We report the case of a 10-year-old girl with a mature teratoma in the hypothalamic region. The patient presented a 2-month history of anorexia, psychic disturbances and a 37% loss of body weight. These symptoms had led initially to a diagnosis of major depression and atypical anorexia nervosa. She also presented some signs and symptoms of diencephalic syndrome. This case illustrates the importance of considering a slow-growing mass as a rare but real possibility in the differential diagnosis of anorexia nervosa, mainly in atypical cases.

Hematospermia is an infrequent condition in adolescence. This report presents a case of hematospermia in an 15-year-old male adolescent. A relationship is postulated between hematospermia and some vascular phenomena accompanying the pubertal reproductive development.