array:24 [
  "pii" => "S1579212914001748"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2014.06.010"
  "estado" => "S300"
  "fechaPublicacion" => "2014-08-01"
  "aid" => "934"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2013"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "cor"
  "cita" => "Arch Bronconeumol. 2014;50:371-2"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 4670
    "formatos" => array:3 [
      "EPUB" => 131
      "HTML" => 3913
      "PDF" => 626
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289614000842"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2014.02.011"
      "estado" => "S300"
      "fechaPublicacion" => "2014-08-01"
      "aid" => "934"
      "copyright" => "SEPAR"
      "documento" => "simple-article"
      "crossmark" => 0
      "subdocumento" => "cor"
      "cita" => "Arch Bronconeumol. 2014;50:371-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 9193
        "formatos" => array:3 [
          "EPUB" => 128
          "HTML" => 8386
          "PDF" => 679
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>"
        "titulo" => "Derrame pleural leuc&#233;mico&#58; aproximaci&#243;n diagn&#243;stica y controversias en pleurodesis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "371"
            "paginaFinal" => "372"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Leukemic Pleural Effusion&#58; Diagnostic Approach and Controversies in Pleurodesis"
          ]
        ]
        "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" => 713
                "Ancho" => 951
                "Tamanyo" => 175381
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Examen microsc&#243;pico de l&#237;quido pleural&#44; donde se observan c&#233;lulas con una cromatina laxa e inmadura&#44; una relaci&#243;n n&#250;cleo-citoplasma elevada y nucl&#233;olos visibles&#44; siendo compatibles con blastos mieloides &#40;tinci&#243;n May-Gr&#252;nwald&#47;Giemsa&#44; 1000&#215;&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Daniel Morell-Garc&#237;a, Josep Miquel Bau&#231;a, Bernardo L&#243;pez Andrade"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Daniel"
                "apellidos" => "Morell-Garc&#237;a"
              ]
              1 => array:2 [
                "nombre" => "Josep Miquel"
                "apellidos" => "Bau&#231;a"
              ]
              2 => array:2 [
                "nombre" => "Bernardo"
                "apellidos" => "L&#243;pez Andrade"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212914001748"
          "doi" => "10.1016/j.arbr.2014.06.010"
          "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/S1579212914001748?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614000842?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005000000008/v1_201407200016/S0300289614000842/v1_201407200016/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212914001761"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2014.06.012"
    "estado" => "S300"
    "fechaPublicacion" => "2014-08-01"
    "aid" => "935"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Arch Bronconeumol. 2014;50:372"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2595
      "formatos" => array:3 [
        "EPUB" => 140
        "HTML" => 1859
        "PDF" => 596
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Should Self-Citation of Articles Be Penalized&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "372"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Debe penalizarse la autocitaci&#243;n de art&#237;culos&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Eduardo Garc&#237;a-Pach&#243;n, Isabel Padilla-Navas"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Garc&#237;a-Pach&#243;n"
            ]
            1 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Padilla-Navas"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289614000854"
        "doi" => "10.1016/j.arbres.2014.02.012"
        "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/S0300289614000854?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001761?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005000000008/v1_201407200014/S1579212914001761/v1_201407200014/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212914001736"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2014.06.009"
    "estado" => "S300"
    "fechaPublicacion" => "2014-08-01"
    "aid" => "933"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Arch Bronconeumol. 2014;50:370-1"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3843
      "formatos" => array:3 [
        "EPUB" => 152
        "HTML" => 3077
        "PDF" => 614
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Pleural and Pericardial Effusion in a Patient With Polymyalgia Rheumatica"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "370"
          "paginaFinal" => "371"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Derrame pleural y peric&#225;rdico en una paciente con polimialgia reum&#225;tica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 805
              "Ancho" => 1450
              "Tamanyo" => 129471
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing small left pleural effusion and minimal pericardial effusion&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Irene Jarana Aparicio, Fernando Pedraza Serrano, Javier de Miguel D&#237;ez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Irene"
              "apellidos" => "Jarana Aparicio"
            ]
            1 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Pedraza Serrano"
            ]
            2 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "de Miguel D&#237;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289614000830"
        "doi" => "10.1016/j.arbres.2014.02.010"
        "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/S0300289614000830?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001736?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005000000008/v1_201407200014/S1579212914001736/v1_201407200014/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Leukemic Pleural Effusion&#58; Diagnostic Approach and Controversies in Pleurodesis"
    "tieneTextoCompleto" => true
    "saludo" => "To the Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "371"
        "paginaFinal" => "372"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Daniel Morell-Garc&#237;a, Josep Miquel Bau&#231;a, Bernardo L&#243;pez Andrade"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Daniel"
            "apellidos" => "Morell-Garc&#237;a"
            "email" => array:2 [
              0 => "dr&#46;morell&#46;uab&#64;gmail&#46;com"
              1 => "daniel&#46;morell&#64;ssib&#46;es"
            ]
            "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" => "Josep Miquel"
            "apellidos" => "Bau&#231;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Bernardo"
            "apellidos" => "L&#243;pez Andrade"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de An&#225;lisis Cl&#237;nicos&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Hematolog&#237;a&#44; Hospital Universitario Son Espases&#44; Palma de Mallorca&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Derrame pleural leuc&#233;mico&#58; aproximaci&#243;n diagn&#243;stica y controversias en pleurodesis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 736
            "Ancho" => 983
            "Tamanyo" => 177472
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of pleural fluid&#44; showing cells with lax and immature chromatin&#44; raised nuclear&#8211;cytoplasmic ratio and visible nucleoli&#44; compatible with myeloblasts &#40;May-Gr&#252;nwald&#47;Giemsa staining&#44; 1000&#215;&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The most common causes of pleural effusion in patients with acute myeloid leukemia &#40;AML&#41; are infections &#40;bacterial or viral&#41;&#44; other malignancy&#44; chemotherapy and those derived from the malignant process itself&#46; Survival is determined by response to treatment of the hematological disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A minimum sample volume of 60<span class="elsevierStyleHsp" style=""></span>mL is required for the cytomorphological diagnosis of malignancy in pleural fluid&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In cases of pleural effusion refractory to treatment of the underlying disease&#44; pleurodesis must be performed to control respiratory symptoms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This letter reports the case of a 76-year-old patient with AML diagnosed 2 months previously with compatible bone marrow phenotype and normal cytogenetic results &#40;46&#44;XY&#91;15&#93;&#41; who had received 3 cycles of 5-azacitidine&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">He was admitted for dyspnea&#44; 38<span class="elsevierStyleHsp" style=""></span>&#176;C fever and tachycardia &#40;120<span class="elsevierStyleHsp" style=""></span>bpm&#41;&#46; He had leukocytosis &#40;45<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L&#41;&#44; anemia &#40;hemoglobin 88<span class="elsevierStyleHsp" style=""></span>g&#47;L&#41;&#44; thrombocytosis &#40;719<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>&#47;L&#41; and serum lactate dehydrogenase &#40;LDH&#41; 1&#46;663<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;normal&#58; 125&#8211;220<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#41;&#46; Chest X-ray and computed tomography showed significant left pleural effusion&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 90<span class="elsevierStyleHsp" style=""></span>mL of pleural fluid were obtained by thoracocentesis&#46; This contained 1200 lymphocytes&#47;&#956;L &#40;normal&#58; &#60;200&#47;&#956;L&#41;&#44; glucose 52<span class="elsevierStyleHsp" style=""></span>mg&#47;dL &#40;normal&#58; 70&#8211;110<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#44; LDH 1724<span class="elsevierStyleHsp" style=""></span>IU&#47;L &#40;normal&#58; 125&#8211;220<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#41; and pH was 7&#46;38&#46; Microbiological cultures were negative&#46; Cytocentrifugation and May-Gr&#252;nwald&#47;Giemsa staining of the pleural fluid were performed for microscopic examination &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The presence of myeloblasts in pleural fluid was confirmed by flow cytometry immunophenotyping &#40;CD34&#44; CD33&#44; CD13 and CD117&#44; but not CD14 or CD15&#41;&#46; Cytogenetic examination with G-banding was normal&#44; consistent with the patient&#39;s AML phenotype&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A diagnosis of leukemic pleural effusion was established and pleural drainage was performed&#44; with little response&#46; One week later&#44; the patient required pleurodesis with bleomycin to control dyspnea derived from worsening pleural effusion&#46; His respiratory syndrome worsened progressively until exitus at 15 days&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the case of leukemic pleural effusion&#44; the clonal cell line must be confirmed with fluorescence <span class="elsevierStyleItalic">in situ</span> hybridization &#40;FISH&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In the routine screening of these patients for the indication of pleurodesis&#44; there is no clear correlation between pleural fluid pH and survival&#59; clinical status appears to be the best predictor for post-pleurodesis survival&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In patients who have not previously undergone pleurodesis&#44; no significant differences in dyspnea relief have been found between permanent pleural catheter drainage and talc pleurodesis&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Both bleomycin and talc have been shown to be good sclerosing agents&#44; with similar efficacy in pleurodesis for the control of symptomatic malignant pleural effusion&#46; Although bleomycin was used in our patient&#44; it is important to note that talc is cheaper and may have the same or better success rate in the reduction of recurrent malignant pleural effusion than bleomycin and other sclerosing agents&#44; although this difference has not been shown to be statistically significant&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The use of many sclerosing agents in pleurodesis has been reported&#44; including iodized povidone&#44; doxycycline&#44; silver nitrate&#44; interferon alpha-2b and others&#46; Good results have been documented&#44; but disparity in the design of these studies make comparison difficult&#46; Future studies are required to reach a consensus on the best method of pleurodesis in these patients&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Morell-Garc&#237;a D&#44; Bau&#231;a JM&#44; L&#243;pez Andrade B&#46; Derrame pleural leuc&#233;mico&#58; aproximaci&#243;n diagn&#243;stica y controversias en pleurodesis&#46; Arch Bronconeumol&#46; 2014&#59;50&#58;371&#8211;372&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 736
            "Ancho" => 983
            "Tamanyo" => 177472
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of pleural fluid&#44; showing cells with lax and immature chromatin&#44; raised nuclear&#8211;cytoplasmic ratio and visible nucleoli&#44; compatible with myeloblasts &#40;May-Gr&#252;nwald&#47;Giemsa staining&#44; 1000&#215;&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pleural effusions in patients with acute leukemia and myelodysplastic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Faiz"
                            1 => "L&#46; Bashoura"
                            2 => "X&#46; Lei"
                            3 => "K&#46;R&#46; Sampat"
                            4 => "T&#46;C&#46; Brown"
                            5 => "G&#46;A&#46; Eapen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/10428194.2012.713478"
                      "Revista" => array:6 [
                        "tituloSerie" => "Leuk Lymphoma"
                        "fecha" => "2013"
                        "volumen" => "54"
                        "paginaInicial" => "329"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22812422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective study to determine the volume of pleural fluid required to diagnose malignancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Swiderek"
                            1 => "S&#46; Morcos"
                            2 => "V&#46; Donthireddy"
                            3 => "R&#46; Surapaneni"
                            4 => "V&#46; Jackson-Thompson"
                            5 => "L&#46; Schultz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-0641"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "68"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19741064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Leukaemic pleural effusion in acute myeloid leukaemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Ou"
                            1 => "W&#46;L&#46; Hwang"
                            2 => "C&#46;L&#46; Teng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Br J Haematol"
                        "fecha" => "2011"
                        "volumen" => "154"
                        "paginaInicial" => "669"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion&#58; the TIME2 randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;E&#46; Davies"
                            1 => "E&#46;K&#46; Mishra"
                            2 => "B&#46;C&#46; Kahan"
                            3 => "J&#46;M&#46; Wrightson"
                            4 => "A&#46;E&#46; Stanton"
                            5 => "A&#46; Guhan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Med Assoc"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "2383"
                        "paginaFinal" => "2389"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evidence on the effectiveness of management for malignant pleural effusion&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Tan"
                            1 => "A&#46; Sedrakyan"
                            2 => "J&#46; Browne"
                            3 => "S&#46; Swift"
                            4 => "T&#46; Treasure"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2005.12.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "29"
                        "paginaInicial" => "829"
                        "paginaFinal" => "838"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16626967"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005000000008/v1_201407200014/S1579212914001748/v1_201407200014/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14576"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Letters to the editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000008/v1_201407200014/S1579212914001748/v1_201407200014/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001748?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 50. Issue 8.
Pages 371-372 (August 2014)
Vol. 50. Issue 8.
Pages 371-372 (August 2014)
Letter to the Editor
Full text access
Leukemic Pleural Effusion: Diagnostic Approach and Controversies in Pleurodesis
Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis
Visits
10440
Daniel Morell-Garcíaa,
Corresponding author
, Josep Miquel Bauçaa, Bernardo López Andradeb
a Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Servicio de Hematología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text
To the Editor:

The most common causes of pleural effusion in patients with acute myeloid leukemia (AML) are infections (bacterial or viral), other malignancy, chemotherapy and those derived from the malignant process itself. Survival is determined by response to treatment of the hematological disease.1

A minimum sample volume of 60mL is required for the cytomorphological diagnosis of malignancy in pleural fluid.2

In cases of pleural effusion refractory to treatment of the underlying disease, pleurodesis must be performed to control respiratory symptoms.

This letter reports the case of a 76-year-old patient with AML diagnosed 2 months previously with compatible bone marrow phenotype and normal cytogenetic results (46,XY[15]) who had received 3 cycles of 5-azacitidine.

He was admitted for dyspnea, 38°C fever and tachycardia (120bpm). He had leukocytosis (45×109/L), anemia (hemoglobin 88g/L), thrombocytosis (719×109/L) and serum lactate dehydrogenase (LDH) 1.663IU/L (normal: 125–220IU/L). Chest X-ray and computed tomography showed significant left pleural effusion.

A total of 90mL of pleural fluid were obtained by thoracocentesis. This contained 1200 lymphocytes/μL (normal: <200/μL), glucose 52mg/dL (normal: 70–110mg/dL), LDH 1724IU/L (normal: 125–220IU/L) and pH was 7.38. Microbiological cultures were negative. Cytocentrifugation and May-Grünwald/Giemsa staining of the pleural fluid were performed for microscopic examination (Fig. 1). The presence of myeloblasts in pleural fluid was confirmed by flow cytometry immunophenotyping (CD34, CD33, CD13 and CD117, but not CD14 or CD15). Cytogenetic examination with G-banding was normal, consistent with the patient's AML phenotype.

Fig. 1.

Microscopic examination of pleural fluid, showing cells with lax and immature chromatin, raised nuclear–cytoplasmic ratio and visible nucleoli, compatible with myeloblasts (May-Grünwald/Giemsa staining, 1000×).

(0.17MB).

A diagnosis of leukemic pleural effusion was established and pleural drainage was performed, with little response. One week later, the patient required pleurodesis with bleomycin to control dyspnea derived from worsening pleural effusion. His respiratory syndrome worsened progressively until exitus at 15 days.

In the case of leukemic pleural effusion, the clonal cell line must be confirmed with fluorescence in situ hybridization (FISH).3

In the routine screening of these patients for the indication of pleurodesis, there is no clear correlation between pleural fluid pH and survival; clinical status appears to be the best predictor for post-pleurodesis survival.

In patients who have not previously undergone pleurodesis, no significant differences in dyspnea relief have been found between permanent pleural catheter drainage and talc pleurodesis.4

Both bleomycin and talc have been shown to be good sclerosing agents, with similar efficacy in pleurodesis for the control of symptomatic malignant pleural effusion. Although bleomycin was used in our patient, it is important to note that talc is cheaper and may have the same or better success rate in the reduction of recurrent malignant pleural effusion than bleomycin and other sclerosing agents, although this difference has not been shown to be statistically significant.5

The use of many sclerosing agents in pleurodesis has been reported, including iodized povidone, doxycycline, silver nitrate, interferon alpha-2b and others. Good results have been documented, but disparity in the design of these studies make comparison difficult. Future studies are required to reach a consensus on the best method of pleurodesis in these patients.

References
[1]
S.A. Faiz, L. Bashoura, X. Lei, K.R. Sampat, T.C. Brown, G.A. Eapen, et al.
Pleural effusions in patients with acute leukemia and myelodysplastic syndrome.
Leuk Lymphoma, 54 (2013), pp. 329-335
[2]
J. Swiderek, S. Morcos, V. Donthireddy, R. Surapaneni, V. Jackson-Thompson, L. Schultz, et al.
Prospective study to determine the volume of pleural fluid required to diagnose malignancy.
Chest, 137 (2010), pp. 68-73
[3]
M.C. Ou, W.L. Hwang, C.L. Teng.
Leukaemic pleural effusion in acute myeloid leukaemia.
Br J Haematol, 154 (2011), pp. 669
[4]
H.E. Davies, E.K. Mishra, B.C. Kahan, J.M. Wrightson, A.E. Stanton, A. Guhan, et al.
Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial.
J Am Med Assoc, 307 (2012), pp. 2383-2389
[5]
C. Tan, A. Sedrakyan, J. Browne, S. Swift, T. Treasure.
The evidence on the effectiveness of management for malignant pleural effusion: a systematic review.
Eur J Cardiothorac Surg, 29 (2006), pp. 829-838

Please cite this article as: Morell-García D, Bauça JM, López Andrade B. Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis. Arch Bronconeumol. 2014;50:371–372.

Copyright © 2013. SEPAR
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?