Letter to the Editor
Leukemic Pleural Effusion: Diagnostic Approach and Controversies in Pleurodesis
Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis
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and Pericardial Effusion in a Patient With Polymyalgia Rheumatica" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "370" "paginaFinal" => "371" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural y pericárdico en una paciente con polimialgia reumática" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 1450 "Tamanyo" => 129471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing small left pleural effusion and minimal pericardial effusion.</p>" ] ] ] "autores" => array:1 [ 0 => 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array:3 [ "nombre" => "Josep Miquel" "apellidos" => "Bauça" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Bernardo" "apellidos" => "López Andrade" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Universitario Son Espases, Palma de Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 983 "Tamanyo" => 177472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of pleural fluid, showing cells with lax and immature chromatin, raised nuclear–cytoplasmic ratio and visible nucleoli, compatible with myeloblasts (May-Grünwald/Giemsa staining, 1000×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The most common causes of pleural effusion in patients with acute myeloid leukemia (AML) are infections (bacterial or viral), other malignancy, chemotherapy and those derived from the malignant process itself. Survival is determined by response to treatment of the hematological disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A minimum sample volume of 60<span class="elsevierStyleHsp" style=""></span>mL is required for the cytomorphological diagnosis of malignancy in pleural fluid.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In cases of pleural effusion refractory to treatment of the underlying disease, pleurodesis must be performed to control respiratory symptoms.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This letter reports the case of a 76-year-old patient with AML diagnosed 2 months previously with compatible bone marrow phenotype and normal cytogenetic results (46,XY[15]) who had received 3 cycles of 5-azacitidine.</p><p id="par0025" class="elsevierStylePara elsevierViewall">He was admitted for dyspnea, 38<span class="elsevierStyleHsp" style=""></span>°C fever and tachycardia (120<span class="elsevierStyleHsp" style=""></span>bpm). He had leukocytosis (45<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L), anemia (hemoglobin 88<span class="elsevierStyleHsp" style=""></span>g/L), thrombocytosis (719<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L) and serum lactate dehydrogenase (LDH) 1.663<span class="elsevierStyleHsp" style=""></span>IU/L (normal: 125–220<span class="elsevierStyleHsp" style=""></span>IU/L). Chest X-ray and computed tomography showed significant left pleural effusion.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 90<span class="elsevierStyleHsp" style=""></span>mL of pleural fluid were obtained by thoracocentesis. This contained 1200 lymphocytes/μL (normal: <200/μL), glucose 52<span class="elsevierStyleHsp" style=""></span>mg/dL (normal: 70–110<span class="elsevierStyleHsp" style=""></span>mg/dL), LDH 1724<span class="elsevierStyleHsp" style=""></span>IU/L (normal: 125–220<span class="elsevierStyleHsp" style=""></span>IU/L) and pH was 7.38. Microbiological cultures were negative. Cytocentrifugation and May-Grünwald/Giemsa staining of the pleural fluid were performed for microscopic examination (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The presence of myeloblasts in pleural fluid was confirmed by flow cytometry immunophenotyping (CD34, CD33, CD13 and CD117, but not CD14 or CD15). Cytogenetic examination with G-banding was normal, consistent with the patient's AML phenotype.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A diagnosis of leukemic pleural effusion was established and pleural drainage was performed, with little response. One week later, the patient required pleurodesis with bleomycin to control dyspnea derived from worsening pleural effusion. His respiratory syndrome worsened progressively until exitus at 15 days.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the case of leukemic pleural effusion, the clonal cell line must be confirmed with fluorescence <span class="elsevierStyleItalic">in situ</span> hybridization (FISH).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In the routine screening of these patients for the indication of pleurodesis, there is no clear correlation between pleural fluid pH and survival; clinical status appears to be the best predictor for post-pleurodesis survival.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In patients who have not previously undergone pleurodesis, no significant differences in dyspnea relief have been found between permanent pleural catheter drainage and talc pleurodesis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Both bleomycin and talc have been shown to be good sclerosing agents, with similar efficacy in pleurodesis for the control of symptomatic malignant pleural effusion. Although bleomycin was used in our patient, it is important to note that talc is cheaper and may have the same or better success rate in the reduction of recurrent malignant pleural effusion than bleomycin and other sclerosing agents, although this difference has not been shown to be statistically significant.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The use of many sclerosing agents in pleurodesis has been reported, including iodized povidone, doxycycline, silver nitrate, interferon alpha-2b and others. Good results have been documented, but disparity in the design of these studies make comparison difficult. Future studies are required to reach a consensus on the best method of pleurodesis in these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morell-García D, Bauça JM, López Andrade B. Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis. Arch Bronconeumol. 2014;50:371–372.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 736 "Ancho" => 983 "Tamanyo" => 177472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of pleural fluid, showing cells with lax and immature chromatin, raised nuclear–cytoplasmic ratio and visible nucleoli, compatible with myeloblasts (May-Grünwald/Giemsa staining, 1000×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural effusions in patients with acute leukemia and myelodysplastic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Faiz" 1 => "L. Bashoura" 2 => "X. Lei" 3 => "K.R. Sampat" 4 => "T.C. Brown" 5 => "G.A. Eapen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/10428194.2012.713478" "Revista" => array:6 [ "tituloSerie" => "Leuk Lymphoma" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "329" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22812422" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective study to determine the volume of pleural fluid required to diagnose malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Swiderek" 1 => "S. Morcos" 2 => "V. Donthireddy" 3 => "R. Surapaneni" 4 => "V. Jackson-Thompson" 5 => "L. Schultz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-0641" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "68" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19741064" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukaemic pleural effusion in acute myeloid leukaemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.C. Ou" 1 => "W.L. Hwang" 2 => "C.L. Teng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Br J Haematol" "fecha" => "2011" "volumen" => "154" "paginaInicial" => "669" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.E. Davies" 1 => "E.K. Mishra" 2 => "B.C. Kahan" 3 => "J.M. Wrightson" 4 => "A.E. Stanton" 5 => "A. Guhan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Med Assoc" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "2383" "paginaFinal" => "2389" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The evidence on the effectiveness of management for malignant pleural effusion: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Tan" 1 => "A. Sedrakyan" 2 => "J. Browne" 3 => "S. Swift" 4 => "T. Treasure" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2005.12.025" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "829" "paginaFinal" => "838" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16626967" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000008/v1_201407200014/S1579212914001748/v1_201407200014/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000008/v1_201407200014/S1579212914001748/v1_201407200014/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001748?idApp=UINPBA00003Z" ]
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| 2021 August | 100 | 44 | 144 |
| 2021 July | 156 | 34 | 190 |
| 2021 June | 124 | 52 | 176 |
| 2021 May | 118 | 27 | 145 |
| 2021 April | 198 | 93 | 291 |
| 2021 March | 149 | 61 | 210 |
| 2021 February | 101 | 25 | 126 |
| 2021 January | 76 | 22 | 98 |
| 2020 December | 85 | 23 | 108 |
| 2020 November | 77 | 19 | 96 |
| 2020 October | 47 | 7 | 54 |
| 2020 September | 90 | 5 | 95 |
| 2020 August | 74 | 20 | 94 |
| 2020 July | 80 | 24 | 104 |
| 2020 June | 88 | 8 | 96 |
| 2020 May | 75 | 17 | 92 |
| 2020 April | 73 | 31 | 104 |
| 2020 March | 73 | 25 | 98 |
| 2020 February | 97 | 18 | 115 |
| 2020 January | 87 | 15 | 102 |
| 2019 December | 128 | 32 | 160 |
| 2019 November | 80 | 16 | 96 |
| 2019 October | 73 | 14 | 87 |
| 2019 September | 95 | 24 | 119 |
| 2019 August | 57 | 18 | 75 |
| 2019 July | 70 | 25 | 95 |
| 2019 June | 64 | 21 | 85 |
| 2019 May | 71 | 23 | 94 |
| 2019 April | 106 | 29 | 135 |
| 2019 March | 85 | 22 | 107 |
| 2019 February | 71 | 17 | 88 |
| 2019 January | 97 | 20 | 117 |
| 2018 December | 80 | 19 | 99 |
| 2018 November | 158 | 27 | 185 |
| 2018 October | 187 | 21 | 208 |
| 2018 September | 97 | 12 | 109 |
| 2018 May | 45 | 1 | 46 |
| 2018 April | 78 | 5 | 83 |
| 2018 March | 124 | 2 | 126 |
| 2018 February | 66 | 8 | 74 |
| 2018 January | 136 | 6 | 142 |
| 2017 December | 117 | 6 | 123 |
| 2017 November | 61 | 6 | 67 |
| 2017 October | 48 | 12 | 60 |
| 2017 September | 68 | 7 | 75 |
| 2017 August | 61 | 10 | 71 |
| 2017 July | 72 | 7 | 79 |
| 2017 June | 79 | 9 | 88 |
| 2017 May | 77 | 4 | 81 |
| 2017 April | 81 | 13 | 94 |
| 2017 March | 66 | 2 | 68 |
| 2017 February | 51 | 4 | 55 |
| 2017 January | 52 | 4 | 56 |
| 2016 December | 48 | 7 | 55 |
| 2016 November | 136 | 5 | 141 |
| 2016 October | 80 | 18 | 98 |
| 2016 September | 116 | 18 | 134 |
| 2016 August | 91 | 7 | 98 |
| 2016 July | 41 | 11 | 52 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 45 | 1 | 46 |
| 2015 September | 57 | 9 | 66 |
| 2015 August | 42 | 6 | 48 |
| 2015 July | 46 | 10 | 56 |
| 2015 June | 44 | 6 | 50 |
| 2015 May | 37 | 4 | 41 |
| 2015 April | 27 | 7 | 34 |
| 2015 March | 30 | 3 | 33 |
| 2015 February | 27 | 6 | 33 |
| 2015 January | 37 | 10 | 47 |
| 2014 December | 32 | 11 | 43 |
| 2014 November | 20 | 12 | 32 |
| 2014 October | 2 | 0 | 2 |
| 2014 September | 0 | 1 | 1 |
Show all
