Derrame pleural como forma de inicio de la artritis reumatoide. Diagnóstico citológico
Pleural effusion as the initial sign of rheumatoid arthritis. Diagnosis by cytology
Servicios de Medicina Interna, Hospital de Tarragona Joan XXIII. Facultad de Medicina y Ciencias de la Salud. Universidad Rovira i Virgili. Tarragona
S. Razquín*
* Servicios de Anatomía Patológica. Hospital de Tarragona Joan XXIII. Facultad de Medicina y Ciencias de la Salud. Universidad Rovira i Virgili. Tarragona
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Diagnóstico citológico" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "429" ] ] "autores" => array:2 [ 0 => array:4 [ "autoresLista" => "J. Fernández-Muixí, F. Vidal, L. Torre, C. Richart" "autores" => array:4 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Fernández-Muixí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Vidal" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Torre" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Richart" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicios de Medicina Interna, Hospital de Tarragona Joan XXIII. Facultad de Medicina y Ciencias de la Salud. Universidad Rovira i Virgili. Tarragona" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia: Servicio de Medicina Interna. Hospital de Tarragona Joan XXIII. Dr. Mallafrè Guasch, 4. 43007 Tarragona." ] ] ] 1 => array:3 [ "autoresLista" => "S. Razquín" "autores" => array:1 [ 0 => array:3 [ "nombre" => "S." "apellidos" => "Razquín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicios de Anatomía Patológica. Hospital de Tarragona Joan XXIII. Facultad de Medicina y Ciencias de la Salud. Universidad Rovira i Virgili. Tarragona" "etiqueta" => "*" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pleural effusion as the initial sign of rheumatoid arthritis. Diagnosis by cytology" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1996-01-30" "fechaAceptado" => "1996-02-06" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546105" "palabras" => array:3 [ 0 => "Artrítis reumatoide" 1 => "Derrame pleural" 2 => "Citología" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec546104" "palabras" => array:3 [ 0 => "Rheumatoid arthritis" 1 => "Pleural effusion" 2 => "Cytology" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Una paciente de 24 años, sin antecedentes de interés, presentó un derrame pleural (DP) derecho importante. El estudio bioquímico del líquido pleural mostró un exudado estéril con nivel bajo de glucosa. Los estudios complementarios no determinaron la etiología del mismo. El derrame fue drenado y la paciente fue dada de alta sin un diagnóstico específico. Nueve meses después recidivó el DP presentando las mismas características bioquímicas. El examen citologico del líquido pleural mostró la presencia de fondo necròtico amorfo y células gigantes multinucleadas. Estos 2 componentes son parte de la tríada patognomónica de los DP reumatoides, junto con los histiocitos fusiformes. Las características bioquímicas del líquido pleural sugerían el diagnóstico, y el examen citologico del mismo lo confirmó, siendo diagnosticada de DP reumatoide. Se realizó tratamiento corticoide con mejoría espectacular. Al disminuir la dosis del mismo, presentó manifestaciones articulares reumatoides. Se debe considerar a la artritis reumatoide como causa de DP inexplicado y debe buscarse el diagnóstico mediante el estudio citologico del líquido pleural.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 24-year-old woman with an unremarkable history presented with a large right-sided pleural effusion. Analysis of the pleural fluid showed a sterile exudate with a low sugar level. Complementary analyses were unable to pinpoint the etiology. The effusion was drained and the patient was released with no specific diagnosis. Nine months later the effusion recurred and the initial laboratory analyses were the same. Pleural fluid cytology revealed the presence of an amorphous necrotic background and non-small cells with multiple nuclei, two signs that constitute part of the pathognomonic triad of rheumatoid pleural effusions, the third characteristic beign fusiform histocytes. The biochemical characteristics of the pleural fluid thus suggested rheumatoid pleural effusion, and cytology confirmed the diagnosis. Corticoid therapy effected spectacular recovery, but when the dose was reduced, rheumatoid symptoms presented in the joints. Rheumatoid arthritis should be considered as a possible explanation for unexplained pleural effusion. Cytology must be used for diagnosis.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 7 | 35 |
| 2024 October | 286 | 32 | 318 |
| 2024 September | 277 | 52 | 329 |
| 2024 August | 217 | 46 | 263 |
| 2024 July | 199 | 40 | 239 |
| 2024 June | 178 | 67 | 245 |
| 2024 May | 214 | 46 | 260 |
| 2024 April | 181 | 42 | 223 |
| 2024 March | 141 | 36 | 177 |
| 2024 February | 96 | 29 | 125 |
| 2024 January | 2 | 4 | 6 |
| 2023 December | 0 | 1 | 1 |
| 2023 November | 0 | 5 | 5 |
| 2023 October | 2 | 4 | 6 |
| 2023 September | 0 | 1 | 1 |
| 2023 July | 0 | 4 | 4 |
| 2023 June | 0 | 14 | 14 |
| 2023 May | 0 | 29 | 29 |
| 2023 April | 0 | 5 | 5 |
| 2023 March | 13 | 15 | 28 |
| 2023 February | 42 | 82 | 124 |
| 2023 January | 37 | 99 | 136 |
| 2022 December | 42 | 76 | 118 |
| 2022 November | 55 | 94 | 149 |
| 2022 October | 42 | 141 | 183 |
| 2022 September | 46 | 108 | 154 |
| 2022 August | 58 | 119 | 177 |
| 2022 July | 38 | 107 | 145 |
| 2022 June | 35 | 107 | 142 |
| 2022 May | 51 | 90 | 141 |
| 2022 April | 45 | 108 | 153 |
| 2022 March | 63 | 144 | 207 |
| 2022 February | 28 | 94 | 122 |
| 2022 January | 39 | 173 | 212 |
| 2021 December | 21 | 176 | 197 |
| 2021 November | 33 | 167 | 200 |
| 2021 October | 70 | 203 | 273 |
| 2021 September | 48 | 205 | 253 |
| 2021 August | 31 | 170 | 201 |
| 2021 July | 42 | 188 | 230 |
| 2021 June | 54 | 167 | 221 |
| 2021 May | 33 | 212 | 245 |
| 2021 April | 59 | 308 | 367 |
| 2021 March | 41 | 292 | 333 |
| 2021 February | 33 | 258 | 291 |
| 2021 January | 32 | 171 | 203 |
| 2020 December | 32 | 140 | 172 |
| 2020 November | 24 | 272 | 296 |
| 2020 October | 35 | 379 | 414 |
| 2020 September | 25 | 271 | 296 |
| 2020 August | 41 | 199 | 240 |
| 2020 July | 68 | 300 | 368 |
| 2020 June | 23 | 198 | 221 |
| 2020 May | 26 | 201 | 227 |
| 2020 April | 30 | 105 | 135 |
| 2020 March | 32 | 119 | 151 |
| 2020 February | 34 | 182 | 216 |
| 2020 January | 47 | 185 | 232 |
| 2019 December | 37 | 198 | 235 |
| 2019 November | 18 | 127 | 145 |
| 2019 October | 17 | 194 | 211 |
| 2019 September | 13 | 163 | 176 |
| 2019 August | 16 | 105 | 121 |
| 2019 July | 31 | 102 | 133 |
| 2019 June | 20 | 158 | 178 |
| 2019 May | 30 | 161 | 191 |
| 2019 April | 42 | 191 | 233 |
| 2019 March | 19 | 171 | 190 |
| 2019 February | 19 | 158 | 177 |
| 2019 January | 14 | 138 | 152 |
| 2018 December | 15 | 175 | 190 |
| 2018 November | 29 | 224 | 253 |
| 2018 October | 42 | 180 | 222 |
| 2018 September | 22 | 117 | 139 |
| 2018 May | 11 | 1 | 12 |
| 2018 April | 7 | 10 | 17 |
| 2018 March | 7 | 7 | 14 |
| 2018 February | 16 | 15 | 31 |
| 2018 January | 22 | 22 | 44 |
| 2017 December | 8 | 19 | 27 |
| 2017 November | 13 | 40 | 53 |
| 2017 October | 14 | 37 | 51 |
| 2017 September | 7 | 32 | 39 |
| 2017 August | 11 | 21 | 32 |
| 2017 July | 13 | 14 | 27 |
| 2017 June | 20 | 23 | 43 |
| 2017 May | 12 | 25 | 37 |
| 2017 April | 19 | 33 | 52 |
| 2017 March | 9 | 10 | 19 |
| 2017 February | 5 | 11 | 16 |
| 2017 January | 16 | 15 | 31 |
| 2016 December | 25 | 12 | 37 |
| 2016 November | 35 | 23 | 58 |
| 2016 October | 64 | 40 | 104 |
| 2016 September | 33 | 14 | 47 |
| 2016 August | 40 | 13 | 53 |
| 2016 July | 36 | 18 | 54 |
| 2016 June | 43 | 20 | 63 |
| 2016 May | 28 | 7 | 35 |
| 2016 April | 28 | 0 | 28 |
| 2016 March | 27 | 0 | 27 |
| 2016 February | 21 | 2 | 23 |
| 2016 January | 45 | 23 | 68 |
| 2015 December | 38 | 10 | 48 |
| 2015 November | 45 | 8 | 53 |
| 2015 October | 11 | 4 | 15 |
| 2015 September | 1 | 0 | 1 |
| 2015 June | 1 | 0 | 1 |
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