Scientific Letter
Chylothorax in Adults. Characteristics of 17 Patients and a Review of the Literature
Quilotórax en adultos. Revisión de la literatura a partir de una serie de 17 casos
Read
10245
Timeswas read the article
3541
Total PDF
6704
Total HTML
Share statistics
array:24 [ "pii" => "S1579212917301842" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.05.013" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1479" "copyright" => "SEPAR" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:407-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2647 "formatos" => array:3 [ "EPUB" => 154 "HTML" => 1859 "PDF" => 634 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289616302629" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.10.002" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1479" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:407-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 19650 "formatos" => array:3 [ "EPUB" => 143 "HTML" => 17474 "PDF" => 2033 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Quilotórax en adultos. Revisión de la literatura a partir de una serie de 17 casos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "408" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chylothorax in Adults. Characteristics of 17 Patients and a Review of the Literature" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2079 "Ancho" => 3053 "Tamanyo" => 206396 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tratamiento y evolución del quilotórax.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge García, Carmen Alemán, Alberto Jáuregui, Ana Vázquez, Óscar Persiva, Tomás Fernández de Sevilla" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jorge" "apellidos" => "García" ] 1 => array:2 [ "nombre" => "Carmen" "apellidos" => "Alemán" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Jáuregui" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Vázquez" ] 4 => array:2 [ "nombre" => "Óscar" "apellidos" => "Persiva" ] 5 => array:2 [ "nombre" => "Tomás" "apellidos" => "Fernández de Sevilla" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212917301842" "doi" => "10.1016/j.arbr.2017.05.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301842?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302629?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289616302629/v2_201706291228/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212917301854" "issn" => "15792129" "doi" => "10.1016/j.arbr.2016.10.008" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1478" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:409-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1932 "formatos" => array:3 [ "EPUB" => 148 "HTML" => 1343 "PDF" => 441 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Factors Associated With a Long Mean Hospital Stay in Patients Hospitalized With Tuberculosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "409" "paginaFinal" => "410" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores asociados con estancia media prolongada en pacientes ingresados por tuberculosis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María del Carmen Vera Sánchez-Rojas, Emma Muñoz Pérez, Ángeles Muñoz Pérez, Salvador Valero Cifuentes, Eva García Villalba, María de la Paz Egea Campoy, Alfredo Cano Sánchez, Enrique Bernal Morell" "autores" => array:8 [ 0 => array:2 [ "nombre" => "María del Carmen Vera" "apellidos" => "Sánchez-Rojas" ] 1 => array:2 [ "nombre" => "Emma Muñoz" "apellidos" => "Pérez" ] 2 => array:2 [ "nombre" => "Ángeles Muñoz" "apellidos" => "Pérez" ] 3 => array:2 [ "nombre" => "Salvador Valero" "apellidos" => "Cifuentes" ] 4 => array:2 [ "nombre" => "Eva García" "apellidos" => "Villalba" ] 5 => array:2 [ "nombre" => "María de la Paz Egea" "apellidos" => "Campoy" ] 6 => array:2 [ "nombre" => "Alfredo Cano" "apellidos" => "Sánchez" ] 7 => array:2 [ "nombre" => "Enrique Bernal" "apellidos" => "Morell" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616302617" "doi" => "10.1016/j.arbres.2016.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302617?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301854?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301854/v1_201706290145/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212917301830" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.05.012" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1482" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:406-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2115 "formatos" => array:3 [ "EPUB" => 142 "HTML" => 1608 "PDF" => 365 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Emphysematous Cystitis and Infectious Exacerbation of COPD. A Highly Unusual Finding" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "406" "paginaFinal" => "407" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cistitis enfisematosa y agudización infecciosa de la EPOC. Un hallazgo altamente infrecuente" ] ] "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" => 661 "Ancho" => 850 "Tamanyo" => 55809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography showing gas in the bladder and the bladder wall.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David P. Rodríguez López, Nuria Marina Malanda, Idoia Salinas Garrido, Juan B. Gáldiz Iturri" "autores" => array:4 [ 0 => array:2 [ "nombre" => "David P." "apellidos" => "Rodríguez López" ] 1 => array:2 [ "nombre" => "Nuria" "apellidos" => "Marina Malanda" ] 2 => array:2 [ "nombre" => "Idoia" "apellidos" => "Salinas Garrido" ] 3 => array:2 [ "nombre" => "Juan B." "apellidos" => "Gáldiz Iturri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616302654" "doi" => "10.1016/j.arbres.2016.10.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302654?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301830?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301830/v1_201706290145/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Chylothorax in Adults. Characteristics of 17 Patients and a Review of the Literature" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "408" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge García, Carmen Alemán, Alberto Jáuregui, Ana Vázquez, Óscar Persiva, Tomás Fernández de Sevilla" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jorge" "apellidos" => "García" "email" => array:1 [ 0 => "Jornega@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carmen" "apellidos" => "Alemán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alberto" "apellidos" => "Jáuregui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Ana" "apellidos" => "Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Óscar" "apellidos" => "Persiva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Tomás" "apellidos" => "Fernández de Sevilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cirugía Torácica, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Quilotórax en adultos. Revisión de la literatura a partir de una serie de 17 casos" ] ] "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" => 2088 "Ancho" => 3053 "Tamanyo" => 198213 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Treatment and course of chylothorax.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chylothorax (CTx) is an uncommon disease caused by extravasation of lymph fluid to the pleural cavity. Diagnosis is based on the detection of triglycerides or chylomicrons in pleural fluid. Triglyceride concentrations higher than 110<span class="elsevierStyleHsp" style=""></span>mg/dl or the presence of chylomicrons are indicative of CTx.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Etiology is defined as traumatic or non-traumatic, the most common causes of which are iatrogenesis or malignancy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Treatment can be conservative in the case of low-output CTx, or surgery may be necessary if disease is high-output or refractory.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Prognosis depends on the underlying cause.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We reviewed 1600 cases of pleural effusion seen in our hospital between January 2010 and December 2013, and selected patients with triglyceride levels higher than 110<span class="elsevierStyleHsp" style=""></span>mg/dl. We analyzed the etiology, clinical manifestations, diagnosis, and treatment of these cases, and reviewed the literature. Seventeen patients were found to have CTx (1.1%). Mean age was 64 (36–81) years, and 8 were men. The most common symptoms were dyspnea (7 cases), cough (3), ascites (3), and anorexia, asthenia and weight loss (4). Pleural effusion was right-sided in 8, left-sided in 2, and bilateral in 7. Pleural fluid obtained from 16 patients was milky in appearance and serous in 1; 12 were exudate, and 4 were transudate (data missing in 1 case). Etiology was non-traumatic in 13 cases, 11 of which were due to malignant disease, mainly lymphoma (<span class="elsevierStyleItalic">n</span>=5). One case was due to lymphangioma, and another was idiopathic. Of the remaining 4, 3 were caused by surgery and 1 by childbirth. With regard to treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), nutritional support was administered, with lipid restriction and medium-chain triglyceride diet in all patients, except 2 (due to death and spontaneous resolution). Pleural drainage was applied in 12 patients, and 5 underwent pleurodesis. Three required surgery (thoracic duct ligation), and 2 lymphography. Octreotide was administered in 3 cases, but results were unsatisfactory: 1 patient developed a skin rash, so it was discontinued, and other measures were required in the other 2 due to persistent effusion. Eight of the 17 cases died, 7 due to malignancy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">CTx is a rare entity, mainly caused by rupture of the thoracic duct and accumulation of chyle in the pleural cavity, or leakage from the peritoneum. Etiology of CTx is classified as traumatic or non-traumatic, the former being the most common, accounting for up to 50% of cases.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> In our study, the predominant etiology was non-traumatic. Traumatic etiologies can be subcategorized as iatrogenic (surgical acts such as esophagectomy) and non-iatrogenic (traumatism, childbirth labor, etc.).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Neoplasic processes, predominantly lymphoma, are the most common non-traumatic cause. The most common symptoms are cough, dyspnea, and chest pain. Fever is less common, since chyle is a non-inflammatory fluid.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> Our series notably included 4 cases of anorexia, asthenia and weight loss, most likely due to the high rate of malignant diseases. Diagnosis is based on analysis of pleural fluid, which has been defined as milky or opalescent, but serous and bloody serous specimens have been described, and are even predominant in some series.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> In biochemical terms, this is a lymphocytic exudate with low LDH levels, although previous studies have described transudates in 32% of cases, mostly due to hepatic cirrhosis, nephrotic syndrome, and heart failure, among others.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> In our series, 4 were transudates due to malignancy. Most CTx are unilateral.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> In our series, 7 were bilateral and 10 were unilateral. CT must be performed if the cause is unknown. Other techniques for locating the lesion are lymphography and lymphoscintigraphy, but these techniques may cause adverse effects, and are of most benefit in patients in whom surgical repair is planned. Treatment of CTx will vary depending on severity and refractoriness. In low-output effusions, a lipid-free diet with medium-chain fatty acids is recommended. In more severe cases, fasting with total parenteral nutrition and pleural drainage is recommended. Since 1990, these conservative medical treatment modalities have been combined with somatostatin or its synthetic analog, octreotide, an effective strategy with a response rate of up to 80%, mainly in postsurgical CTx.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6–8</span></a> These products are thought to act by reducing gastrointestinal blood flow, inhibiting gut motility and reducing lymphatic flow, leading to a reduction in the intestinal production of chyle.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> In our series, however, this treatment was ineffective or had to be discontinued due to adverse effects in the 3 patients who received it, although we must point out that none of these cases were postsurgical. Pleurodesis is a good option in persistent cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Surgery is necessary in refractory or high-output CTx. Thoracic duct ligation has been shown to be effective 67%–100% of the time,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> but patients who are not candidates for this intervention may receive a pleuroperitoneal or pleurovenous shunt<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> or thoracic duct embolization, although outcomes are variable.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> In our series, 15 patients received nutritional support, and 12 required an endothoracic tube. Three thoracic duct ligations and 2 lymphographies were performed, with CTx resolution in all cases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, CTx is a rare entity, diagnosed by the detection of chylomicrons or triglycerides >110<span class="elsevierStyleHsp" style=""></span>mg/dl in the pleural fluid. Surgical interventions and lymphoproliferative diseases are the main causes. In low-output CTx, nutritional support and repeated thoracocentesis are generally effective, but cases of persistent or high-output CTx may require invasive techniques.</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: García J, Alemán C, Jáuregui A, Vázquez A, Persiva Ó, Fernández de Sevilla T. Quilotórax en adultos. Revisión de la literatura a partir de una serie de 17 casos. Arch Bronconeumol. 2017;53:407–408.</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" => 2088 "Ancho" => 3053 "Tamanyo" => 198213 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Treatment and course of chylothorax.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pleural fluid characteristics of chylothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F. Maldonado" 1 => "F.J. Hawkins" 2 => "C.E. Daniels" 3 => "C.H. Doerr" 4 => "P.A. Decker" 5 => "J.H. Ryu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0025-6196(11)60820-3" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc" "fecha" => "2009" "volumen" => "84" "paginaInicial" => "129" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19181646" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chylothorax: aetiology, diagnosis and therapeutic options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.E. McGrath" 1 => "Z. Blades" 2 => "P.B. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2009.08.010" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2010" "volumen" => "104" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19766473" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The changing management of chylothorax in the modern era" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Bender" 1 => "V. Murthy" 2 => "R.S. Chamberlain" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2015" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10077365" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on uncommon pleural effusions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.H. Ryu" 1 => "S. Tomassetti" 2 => "F. Maldonado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2010.01900.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2011" "volumen" => "16" "paginaInicial" => "238" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21073678" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chylothorax: diagnostic approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Skouras" 1 => "I. Kalomenidis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCP.0b013e328338dde2" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pulm Med" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "387" "paginaFinal" => "393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20410823" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Conservative management of chylothorax" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Altun" 1 => "Z. Pulathan" 2 => "D. Kutanis" 3 => "D. Hemsinli" 4 => "E. Erturk" 5 => "A. Civelek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Texas Heart Inst J" "fecha" => "2015" "volumen" => "42" "paginaInicial" => "148" "paginaFinal" => "151" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of octreotide in the treatment of chylothrax following cardiothoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Ismail" 1 => "J. Gordon" 2 => "J. Dunning" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivv046" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2015" "volumen" => "20" "paginaInicial" => "848" "paginaFinal" => "854" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25784759" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.S. Bryant" 1 => "D.J. Minnich" 2 => "B. Wei" 3 => "R.J. Cerfolio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2014.03.003" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2014" "volumen" => "98" "paginaInicial" => "232" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24811982" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301842/v1_201706290145/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000007/v1_201706290145/S1579212917301842/v1_201706290145/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301842?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 14 | 23 |
| 2024 October | 66 | 86 | 152 |
| 2024 September | 83 | 97 | 180 |
| 2024 August | 92 | 126 | 218 |
| 2024 July | 81 | 102 | 183 |
| 2024 June | 84 | 114 | 198 |
| 2024 May | 109 | 108 | 217 |
| 2024 April | 55 | 95 | 150 |
| 2024 March | 82 | 90 | 172 |
| 2024 February | 59 | 102 | 161 |
| 2023 March | 18 | 17 | 35 |
| 2023 February | 65 | 82 | 147 |
| 2023 January | 60 | 101 | 161 |
| 2022 December | 79 | 100 | 179 |
| 2022 November | 117 | 82 | 199 |
| 2022 October | 125 | 62 | 187 |
| 2022 September | 93 | 57 | 150 |
| 2022 August | 114 | 49 | 163 |
| 2022 July | 97 | 56 | 153 |
| 2022 June | 101 | 52 | 153 |
| 2022 May | 85 | 55 | 140 |
| 2022 April | 77 | 67 | 144 |
| 2022 March | 142 | 63 | 205 |
| 2022 February | 95 | 36 | 131 |
| 2022 January | 76 | 56 | 132 |
| 2021 December | 103 | 54 | 157 |
| 2021 November | 79 | 54 | 133 |
| 2021 October | 87 | 54 | 141 |
| 2021 September | 73 | 57 | 130 |
| 2021 August | 451 | 79 | 530 |
| 2021 July | 44 | 42 | 86 |
| 2021 June | 105 | 48 | 153 |
| 2021 May | 77 | 53 | 130 |
| 2021 April | 295 | 159 | 454 |
| 2021 March | 160 | 46 | 206 |
| 2021 February | 103 | 34 | 137 |
| 2021 January | 128 | 38 | 166 |
| 2020 December | 105 | 45 | 150 |
| 2020 November | 102 | 31 | 133 |
| 2020 October | 157 | 41 | 198 |
| 2020 September | 114 | 29 | 143 |
| 2020 August | 130 | 33 | 163 |
| 2020 July | 138 | 35 | 173 |
| 2020 June | 63 | 16 | 79 |
| 2020 May | 72 | 25 | 97 |
| 2020 April | 75 | 31 | 106 |
| 2020 March | 76 | 20 | 96 |
| 2020 February | 98 | 33 | 131 |
| 2020 January | 108 | 38 | 146 |
| 2019 December | 99 | 32 | 131 |
| 2019 November | 116 | 38 | 154 |
| 2019 October | 125 | 25 | 150 |
| 2019 September | 122 | 20 | 142 |
| 2019 August | 83 | 38 | 121 |
| 2019 July | 58 | 23 | 81 |
| 2019 June | 69 | 28 | 97 |
| 2019 May | 110 | 38 | 148 |
| 2019 April | 53 | 42 | 95 |
| 2019 March | 62 | 23 | 85 |
| 2019 February | 49 | 21 | 70 |
| 2019 January | 159 | 27 | 186 |
| 2018 December | 36 | 27 | 63 |
| 2018 November | 71 | 31 | 102 |
| 2018 October | 98 | 23 | 121 |
| 2018 September | 54 | 37 | 91 |
| 2018 May | 14 | 2 | 16 |
| 2018 April | 23 | 5 | 28 |
| 2018 March | 15 | 5 | 20 |
| 2018 February | 26 | 8 | 34 |
| 2018 January | 92 | 5 | 97 |
| 2017 December | 102 | 29 | 131 |
| 2017 November | 34 | 40 | 74 |
| 2017 October | 25 | 10 | 35 |
| 2017 September | 2 | 0 | 2 |
Show all
