[Multiple treatment for non-Hodgkin's malignant lymphoma in Costa Rica children. Results in 41 patients (author's transl)].
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Biomedical subjects
Publications and source records attributed to J M Carrillo.
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The clinical and pathologic features of 43 dogs with neoplasia of the rostral cerebrum were reviewed. Primary brain tumors included meningioma, astrocytoma, neuroblastoma, oligodendroglioma, and ependymoma. Other tumors that secondarily affected these areas included solitary hemangiosarcoma, nasal neuroendocrine carcinoma, nasal cell adenocarcinoma, nasal squamous cell carcinoma, and nasal neurofibrosarcoma. Older dogs were usually affected (mean, 10 years), and meningioma was the most frequent tumor type. Thirty-one dogs (72% of total) had a late-onset (greater than 5 years of age) of either generalized seizures or behavior abnormalities, or both, with an initially normal neurologic examination. In these 31 dogs, a mean time of 78 days (range, 2 to 400 days) elapsed from the onset of seizures or behavior change to the detection of a persistently abnormal neurologic examination. In all 43 dogs, the time from the detection of neurologic deficits to death or euthanasia and necropsy ranged from 1 to 63 days (mean, 13 days). On the basis of this review, it appears that dogs with late-onset seizures or behavior change, or both, should be suspected of having tumors involving the rostral cerebrum, despite the absence of persistent neurologic deficits commonly associated with cerebral tumors. Further, the onset of abnormalities in the neurologic examination and the time of death seem to occur within predictable time periods.
Myasthenia gravis (MG) was diagnosed in four cats--one had an apparently congenital form and three had the acquired autoimmune form. All four cats were examined because of episodes of weakness including gait abnormalities, voice change, neck ventroflexion, and regurgitation. Palpebral reflexes were absent in all cats. Administration of edrophonium chloride resulted in transient resolution of clinical signs in all four cats. Three cats were tested for the presence of serum autoantibodies against acetylcholine receptor (AChR) by radioimmunoassay. Two cats with acquired MG had anti-AChR antibody titers of 10.5 and 96.8 nmol/l (normal, less than or equal to 0.03 nmol/l). Antibodies were not detected in the cat with presumptive congenital MG. All four cats were treated with pyridostigmine bromide. Two cats with acquired MG were euthanatized because of clinical deterioration. The third cat with acquired MG has been asymptomatic since 2 months after diagnosis. The cat with presumed congenital MG is alive 3 years after diagnosis.
A cytogenetic and/or cytochemical study was performed in 166 individuals with leukemia or related disorders, in two major Costa Rican hospitals. In those patients treated at an adult's hospital (14 years old and over), acute leukemias represented 66% of all cases. In that hospital the most frequent types of disorders were, in decreasing order: ANLL (> M1), ALL, CML (all of them showed the Ph chromosome) and MDS. In the cases from a childrens' hospital (< 14 years old) acute leukemias were 98%. Among them the order of frequency was: ALL (70%): ALL-1 (84%), ALL-2 (16%) and ANLL (27%): M5a > M3 > M4 > M5b. In ALL 85% were type B and occurred mostly in women while 15% of them were type T and more frequent in males. There was 5.6% infant leukemia, which presented a similar number of acute lymphoids and myeloids. The cytogenetic pattern was similar among Costa Rica and other tropical and temperate countries.
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In Arizona, undocumented pregnant Hispanic women without private care have no recourse but to enter an emergency room after labor begins. A survey we conducted showed over 150 such "emergency" births annually in Tucson. As a result, a prenatal care program, "Dar a Luz," specifically targeted at this population, was developed. It includes prenatal obstetrical care and anticipatory birthing education that is sensitive to Mexican-American traditions, community consciousness-raising, and a cooperative obstetrical agreement with Tucson hospitals. Bilingual community volunteers act as patient advocates, following these patients through pregnancy and accompanying them to emergency rooms for hospital deliveries. Based in an Hispanic neighborhood community center, professional and lay volunteers provide health care coordinated by medical students in the paracurricular Commitment to Underserved People Program at the University of Arizona College of Medicine.
The study included 30 children with anemia and significant infectious process. The hematologic characteristics of this anemia were identified in their evolution and these findings were correlated with levels of serum iron to disclose whether variations are present to support the diagnosis of mixed etiology of the anemic syndrome. Transferrin saturation index was found to be the best parameter to diagnose iron deficiency in cases of anemia associated to infectious processes and due to the fact that 50% of these cases showed mixed etiology anemia, it seems reasonable that further integral studies should be carried out in this anemic syndrome.
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One hundred and twenty-five febrile episodes in 82 children with acute leukemia were studied; 46% of the patients were from urban and 54% from rural areas. The origin of the fever was identified in 91% of the episodes, prevailing pneumonia, septicemia, chickenpox and herpes zoster. The etiological agent was identified in 46% of the cases. A viral predominance was evident, and among them varicela-zoster, following in importance gram-negative bacteria. Histoplasma capsulatum and Pneumocystis carinii were isolated in two occassions each. Sepsis was found more frequently in children with active leukemia than in those in remission (p less than 0.001). Forty-four febrile episodes occurred in patients with less than 1,000 neutrophils/ul. The daily-risk rate of infection was higher in children fom rural than in those from urban areas (p less than 0.001). After clinical and laboratory studies, methicillin and gentamicin were used, in addition to carbenicillin or trimethoprim-sulfamethoxazole is selected cases. This treatment was effective in 86% of the cases. Twelve (15%) children died, 6 of whom were in remission at that moment.
In eighty nine anemic children, aged from 6 months to 13 years, the etiology of their anemia was studied: 67(75%) of the cases presented iron deficiency, 18(20%) iron and folate deficiency and 4 megaloblastic anemia (2 folate and 2 vitamin B12 deficiency). Patients with vitamin B12 deficiency showed severe pancytopenia and megaloblastic changes in bone marrow; but no morphological difference, either in circulating blood or bone marrow was found in patients with iron deficiency, compared to iron plus folate deficiency. The seric measurement of iron, folate and B12 were essential in order to establish the etiology of nutritional anemias. The majority of the children were accepted to the hospital for other causes than anemia, such as diarrhea (58%) and respiratory diseases (18%). Clinical features and the high incidence of anemia in children under two years of age are also discussed.
Clinical features and treatment evaluation of 38 children with disseminated histoplasmosis were studied. Thirty-six cases presented the severe form and two of them showed the mild chronic type. A higher incidence of this disease was found in infants (65%) and in severe malnutrition (68%) and lethality in the overall group was 61%. Patients died either because they did not receive specific treatment or were given amphotericin for less than 15 days. These figures stress the importance of this treatment in disseminated histoplasmosis.