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"apellidos" => "Valdés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887417301376" "doi" => "10.1016/j.rceng.2017.11.001" "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/S2254887417301376?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302618?idApp=WRCEE" "url" => "/00142565/0000021800000002/v1_201802240414/S0014256517302618/v1_201802240414/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887417301030" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.07.002" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1422" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Rev Clin Esp. 2018;218:98-107" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Safety of diabetes drugs in patients with heart failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "98" "paginaFinal" => "107" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad de los fármacos antidiabéticos en pacientes con insuficiencia cardiaca" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. 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"apellidos" => "Soto-Martín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517301819" "doi" => "10.1016/j.rce.2017.07.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517301819?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301030?idApp=WRCEE" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887417301030/v1_201802230423/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2254887418300122" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.12.004" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1457" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2018;218:74-88" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 9 "formatos" => array:2 [ "HTML" => 5 "PDF" => 4 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Treatment of type 2 diabetes mellitus in elderly patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "74" "paginaFinal" => "88" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la diabetes mellitus tipo 2 en el paciente anciano" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1519 "Ancho" => 2506 "Tamanyo" => 258442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment algorithm for type 2 diabetes mellitus in elderly patients.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: DPP4i: dipeptidyl peptidase-4 inhibitors; GLP-1RA: glucagon-like peptide-1 receptor agonists; SGLT2i: sodium-glucose cotransporter 2 inhibitors.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Repaglinide and pioglitazone can be used in patients with GFR <30<span class="elsevierStyleHsp" style=""></span>mL/min, but their use is not recommended due to the risk of adverse effects: hypoglycemia (repaglinide); salt and fluid retention, heart failure and fractures (pioglitazone).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span> Empagliflozin, canagliflozin and liraglutide have shown reduced cardiovascular morbidity and mortality in patients with high vascular risk type 2 diabetes.</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">c</span> Saxagliptin should be avoided for patients with heart failure.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">d</span> Pioglitazone is contraindicated for patients with heart failure or at risk for fractures.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Gómez-Huelgas, F. Gómez Peralta, L. Rodríguez Mañas, F. Formiga, M. Puig Domingo, J.J. Mediavilla Bravo, C. Miranda, J. Ena" "autores" => array:8 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Gómez Peralta" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Rodríguez Mañas" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Formiga" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Puig Domingo" ] 5 => array:2 [ "nombre" => "J.J." "apellidos" => "Mediavilla Bravo" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Miranda" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Ena" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256517302886" "doi" => "10.1016/j.rce.2017.12.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256517302886?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300122?idApp=WRCEE" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887418300122/v1_201802230423/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S2254887417301510" "issn" => "22548874" "doi" => "10.1016/j.rceng.2017.11.002" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1451" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2018;218:66-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "PDF" => 3 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Pleural effusion in multiple myeloma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "66" "paginaFinal" => "67" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Derrame pleural en el mieloma múltiple" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Porcel" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Porcel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425651730262X" "doi" => "10.1016/j.rce.2017.11.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425651730262X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887417301510?idApp=WRCEE" "url" => "/22548874/0000021800000002/v1_201802230423/S2254887417301510/v1_201802230423/en/main.assets" ] ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Characteristics of patients with myelomatous pleural effusion. A systematic review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "89" "paginaFinal" => "97" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Riveiro, L. Ferreiro, M.E. Toubes, A. Lama, J.M. Álvarez-Dobaño, L. Valdés" "autores" => array:6 [ 0 => array:3 [ "nombre" => "V." "apellidos" => "Riveiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "L." "apellidos" => "Ferreiro" "email" => array:1 [ 0 => "lferfer7@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "M.E." "apellidos" => "Toubes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Lama" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J.M." "apellidos" => "Álvarez-Dobaño" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Valdés" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características de los pacientes con derrame pleural mielomatoso. Revisión sistemática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1672 "Ancho" => 2667 "Tamanyo" => 218564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">PRISMA flow diagram of the reviewed literature. Abbreviation: PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of malignant plasma cells in the bone marrow, with subsequent spreading to other locations, including the chest.<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">1</span></a> These neoplastic plasma cells are characterized by the abnormal production of monoclonal proteins, which can be detected in blood, urine and organs (where they can cause damage).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Pleural effusion (PE) is present in approximately 6% of patients with MM,<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">2</span></a> can have varying etiologies and is divided into 2 groups: nonmyelomatous and myelomatous pleural effusion (MPE). MPE is present in only 1% of cases,<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">3</span></a> and its diagnostic criteria are as follows: (1) detection of atypical plasma cells in the pleural fluid (PF), (2) pleural biopsy compatible with malignancy or (3) demonstration of monoclonal proteins in the PF through electrophoresis. The most common causes of nonmyelomatous effusions are heart failure, nephrotic syndrome, infections, pulmonary thromboembolism and amyloidosis. Although there are various treatments for MPE (chemotherapy, therapeutic thoracentesis, placement of chest drainage and pleurodesis), there is no consensus on how to handle these patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There are no sufficiently large series in the literature that describe the characteristics of patients with MPE or their treatment. The objective of this systematic review is to document the characteristics of patient with MPE, the biochemical characteristics of PF and the most effective treatment for these patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">In this systematic review, we used the methodology based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system.<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">4</span></a> Due to the lack of sufficiently large series that met the study objectives, we used the sum of the cases described in the literature.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selection criteria</span><p id="par0025" class="elsevierStylePara elsevierViewall">All cases of MPE of any age published under any format were considered eligible for inclusion, except those corresponding to abstracts of congresses and editorials, reviews or letters to the editor that did not document a new case.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Information sources</span><p id="par0030" class="elsevierStylePara elsevierViewall">The literature search included the following electronic databases (online): Medline (through Pubmed interface), Embase, Scopus and Web of Science. The searches in the various databases were conducted between July 1, 2016 and December 31, 2016. The terms used for the database searches were “multiple myeloma” and “pleural effusion”. We selected articles in English or Spanish only.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In addition to the electronic databases, we conducted a manual search of the references included in the selected articles. The articles were reviewed in 3 stages, according to the title, abstract and complete text, searching for consensus for each of them among 3 individuals (VR, MET and AL).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection process</span><p id="par0040" class="elsevierStylePara elsevierViewall">The data from the selected studies were processed electronically (Microsoft Excel 2010, Microsoft Corp., USA). The extracted information included the following items: authors, year of publication, number of cases in the series, patient age (both at the time of MM diagnosis and MPE diagnosis), sex, history of smoking, clinical symptoms (dyspnea, pleuritic or bone pain in any location), abnormal laboratory test results (anemia, hypercalcemia, renal failure), presence of osteolytic lesions or plasmacytomas, laterality and MPE size, chest computed tomography (CT) findings, PF appearance, laboratory data for the PF (transudate or exudate, total count and percentage of nucleated cells, total proteins, lactate dehydrogenase [LDH], albumin, glucose, pH, adenosine deaminase, cultures, cytology), pleural biopsy results and treatments undergone (including response and complications).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methodological quality of the individual studies</span><p id="par0045" class="elsevierStylePara elsevierViewall">Due to the low number of cases provided by each article, we did not assess any of the articles’ overall quality regarding the type of study, internal or external validity, heterogeneity or precision.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Measures of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The measures of interest were to determine the patients’ demographic and clinical characteristics, abnormal laboratory test results, the presence of osteolytic lesions or plasmacytomas, the biochemical, microbiological and cytological characteristics of the PE and the MPE's response to the treatments.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Due to the considerable heterogeneity and descriptive nature of most of the studies, we performed a simple statistical analysis (proportion, median and range) on each result of interest.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">We selected 98 articles that included 153 patients with MPE and that covered a period of 59 years. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the flow diagram for the full breakdown<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5–29</span></a> in the identification<a class="elsevierStyleCrossRefs" href="#bib0685"><span class="elsevierStyleSup">30–54</span></a> of the appropriate studies<a class="elsevierStyleCrossRefs" href="#bib0810"><span class="elsevierStyleSup">55–79</span></a> of this review,<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">80–102</span></a> which corresponded to 83 articles that included only 1 patient; 7 that included 2 patients; 3 that included 3 cases; 2 that included 4 patients and 3 articles that included 5, 11 and 23 patients, respectively.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Demographic, clinical and radiological characteristics</span><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic, clinical and radiological characteristics of the 153 included patients. The age groups to which these patients belonged were as follows: 31–40 years, 5 patients; 41–50 years, 22 patients; 51–60 years, 32 patients; 61–70 years, 44 patients; 71–80 years, 21 patients; and older than 80 years, 4 patients. The median age at the MM diagnosis was 62 years (range, 33–85 years). The number of cases increased up to the seventh decade of life, and 76.6% (98/128) of the patients were 41–70 years of age. The age of 25 patients could not be determined. The time between the MM diagnosis and the onset of MPE was short. In 52.6% of the cases (30/57), the MPE appeared in the first year of follow-up after the MM diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">19,47,52,57,83,89,100</span></a> In 17.5% (10/57), the MM diagnosis and MPE diagnosis were simultaneous,<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">19,47,52,57,83,89,100</span></a> and for 5 patients the MPE appeared before the MM was diagnosed.<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">20,33,61,68,69</span></a> For the remaining 21.1% of cases (12/57), the MPE was detected in the second year from the MM diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">9,11–13,34,45,49,73</span></a> Of the 146 patients whose sex could be determined, 92 (63%) were men (male/female ratio: 1.7/1).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The most common clinical symptoms at the MPE diagnosis were dyspnea (83/84, 98.8%), bone pain (35/35, 100%) and chest pain (62/65, 95.3%). The most common abnormal laboratory test results were anemia (73/81, 90.1%), renal failure (35/65, 53.8%) and hypercalcemia (22/62, 35.4%). Of the 86 cases in which chest radiography/CT was available, lytic lesions were observed in 67 (77.9%) cases and plasmacytomas in 30 (34.9%), of which 7 were bone.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Pleural effusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The MPE was unilateral in 85 of 133 (63.9%) patients and left-sided in 53 (62.4%). In 48 patients (36.1%) the MPE was bilateral, while in 20 cases the laterality was not specified. In 54.5% of the patients (36/66), the MPE covered more than two-thirds of the hemithorax. The presence of pleural thickening or pleural nodules was reported in 21 of 46 cases (45.6%).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The appearance of the MPE was described in 92 patients: hemorrhagic in 51 (55.4%), serohemorrhagic in 29 (31.6%) and serous in 12 (13%). The PF's biochemical characteristics and total nucleated cell count and percentage are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The differentiation between pleural transudate/exudate was only mentioned in 38 cases, of which only 2 (5.3%) met Light's criteria for transudate.<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">32,39</span></a> In 1 case, the bilateral MPE was exudative on the left side and transudative on the right.<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">32</span></a> The PF cultures were negative in the 31 cases in which they were performed.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Cytology, pleural biopsy and monoclonal peak in pleural fluid</span><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the cost-effectiveness of the MPE diagnostic procedures in the reviewed cohort. Pleural cytology was performed in 145 cases and was positive for malignancy in 139 (95.9%). Pleural biopsies were conducted in 36 patients and were positive for malignancy in 32 (88.9%). The pleural biopsies were obtained by thoracoscopy (3 patients),<a class="elsevierStyleCrossRefs" href="#bib0770"><span class="elsevierStyleSup">47,88,102</span></a> CT-guided closed pleural biopsy (1 case),<a class="elsevierStyleCrossRef" href="#bib0940"><span class="elsevierStyleSup">81</span></a> or mostly by unspecified methods. In 54 of 57 cases (94.7%), the presence of a monoclonal peak in the PF was demonstrated. In the 6 cases in which the cytology was negative, the diagnosis was established by pleural biopsy (1 case),<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">45</span></a> pleural biopsy along with a monoclonal peak in the PF (2 patients),<a class="elsevierStyleCrossRefs" href="#bib0835"><span class="elsevierStyleSup">60,71</span></a> a monoclonal peak in PF (2 cases)<a class="elsevierStyleCrossRefs" href="#bib0730"><span class="elsevierStyleSup">39,72</span></a> and flow cytometry in PF (1 patient).<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">45</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Treatment for pleural effusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The 170 treatments started in the various therapeutic phases and the results of each treatment are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. The most common treatments were medical (chemotherapy, with or without corticosteroids, administered both in isolation and combined with other more invasive treatments), repeated therapeutic thoracentesis, the placement of chest drainage and pleurodesis. The response was favorable to any of these treatments (total or partial control of the MPE or symptoms) in 53 patients (31.2%), unfavorable (no control of the MPE or symptoms or recurrence of the MPE or symptoms) in 93 patients (54.7%) and unknown in 24 patients (14.1%). Other treatments employed, with anecdotal frequency, were local radiation therapy for plasmacytomas (5 cases), plasmapheresis (1 patient) and nitrogen mustard through a chest drainage tube (2 cases). No treatment was performed on 6 patients, and their outcomes were not specified.<a class="elsevierStyleCrossRefs" href="#bib0710"><span class="elsevierStyleSup">35,38,42,65,83,86</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Publications on MPE include isolated case studies and small series (the largest containing 23 cases).<a class="elsevierStyleCrossRef" href="#bib0995"><span class="elsevierStyleSup">92</span></a> Key aspects such as clinical progression, MPE characteristics and the most effective treatments are therefore not well known. These issues have been addressed in this systematic literature review.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Although MPE can occur in any individual, the patient type is a man (63%; male/female ratio, 1.7/1), 41–70 years of age (77.1%), with dyspnea (98.8%), bone pain (100%), chest pain (95.3%), anemia (90.1%), osteolytic lesions (77.9%) and unilateral effusion (63.9%), mostly left-sided and covering more than two thirds of the hemithorax (55.4%).</p><p id="par0105" class="elsevierStylePara elsevierViewall">When faced with PE in a patient with MM, we need to determine whether MPE is involved or is due to other etiologies (e.g., heart failure and nephrotic syndrome). Among the accepted criteria for the diagnosis of MPE, the most cost-effective test was PF cytology (95.9%; negative in only 6 cases),<a class="elsevierStyleCrossRefs" href="#bib0730"><span class="elsevierStyleSup">39,45,60,71,72</span></a> followed by the presence of a monoclonal peak in the PF (94.7%; absent in 3 patients)<a class="elsevierStyleCrossRefs" href="#bib0670"><span class="elsevierStyleSup">27,59,76</span></a> and pleural biopsy (80%; negative in 4 patients).<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5,19,30,57</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">As happens in most malignant effusions, the PF of MPE was hemorrhagic (55.4%) or serohemorrhagic (31.6%). PF is usually exudative, due more to the increase in vascular patency (94.2% of cases with total proteins >3<span class="elsevierStyleHsp" style=""></span>g/dL; 49/52) than to an increase in inflammation (LDH >220<span class="elsevierStyleHsp" style=""></span>IU/L in 75.8% of cases; 25/33). Nevertheless, a transudate does not rule out the diagnosis of a malignant effusion<a class="elsevierStyleCrossRef" href="#bib1050"><span class="elsevierStyleSup">103</span></a> or an MPE.<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">32,39</span></a> Possible explanations for this fact include the following: (1) in an initial stage, PF accumulation can be due more to lymphatic drainage obstruction by the tumor than to direct infiltration of the pleura. In these circumstances, such as when the PF that enters the pleural space is an ultrafiltrate with low protein levels, at least several weeks are needed for the accumulating proteins to reach >50% of the serum concentration; (2) the PF accumulates because there is another etiology capable of causing a transudative effusion, given that a tumor that affects the pleura does not necessarily have to cause a PE; and (3) both the neoplasm and some of the previously mentioned causes contribute to the development of the effusion.<a class="elsevierStyleCrossRef" href="#bib1055"><span class="elsevierStyleSup">104</span></a> Fifty percent of the MPEs (11/22) had more than 5000 leukocytes/μL and were generally of lymphocyte predominance (11/14, 78.6%), although a predominance of neutrophils does not rule out the diagnosis (1/9, 11.1%).<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">5</span></a> It is worth noting that the median total proteins in PF was 6.2<span class="elsevierStyleHsp" style=""></span>g/dL; 34 of 52 patients (65.4%) had levels >5<span class="elsevierStyleHsp" style=""></span>g/dL, and 21 (40.4%) had levels >7<span class="elsevierStyleHsp" style=""></span>g/dL, which could be explained by the abnormal production of proteins by the neoplastic plasma cells present in the PF. These data seem to confirm the results of previous studies that established that high concentrations of total proteins in PF suggest the Waldenstrom macroglobulinemia<a class="elsevierStyleCrossRef" href="#bib1060"><span class="elsevierStyleSup">105</span></a> or MPE.<a class="elsevierStyleCrossRef" href="#bib1065"><span class="elsevierStyleSup">106</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The MPE rates with glucose levels in PF<span class="elsevierStyleHsp" style=""></span><60<span class="elsevierStyleHsp" style=""></span>mg/dL (17.9%) and pH <7.35 (33.3%) were similar to those of any malignant effusion.<a class="elsevierStyleCrossRef" href="#bib1070"><span class="elsevierStyleSup">107</span></a> The high adenosine deaminase levels (>35<span class="elsevierStyleHsp" style=""></span>U/I) observed in the PF (64.7%) required the ruling out of the presence of tuberculosis (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The treatment for MPE is not well defined. Although there is consensus on how to diagnose MPE, there is none on how to treat it. In 93 of the 170 treatments applied (54.7%), the results were unfavorable. Based on the results, it seems that therapeutic thoracentesis, chest drainage alone, nitrogen mustard or local radiation therapy are not the best options for treating MPE (0%, 18.2%, 0% and 0% of favorable responses, respectively). Medical treatment (chemotherapy, combined or not with corticosteroids) achieved better results (34.4% of favorable responses). There is a strikingly small number of patients for whom the MPE was treated with chest drainage and pleurodesis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). One explanation could be that the physicians responsible for these patients do not usually belong to departments familiar with managing malignant effusions. Given the success of pleurodesis in these patients (80%), it is likely that a greater implementation of these procedures could positively affect the overall rate of favorable results. A favorable result was also achieved in the only recorded patient in whom the MPE was treated with plasmapheresis.<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">16</span></a> Nevertheless, in most cases, the MPE represented a disease progression, as shown by the fact that most of the patients were already diagnosed with MM when diagnosed with the effusion, which makes it difficult to assess the response to treatment. Thus, 118 of the reviewed patients underwent a follow-up, and 81.4% ended up dying, either due to disease progression or to complications that emerged during treatment.<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5,9,11,12,17,26,36,39,42,52,59,62,67</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">This review had a number of limitations, the most important of which was the inclusion of isolated cases instead of case series or comparative clinical trials. Therefore, the quality of the literature employed could limit the internal and external validity and the precision. The articles reviewed were also not homogeneous, given that some highlighted clinical characteristics, while others emphasized the diagnostic or therapeutic aspects. Due to the heterogeneity of the information, we cannot provide accurate data on the symptoms or response to a particular treatment. As with all rare diseases, publication bias is another limitation, given that cases treated successfully or atypical cases are more likely to be published.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In summary, despite the systematic review, the available data are insufficiently numerous to draw firm conclusions. However, when dealing with PE in a patient with MM, we need to confirm its origin because it does not always involve MPE. To this end, PF cytology and the demonstration of a monoclonal peak in the PF are the most cost-effective diagnostic procedures. These patients are usually middle to older aged men with dyspnea and bone and chest pain. The presence of anemia and lytic bone lesions is common. The MPE is usually unilateral and occupies more than two-thirds of the hemithorax. The PF is serohemorrhagic or hemorrhagic and behaves biochemically as an exudate, generally of lymphocyte predominance, which can present very high levels of total proteins. Most of these patients do not respond to treatment, although the number of patients with a specific treatment for MPE (chest drainage and pleurodesis) was low. The most effective treatment appears to be chemotherapy (with or without corticosteroids) combined with chest drainage and pleurodesis.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres991079" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec954995" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres991077" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec954996" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Selection criteria" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Information sources" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection process" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Methodological quality of the individual studies" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Measures of interest" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Demographic, clinical and radiological characteristics" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Pleural effusion" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Cytology, pleural biopsy and monoclonal peak in pleural fluid" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Treatment for pleural effusion" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-09-24" "fechaAceptado" => "2017-11-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec954995" "palabras" => array:8 [ 0 => "Pleural effusion" 1 => "Pleural fluid" 2 => "Myelomatous pleural effusion" 3 => "Multiple myeloma" 4 => "Pleural cytology" 5 => "Monoclonal peak" 6 => "Pleural biopsy" 7 => "Systematic review" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec954996" "palabras" => array:8 [ 0 => "Derrame pleural" 1 => "Líquido pleural" 2 => "Derrame pleural mielomatoso" 3 => "Mieloma múltiple" 4 => "Citología pleural" 5 => "Pico monoclonal" 6 => "Biopsia pleural" 7 => "Revisión sistemática" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Myelomatous pleural effusion (MPE) is rare in multiple myeloma, and therefore its characteristics are not well defined.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A systematic review (4 online databases) was conducted of articles describing the clinical characteristics of patients with MPE, pleural effusion's biochemical characteristics and treatment efficacy. We analyzed isolated cases and small retrospective series.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We included 98 articles with a total of 153 patients with MPE. The median age was 62 years, and the ratio of males to females was 1.7:1. The most common symptoms were dyspnea (98.8%), bone pain (100%) and chest pain (95.3%), and the most relevant abnormal laboratory test results were anemia (90.1%) and renal failure (53.8%). MPE was predominantly unilateral (63.9%) and covered more than two-thirds of the hemithorax (54.5%). The pleural fluid (PF) had a haematologic/serohaematologic appearance (87%) and met the criteria for lymphocytic (78.6%) exudate (94.7%). The most cost-effective diagnostic procedures were pleural cytology (95.9%) and the observation of a monoclonal peak in the PF (94.7%). In a significant proportion of patients (54.7%), the MPE did not respond to treatment, and the best response was achieved when chemotherapy (with/without corticosteroids) was combined with therapeutic thoracentesis, chest drainage or pleurodesis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MPE predominates in middle to older age men, is symptomatic and is usually unilateral. PF is an exudate with a hemorrhagic appearance, and the most cost-effective diagnostic procedure is pleural cytology. Treatment response is unfavorable in more than half of patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El derrame pleural mielomatoso (DPM) es raro en el mieloma múltiple, por lo que sus características no están bien definidas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisión sistemática (cuatro bases de datos electrónicas) de los artículos que describen las características clínicas de estos pacientes, las características bioquímicas del derrame pleural y la eficacia de los tratamientos instaurados. Se analizaron casos aislados y pequeñas series retrospectivas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 98 artículos con un total de 153 pacientes con DPM. La mediana de edad fue de 62 años y la razón hombre/mujer, de 1,7/1. La sintomatología más frecuente consistió en disnea (98,8%), dolor óseo (100%) y dolor torácico (95,3%); las alteraciones analíticas más relevantes fueron la anemia (90,1%) y la insuficiencia renal (53,8%). El DPM fue predominantemente unilateral (63,9%) y mayor de 2/3 del hemitórax (54,5%). El líquido pleural (LP) tuvo aspecto hemático/serohemático (87%) y cumplió criterios de exudado (94,7%) linfocitario (78,6%). Los procedimientos diagnósticos más rentables fueron la citología pleural (95,9%) y la observación en el LP de un pico monoclonal (94,7%). En una proporción significativa de pacientes (54,7%) el DPM no respondió al tratamiento y la mejor respuesta se obtuvo cuando la quimioterapia (con/sin corticoesteroides) se asoció a toracocentesis terapéuticas, drenaje torácico o pleurodesis.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El DPM predomina en varones de edad media/alta, es sintomático y suele ser unilateral. El LP es un exudado de aspecto hemorrágico y el procedimiento diagnóstico más rentable es la citología pleural. La respuesta al tratamiento no es favorable en más de la mitad de los pacientes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Please cite this article as: Riveiro V, Ferreiro L, Toubes ME, Lama A, Álvarez-Dobaño JM, Valdés L. Características de los pacientes con derrame pleural mielomatoso. Revisión sistemática. Rev Clin Esp. 2018;218:89–97.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1672 "Ancho" => 2667 "Tamanyo" => 218564 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">PRISMA flow diagram of the reviewed literature. Abbreviation: PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 992 "Ancho" => 2667 "Tamanyo" => 120311 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cost-effectiveness of the procedures employed for establishing the diagnosis of myelomatous pleural effusion.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \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">Data (<span class="elsevierStyleItalic">n</span>)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean age, years (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (33–85) (128) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex, male/female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92/54 (146) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking, yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/4 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyspnea, yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83/1 (84) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chest pain, yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62/3 (65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bone pain, yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35/0 (35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lytic lesions, yes/no \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67/19 (86) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pleural effusion laterality, right/left/bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32/53/48 (133) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pleural effusion size, <1/3 hemithorax, 1/3–2/3, >2/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15/15/36 (66) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1678934.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Data was not available for all included patients (153). Therefore, the number of patients for whom the corresponding variable was calculated is specified between the parentheses.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Demographic, clinical and radiological characteristics of patients with myelomatous pleural effusion.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \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"><span class="elsevierStyleItalic">n</span> (%) \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">Median (range) \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">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nucleated cells, cell/μL</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (14.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5850 (420–20,500) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/22 (50%) >5000<span class="elsevierStyleHsp" style=""></span>cells/μL<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">14,24,27,41,54,61,66,76,85,87,98</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Percentage cell count</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lymphocytes, %<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (6–100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/14 (78.6%) >50%<a class="elsevierStyleCrossRefs" href="#bib0735"><span class="elsevierStyleSup">40,56,57,60,66,71,76,85,87,90,98</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neutrophils, %<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (9–60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/9 (11.1%) >50%<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Proteins, g/dl</span></td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">52 (34)</td><td class="td" title="table-entry " rowspan="3" align="char" valign="top">6.2 (2.5–38)</td><td class="td" title="table-entry " align="left" valign="top">49/52 (94.2%) >3<span class="elsevierStyleHsp" style=""></span>g/dL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">34/52 (65.4%) >5<span class="elsevierStyleHsp" style=""></span>g/dL<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5,6,9,12–14,18,19,25,28,30,31,34,36,38,40,41,43,44,54,56,60,74,76,77,85,88,90,94,97–99,101</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21/52 (40.4%) >7<span class="elsevierStyleHsp" style=""></span>g/dL<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5,6,9,12,18,25,28,30,31,34,36,41,44,60,74,76,77,88,97–99</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Lactate dehydrogenase, IU</span>/<span class="elsevierStyleItalic">L</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></td><td class="td" title="table-entry " align="char" valign="top">33 (21.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">548 (86–5941) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/33 (24.2%) <220<span class="elsevierStyleHsp" style=""></span>IU/L<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">6,36,44,60,66,70,81,102</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/33 (30.3%) >800<span class="elsevierStyleHsp" style=""></span>IU/L<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">14,17,29,33,54,77,90,95,98,101</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Glucose, mg/dL</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (18.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.5 (3.4–152) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/28 (17.9%) <60<span class="elsevierStyleHsp" style=""></span>mg/dL<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">6,54,77,98,101</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">pH</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.39 (7–7.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/9 (33.3%) <7.35<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">41,54,101</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Adenosine deaminase, U/L</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (10–142.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/17 (64.7%) >35<span class="elsevierStyleHsp" style=""></span>U/L<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">28–30,40,43,54,61,63,68,81,99</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1678936.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">>50%.</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">The chosen arbitrary cutoff was 2/3 the upper value of normality in blood (in our hospital, 220<span class="elsevierStyleHsp" style=""></span>IU/L in pleural fluid).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Descriptive analysis of the specified parameters in the pleural fluid.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \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"><span class="elsevierStyleItalic">n</span> \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">Favorable<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \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">Unfavorable<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \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">Unknown \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Therapeutic thoracentesis</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (91.7%)<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">6,9,10,20,24,29–31,39,43,53,54,57,66,68,74,78,79,95,97,98,100</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (8.3%)<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">22,58</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chest drainage</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (18.2%)<a class="elsevierStyleCrossRefs" href="#bib0970"><span class="elsevierStyleSup">87,98</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (45.4%)<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">17,45,47,50,77</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (36.4%)<a class="elsevierStyleCrossRefs" href="#bib0665"><span class="elsevierStyleSup">26,27,68,84</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pleurodesis</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (41.7%)<a class="elsevierStyleCrossRefs" href="#bib0655"><span class="elsevierStyleSup">24,29,31,53</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (33.3%)<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">43,46,47,80</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (25%)<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">9,57,95</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Medical treatment</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (34.4%)<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">12,14,19,25,35,37,40,49,51,59,60,62,63,77,81,89,92</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (51.6%)<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5–8,10,11,15,17,18,22–24,26,27,29–31,33,37,39,43,46,53,56,66,67,69–71,73,78,89,92,94,95,99</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (14%)<a class="elsevierStyleCrossRefs" href="#bib0640"><span class="elsevierStyleSup">21,28,44,48,50,52,75,85,89,91</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Medical treatment combined with...</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Therapeutic thoracentesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (50%)<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">32,51</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (50%)<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">9,64</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chest drainage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (50%)<a class="elsevierStyleCrossRefs" href="#bib0760"><span class="elsevierStyleSup">45,54</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (50%)<a class="elsevierStyleCrossRefs" href="#bib0760"><span class="elsevierStyleSup">45,90</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pleurodesis<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (80%)<a class="elsevierStyleCrossRefs" href="#bib0715"><span class="elsevierStyleSup">36,45,74</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (20%)<a class="elsevierStyleCrossRefs" href="#bib0650"><span class="elsevierStyleSup">23,67</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plasmapheresis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (100%)<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">16</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="char" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nitrogen mustard</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100%)<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">6,9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Local radiation therapy</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (80%)<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">8,9,11,17</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (20%)<a class="elsevierStyleCrossRef" href="#bib0945"><span class="elsevierStyleSup">82</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tunneled pleural catheter</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (50%)<a class="elsevierStyleCrossRef" href="#bib0920"><span class="elsevierStyleSup">77</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (50%)<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">43</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">No treatment of the pleural effusion</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (100%)<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">34,38,42,65,83,86</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1678935.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">The treatments were applied by phases, such that one patient could have undergone several. Each treatment was administered separately, except those under “Medical treatment combined with”, in which several therapeutic options were combined.</p>" ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Favorable: total or partial control of the pleural effusion or symptoms; unfavorable: no control of the pleural effusion or symptoms or recurrence of the pleural effusion or symptoms.</p>" ] 2 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Includes 1 or more thoracenteses.</p>" ] 3 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Includes talc pleurodesis, cisplatin, tetracycline, vibramycin, bortezomib, adriamycin, interferon-alpha, bleomycin, doxycycline and thiotepa.</p>" ] 4 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Includes chemotherapy, combined or not with corticosteroids.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Established treatments in myelomatous pleural effusion.<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a></p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:107 [ 0 => array:3 [ "identificador" => "bib0540" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple myeloma" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra1011442" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "1046" "paginaFinal" => "1060" "link" => array:1 [ …1] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0545" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic and pulmonary abnormalities in multiple myeloma. 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