Mieloma múltiple: enfermedad ósea extensa en una paciente joven / Myeloma multiple: extensive bone disease in a young patient

El mieloma múltiple (MM) es un tumor de proliferación clonal de plasmocitos en la médula ósea (MO). Hasta ahora no es curable1,2. Puede presentarse como una enfermedad indolente o con manifestaciones clínicas como insuficiencia renal, anemia y lesiones osteolíticas1. Se presenta el caso de una paciente femenina de 46 años, quien padecía dolor en la región del brazo izquierdo, acompañado por dolores óseos generalizados. Al examen físico se observó en el tercio proximal de la región humeral izquierda y hombro ipsilateral, gran tumoración que deformaba la anatomía local, indurada, inmóvil y dolorosa. Presentaba anemia severa (Hb. 6 g/dL), cuantificación de ß2 Microglobulina 4,23 mg/L (VR 0,80 ­ 3,0 mg/L) y rastreo óseo radiológico con múltiples lesiones líticas. En la muestra de médula ósea se encontró infiltración de 80 % de células plasmáticas mono- clonales kappa. Se le diagnosticó discrasia de células plasmáticas tipo MM monoclonal kappa sintomático, estadio II (ISS), con enfermedad ósea extensa y un gran plasmocitoma humeral izquier- do. Se indicó tratamiento de inducción de la remisión con el esquema VCD (bortezomib, ciclofosfamida y dexametasona). Adicionalmente ácido zoledrónico. Posteriormente se modificó a bortezomib, talidomida y prednisona. Luego del tratamiento antineoplásico, refirió acalmia completa del dolor con mejoría de la movilidad. Este caso clínico se trata de una presentación inusual de MM debido a la edad de la paciente y a la extensa enfermedad ósea. Llamó la atención la ausencia de niveles elevados de la cadena liviana kappa de las inmunoglobulinas libres en suero. Por la edad de la paciente y la ausencia de co-morbilidades significativas, es candidata para trasplante de células progenitoras hematopoyéticas (TCPH)(AU)

Multiple myeloma (MM) is a tumor of clonal proliferation of plasma cells in the bone marrow (BM). Until now it is not curable1,2. It can present as without symptoms or with clinical manifestations such as renal failure, anemia and osteolytic lesions1. We describe the case of a 46-year-old female patient, who complained of pain in her left arm, and, also, by generalized bone pain. On physical examination a large tumor was present in the proximal third of the left humeral region and ipsilateral shoulder, it was hard, painful and immo- bile. She had severe anemia (Hb 6 g / dL), quantification of ß2 Microglobulin 4.23 mg / L (VR 0.80 - 3.0 mg /L) and the radiological bone survey showed multiple lytic lesions. In the bone marrow sample, an infiltration of 80 % kappa monoclonal plasma cells was found. Her diagnosis was MM-type plasma cell dyscrasia, symptomatic kappa, stage II (ISS), with extensive bone disease and a large left humeral plasmacytoma. Remission induction therapy was indicated with the VCD scheme (bortezomib, cyclophosphamide and dexa- methasone). Additionally zoledronic acid was administered. Subsequently, it was modified to bortezomib, thalidomide and prednisone. After antineoplastic treatment, she referred pain relief with improvement of mobility. This clinical case is an unusual presentation of MM due to the age of the patient and extensive bone disease. The absence of high levels of the kappa light chain of free immunoglobulins in serum attracted attention. Due to the age of the patient and the absence of significant comorbidities, she is a candidate for trans- plantation of hematopoietic stem cells(AU)

Características clínicas y microbiológicas de pacientes con neutropenia febril en un hospital Universitario / Clinical and microbiological characteristics of patients with febrile neutropenia in one Colombian Universitary Hospital

Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San Ignacio Métodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014 Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos. Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.

Objective: To describe the demographic and clinical characteristics, as well as frequency and type of bacterial isolate and resistance patterns in patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital Methods: This is a retrospective observational study. Data were collected from medical records of adult patients admitted in the Hemato-oncology and Bone Marrow Transplant Unit. Inclusion criteria was presence of febrile neutropenia in the setting of a hematological neoplasm from January 2013 to December 2014. Results: 345 episodes of febrile neutropenia from 193 patients were studied. An infectious focus was identified in 68.1% of episodes, and a bacterial isolate was obtained in 62.9% of episodes. The predominant microorganisms were gram-negative rods, gram-positive cocci, and fungi with a frequency of 63.7%, 27.9%, and 4.9% respectively. In term of resistance patterns, Escherichia coli and Klebsiella peumoniae isolates had a frequency of ESBL susceptibility pattern of 17.5% and 13.8% respectively; and a frequency of KPC susceptibility pattern of 1.25% and 2.8% respectively. The frequency of methicillin resistant Staphylococcus aureus was 6.8%. Death associated to infection ocurred in 16.5% of episodes. Conclusions: In patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital, we found a high rate of documentation of infectious focus, with a predominance of gram-negative rods, specially Enterobacteriacea; with a similar pattern in receptors of hematopoietic stem cell transplantation.

Neutropenia febril asociada a quimioterapia en pacientes con neoplasias hematológicas de un centro de referencia en Colombia: características clínicas y desenlaces / Febrile neutropenia in patients with hematological malignancies at a reference center in Colombia

RESUMEN Objetivo: analizar las características epidemiológicas, clínicas y bacteriológicas que influyen en la supervivencia de los pacientes con neoplasias hematológicas que desarrollaron neutropenia febril posterior a quimioterapia. Materiales y métodos: estudio de corte transversal que incluyó adultos con diagnóstico de neoplasias hematológicas que presentaron neutropenia febril durante la hospitalización en 2014 en las sedes de Oncólogos de Occidente en Pereira, Manizales y Armenia (Colombia). Se realizaron análisis univariados y multivariados; la supervivencia se estableció según el método de Kaplan-Meier. Se estableció un valor de p <0.05. Se usó el software STATA. Se tuvo aval de bioética de la Universidad Tecnológica de Pereira. Resultados: se incluyó a 55 pacientes. La mediana de edad fue de 48 años (31-63), 27(49 %) fueron hombres. Los diagnósticos oncológicos más frecuentes fueron el linfoma no Ho-dgkin (29 %), leucemia mieloide aguda (24%) y leucemia linfoblástica aguda (20 %). La mayor letalidad se presentó en los días 21, 32 y 48. La mortalidad general fue del 9 % y la mortalidad por neutropenia profunda fue del 18 %. Conclusión: el número de neutropenias febriles, mayor tiempo de duración de la neutropenia febril, índice de Charlson y el antecedente de ingreso a UCI son factores de riesgo para mortalidad, mientras que el uso de piperacilina-tazobactam y el incremento en la puntuación del índice de MASCC son factores protectores.

ABSTRACT Objective: analyze the epidemiological, clinical and bacteriological characteristics that influence the survival of patients with haematological malignancies who developed febrile neutropenia after chemotherapy. Materials and methods: cross-sectional study of adult patients diagnosed with hema-tologic malignancies who presented febrile neutropenia during hospitalization in 2014 at Oncólogos de Occidente in Pereira, Manizales and Armenia (Colombia). Univariate and multivariate analyzes were performed. The survival analysis was established according to the Kaplan-Meier method. A value of p<0.05 was established for it. The STATA software was used. This study was endorsed by the bioethics committee of the Universidad Tecnológica de Pereira. Results: 55 patients were included. The median age was 48 years (31-63), 27 (49%) were men. The most frequent oncological diagnoses were non-Hodgkin's lymphoma (29 %), acute myeloid leukemia (24 %) and acute lymphoblastic leukemia (20 %). The highest lethality occurred on days 21, 32 and 48. Overall mortality was 9 %, mortality due to deep neutro-penia was 18 %. Conclusion: the number of febrile neutropenia, longer duration of febrile neutropenia, Charlson index and the history of admission to the ICU are risk factors for mortality, while the use of piperacillin-tazobactam and the increase in the score of the MASCC index are protective factors.

Implementation de un protocolo de seguridad en la administración de quimioterapia En el servicio de Hematología de un hospital de cuarto nivel / Implementation of a security protocol in the administration of chemotherapy in the hematology Department of a fourth level hospital

Resumen Objetivo: evaluar el conocimiento del personal e implementación del protocolo de seguridad en la administración de la quimioterapia en el servicio de Hematología del Hospital de San José. Material y métodos: la implementación fue evaluada por medio de listas de chequeo en cada proceso del protocolo y la evaluación del conocimiento por un cuestionario de 15 preguntas. Marco de referencia: servicio de Hematología del Hospital de San José, de Bogotá. Unidades de análisis: ciclos de quimioterapia administrados a pacientes adultos con diagnóstico de neoplasias hematológicas. Participantes: personal del servicio implicado en procesos de administración de quimioterapia. Mediciones: con las historias clínicas se describieron las características demográficas de los pacientes, los incidentes del proceso de administración de quimioterapia y la adherencia al protocolo por parte del personal de salud. El cuestionario de evaluación fue diseñado por los autores. Resultados: en 291 ciclos de quimioterapia (129 pacientes) se presentaron 214 incidentes del proceso de administración de quimioterapia de un total de 4074 posibles (5.2%), de estos, 16 están directamente relacionados con el uso de los medicamentos. La adherencia a los procesos del protocolo oscilo entre 40.5 y 100%. El conocimiento del personal tuvo una mejoría leve al comparar las dos evaluaciones realizadas. Conclusiones: aunque no se alcanzó la adherencia esperada al protocolo, se logró una disminución de los incidentes en comparación con estudios previos institucionales. Se requiere un nuevo plan de mejoramiento para aumentar la adherencia e impactar en la seguridad de los pacientes. (Acta Med Colomb 2017; 42: 112-120).

Abstract Objective: assess staff knowledge and implementation of the security protocol in the administration of chemotherapy in the hematology department at the San Jose Hospital, Bogota. Material and methods: the implementation was evaluated through checklists in each protocol process and the knowledge evaluation by a15 questions questionnaire. Reference frame: hematology department of the San Jose Hospital, Bogota. Units of analysis: chemotherapy cycles administered to adult patients with diagnosis of hematologic malignancies. Participants: service personnel involved in chemotherapy administration processes. Measurements: the patient's demographic characteristics, the incidents of the chemotherapy administration process and adherence to the protocol by the health personnel were described with the medical records. Authors designed the evaluation questionnaire. Results: in 291 chemotherapy cycles (129 patients) there were 214 incidents of the chemotherapy administration process out of a total of 4074 possible (5.2%), of which 16 are directly related to the use of the drugs. Adherence to protocol processes ranged from 40.5 to 100%. Staff knowledge had a slight improvement when comparing the two evaluations performed. Conclusions: although the expected adherence to the protocol was not achieved, a decrease in incidents was obtained compared to previous institutional studies. A new improvement plan is required to increase adherence and achieve greater impact on patient safety. (Acta Med Colomb 2017; 42: 112-120).

Hibridación in situ fluorescente: herramienta en el diagnóstico de las hemopatías malignas / Fluorescence in situ hybridization: diagnostic tool for hematological malignancies

Introducción: las neoplasias hematológicas tienen origen clonal y se caracterizan por presentar gran heterogeneidad genética. El desarrollo de la citogenética molecular a través de la hibridación in situ por fluorescencia (FISH, por su sigla en inglés) se convirtió en un avance importante en el diagnóstico citogenético de estas neoplasias. Objetivo: describir las alteraciones cromosómicas detectadas en pacientes con neoplasias hematológicas a partir de la introducción de esta técnica. Métodos: se realizó un estudio descriptivo de tipo transversal de pacientes con neoplasias hematológicas en el Laboratorio de Citogenética del Instituto de Hematología e Inmunología (IHI), en el período comprendido entre julio de 2014 y abril de 2015. Se utilizó la técnica de FISH con las sondas fluorescentes específicas. Resultados: se estudiaron 87 muestras correspondientes a diferentes tipos de neoplasias hematológicas. Con la sonda LSI BCR/ABL se observaron 18 casos positivos de leucemia mieloide crónica y los ocho pacientes con leucemia linfoide aguda fueron negativos. Se marcaron con sonda PML/RARα 17 muestras con diagnóstico de leucemia promielocítica: 10 fueron positivas. Se procesaron 8 muestras con la sonda LSI RUNX1/RUNX1T1, una resultó positiva. Dos muestras marcadas con sonda LSI RB1 (13q14) y una con LSI TP53 (17p13.1), resultaron negativas. se observó un caso positivo de deleción 7q31. Conclusiones: a pesar de que la muestra estudiada es pequeña, resulta importante reportar los primeros resultados como evidencia de la incorporación de la técnica de FISH en el IHI, lo que constituye una nueva herramienta para el diagnóstico, pronóstico y seguimiento de las neoplasias hematológicas(AU)

Introduction: hematological neoplasias have clonal origin and are characterized by great genetic heterogeneity. The development of molecular cytogenetic through fluorescence in situ hybridization (FISH) became a major advance in the cytogenetic diagnosis of these neoplasias. Aim: to describe chromosomal abnormalities detected in patients with hematological malignancies after the introduction of this technique. Methods: a descriptive cross-sectional study of patients with hematological malignancies was performed. Their bone marrow samples were processed at the Laboratory of Cytogenetics of the Institute of Hematology and Immunology, between July 2014 and April 2015. FISH technique was used along with various fluorescent probes. Results: 87 samples were studied. With LSI BCR / ABL probe, 18 samples were positive of chronic myeloid leukemia and 8 patients with diagnostic of acute lymphoblastic leukemia were negative. With PML/RARα probe 17 samples of patients with promyelocytic leukemia were labeled, 10 were positive. Eight samples were labeled with probe RUNX1 / RUNX1T1, one was positive. Two samples for LSI probes labeled RB1 (13q14) and one with LSI TP53 (17p13.1) were negative. One positive case 7q31 deletion was observed. Conclusions: despite the sample is small, we consider it important to report our first results as evidence of the incorporation of the FISH technique at the IHI, which constitutes a new tool for the diagnosis, prognosis and monitoring of hematological malignances(AU)

Immunoglobulin heavy chain gene rearrangement in non B-cell haematological malignancies / Reordenamiento del gen de la cadena pesada de inmunoglobulina en las neoplasias hematológicas de linfocitos no B

PURPOSE: Clonality detection through amplifying immunoglobulin heavy chain (IGH) gene rearrangements by polymerase chain reaction (PCR) is a useful tool in diagnosis of various B-lymphoid malignancies. Immunoglobulin heavy chain gene rearrangement can be an optimal target for clonality detection in B-lymphoid malignancies. In the present study, we evaluated the presence of IGH gene rearrangement in non B-cell haemato-oncologypatients including T-cell acute lymphoblastic leukaemia (T-ALL), acute myeloblastic leukaemia (AML) and biphenotypic leukaemia. METHODS: We studied 18 cases of haematological malignancies which comprised five patients with TALL, 12 patients with AML and one with biphenotypic leukaemia. RESULTS: We found that the incidence of IGH gene rearrangement in T-ALL and AML were three (60%) and two (16.7%), respectively. The patient with biphenotypic leukaemia was negative for IGH gene rearrangement. CONCLUSION: Immunoglobulin gene rearrangement, which occurs in almost all haematological malignancies of B-cell lineage, also presents in a very small proportion of T-cell or myeloid malignancies.

OBJETIVO: La detección de la clonalidad mediante amplificación de los reordenamientos del gen de la cadena pesada (IGH) de inmunoglobulina por reacción en cadena de la polimerasa (RCP) es una herramienta útil en el diagnóstico de varios tumores malignos linfoides de células B. El reordenamiento del gen de la cadena pesada de inmunoglobulina puede ser un objetivo óptimo de la detección de la clonalidad en tumores malignos linfoides de células B. En el presente estudio, se evaluó la presencia de reordenamiento del gen IGH en pacientes de hemato-oncología de células no B, incluyendo la leucemia linfoblástica aguda de células T (LLA-T), leucemia mieloblástica aguda (LMA), y leucemia bifenotípica. MÉTODOS: Se estudiaron 18 casos de neoplasias malignas hematológicas que abarcaron cinco pacientes con (LLA-T), 12pacientes con AML y uno con leucemia bifenotípica. CONCLUSIÓN: Reordenamiento del gen de la inmunoglobulina que ocurre en casi todas las neoplasias malignas hematológicas del linaje de las células B, también se presenta en una proporción muy pequeña de células T o las neoplasias mieloides.

Trombocitemia esencial en una mujer joven / Essential thrombocythemia in a young woman

Se describe el caso clínico de una fémina de 35 años de edad, quien acudió a la consulta de Hematología del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, por presentar decaimiento, insomnio, así como sospecha de anemia y trastornos de la coagulación por antecedentes de sangrado intraabdominal, además de sensación de quemazón en las falanges distales de los dedos de las manos. Los resultados de los exámenes efectuados confirmaron la presencia de neoplasia hematológica mieloproliferativa crónica (trombocitemia esencial). Luego del plan terapéutico inicial con hidroxiurea y Aspirina®, se indicó tratamiento con interferón alfa- 2b recombinante, con lo cual las cifras de plaquetas disminuyeron paulatinamente.

The case report of a 35 year-old female who visited the Hematology Department from "Saturnino Lora Torres" Provincial Clinical Surgical Teaching Hospital in Santiago de Cuba, because of weakness, insomnia, as well as anemia suspicion and clotting disorders due to a history of intraabdominal bleeding, besides burning sensation in the distal phalanges of the hand fingers is described. The results of the laboratory tests confirmed the presence of chronic hematologic myeloproliferative neoplasm (essential thrombocythemia). After the initial therapeutic plan with hydroxiurea and Aspirin®, treatment was indicated with recombinant alpha-2b interferon, with which the number of platelets decreased gradually.

Papel da célula endotelial em neoplasias malignas hematológicas / The role of endothelial cells in hematologic malignancies

A neoformação vascular constitui evento essencial para que ocorra o desenvolvimento humano. Nesta fase, o sistema vascular sofre expansão. Células endoteliais maduras (ECs) irão compor a parede dos vasos, enquanto células endoteliais oriundas da medula óssea (MO) migram para locais de neoformação vascular com subseqüente diferenciação em células endoteliais maduras. Processos fisiológicos e patológicos como câncer têm a angiogênese como importante componente. Estudos correlacionam a angiogênese com a agressividade tumoral em alguns tipos de tumores incluindo hematológicos, o que ressalta a importância da terapia antiangiogênica como alvo de pesquisas cada vez mais profundas. Neste artigo de revisão enfocamos o papel da angiogênese nas neoplasias hematológicas com ênfase em possíveis alvos terapêuticos.

Vascular neoformation is an essential event in the development of the human body. In this phase vascular networks undergo expansion. Mature endothelial cells constitute the structure of vessel walls so endothelial cells from bone marrow migrate to sites of vascular neoformation with subsequent differentiation as mature endothelial cells (endothelial progenitor cells). Physiopathological and pathological processes such as cancer use angiogenesis as an important component for growth. Studies correlate angiogenesis with aggressive tumors for some types of tumors, including hematological malignancies, thereby highlighting the importance of anti-angiogenic therapy.

Ação do prebiótico sobre as proteínas de fase aguda de pacientes com neoplasia hematológica / Action of prebiotics on proteins in the acute phase of hematologic neoplasia

Os pacientes com neoplasias hematológicas são submetidos a tratamento quimioterápico que induz uma intensa alteração na integridade da mucosa intestinal, favorecendo um aumento da sua morbi-mortalidade. O presente trabalho foi desenvolvido na Unidade de Transplante de Medula Óssea do Centro de Pesquisas Oncológicas em Florianópolis - SC e teve como objetivo estudar a ação do prebiótico na resposta de proteína da fase aguda de pacientes com neoplasias hematológicas submetidos à quimioterapia. Foi realizado um estudo clínico randomizado duplo cego envolvendo 25 pacientes divididos em dois grupos que receberam por 15 dias: 12g de FOS (n=14) ou placebo (maltodextrina) (n=11). Todas as variáveis foram determinadas antes e após a suplementação. Foram avaliados os níveis séricos das proteínas de fase aguda negativas (albumina e pré-albumina) e a proteína de fase aguda positiva, proteína C reativa (PCR). Verificaram-se a presença de diarréia e de constipação, bem como a quantidade de bifidobactérias e valores de pH fecal. A redução dos níveis séricos de proteínas de fase aguda negativas (albumina e pré-albumina) comprovam o intenso catabolismo protéico, priorizando a síntese de proteína de fase aguda positiva (PCR). O grupo suplementado apresentou um aumento significante na quantidade de bifidobactérias e o pH fecal não foi alterado em ambos os grupos. Os níveis séricos de PCR foram estatisticamente superiores no grupo controle, indicando a ocorrência de processos inflamatórios e maior demanda metabólica, sugerindo que a quantidade de bifidobactérias pode ter favorecido a redução deste quadro no grupo suplementado, confirmado pela correlação negativa entre estas variáveis.

Patients with hematologic neoplasias are submitted to chemotherapeutic treatment that induces intense alterations in the integrity of the intestinal mucous membrane, favoring an increase in the morbimortality rate. The current work was developed in the Bone Marrow Transplantation Unit of the Oncology Research Center in Florianopolis and was aimed at studying the action of prebiotic agents on protein response in the acute phase of hematologic neoplastic patients submitted to chemotherapy. A double-blind randomized clinical trial was performed involving 25 patients divided into two groups. Patients received 12 g FOS (n=14) or placebo (maltdextrine) (n=11) over 15 days. All the variables were determined before and after supplementation. The serum levels of negative acute phase proteins, albumin and pre-albumin, and positive acute phase proteins, C-reactive protein, were evaluated. The presence of diarrhea and constipation are reported, as are the quantity of bifidobacteria and fecal pH measurements. Reductions in the serum levels of negative acute phase proteins (albumin and pre-albumin) show intense proteic catabolism thereby, favoring the synthesis of protein in the positive acute phase. The supplemented group presented with a significant increase in the quantity of bifidobacteria. The fecal pH levels were affected in both groups. The serum levels of positive acute phase proteins were statistically higher in the control group indicating the occurrence of inflammatory processes and a higher metabolic demand suggesting that the quantity of bifidobacteria may favor a reduction of these adverse conditions in the supplemented group as was confirmed by the negative correlation between variables.

Cateteres venosos totalmente implantáveis em pacientes com neoplasia hematológica e não hematológica / Totally implantable venous catheters in patients with hematological and non hematological neoplasias

OBJETIVO: Analisar se a presença de neoplasia hematológica acarreta maior risco de complicações para inserção de cateteres totalmente implantáveis e se há diferença de tempo cirúrgico quando o procedimento é realizado por punção ou dissecção venosa. MÉTODO: Foram avaliados 68 pacientes com neoplasia internados no Hospital Santa Rita de Porto Alegre entre fevereiro de 1998 e dezembro de 1999, os quais necessitavam de acesso venoso central para tratamento quimioterápico, sendo 48 do sexo feminino e com idade média de 55,6 anos. Desses, 31 apresentavam neoplasia hematológica. RESULTADOS: Complicações pós-operatórias ocorreram em 13 pacientes (19 por cento), sendo elas: obstrução do sistema (7 por cento), hematoma (6 por cento) e infecção (6 por cento), não havendo diferença quanto ao tipo de neoplasia (p = 0,56). Foram realizadas dissecção e punção venosa em 30 e 38 pacientes, respectivamente, sem diferença em relação ao tempo de implantação do cateter (p = 0,42). CONCLUSÃO: Neoplasias hematológicas não aumentaram o risco de complicações quando do uso de cateteres totalmente implantáveis no presente estudo, além disso, ambas as técnicas cirúrgicas - dissecção ou punção - são exeqüíveis, haja visto o tempo cirúrgico semelhante entre elas, desde que sejam respeitados o valor sérico mínimo de plaquetas (50.000/mL) e a técnica cirúrgica apropriada, com hemostasia rigorosa e curativo compressivo.

BACKGROUND: We analyse whether hematological tumors increase the risk of complications of totally implantable catheters and if there are differences regarding procedure time when it is perfomed through venous dissection or venous puncture. METHODS: We studied 68 patients with neoplasia in Hospital Santa Rita from Porto Alegre, between February 1998 and December 1999, who had required central venous access for chemotherapy. Forty-eight patients were female and the mean age was 55.6 years. Thirty-one patients had hematological tumors. RESULTS: Postoperative complications were observed in 13 patients (7 percent with device obstruction, 6 percent with hematoma and 6 percent with infection), but there was no difference regarding the pattern of the neoplasia (p = 0.56). Venous dissection and venous puncture were performed in 30 and 38 patients, respectively, with no difference concerning surgical time (p = 0.42). CONCLUSIONS: Hematological tumors did not increase the risk of complications of totally implantable catheters; furthermore, both surgical techniques (venous dissection or venous puncture) are acceptable choices, with similar surgical times, since one respects minimal platelet count of 50 000/mL and careful hemostasis techniques and compressive dressings.