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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pleural effusion &#40;PE&#41; is a common problem in patients seen in internal medicine and pneumology departments&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Etiology can vary according to geographical area&#44; healthcare setting&#44; patient age or the time period studied&#44; among other factors&#46; Knowledge of the main etiologies of PE &#40;pre-test probability&#41; enables clinicians to correctly choose and interpret different diagnostic tests following a Bayesian clinical reasoning model&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Only 3 studies on the etiology of PE &#40;with 484&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 642<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and 1000<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> patients&#41; have been published in Spain in the past 25 years&#59; the last of these was published more than a decade ago&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The aim of this study was to describe the causes of PE and the accuracy of some basic tests such as pleural fluid &#40;PF&#41; cytology and culture in over 3000 consecutive patients diagnosed in a university hospital over the past 19 years&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Our hospital created a database in which the demographic and clinical characteristics of all consecutive adult patients undergoing diagnostic thoracentesis since 1994 have been entered prospectively&#44; irrespective of the medical or surgical service from which they were referred&#46; Most procedures were performed on hospitalized patients&#44; and very few on outpatients&#46; In this study&#44; we analyze the etiologies of PE from January 1994 to June 2013&#46; In total&#44; 206 patients that had either no definite diagnosis or insufficient PF testing&#44; imaging and clinical follow-up to establish a presumptive diagnosis or to consider the PE idiopathic was excluded&#46; Each patient was included only once if 2 or more thoracenteses were performed for the same reason&#44; i&#46;e&#46;&#44; to determine the etiology of PE&#46; The data collection protocol was approved by the local ethics committee&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Diagnostic Criteria</span><p id="par0020" class="elsevierStylePara elsevierViewall">Heart failure was diagnosed based on the patient&#39;s history&#44; physical examination&#44; chest X-ray&#44; ECG&#44; echocardiogram&#44; if available&#44; and response to diuretic therapy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients were given a definitive diagnosis of malignant PE when PF cytology or pleural biopsy culture showed malignant cells&#46; A diagnosis of probable malignancy was also accepted in patients with a known primary tumor&#44; cytology-negative PE&#44; and when other potential causes of PE had been ruled out&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A diagnosis of tuberculous PE was based on isolation of the tuberculosis bacillus in sputum samples&#44; PF or pleural biopsy&#44; or when the latter showed granuloma&#46; Probable diagnosis was given in patients with lymphocytic exudate and pleural fluid adenosine deaminase of over &#62;35<span class="elsevierStyleHsp" style=""></span>U&#47;L that was resolved with empirical antituberculosis therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">PE was considered parapneumonic when associated with pneumonia&#44; bronchiectasis or pulmonary abscess&#46; The effusion was classified as uncomplicated parapneumonic PE when it was resolved with antibiotic therapy alone&#46; Complicated parapneumonic PE were those that could not be resolved without complete drainage of non-purulent PF&#44; insertion of a pleural catheter or surgery&#46; The term empyema means the presence of pus in the pleural space and is&#44; by definition&#44; classified as complicated PE even though it is not always associated with pneumonia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A diagnosis of pulmonary embolism was dependent on a positive CT angiography or ventilation perfusion scan performed in a suitable clinical setting&#46; Hepatic hydrothorax was considered in all cirrhosis patients who had no heart&#44; infectious or malignant disease that would otherwise explain the PE&#46; Idiopathic PE cases were those in which the etiology of the condition could not be determined despite thorough testing&#44; and which resolved during follow-up&#46; Widely accepted clinical criteria were applied to diagnose other diseases&#46; PE were classified as exudative or transudative according to Light&#39;s criteria cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical Analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Quantitative variables are expressed as percentages&#44; and qualitative variables as medians &#40;25th and 75th percentiles&#41; The chi-square and Kruskal&#8211;Wallis tests&#44; with post hoc analysis of standard residuals&#44; or the Mann&#8211;Whitney test was used as required to compare variables from the different PE etiology groups&#46; <span class="elsevierStyleItalic">P</span> values of &#60;&#46;05 were considered statistically significant&#46; The data were analyzed using SPSS version 18&#46;0 &#40;Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Causes of Pleural Effusion</span><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 3077 patients with PE were included in the study&#46; The mean age was 69 &#40;52&#8211;79&#41; years&#59; 1826 &#40;59&#37;&#41; were men and 1251 &#40;41&#37;&#41; were women&#46; In total&#44; 75&#37; of PE were due to one of the following 4 causes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; cancer &#40;27&#37;&#41;&#44; heart failure &#40;21&#37;&#41;&#44; pneumonia &#40;19&#37;&#41; or tuberculosis &#40;9&#37;&#41;&#46; These were followed&#44; in terms of frequency&#44; by post-abdominal surgery PE &#40;4&#37;&#41;&#44; pericardial disease &#40;4&#37;&#41; and hepatic hydrothorax &#40;3&#37;&#41;&#46; Although gender did not significantly affect the etiology of PE&#44; compared with other etiologies patients with tuberculous PE were significantly younger &#40;median age 32 years&#41;&#44; and those with heart failure were significantly older &#40;80 years of age&#41;&#46; As for older patients&#44; the most common causes of PE in 760 octogenarians were heart failure &#40;344&#59; 45&#37;&#41;&#44; cancer &#40;181&#59; 24&#37;&#41; and pneumonia &#40;86&#59; 11&#37;&#41;&#46; At the other end of the scale&#44; meanwhile&#44; causes of PE in 293 subjects &#60;34 years old were mainly tuberculosis &#40;153&#59; 52&#37;&#41; and pneumonia &#40;75&#59; 26&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Over the 19-year study period we observed a steady increase in heart failure &#40;29&#37; of PE from 2011 vs 15&#37; prior to 2000&#41; and a reduction in the number of cases of tuberculosis &#40;5&#37; of PE from 2011 vs 13&#37; prior to 2000&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Causes of Exudative and Transudative Effusions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Sufficient data were available to permit the application of Light&#39;s criteria in 2981 patients&#44; of which 2316 &#40;78&#37;&#41; had exudative and 665 &#40;22&#37;&#41; transudative effusions&#46; Of the former group&#44; 797 &#40;34&#46;4&#37;&#41; had malignant PE&#44; 542 &#40;23&#46;4&#37;&#41; parapneumonic PE&#44; 269 &#40;11&#46;6&#37;&#41; tuberculous DP&#44; and 154 &#40;6&#46;6&#37;&#41; heart failure&#46; Transudate was mainly due to heart failure &#40;485&#59; 73&#37;&#41; and cirrhosis of the liver &#40;87&#59; 13&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Light&#39;s criteria for exudative effusions were met by all &#40;100&#37;&#41; tuberculous PE&#44; post-traumatic effusion&#44; pulmonary embolism and connective disease cases&#44; 99&#37; of pneumonia cases&#44; 98&#37; of malignant PE cases&#44; 97&#37; of post-heart surgery PE cases&#44; 94&#37; of PE secondary to pericardial disease and idiopathic PE&#44; 24&#37; of heart failure cases&#44; and 9&#37; of hepatic hydrothorax&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Radiological Aspects of Pleural Effusion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 2767 patients for whom posteroanterior chest X-ray data were available&#44; 423 &#40;15&#37;&#41; had massive PE occupying two-thirds or more of the hemithorax&#46; Of these&#44; most had malignant PE &#40;244&#59; 58&#37;&#41;&#44; pneumonia &#40;72&#59; 17&#37;&#41;&#44; tuberculosis &#40;36&#59; 8&#46;5&#37;&#41; and hepatic hydrothorax &#40;27&#59; 6&#46;4&#37;&#41;&#46; The percentage of massive PE due to these etiologies was 32&#37;&#44; 14&#37;&#44; 14&#37;&#44; and 34&#37;&#44; respectively&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Of a total of 2958 evaluable patients&#44; chest X-rays showed bilateral PE in 667 &#40;23&#37;&#41; cases&#46; The most common causes were heart failure &#40;357&#59; 53&#46;5&#37;&#41;&#44; cancer &#40;121&#59; 18&#37;&#41; and pericardial disease &#40;47&#59; 7&#37;&#41;&#46; Considering each etiology individually&#44; 58&#37; of heart disease&#44; 47&#37; of pericardial diseases and 41&#37; of connective tissue diseases were associated with bilateral PE&#44; while this characteristic was only detected in 15&#37; of malignant and pulmonary embolism PE&#44; in 8&#37; of cirrhosis&#44; in 6&#37; of pneumonia&#44; and in 4&#37; of tuberculosis cases&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Malignant Pleural Effusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cytological or histological confirmation was obtained in 538 &#40;64&#37;&#41; of 840 patients with malignant PE&#44; while 302 &#40;36&#37;&#41; of the remaining cases were considered probably malignant on the basis of the previously established criteria&#46; All mesotheliomas were diagnosed using histological criteria&#46; In approximately half of all malignant PE patients&#44; the primary tumor was located in the lung &#40;37&#37;&#41; or the breast &#40;16&#37;&#41;&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Prevalence of primary pleural tumors &#40;mesotheliomas&#41; was low in our region &#40;3&#37; of all malignant PE&#41;&#46; Both lung tumors and mesotheliomas predominated in male subjects &#40;80&#37; and 86&#37; of cases&#44; respectively&#41;&#46; At least half of the metastatic pleural tumors were adenocarcinomas&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Overall&#44; preliminary PF cytology was positive in 424 &#40;51&#37;&#41; of 831 patients with malignant PE&#46; A second test was performed on 214 patients with a preliminary cytologically negative effusion&#44; and a positive result was obtained in 55 &#40;26&#37;&#41; cases&#46; Finally&#44; in 52 patients with two negative cytologies&#44; a third sample yielded positive results in 12 &#40;23&#37;&#41; cases&#46; On the whole&#44; considering all the cytologies performed&#44; the accuracy of this test in identifying malignancy was 59&#37; &#40;491&#47;831&#41;&#46; PF cytology was significantly less successful in identifying mesotheliomas &#40;27&#37;&#41; and squamous cell lung cancer &#40;25&#37;&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Parapneumonic Pleural Effusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">PF culture was performed on 562 parapneumonic and empyema PE cases&#44; and was positive in 108 &#40;66&#37;&#41; of 163 empyemas&#44; 47 &#40;23&#37;&#41; of 208 complicated parapneumonic PE&#44; and 14 &#40;7&#37;&#41; of 191 uncomplicated parapneumonic PE cases&#46; In total&#44; 18&#37; of empyemas were not associated with pneumonia but with other processes such as esophageal perforation&#44; post-surgical complications or spontaneous bacterial empyema in cirrhosis patients&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">A total of 184 germs were isolated in 169 patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#59; 156 cultures yielded a single pathogen&#44; 11 had two pathogens and 2 had three pathogens&#46; <span class="elsevierStyleItalic">Viridans</span> streptococci were the most commonly isolated pathogens both individually &#40;39&#44; 25&#37;&#41; and in polymicrobial cultures &#40;9 of 13 cultures&#41;&#46; In terms of purulent discharge&#44; anaerobic bacteria &#40;85&#37;&#41;&#44; enterococci &#40;82&#37;&#41; and <span class="elsevierStyleItalic">viridans</span> streptococci &#40;77&#37;&#41; were isolated in a significantly higher proportion than other bacteria &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Tuberculous Pleural Effusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Tuberculous pleural effusion was clinically diagnosed in 65&#37; of cases&#46; <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> was only found in 44 &#40;18&#46;5&#37;&#41; of 237 PF samples using Lowenstein&#8211;Jensen solid media culture&#46; A total of 15 pleural biopsies were performed in patients with negative PF culture&#44; and caseating granulomas were found in 13 of these cases&#46; In patients with pleural tuberculosis&#44; 78&#37; &#40;175&#47;225&#41; tested positive for tuberculosis&#44; and 12&#46;6&#37; &#40;17&#47;135&#41; were co-infected with HIV&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">This study shows that in 75&#37; patients undergoing diagnostic thoracentesis&#44; the etiology of PE was&#44; in order of frequency&#44; cancer&#44; heart failure&#44; pneumonia and tuberculosis&#46; These findings are consistent with previous Spanish series<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; although the relative frequency of these 4 conditions varies&#46; Specifically&#44; a higher percentage of heart failure patients are found in a series taken from internal medicine departments&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> since this is one of the diagnosis-related groups most frequently seen by these specialists&#46; Pleural tuberculosis etiology predominates in Spanish regions with a greater prevalence of this disease&#44; such as Galicia&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> although the number of cases has steadily diminished over the past 10 years&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> a trend that was also reflected in our series&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The causes of PE in patients at either end of the age scale differ significantly&#46; While the cause of approximately half of all PE cases among young patients &#40;&#60;34&#41; is tuberculosis&#44; among octogenarians PE is secondary to heart failure&#44; which is consistent with the findings of Villena et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is important to note that the higher prevalence of pericardial &#40;4&#37;&#41; and hepatic hydrothorax &#40;3&#37;&#41; etiologies in our study compared with previous series<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> is probably due to the fact that these studies recruited&#44; either solely or chiefly&#44; pulmonology patients&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Distinguishing between transudative and exudative effusion is traditionally considered a fundamental first step in the diagnosis of PE&#46; In clinical practice&#44; these are distinguished using Light&#39;s criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Most transudates are associated with heart failure &#40;75&#37;&#8211;80&#37;&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> although pericardial effusion meets Light&#39;s criteria for exudate&#44; albeit narrowly&#44; in around 25&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Contrary to the belief that pulmonary embolism can produce transudative PE&#44; we agree with other authors<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> who claim that PE due to pulmonary embolism always meets Light&#39;s criteria for exudative effusion&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">As far as radiological evidence is concerned&#44; differential diagnosis is further refined by the presence of bilateral PE or effusion clouding almost the entire hemithorax&#46; Cancers cause over half of massive PE&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and heart failure causes over half of bilateral PE&#46; Occasionally&#44; bilateral PE can have a different causative factor for each side&#44; a condition known as Contarini&#39;s syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In both this and other series published&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4&#44;11</span></a> lung cancer is responsible for a third or more of malignant PE&#46; Experts&#44; with a few exceptions&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> also agree that around 10&#37; of malignant PE are associated with an unknown primary tumor&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3&#44;11&#44;12</span></a> However&#44; the relative frequency of mesotheliomas varies according to geographical region&#44; in relation to the risk of asbestos exposure&#46; Therefore&#44; while mesotheliomas in ours and other series<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> account for only 3&#37; of all malignant PE&#44; this increases by four- or five-fold &#40;13&#37;&#8211;14&#46;5&#37;&#41; in other Spanish studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;12</span></a> In line with the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> overall accuracy of PF cytology in diagnosing malignancy was found to be approximately 60&#37;&#46; Nevertheless&#44; it is important to note that accuracy was considerably lower in squamous cell lung cancer and mesotheliomas &#40;25&#37; and 75&#37;&#44; respectively&#41;&#46; Mesothelioma is a prime example of how the combination of an experienced cytologist &#40;in parallel to the prevalence of the disease&#41; and the use of immunocytochemistry can significantly improve the accuracy of PF cytology&#46; These factors were combined in the study conducted by the Australian group Segal et al&#46; who recently reported a PF cytology sensitivity of 73&#37; in 517 cases of mesothelioma&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Finally&#44; the diagnostic yield of PF cytology for hematological malignancies &#40;61&#37;&#41; reported in our study contrasts with the findings of another Spanish group &#40;18&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> However&#44; this could be due to the fact that in our hospital it is common practice to request a flow cytometric analysis of PF whenever a lymphoma is suspected&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">With regard to PF microbiology&#44; in our study only 30&#37; of patients with infectious PE tested positive using standard PF culture&#44; a percentage that increases to 60&#37; in the case of purulent fluid &#40;empyema&#41;&#46; Two large studies have also reported positive results in 56&#46;4&#37; and 58&#37; of 406<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and 434<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> empyemas&#44; respectively&#46; In our series&#44; streptococci accounted for 43&#37; of all isolates&#44; the most common being <span class="elsevierStyleItalic">viridans</span> &#40;formerly <span class="elsevierStyleItalic">milleri</span>&#41;&#44; which accounted for 25&#46;5&#37; of all positive cultures&#44; a finding that is consistent with the results of Maskell et al&#46; &#40;24&#37; of 336 isolations in community-acquired empyemas&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Anaerobic bacteria isolation is dependent not only on correct collection&#44; transport and processing procedures&#44; but also on the culture medium used&#46; These bacteria made up 7&#37; of the isolates in our series&#44; compared with 5&#46;7&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> 8&#46;5&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and 20&#37;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported in three other large studies&#46; Of course&#44; inoculating PF into blood culture bottles<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> or the use of nucleic acid amplification techniques<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> can significantly increase the number of bacteria isolated&#46; With regard to pleural tuberculosis&#44; we were only able to isolate <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> from PF using the Lowenstein&#8211;Jensen method in 18&#46;5&#37; of cases&#44; a percentage well within the 7&#37;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> to 36&#37;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> range described in the literature&#46; The low yield in this case is due to the fact that tuberculous pleuritis is a paucibacillary disease&#46; However&#44; yield can be greatly increased by using liquid culture media &#40;63&#37; sensitivity in a series of 382 pleural tuberculosis cases&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">This study has certain limitations&#46; Only patients undergoing diagnostic thoracentesis were included&#46; This could mean that some PE etiologies are poorly represented&#44; such as heart failure &#40;many patients presenting with characteristic symptoms are diagnosed with pericardial effusion and do not undergo thoracentesis&#41; or pulmonary embolism &#40;effusion is generally insignificant and the patient is usually given anticoagulants while awaiting confirmatory lab results&#41;&#46; In addition&#44; the lack of cardiothoracic surgery services in our hospital could explain the paucity of PE cases associated with these procedures&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In conclusion&#44; cancer&#44; pneumonia and tuberculosis are the causes of most pleural exudates&#44; while heart failure is the main cause of transudates&#46; Pericardial and hepatic hydrothorax conditions are also relatively frequent causes of PE&#46; Pleural tuberculosis predominates in young adults&#44; while in octogenarians the main etiology is heart failure&#46; The bacterial yield from infectious pleural effusion culture is low&#44; except in the case of purulent PF&#46; Likewise&#44; solid medium culture identifies very few cases of tuberculous PE&#46; PF cytology is a simple method for diagnosing malignancies&#44; although it can yield false negatives in at least 40&#37; of cases&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0145" class="elsevierStylePara elsevierViewall">No funding was received for this study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of Interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Causes of Pleural Effusion"
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              "titulo" => "Malignant Pleural Effusion"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To investigate the etiology of pleural effusions &#40;PE&#41; in adults and the accuracy of pleural fluid &#40;PF&#41; cytology and cultures in malignant and infectious PE&#44; respectively&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of all consecutive patients with PE undergoing diagnostic thoracentesis during the last 19 years in a university hospital&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The leading causes of PE among the 3077 patients were cancer &#40;27&#37;&#41;&#44; heart failure &#40;21&#37;&#41;&#44; pneumonia &#40;19&#37;&#41;&#44; tuberculosis &#40;9&#37;&#41;&#44; abdominal surgery &#40;4&#37;&#41;&#44; pericardial diseases &#40;4&#37;&#41; and cirrhosis &#40;3&#37;&#41;&#46; Tuberculosis was the most common etiology in patients &#60;34 years of age &#40;52&#37;&#41;&#44; whereas heart failure predominated in octogenarians &#40;45&#37;&#41;&#46; The most common primary tumors in malignant PE were lung &#40;37&#37;&#41; and breast &#40;16&#37;&#41; tumors&#46; The overall accuracy of PF cytology was 59&#37;&#44; although it was significantly lower in mesotheliomas &#40;27&#37;&#41; and squamous cell lung cancer &#40;25&#37;&#41;&#46; In infectious PE&#44; only 30&#37; of cultures yielded positive results&#44; a percentage which increased two-fold &#40;66&#37;&#41; in purulent fluids &#40;empyemas&#41;&#46; Viridans streptococci were the most commonly isolated pathogens &#40;25&#46;5&#37;&#41;&#46; The sensitivity of solid media cultures of PF for <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> was low &#40;18&#46;5&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Three quarters of patients with PE in whom a diagnostic thoracentesis was indicated had cancer&#44; heart failure&#44; pneumonia or tuberculosis&#46; PF cytology and cultures give false negative results in a significant number of cases&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer la etiolog&#237;a del derrame pleural &#40;DP&#41; en pacientes adultos y la rentabilidad de la citolog&#237;a y del cultivo de l&#237;quido pleural &#40;LP&#41; en DP malignos e infecciosos&#44; respectivamente&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de todos los pacientes consecutivos con DP sometidos a una toracocentesis diagn&#243;stica durante los &#250;ltimos 19 a&#241;os en un hospital universitario&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las principales causas de DP en los 3&#46;077 pacientes estudiados fueron&#58; c&#225;ncer &#40;27&#37;&#41;&#44; insuficiencia cardiaca &#40;21&#37;&#41;&#44; neumon&#237;a &#40;19&#37;&#41;&#44; tuberculosis &#40;9&#37;&#41;&#44; cirug&#237;a abdominal &#40;4&#37;&#41;&#44; enfermedades del pericardio &#40;4&#37;&#41; y cirrosis &#40;3&#37;&#41;&#46; La tuberculosis fue la etiolog&#237;a m&#225;s com&#250;n en pacientes<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>34 a&#241;os &#40;52&#37;&#41;&#44; mientras que la insuficiencia cardiaca lo fue en octogenarios &#40;45&#37;&#41;&#46; Entre los DP malignos&#44; los tumores primarios m&#225;s comunes fueron el de pulm&#243;n &#40;37&#37;&#41; y el de mama &#40;16&#37;&#41;&#46; La citolog&#237;a del LP tuvo una rentabilidad global del 59&#37;&#44; pero fue significativamente inferior en mesoteliomas &#40;27&#37;&#41; y carcinomas escamosos de pulm&#243;n &#40;25&#37;&#41;&#46; En pacientes con DP infecciosos&#44; solo el 30&#37; de los cultivos del LP resultaron positivos&#44; un porcentaje que se duplic&#243; &#40;66&#37;&#41; cuando el l&#237;quido era purulento &#40;empiemas&#41;&#46; Los estreptococos del grupo <span class="elsevierStyleItalic">viridans</span> representaron el 25&#44;5&#37; del total de aislamientos&#46; El cultivo del LP en medio s&#243;lido para <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> tuvo escasa sensibilidad &#40;18&#44;5&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las 3 cuartas partes de los pacientes con un DP en los que se indica la realizaci&#243;n de una toracocentesis diagn&#243;stica tienen una neoplasia&#44; insuficiencia cardiaca&#44; neumon&#237;a o tuberculosis&#46; La citolog&#237;a y los cultivos del LP son falsamente negativos en un porcentaje significativo de casos&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Please cite this article as&#58; Porcel JM&#44; Esquerda A&#44; Vives M&#44; Bielsa S&#46; Etiolog&#237;a del derrame pleural&#58; an&#225;lisis de m&#225;s de 3&#46;000 toracocentesis consecutivas&#46; Arch Bronconeumol&#46; 2014&#59;50&#58;161&#8211;165&#46;</p>"
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                  \t\t\t\t">582 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">202&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">216&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">491&#47;831 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab494008.png"
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            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Includes unknown &#40;34&#41;&#44; non-strain specific non-small cell &#40;18&#41;&#44; non-differentiated &#40;2&#41; and sarcoma &#40;1&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Includes non-Hodgkin&#39;s lymphoma &#40;61&#41;&#44; leukemia &#40;9&#41;&#44; myelodysplastic syndromes &#40;5&#41;&#44; multiple myeloma &#40;5&#41; and Hodgkin&#39;s lymphoma &#40;2&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Includes colon &#40;25&#41;&#44; stomach &#40;22&#41;&#44; pancreas &#40;15&#41;&#44; esophagus &#40;5&#41;&#44; bile duct &#40;3&#41; and gastrointestinal stromal tumor &#40;1&#41;&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Includes kidney &#40;21&#41;&#44; endometrial &#40;12&#41;&#44; melanoma &#40;10&#41;&#44; head and neck &#40;9&#41;&#44; prostate &#40;6&#41;&#44; sarcomas &#40;6&#41;&#44; bladder &#40;4&#41;&#44; thymoma &#40;3&#41;&#44; thyroid &#40;3&#41;&#44; vulva &#40;2&#41;&#44; adrenal &#40;1&#41; and pleural epithelioid hemangioendothelioma &#40;1&#41;&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Significantly lower than other histological types of lung cancer &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Significantly lower than the other groups &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;002&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Causes of Malignant Pleural Effusion and Accuracy of Pleural Fluid Cytology&#46;</p>"
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      ]
      2 => array:7 [
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">pathogens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gram-positive bacteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Streptococci &#40;<span class="elsevierStyleItalic">viridans</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Staphylococcus aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enterococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coagulase-negative staphylococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Streptococci &#946;-blood groups A and B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other Gram-positive bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Gram-negative bacteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enterobacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other Gram-negative bacteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anaerobic bacteria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mycoses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Candida</span> spp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rhodotorula</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Microbial Isolates in Pleural Fluid&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Causes of pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mart&#237;nez-Berganza and C&#237;a-G&#243;mez&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 1988 &#40;n&#61;484&#41;No<span class="elsevierStyleItalic">&#46;</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Vald&#233;s et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> 1996 &#40;n&#61;642&#41;No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Villena et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> 2002 &#40;n&#61;1000&#41;No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">This series &#40;n&#61;3077&#41;No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cancer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">364 &#40;36&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">840 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">640 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Pneumonia or infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 &#40;24&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">130 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">582 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Tuberculosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">160 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">155 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">396 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">512 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">739 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2337 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:22 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of pleural effusions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Porcel"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hosp Med Clin"
                        "fecha" => "2013"
                        "volumen" => "2"
                        "paginaInicial" => "e337"
                        "paginaFinal" => "e357"
                      ]
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                  ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiolog&#237;a de las enfermedades de la pleura&#46; A prop&#243;sito de 562 casos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Mart&#237;nez-Berganza"
                            1 => "P&#46; C&#237;a-G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "1988"
                        "volumen" => "90"
                        "paginaInicial" => "311"
                        "paginaFinal" => "315"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The etiology of pleural effusions in an area with high incidence of tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Vald&#233;s"
                            1 => "D&#46; Alvarez"
                            2 => "J&#46;M&#46; Valle"
                            3 => "A&#46; Pose"
                            4 => "E&#46; San Jos&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "109"
                        "paginaInicial" => "158"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8549179"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio prospectivo de 1&#46;000 pacientes consecutivos con derrame pleural&#46; Etiolog&#237;a del derrame y caracter&#237;sticas cl&#237;nicas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Villena"
                            1 => "A&#46; L&#243;pez-Encuentra"
                            2 => "J&#46; Echave-Sustaeta"
                            3 => "C&#46; &#193;lvarez-Mart&#237;nez"
                            4 => "P&#46; Mart&#237;n-Escribano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2002"
                        "volumen" => "38"
                        "paginaInicial" => "21"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11809133"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Light criteria&#58; the beginning and why they are useful 40 years later"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;W&#46; Light"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccm.2012.11.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "21"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23411053"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recent epidemiological trends in tuberculous pleural effusion in Galicia&#44; Spain"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Vald&#233;s"
                            1 => "L&#46; Ferreiro"
                            2 => "E&#46; Cruz-Ferro"
                            3 => "F&#46;J&#46; Gonz&#225;lez-Barcala"
                            4 => "F&#46; Gude"
                            5 => "M&#46;I&#46; Urs&#250;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejim.2012.06.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Intern Med"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "727"
                        "paginaFinal" => "732"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22818626"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying transudates misclassified by Light&#39;s criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Porcel"
                          ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/MCP.0b013e32836022dc"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "362"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23508114"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Romero-Candeira"
                            1 => "L&#46; Hern&#225;ndez-Blasco"
                            2 => "M&#46;J&#46; Soler"
                            3 => "A&#46; Mu&#241;oz"
                            4 => "I&#46; Aranda"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2002"
                        "volumen" => "121"
                        "paginaInicial" => "465"
                        "paginaFinal" => "469"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11834658"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0045"
              "etiqueta" => "9"
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                      "titulo" => "Etiology and prognostic significance of massive pleural effusions"
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                            2 => "D&#46; Gil"
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                            4 => "E&#46; P&#233;rez-Rodriguez"
                            5 => "A&#46; Sueiro"
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                        "tituloSerie" => "Respir Med"
                        "fecha" => "2005"
                        "volumen" => "99"
                        "paginaInicial" => "1183"
                        "paginaFinal" => "1187"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
                        ]
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                  ]
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              "etiqueta" => "10"
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                      "titulo" => "Contarini&#39;s syndrome&#58; bilateral pleural effusion&#44; each side from different causes"
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                          "etal" => false
                          "autores" => array:4 [
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                            1 => "M&#46;C&#46; Civit"
                            2 => "S&#46; Bielsa"
                            3 => "R&#46;W&#46; Light"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1002/jhm.981"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hosp Med"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "164"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22042579"
                            "web" => "Medline"
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              "identificador" => "bib0055"
              "etiqueta" => "11"
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                      "titulo" => "Management of a malignant pleural effusion&#58; British Thoracic Society pleural disease guideline 2010"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;E&#46; Roberts"
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                            4 => "N&#46;J&#46; Ali"
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                        "tituloSerie" => "Thorax"
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                        "link" => array:1 [
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                            "web" => "Medline"
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              "identificador" => "bib0060"
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                    0 => array:2 [
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19018161"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0065"
              "etiqueta" => "13"
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                      "titulo" => "A diagnosis of malignant pleural mesothelioma can be made by effusion cytology&#58; results of a 20 year audit"
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                            5 => "A&#46;W&#46; Musk"
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                            "web" => "Medline"
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                      "titulo" => "Thoracic empyema&#58; a 12-year study from a UK tertiary cardiothoracic referral centre"
                      "autores" => array:1 [
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                          "etal" => true
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                            3 => "M&#46; Pavlou"
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                    0 => array:2 [
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22276145"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The bacteriology of pleural infection by genetic and standard methods and its mortality significance"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;A&#46; Maskell"
                            1 => "S&#46; Batt"
                            2 => "E&#46;L&#46; Hedley"
                            3 => "C&#46;W&#46;H&#46; Davies"
                            4 => "S&#46;H&#46; Gillespie"
                            5 => "R&#46;J&#46;O&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200601-074OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "174"
                        "paginaInicial" => "817"
                        "paginaFinal" => "823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16840746"
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                          ]
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                ]
              ]
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              "etiqueta" => "17"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pleural infections&#58; a 9-year review of bacteriology&#44; case characteristics and mortality"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            3 => "R&#46; Fader"
                            4 => "P&#46; Quiroga"
                            5 => "A&#46;C&#46; Arroliga"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/MAJ.0b013e318259bd24"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Med Sci"
                        "fecha" => "2013"
                        "volumen" => "345"
                        "paginaInicial" => "349"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23044652"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood culture bottle culture of pleural fluid in pleural infection"
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Menzies"
                            1 => "N&#46;M&#46; Rahman"
                            2 => "J&#46;M&#46; Wrightson"
                            3 => "H&#46;E&#46; Davies"
                            4 => "R&#46; Shorten"
                            5 => "S&#46;H&#46; Gillespie"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Thorax"
                        "fecha" => "2011"
                        "volumen" => "66"
                        "paginaInicial" => "658"
                        "paginaFinal" => "662"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21459855"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic use of universal 16S rRNA gene polymerase chain reaction &#40;PCR&#41; and sequencing for processing pleural effusions improves conventional culture techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Mar&#237;n"
                            2 => "A&#46; Mart&#237;n"
                            3 => "P&#46; Mart&#237;n-Rabad&#225;n"
                            4 => "L&#46; Alcal&#225;"
                            5 => "E&#46; Cercenado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Medicine &#40;Baltimore&#41;"
                        "fecha" => "2012"
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                        "paginaInicial" => "103"
                        "paginaFinal" => "110"
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                          "pii" => "S1699258X11003172"
                          "estado" => "S300"
                          "issn" => "1699258X"
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                    ]
                  ]
                ]
              ]
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            19 => array:3 [
              "identificador" => "bib0100"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved diagnosis of pleural tuberculosis using the microscopic-observation drug-susceptibility technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Tovar"
                            1 => "M&#46;J&#46; Siedner"
                            2 => "R&#46;H&#46; Gilman"
                            3 => "C&#46; Santillan"
                            4 => "L&#46; Caviedes"
                            5 => "T&#46; Valencia"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/527447"
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                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "paginaInicial" => "909"
                        "paginaFinal" => "912"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18300380"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone&#63;"
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                          "autores" => array:5 [
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                            3 => "J&#46;M&#46; &#193;lvarez-Doba&#241;o"
                            4 => "L&#46; Vald&#233;s"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5588/ijtld.12.0892"
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                        "tituloSerie" => "Int J Tuberc Lung Dis"
                        "fecha" => "2013"
                        "volumen" => "17"
                        "paginaInicial" => "787"
                        "paginaFinal" => "793"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23676163"
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                          ]
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                    ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Revisiting tuberculous pleurisy&#58; pleural fluid characteristics and diagnostic yield of mycobacterial culture in an endemic area"
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                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1136/thoraxjnl-2011-201363"
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                        "fecha" => "2012"
                        "volumen" => "67"
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                        "paginaFinal" => "827"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22436167"
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