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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comprobada la eficacia de la urocinasa como agente trombol&#237;tico y proteol&#237;tico&#44; los autores valoran la utilidad de &#233;sta en el tratamiento de los derrames pleurales multiloculados&#44; as&#237; como de empiemas y hematomas&#44; con el fin de evitar otras t&#233;cnicas m&#225;s agresivas&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el presente estudio cl&#237;nico 18 casos consecutivos en los que se utiliz&#243; el mencionado tratamiento&#46; El criterio de inclusi&#243;n fue sonda tor&#225;cica bien colocada&#44; que no drenaba y con imagen radiol&#243;gica de ocupaci&#243;n&#46; Se excluyeron expresamente las f&#237;stulas bronquiales y los hemot&#243;rax de menos de 7 d&#237;as de evoluci&#243;n&#46; La etiolog&#237;a de los derrames fue posneum&#243;nica&#44; posquir&#250;rgica y postraum&#225;tica&#46; El tratamiento se aplic&#243; durante 3-4 d&#237;as&#46; Como criterios de eficacia se utilizaron el volumen de l&#237;quido drenado y la evoluci&#243;n de la imagen radiol&#243;gica&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La cantidad de l&#237;quido drenada fue muy variable &#40;media&#44; 1&#46;282&#44; DT&#44; 1&#46;224&#59; rangos&#44; 100-3&#46;975&#41;&#46; La evoluci&#243;n radiol&#243;gica se consider&#243; completamente satisfactoria en 10 casos&#44; quedando en 6 pacientes una ocupaci&#243;n del seno costofr&#233;nico sin repercusi&#243;n cl&#237;nica&#46; Hubo dos fallecimientos&#44; pero no se relacionaron con la administraci&#243;n del f&#225;rmaco&#46; Se diagnosticaron dos recidivas de escasa entidad&#44; que no precisaron repetir el tratamiento con urocinasa&#46; El seguimiento de los pacientes a un m&#237;nimo de 30 d&#237;as tras el alta hospitalaria no ha encontrado nuevas recidivas&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los autores han encontrado utilidad en el uso de urocinasa como agente fibrinol&#237;tico en el caso de los derrames multiloculados&#44; con escasas contraindicaciones&#44; por lo que deber&#237;a ser considerado de primera elecci&#243;n antes que otras medidas terap&#233;uticas m&#225;s agresivas&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recognizing the confirmed efficacy of urokinase as a thrombolytic and proteolytic agent&#44; we assess its usefulness in the treatment of multiloculated pleural effusion&#44; empyema and hematoma as a substitute of other more invasive procedures&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Treatment with urokinase was applied in 18 consecutive cases&#46; Inclusion criteria were a well-placed thoracic probe that did not drain and a radiological image showing occupation&#46; Patients were excluded if they had bronchial fistulas or hemothorax of less than 7 days duration&#46; Effusion in the included cases had developed after pneumonia&#44; after surgery or after trauma&#46; Treatment lasted 3 to 4 days ant was considered effective or not based on the volume of liquid drained and on radiological evidence of change&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The amount of liquid drained was highly variable &#40;mean 1&#44;282 and S&#46;D&#46; 1&#44;224&#59; range 100-3&#44;975&#41;&#46; Radiological change was considered completely satisfactory in 10 cases&#44; with 6 patients continuing to show occupation of the costophrenic sinus with no clinical repercussions&#46; Two patients died of causes unrelated to administration of the drug&#46; There were two mild relapses that did not require a second round of treatment with urokinase&#46; Patients were followed for a least 30 days after discharge and no new recurrences were detected&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">We have found urokinase to be a useful fibrinolytic agent for treating multiloculated effusion&#46; Contraindications are few and therefore urokinase should be considered the first-choice treatment to be applied before other more invasive measures are taken&#46;</p></span>"
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Vol. 31. Issue 2.
Pages 51-55 (February 1995)
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Vol. 31. Issue 2.
Pages 51-55 (February 1995)
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Utilidad de la urocinasa en derrames pleurales multiloculados
Use of urokinase to treat multiloculated pleural effusion
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J. Casanova Viúdez*, J.M. Izquierdo Elena, J. Pac Ferrer, M. Mariñán Gorospe, R. Rojo Marcos, J.C. Rumbero Sánchez, F. Vara Cuadrado
Servicio de Cirugía Torácica. Hospital de Cruces. Baracaldo. Vizcaya
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Comprobada la eficacia de la urocinasa como agente trombolítico y proteolítico, los autores valoran la utilidad de ésta en el tratamiento de los derrames pleurales multiloculados, así como de empiemas y hematomas, con el fin de evitar otras técnicas más agresivas.

Se incluyeron en el presente estudio clínico 18 casos consecutivos en los que se utilizó el mencionado tratamiento. El criterio de inclusión fue sonda torácica bien colocada, que no drenaba y con imagen radiológica de ocupación. Se excluyeron expresamente las fístulas bronquiales y los hemotórax de menos de 7 días de evolución. La etiología de los derrames fue posneumónica, posquirúrgica y postraumática. El tratamiento se aplicó durante 3-4 días. Como criterios de eficacia se utilizaron el volumen de líquido drenado y la evolución de la imagen radiológica.

La cantidad de líquido drenada fue muy variable (media, 1.282, DT, 1.224; rangos, 100-3.975). La evolución radiológica se consideró completamente satisfactoria en 10 casos, quedando en 6 pacientes una ocupación del seno costofrénico sin repercusión clínica. Hubo dos fallecimientos, pero no se relacionaron con la administración del fármaco. Se diagnosticaron dos recidivas de escasa entidad, que no precisaron repetir el tratamiento con urocinasa. El seguimiento de los pacientes a un mínimo de 30 días tras el alta hospitalaria no ha encontrado nuevas recidivas.

Los autores han encontrado utilidad en el uso de urocinasa como agente fibrinolítico en el caso de los derrames multiloculados, con escasas contraindicaciones, por lo que debería ser considerado de primera elección antes que otras medidas terapéuticas más agresivas.

Palabras clave:
Derrame pleural
Urocinasa

Recognizing the confirmed efficacy of urokinase as a thrombolytic and proteolytic agent, we assess its usefulness in the treatment of multiloculated pleural effusion, empyema and hematoma as a substitute of other more invasive procedures.

Treatment with urokinase was applied in 18 consecutive cases. Inclusion criteria were a well-placed thoracic probe that did not drain and a radiological image showing occupation. Patients were excluded if they had bronchial fistulas or hemothorax of less than 7 days duration. Effusion in the included cases had developed after pneumonia, after surgery or after trauma. Treatment lasted 3 to 4 days ant was considered effective or not based on the volume of liquid drained and on radiological evidence of change.

The amount of liquid drained was highly variable (mean 1,282 and S.D. 1,224; range 100-3,975). Radiological change was considered completely satisfactory in 10 cases, with 6 patients continuing to show occupation of the costophrenic sinus with no clinical repercussions. Two patients died of causes unrelated to administration of the drug. There were two mild relapses that did not require a second round of treatment with urokinase. Patients were followed for a least 30 days after discharge and no new recurrences were detected.

We have found urokinase to be a useful fibrinolytic agent for treating multiloculated effusion. Contraindications are few and therefore urokinase should be considered the first-choice treatment to be applied before other more invasive measures are taken.

Key words:
Pleural effusion
Urokinase
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Copyright © 1995. Sociedad Española de Neumología y Cirugía Torácica
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