ABSTRACT
BACKGROUND: In Mexico and other developing countries, few reports of the survival of children with acute leukaemia exist. Objective. We aimed at comparing the disease-free survival of children with acute myeloid leukaemia who, in addition to being treated with the Latin American protocol of chemotherapy and an autologous transplant, either underwent early intensified chemotherapy or did not undergo such treatment. PROCEDURE: This was a cohort study with a historical control group, forty patients, less than 16 years old. Group A (20 patients), diagnosed in the period 2005-2007, was treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy: high doses of cytarabine and mitoxantrone. Group B (20 patients), diagnosed in the period 1999-2004, was treated as Group A, but without the early intensified chemotherapy. RESULTS: Relapse-free survival for Group A was 90% whereas that for Group B it was 60% (P = 0.041). Overall survival for Group A (18, 90%) was higher than that for Group B (60%). Complete remission continued for two years of follow-up. CONCLUSIONS: Relapse-free survival for paediatric patients treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy was higher than that for those who did not receive early intensified chemotherapy.
Subject(s)
Antineoplastic Agents/therapeutic use , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Stem Cell Transplantation/mortality , Stem Cell Transplantation/statistics & numerical data , Survivors/statistics & numerical data , Child , Child, Preschool , Combined Modality Therapy , Female , Humans , Infant , Longitudinal Studies , Male , Mexico/epidemiology , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVE: To report medical and surgical treatment in a patient with acute lymphoblastic leukemia type 1 who developed a dangerous cyst. CLINICAL CASE: A male of 8 years with acute lymphoblastic leukemia type 1, whose treatment was in induction. In one month, the patient presented a facial asymmetry due to mandibular growth and acute pain, hyperthermia and malaise. In the examination, we identified lip parestesia, a second temporal molar treated with chromium steel and expansion involving the cortical of the lateral permanent incisive until the first permanent molar was identified. Since we suspected of bone metastasis, we performed an orthopantomography. We established the diagnosis of dentigerous cyst. Enucleation, curettage, and extraction of decay teeth were done in order to avoid and prevent infectious sources. CONCLUSIONS: The most frequent clinical manifestations of acute lymphoblastic leukemia are anemia, leukopenia, and thrombocytopenia. This leukemia may be manifested also as infiltration of the jaw bone. In this case, the results showed no presence of bone metastasis. As a first step before to begin treatment, the physician ought to make sure that the patient is free of infectious processes anywhere that may influence the clinical development of leukemia. Due to the surgical intervention and to a successful bone marrow transplant, the patient is on remission.
OBJETIVO: describir el tratamiento médico-quirúrgico en un niño con leucemia linfoblástica aguda tipo 1 que desarrolló un quiste dentígero. CASO CLÍNICO: niño de ocho años de edad con leucemia linfoblástica aguda, cuyo tratamiento estaba en fase de inducción. En el transcurso de un mes, el niño presentó asimetría facial por aumento de la mandíbula, así como dolor agudo, hipertermia y malestar general. A la exploración se identificó parestesia labial, segundo molar temporal con restauración de corona de acero cromo y expansión de la cortical del incisivo lateral permanente hasta primer molar permanente. Por sospecha de metástasis ósea se realizó una ortopantomografía con la que se estableció el diagnóstico de quiste dentígero. Se realizó enucleación, curetaje y extracción de órganos dentarios cariados para prevenir infecciones. CONCLUSIONES: las manifestaciones clínicas más frecuentes de la leucemia linfoblástica aguda suelen ser anemia, trombocitopenia, leucopenia y ocupación de la médula ósea por blastos. También puede manifestarse con infiltrado óseo en mandíbula; en el paciente descrito no se demostró metástasis ósea. Antes de iniciar el tratamiento de la leucemia linfoblástica aguda, se debe verificar que los pacientes estén libres de fuentes de infección que pudieran influir en su evolución. Debido a la intervención quirúrgica oportuna y al trasplante autólogo de médula, al momento de este informe el paciente se encontraba en remisión.
Subject(s)
Dentigerous Cyst/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Child , Dentigerous Cyst/diagnosis , Dentigerous Cyst/surgery , Humans , MaleABSTRACT
BACKGROUND: Gaucher's disease, the most prevalent lysosome storage disorder, presents an autosomal recessive mode of inheritance with a deficiency of the acid b-glucosidase enzyme. Our objective was to describe the clinical features, symptoms, evolution and treatment of Gaucher's disease in Mexican pediatric patients. METHODS: the medical files of every patient diagnosed with Gaucher's treated during the last 11 years at the Pediatrics Department at General Hospital "Dr. Gaudencio González Garza" were reviewed. Demographic and clinical data were registered. RESULTS: eleven patients were diagnosed with Gaucher's Disease: eight women and three men between the age of 7 and 172 months. Four patients were classified as type I, two as type II and five as type III. CONCLUSIONS: a better understanding of the clinical features and diverse phenotypes in Mexican patients with Gaucher's disease will contribute to a timely diagnosis and a continuous, individualized treatment.
Subject(s)
Gaucher Disease/diagnosis , Adolescent , Child , Child, Preschool , Female , Gaucher Disease/therapy , Humans , Infant , Male , Retrospective StudiesABSTRACT
The lysosomal storage diseases (LSD) are a group of entities with a meaningful organic affectation profile and important morbidity-mortality rates, which considerably affect the patients' quality of life. At present, new LSD are regularly described because their physiopathological mechanism is recognized and they are susceptible to be treated with enzyme replacement therapy. During 2009, a cross-disciplinary group of Mexican experts on the Gaucher's disease gathered to develop diagnosis and treatment guidelines. This document presents the approach and recommendations of Mexican experts, according to the demography, resources, and epidemiologic reality in Mexico, a country with over 100 million inhabitants.
Subject(s)
Gaucher Disease/diagnosis , Gaucher Disease/therapy , Algorithms , Gaucher Disease/classification , Gaucher Disease/complications , Humans , Mexico , Practice Guidelines as TopicABSTRACT
The objective of this population-based survey was to assess the peak age of incidence of B-cell precursor acute lymphoblastic leukemia (ALL) in children in Mexico City (MC). All patients were classified according to their immunophenotype, and only B-cell precursor and T-lineage were analyzed. Rates of incidence were calculated x10 children. Of the 364 children from MC who were included in this study, immunophenotyping had been performed for 81.6%. The frequency of B-cell precursor ALL was 76.1%, whereas T lineage ALL showed a frequency of 23.6%. Peak age for ALL was 2 to 3 years of age. B-cell precursor ALL was the major contributor to peak age; T lineage ALL showed a peak among 1 and 3 years of age. We conclude that the age peak for children with ALL in MC is within the ranges reported for developed countries and that B-cell precursor ALL is the main contributor to these peak.
Subject(s)
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Adolescent , Age Distribution , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Mexico/epidemiology , Population , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Survival AnalysisABSTRACT
La hemorragia intracraneana es la principal causa de muerte entre los pacientes hemofílicos. Por esta razón se revisaron 75 expedientes clínicos de pacientes menores de 16 años con el diagnóstico de hemofilia. Se encontraron seis niños con hemorragia intracraneana (HIC). El tiempo de inicio de la sintomatología fue de 12 h hasta cuatro días con una media de 39 h. Los signos y síntomas encontrados fueron: cefalea, vómito, crisis convulsiva, hematoma en el sitio del traumatismo, hemiperesia corporal izquierda, nistagmus, náusea. Se dio tratamiento substitutivo en todos los niños. Cuatro presentaron secuelas neurológicas. La frecuencia de HIC se estimó en 8 por ciento de los hemofílicos. Se concluye que para prevenir la muerte y minimizar las secuelas, una terapia de reemplazo adecuada, ésta debe ser instituida tan pronto como se sospecha el sangrado o inmediatamente después del traumatismo craneoencefálico
Subject(s)
Humans , Child , Adolescent , Adult , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/prevention & control , Cerebral Hemorrhage/therapy , Statistics on Sequelae and Disability , Hemophilia A/complications , Hemophilia A/diagnosis , Signs and SymptomsABSTRACT
Se realizó en 16 niños con leucemia aguda no linfoblástica estudio citogenético de la médula ósea por medio de dos métodos para la obtención de cariotipo para su análisis cromosómico: el método directo y el de cultivo de 48 horas. La investigación tuvo como objeto conocer las alteraciones citogenéticas en la población, debido al origen clonal de la enfermedad. Estas son útiles para valorar la remisión de la enfermedad y la respuesta al tratamiento, a la vez que permite dar un pronóstico
