Multidisciplinary Management of Paget-Schroetter Syndrome. A Case Series of Eight Patients

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A Case Series of Eight Patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e41" "paginaFinal" => "e43" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Vladimir Rosa Salazar, Sonia del Pilar Otálora Valderrama, María Encarnación Hernández Contreras, Bartolomé García Pérez, Andrés del Amor Arroyo Tristán, María del Mar García Méndez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Vladimir" "apellidos" => "Rosa Salazar" "email" => array:1 [ 0 => "Vladi_medico@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sonia del Pilar" "apellidos" => "Otálora Valderrama" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Encarnación" "apellidos" => "Hernández Contreras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Bartolomé" "apellidos" => "García Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Andrés del Amor" "apellidos" => "Arroyo Tristán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "María del Mar" "apellidos" => "García Méndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Corta Estancia/Trombosis, Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo multidisciplinar del síndrome de Paget-Schroetter. A propósito de una serie de 8 casos" ] ] "textoCompleto" => "IntroductionPaget-Schroetter syndrome (PSS) refers to primary deep vein thrombosis (DVT) at the costoclavicular junction, where the subclavian vein is highly vulnerable to injury as it passes by the junction of the first rib and clavicle in the most anterior part of the thoracic outlet. Repetitive forced abduction and retroversion movements of the arm can damage the innermost layer of the vessel, generating a thrombogenic surface and extrinsic scar tissue, which triggers this entity.<a class="elsevierStyleCrossRef" href="#bib0040">1</a>PSS has an estimated prevalence of around 30% of cases of upper extremity DVT and 1%–4% of all DVT; the mean age at presentation is between 30 and 40 years, predominantly in men, in the dominant upper limb, and in relation to activities requiring effort.<a class="elsevierStyleCrossRefs" href="#bib0045">2,3</a>Clinical manifestations vary in severity, but the disease generally presents as axillo-humeral pain, edema in the extremity, cyanosis and collateral circulation at shoulder level.Doppler ultrasound is usually the first diagnostic test, with specificity of 93% and sensitivity greater than 80%.<a class="elsevierStyleCrossRefs" href="#bib0050">3,4</a> Other imaging studies, such as computed tomography (CT) or nuclear magnetic resonance imaging (MRI) are suitable for investigating other causes of compression or confirming the diagnosis when there is high suspicion of the condition, but normal ultrasound findings (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>When not treated promptly, an intraluminal fibrotic reaction is generated that leads to chronic venous hypertension and onset of post-thrombotic syndrome (PTS), which in some cases can cause significant functional discapacity and severely impair quality of life.<a class="elsevierStyleCrossRef" href="#bib0050">3</a>The most effective therapeutic strategy is controversial. Current guidelines recommend conventional anticoagulation, although they consider the possibility of catheter-guided local thrombolysis and thoracic outlet release surgery in experienced centers.<a class="elsevierStyleCrossRef" href="#bib0060">5</a>Clinical ObservationA prospective study was conducted between November 2011 and May 2013 in 5 men and 3 women with acute symptoms consistent with PSS, in whom DVT was confirmed by Doppler ultrasound. After admission, an established protocol was applied, which included:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Detailed medical history.</li><li class="elsevierStyleListItem" id="lsti0010">-Complete laboratory workup with D-dimer.</li><li class="elsevierStyleListItem" id="lsti0015">-Dynamic CT of the affected limb.</li><li class="elsevierStyleListItem" id="lsti0020">-Initial venography with placement of a multihole catheter upstream of the occlusion, using the basilic vein approach.</li><li class="elsevierStyleListItem" id="lsti0025">-Local thrombolysis with urokinase (100000IU/100ml/h).</li><li class="elsevierStyleListItem" id="lsti0030">-Follow-up venography. The thrombolysis is considered successful if no residual thrombus is detected on the follow-up venography, partially successful if the persistent thrombus is less than 50% of the initial thrombus, and unsuccessful if the persistent thrombus is greater than 50% of the initial thrombus.</li><li class="elsevierStyleListItem" id="lsti0035">-Low molecular weight heparin (LMWH) at therapeutic doses.</li><li class="elsevierStyleListItem" id="lsti0040">-Thoracic outlet decompression surgery, which included disinsertion of the anterior scalene muscle and transaxillary first rib resection, as per the Roos technique, within 16 weeks of diagnosis.</li><li class="elsevierStyleListItem" id="lsti0045">-LMWH for 1 month at therapeutic doses.</li><li class="elsevierStyleListItem" id="lsti0050">-Thrombophilia study 3 months after the surgery.</li><li class="elsevierStyleListItem" id="lsti0055">-Clinical follow-up every 6 months to date, with assessment of the PTS using the Villalta scale<a class="elsevierStyleCrossRef" href="#bib0065">6</a> at each follow-up visit.</li></ul>Following implementation of the protocol, none of the patients have presented complications or thrombotic recurrences to date. One of the 8 patients presented mild PTS on the Villalta scale, although this did not prevent him from carrying out his daily work activities.DiscussionFor many years, the treatment of PSS has included elevation of the extremity and anticoagulation, with surgery considered only when symptoms recur.<a class="elsevierStyleCrossRefs" href="#bib0040">1,4</a> Current guidelines recommend initial treatment with parenteral anticoagulation for at least 3 months, over no such initial treatment. Similarly, in selected patients with a low risk for bleeding and severe symptoms of recent onset, catheter-directed thrombolysis is recommended in experienced centers. First rib resection and scalene muscle disinsertion when subclavian vein entrapment is suspected are also recommended.<a class="elsevierStyleCrossRef" href="#bib0060">5</a>The use of anticoagulants as monotherapy is now being questioned after some studies found residual venous obstruction in close to 80% of patients, and persistent venous congestion symptoms in up to 90% of patients receiving this treatment.<a class="elsevierStyleCrossRef" href="#bib0055">4</a>Opinions differ with regard to the best time to perform surgery. However, studies with longer series have compared surgical times and found that thrombolysis followed by early surgery is the strategy with the best clinical outcomes.<a class="elsevierStyleCrossRefs" href="#bib0060">5,7</a>ConclusionsPSS is a rare entity affecting young, healthy individuals, and early diagnosis is the key to obtaining adequate venous patency. In our case series, early diagnosis and treatment, following the recommendations of the most advanced studies, has so far led to favorable evolution and outcomes in our patients. Multidisciplinary management using local catheter-directed thrombolysis and early decompressive surgery performed by an experienced multidisciplinary medical team shows satisfactory results, with no major complications and a far lower incidence of PTS compared with conservative treatment.Conflict of InterestsThe authors declare that they have no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres580698" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec597198" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres580699" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec597197" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Observation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-03-22" "fechaAceptado" => "2014-09-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec597198" "palabras" => array:4 [ 0 => "Paget-Schroetter syndrome" 1 => "Upper extremity deep vein thrombosis" 2 => "Thoracic outlet syndrome" 3 => "Effort thrombosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec597197" "palabras" => array:4 [ 0 => "Síndrome de Paget-Schroetter" 1 => "Trombosis venosa profunda de extremidad superior" 2 => "Síndrome de la salida del tórax" 3 => "Trombosis de esfuerzo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Paget-Schroetter syndrome (PSS) in the context of upper extremity deep venous thrombosis (DVT) is an uncommon but potentially very serious condition affecting young, healthy adults, in which secondary post-thrombotic syndrome (PTS) can be a complication with major implications. The best treatment option remains controversial, with current guidelines recommending anticoagulation for at least 3 months. However, an incidence of PTS of approximately 50% after 6 months, 30% after 1 year and 25% after 2 years has been found using this therapeutic approach. Consequently, specialized units recommend local thrombolysis and early decompressive surgery. We describe a series of eight cases treated in this way. None of the patients showed signs of complications, and an early return to regular activities with no PTS was observed in 90% of cases." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El síndrome de Paget-Schroetter (SPS) en el contexto de trombosis venosa profunda (TVP) de miembro superior es una patología poco frecuente pero de gran importancia por afectar personas sanas y jóvenes, donde el síndrome postrombótico (SPT) secundario puede ser una complicación con importantes implicaciones. La mejor opción de tratamiento es controvertida. Las guías actuales recomiendan anticoagulación durante un mínimo de 3 meses, aunque se han visto con este manejo incidencias de SPT cercanas al 50% a los 6 meses, al 30% al año y al 25% a los 2 años, por lo que unidades especializadas abogan por la realización de trombólisis local y cirugía descompresiva precoz, con el propósito de disminuir estas cifras. Describimos una serie de 8 casos, a los que tratamos de esta última manera. Ningún paciente presentó complicaciones, y en todos se observó reintegro precoz a la actividad diaria, con ausencia de SPT en el 90% de ellos." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Rosa Salazar V, Otálora Valderrama SP, Hernández Contreras ME, García Pérez B, Arroyo Tristán AA, García Méndez MM. Manejo multidisciplinar del síndrome de Paget-Schroetter. A propósito de una serie de 8 casos. Arch Bronconeumol. 2015;51:e41–e43." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "PMF: predisposing mechanical factor." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 3 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 5 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 6 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 7 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 8 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87kg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PMF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bodybuilding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Use of crutches \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lifting weight in a sweet factory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bodybuilding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Warehouse assistant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Canoeist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cook \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bodybuilding \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Side \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">D-Dimer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">670ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1930ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3830ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1950ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8600ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1380ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">540ng/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">310ng/ml \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Doppler \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Thrombophilia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Thrombolysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Partially successful (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Successful \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">LMWH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tinzaparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bemiparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Enoxaparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bemiparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tinzaparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bemiparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tinzaparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Tinzaparin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">117 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">117 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">110 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time free of thrombotic recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">971 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">849 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">634 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">605 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">532 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">510 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">456 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">279 days \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab947544.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical Characteristics of Patients Included in the Study." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comprehensive review of Paget-Schroetter syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.A. Illig" 1 => "A.J. Doyle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvs.2009.12.022" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2010" "volumen" => "51" "paginaInicial" => "1538" "paginaFinal" => "1547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20304578" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hipertensión pulmonar tromboembólica crónica debida a trombosis venosa profunda de miembro superior por síndrome del desfiladero torácico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.M. Ferrer" 1 => "P.L. Jara" 2 => "E.C. Caballero" 3 => "V.J. López" 4 => "H.T. Elías" 5 => "C.R. 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Comerota" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Interv Cardiol" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "103" "paginaFinal" => "115" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contemporary management of axillosubclavian vein thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.J. Bailey" 1 => "K.A. Illig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Interv Cardiol" "fecha" => "2013" "volumen" => "5" "paginaInicial" => "453" "paginaFinal" => "463" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians. 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Case report

Multidisciplinary Management of Paget-Schroetter Syndrome. A Case Series of Eight Patients

Manejo multidisciplinar del síndrome de Paget-Schroetter. A propósito de una serie de 8 casos

Vladimir Rosa Salazara,

Corresponding author

Vladi_medico@yahoo.es

Corresponding author.

, Sonia del Pilar Otálora Valderramab, María Encarnación Hernández Contrerasa, Bartolomé García Péreza, Andrés del Amor Arroyo Tristánc, María del Mar García Méndeza

a Unidad de Corta Estancia/Trombosis, Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

b Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

c Servicio de Cirugía Torácica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

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        "titulo" => "Manejo multidisciplinar del s&#237;ndrome de Paget-Schroetter&#46; A prop&#243;sito de una serie de 8 casos"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Paget-Schroetter syndrome &#40;PSS&#41; refers to primary deep vein thrombosis &#40;DVT&#41; at the costoclavicular junction&#44; where the subclavian vein is highly vulnerable to injury as it passes by the junction of the first rib and clavicle in the most anterior part of the thoracic outlet&#46; Repetitive forced abduction and retroversion movements of the arm can damage the innermost layer of the vessel&#44; generating a thrombogenic surface and extrinsic scar tissue&#44; which triggers this entity&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">PSS has an estimated prevalence of around 30&#37; of cases of upper extremity DVT and 1&#37;&#8211;4&#37; of all DVT&#59; the mean age at presentation is between 30 and 40 years&#44; predominantly in men&#44; in the dominant upper limb&#44; and in relation to activities requiring effort&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical manifestations vary in severity&#44; but the disease generally presents as axillo-humeral pain&#44; edema in the extremity&#44; cyanosis and collateral circulation at shoulder level&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Doppler ultrasound is usually the first diagnostic test&#44; with specificity of 93&#37; and sensitivity greater than 80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#44;4</span></a> Other imaging studies&#44; such as computed tomography &#40;CT&#41; or nuclear magnetic resonance imaging &#40;MRI&#41; are suitable for investigating other causes of compression or confirming the diagnosis when there is high suspicion of the condition&#44; but normal ultrasound findings &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">When not treated promptly&#44; an intraluminal fibrotic reaction is generated that leads to chronic venous hypertension and onset of post-thrombotic syndrome &#40;PTS&#41;&#44; which in some cases can cause significant functional discapacity and severely impair quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The most effective therapeutic strategy is controversial&#46; Current guidelines recommend conventional anticoagulation&#44; although they consider the possibility of catheter-guided local thrombolysis and thoracic outlet release surgery in experienced centers&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><p id="par0035" class="elsevierStylePara elsevierViewall">A prospective study was conducted between November 2011 and May 2013 in 5 men and 3 women with acute symptoms consistent with PSS&#44; in whom DVT was confirmed by Doppler ultrasound&#46; After admission&#44; an established protocol was applied&#44; which included&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Detailed medical history&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Complete laboratory workup with D-dimer&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Dynamic CT of the affected limb&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Initial venography with placement of a multihole catheter upstream of the occlusion&#44; using the basilic vein approach&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Local thrombolysis with urokinase &#40;100<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>IU&#47;100<span class="elsevierStyleHsp" style=""></span>ml&#47;h&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Follow-up venography&#46; The thrombolysis is considered <span class="elsevierStyleItalic">successful</span> if no residual thrombus is detected on the follow-up venography&#44; <span class="elsevierStyleItalic">partially successful</span> if the persistent thrombus is less than 50&#37; of the initial thrombus&#44; and <span class="elsevierStyleItalic">unsuccessful</span> if the persistent thrombus is greater than 50&#37; of the initial thrombus&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Low molecular weight heparin &#40;LMWH&#41; at therapeutic doses&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Thoracic outlet decompression surgery&#44; which included disinsertion of the anterior scalene muscle and transaxillary first rib resection&#44; as per the Roos technique&#44; within 16 weeks of diagnosis&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">LMWH for 1 month at therapeutic doses&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Thrombophilia study 3 months after the surgery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Clinical follow-up every 6 months to date&#44; with assessment of the PTS using the Villalta scale<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> at each follow-up visit&#46;</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Following implementation of the protocol&#44; none of the patients have presented complications or thrombotic recurrences to date&#46; One of the 8 patients presented mild PTS on the Villalta scale&#44; although this did not prevent him from carrying out his daily work activities&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">For many years&#44; the treatment of PSS has included elevation of the extremity and anticoagulation&#44; with surgery considered only when symptoms recur&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;4</span></a> Current guidelines recommend initial treatment with parenteral anticoagulation for at least 3 months&#44; over no such initial treatment&#46; Similarly&#44; in selected patients with a low risk for bleeding and severe symptoms of recent onset&#44; catheter-directed thrombolysis is recommended in experienced centers&#46; First rib resection and scalene muscle disinsertion when subclavian vein entrapment is suspected are also recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The use of anticoagulants as monotherapy is now being questioned after some studies found residual venous obstruction in close to 80&#37; of patients&#44; and persistent venous congestion symptoms in up to 90&#37; of patients receiving this treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Opinions differ with regard to the best time to perform surgery&#46; However&#44; studies with longer series have compared surgical times and found that thrombolysis followed by early surgery is the strategy with the best clinical outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5&#44;7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0115" class="elsevierStylePara elsevierViewall">PSS is a rare entity affecting young&#44; healthy individuals&#44; and early diagnosis is the key to obtaining adequate venous patency&#46; In our case series&#44; early diagnosis and treatment&#44; following the recommendations of the most advanced studies&#44; has so far led to favorable evolution and outcomes in our patients&#46; Multidisciplinary management using local catheter-directed thrombolysis and early decompressive surgery performed by an experienced multidisciplinary medical team shows satisfactory results&#44; with no major complications and a far lower incidence of PTS compared with conservative treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of Interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres580698"
          "titulo" => "Abstract"
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              "identificador" => "abst0005"
            ]
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        1 => array:2 [
          "identificador" => "xpalclavsec597198"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres580699"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec597197"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Clinical Observation"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusions"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of Interests"
        ]
        9 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-03-22"
    "fechaAceptado" => "2014-09-09"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec597198"
          "palabras" => array:4 [
            0 => "Paget-Schroetter syndrome"
            1 => "Upper extremity deep vein thrombosis"
            2 => "Thoracic outlet syndrome"
            3 => "Effort thrombosis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec597197"
          "palabras" => array:4 [
            0 => "S&#237;ndrome de Paget-Schroetter"
            1 => "Trombosis venosa profunda de extremidad superior"
            2 => "S&#237;ndrome de la salida del t&#243;rax"
            3 => "Trombosis de esfuerzo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Paget-Schroetter syndrome &#40;PSS&#41; in the context of upper extremity deep venous thrombosis &#40;DVT&#41; is an uncommon but potentially very serious condition affecting young&#44; healthy adults&#44; in which secondary post-thrombotic syndrome &#40;PTS&#41; can be a complication with major implications&#46; The best treatment option remains controversial&#44; with current guidelines recommending anticoagulation for at least 3 months&#46; However&#44; an incidence of PTS of approximately 50&#37; after 6 months&#44; 30&#37; after 1 year and 25&#37; after 2 years has been found using this therapeutic approach&#46; Consequently&#44; specialized units recommend local thrombolysis and early decompressive surgery&#46; We describe a series of eight cases treated in this way&#46; None of the patients showed signs of complications&#44; and an early return to regular activities with no PTS was observed in 90&#37; of cases&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Paget-Schroetter &#40;SPS&#41; en el contexto de trombosis venosa profunda &#40;TVP&#41; de miembro superior es una patolog&#237;a poco frecuente pero de gran importancia por afectar personas sanas y j&#243;venes&#44; donde el s&#237;ndrome postromb&#243;tico &#40;SPT&#41; secundario puede ser una complicaci&#243;n con importantes implicaciones&#46; La mejor opci&#243;n de tratamiento es controvertida&#46; Las gu&#237;as actuales recomiendan anticoagulaci&#243;n durante un m&#237;nimo de 3 meses&#44; aunque se han visto con este manejo incidencias de SPT cercanas al 50&#37; a los 6 meses&#44; al 30&#37; al a&#241;o y al 25&#37; a los 2 a&#241;os&#44; por lo que unidades especializadas abogan por la realizaci&#243;n de tromb&#243;lisis local y cirug&#237;a descompresiva precoz&#44; con el prop&#243;sito de disminuir estas cifras&#46; Describimos una serie de 8 casos&#44; a los que tratamos de esta &#250;ltima manera&#46; Ning&#250;n paciente present&#243; complicaciones&#44; y en todos se observ&#243; reintegro precoz a la actividad diaria&#44; con ausencia de SPT en el 90&#37; de ellos&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rosa Salazar V&#44; Ot&#225;lora Valderrama SP&#44; Hern&#225;ndez Contreras ME&#44; Garc&#237;a P&#233;rez B&#44; Arroyo Trist&#225;n AA&#44; Garc&#237;a M&#233;ndez MM&#46; Manejo multidisciplinar del s&#237;ndrome de Paget-Schroetter&#46; A prop&#243;sito de una serie de 8 casos&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;e41&#8211;e43&#46;</p>"
      ]
    ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PMF&#58; predisposing mechanical factor&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PMF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bodybuilding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Use of crutches&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lifting weight in a sweet factory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bodybuilding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Warehouse assistant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Canoeist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cook&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bodybuilding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Side&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">D-Dimer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">670<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1930<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3830<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1950<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8600<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1380<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">540<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">310<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Thrombophilia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Thrombolysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Partially successful &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Successful&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">LMWH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enoxaparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bemiparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tinzaparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Time free of thrombotic recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">971 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">849 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">634 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">605 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">532 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">510 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">456 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">279 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  "contribucion" => array:1 [
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                          "etal" => false
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2015.05.026

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2024 October	82	18	100
2024 September	57	26	83
2024 August	77	49	126
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2024 June	68	42	110
2024 May	81	38	119
2024 April	47	24	71
2024 March	46	18	64
2024 February	40	29	69
2023 March	8	9	17
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2023 January	50	45	95
2022 December	68	42	110
2022 November	50	37	87
2022 October	54	50	104
2022 September	46	31	77
2022 August	48	36	84
2022 July	30	48	78
2022 June	42	41	83
2022 May	54	36	90
2022 April	54	44	98
2022 March	60	51	111
2022 February	56	37	93
2022 January	67	37	104
2021 December	37	43	80
2021 November	55	43	98
2021 October	99	56	155
2021 September	58	47	105
2021 August	60	49	109
2021 July	42	25	67
2021 June	63	36	99
2021 May	57	44	101
2021 April	149	119	268
2021 March	98	30	128
2021 February	75	28	103
2021 January	84	30	114
2020 December	79	31	110
2020 November	62	34	96
2020 October	45	16	61
2020 September	53	15	68
2020 August	74	25	99
2020 July	72	36	108
2020 June	71	10	81
2020 May	59	31	90
2020 April	36	22	58
2020 March	45	14	59
2020 February	55	29	84
2020 January	43	17	60
2019 December	41	16	57
2019 November	40	20	60
2019 October	48	27	75
2019 September	75	19	94
2019 August	30	19	49
2019 July	34	21	55
2019 June	26	9	35
2019 May	47	27	74
2019 April	64	43	107
2019 March	61	32	93
2019 February	39	23	62
2019 January	50	20	70
2018 December	41	19	60
2018 November	59	28	87
2018 October	95	32	127
2018 September	32	9	41
2018 May	17	1	18
2018 April	39	6	45
2018 March	37	7	44
2018 February	28	9	37
2018 January	86	12	98
2017 December	105	5	110
2017 November	21	8	29
2017 October	29	11	40
2017 September	19	11	30
2017 August	23	10	33
2017 July	16	26	42
2017 June	46	23	69
2017 May	31	14	45
2017 April	31	21	52
2017 March	19	15	34
2017 February	19	16	35
2017 January	12	6	18
2016 December	32	11	43
2016 November	44	13	57
2016 October	50	14	64
2016 September	44	16	60
2016 August	38	11	49
2016 July	40	15	55
2016 March	2	0	2
2015 December	2	0	2
2015 October	0	1	1

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