Hairy cell leukemia is infrequent in México and has a geographic distribution.

Considering that the prevalence of some hematologic malignancies may have a geographic distribution that could be related with its etiology, a group of 2,387 patients with acute leukemia (1,968 adults and 419 children) was studied along a 5-year period in six different locations within México. Twenty-seven patients (16 males and 11 females) with hairy cell leukemia (HCL) were identified. The adjusted overall proportion of HCL, after excluding data from centers reporting only adults, was 1.12% of all leukemia cases; this figure is lower than that reported in the United States or England. The proportion of adult leukemic patients with HCL was significantly higher in the northern region of the country-where there are more people devoted to farming and agricultural activities-as compared with the central or southeastern regions (3.07 vs. 1.03% vs. 0%; P < 0.05); possible explanations for these differences are briefly discussed.

Neurotoxicity associated with fludarabine and cytosine arabinoside chemotherapy for acute leukemia and myelodysplasia.

Neurological toxicity occurred in 8/219 patients treated with fludarabine (FAMP), 30 mg/m2 per day and cytosine arabinoside (Ara-C), 0.5 g/m2 per hour for 2-6 hours for 5 days, for new or relapsed acute leukemia or myelodysplasia. Two patients developed severe, progressive cerebral dysfunction that was ultimately fatal. This toxicity was similar to that seen with high-dose fludarabine therapy and was limited to patients with serum creatine > or = 2.0 mg/dl and age over 60 years, occurring in 2/9 such patients compared to 0/210 among the other patients (p < 0.005). Since FAMP is partially excreted by the kidney, toxicity in these two patients was likely due to receiving an effectively high dose of FAMP. Five patients developed peripheral neuropathy but there was no association with age, creatinine, dose of Ara-C, or number of courses. A patient, who also received intrathecal Ara-C, developed myelopathy. At this dose rate and duration of Ara-C peripheral neuropathy rarely arises, and cerebral toxicity is not seen. Neither toxicity was observed in 481 chronic lymphocytic leukemia patients treated with FAMP alone, by the same dose and schedule, suggesting that combination with Ara-C is important for the development of at least the peripheral neuropathy. The incidence of neurotoxicity with FAMP/Ara-C is low especially in comparison with high-dose Ara-C therapy (3 g/m2 over 2 hours). Cerebral toxicity can likely be decreased by dose reduction of FAMP in patients with increased creatinine and peripheral neuropathy decreased by detailed neurological examination before courses of FAMP/Ara-C.

[The transfer of critically ill patients]. / El traslado de pacientes en estado crítico.

Critically ill patients admitted to an intensive care unit or an emergency ward, frequently need to be transported to different areas within the hospital in order to perform diagnostic procedures. An increased mortality and morbidity risk has been found associated with the transportation of these patients. In order to investigate the effect of the intra-hospitalary transport of our patients on their clinical status this study was conducted. We studied 12 patients admitted to the intensive care unit or the emergency ward; all were on mechanical-assisted ventilation and had been stable for at least six hours prior to transportation. Blood gas and hemodynamic measurements were obtained before, immediately after and thirty minutes after transportation. The most significant changes seen immediately in our patients were an increase in PaCO2 (30.8 +/- 7.35 vs 35.6 +/- 7.49, p less than 0.02) and a decrease in pH (7.36 +/- 0.08 vs 7.31 +/- 0.05, p less than 0.02). Patients with higher pH values prior to their transportation had the most significant change towards acidosis (r = -0.79). All changes reversed thirty minutes after reinstallation of the mechanical ventilation. There was no change in the hemodynamic measurements. We conclude that the transportation of critically ill patients within a hospital is fairly safe if patients are previously stabilized.