Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis

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Survival probabilities estimates by Kaplan-Meier method, in five years of follow-up of CBP patients treated with UDCA and others drugs vs. OT without UDCA. B. Adjusted survival curves obtained from a Cox Proportional Hazard Model by treatment (OT vs. UDCA) and letting Mayo Score Risk be the mean value (6.3) and female gender." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yazmín Karel Melchor-Mendoza, Braulio Martínez-Benítez, Aline Mina-Hawat, Gustavo Rodríguez-Leal, Ximena Duque, Segundo Moran-Villota" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Yazmín Karel" "apellidos" => "Melchor-Mendoza" ] 1 => array:2 [ "nombre" => "Braulio" "apellidos" => "Martínez-Benítez" ] 2 => array:2 [ "nombre" => "Aline" "apellidos" => "Mina-Hawat" ] 3 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Rodríguez-Leal" ] 4 => array:2 [ "nombre" => "Ximena" "apellidos" => "Duque" ] 5 => array:2 [ "nombre" => "Segundo" "apellidos" => "Moran-Villota" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119304168?idApp=UINPBA00004N" "url" => "/16652681/0000001600000003/v1_201905301200/S1665268119304168/v1_201905301200/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "titulo" => "Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "436" "paginaFinal" => "441" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Manterola, Tamara Otzen" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carlos" "apellidos" => "Manterola" "email" => array:1 [ 0 => "carlos.manterola@ufrontera.cl" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "**" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Tamara" "apellidos" => "Otzen" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "**" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "***" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Surgery and CEMyQ (Center of Morphological and Surgical Studies), Universidad de La Frontera, Chile" "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile" "etiqueta" => "**" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Universidad de Tarapacá, Chile" "etiqueta" => "***" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Corresponce and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 576 "Ancho" => 2074 "Tamanyo" => 122034 ] ] "descripcion" => array:1 [ "en" => "Female 66-year-old patient presented with four days’ evolution of right upper abdominal pain, fever and jaundice. Abdominal CT scan verified a heterogeneous cystic mass that represented germinative membrane residues and some daughter vesicles. The intimate relation between the cyst and the right biliary tree can also be seen, specifically with its anterior branches. The biliary communication at this level (segment VI) gave rise to cholangiohydatidosis and secondary acute cholangitis." ] ] ] "textoCompleto" => "IntroductionIntrabiliary rupture of hepatic echinococcosis (HE) is one of the most frequent evolutionary complications of this pathological entity. Once this rupture occurs and there is communication between a cyst and the biliary tree, the conditions are created that allow the further migration of the parasitic structures (pieces of germinal layer or daughter vesicles) into the biliary tract.<a class="elsevierStyleCrossRefs" href="#bib0010">1,2</a> This situation (cholangiohydatidosis) may produce a secondary cholan-gitis<a class="elsevierStyleCrossRef" href="#bib0020">3</a> and even infection of the cyst with liver abscess.<a class="elsevierStyleCrossRef" href="#bib0025">4</a> Obviously, any of these situations might increase the risk of post-operative morbidity (POM).<a class="elsevierStyleCrossRefs" href="#bib0020">3-5</a>The reported prevalence of intrabiliary rupture of HE is between 9.0% and 42.0%,<a class="elsevierStyleCrossRefs" href="#bib0015">2,6-9</a> but the frequency of cholangiohydatidosis and secondary cholangitis is unclear. There are few related reports; most are about intrabiliary rupture, but not about cholangiohydatidosis and secondary cholangitis, about which we found only 15 articles.<a class="elsevierStyleCrossRefs" href="#bib0020">3,10-23</a> The information available is scarce and with a low level of evidence, so collecting specific data regarding the prevalence or incidence of cholangitis due to cholangiohydati-dosis is virtually impossible.However, a preoperative diagnosis of cholangiohy-datidosis and secondary cholangitis is difficult unless it can be observed in images such as those in <a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>. Diagnosis is usually intraoperative once a dilatation of the bile duct has been confirmed, where tension bile or bilious pus and parasite remnants may be flowing in the interior (<a class="elsevierStyleCrossRef" href="#f0015">Figure 2</a>).<elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia>The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohy-datidosis and secondary cholangitis in terms of POM.This report was written on the basis of the MINCIR Statement (Methodology and Investigation in Surgery) for reporting observational descriptive studies.<a class="elsevierStyleCrossRef" href="#bib0125">24</a>Material and MethodsStudy designA case series of patients operated on for cholangiohy-datidosis and secondary cholangitis, who are part of a concurrent cohort of subjects operated on for HE.SettingThe study was conducted at the Department of Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile. The recruitment period was between January 2004 and December 2014. The minimum follow-up time was six months.ParticipantsPatients operated on for HE (only E. granulosus variety) by the first author (CM) during the study period were included. Patients with a history of prior surgery for HE or other concomitant hepatic pathologies were excluded. A non-probabilistic sampling of consecutive cases was used.Diagnostic criteriaDiagnosis of cholangiohydatidosis and secondary cholangitis was suspected by images (abdominal CT-Scan or IMR) in all patients and confirmed intraoperatively by the observation of a solution of continuity in the bile duct and the existence of pus and parasitic structures in the biliary ducts. Typification of echinococcosis was made post-operatively at a parasitology laboratory, using direct microscope observation of protoscolices, and histological study of surgical specimens confirmed the preoperative diagnosis in all the patients.Surgical procedureAll patients underwent emergency surgery with prior antibiotic prophylaxis. The criterion for open surgery in acute cholangitis in our center is: patient with Charcot triad associated with dilatation of the biliary tract verified by abdomi-ationn.al ultrasonography when endoscopic surgery is not available. Surgery consisted of the exploration of the bile duct, removal of hydatid structures, choledochal drainage (Kehr drain) and concomitant treatment of the cyst with pericystectomy or liver resection. Then, all patients continued with antibiotics postoperatively for seven days.Study protocolAfter hospital discharge, all patients were followed with strict check-ups at least at months 1 and 6 and then once per year (where possible). At these check-ups, clinical evaluation was performed as well as general laboratory and liver function tests, immunodiagnostics and abdominal ultrasound.VariablesThe principal outcome variable was “development of POM”, measured at least six months after surgery. This was considered dichotomously (present or absent), and from the point of view of the severity of POM, applying the Clavien-Dindo surgical complications classification.<a class="elsevierStyleCrossRef" href="#bib0130">25</a> Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phos-phatase and transaminases, type of surgery (categorized in pericystectomy and liver resection), existence of concomitant evolutionary complications in the cyst (dichotomized as yes or no), length of hospital stay, need for surgical re-intervention and operative mortality.BiasesIn the recruitment and follow-up stage, biases were reduced with a complete follow-up and blinded data collection. Then, data were encoded and not revealed until the analysis period was complete.Study sizeSince it is an observational and descriptive study, no sample size was estimated.Statistical methodsThe data were analyzed with the Stata 11.0/SE® program. Descriptive statistics were used to calculate percentages, averages and standard deviations, medians and extreme values.EthicsWritten informed consent was obtained from each patient. All the ethical guidelines for research on human beings as defined by the Helsinki Declaration<a class="elsevierStyleCrossRef" href="#bib0135">26</a> were observed.FundingThere was no special funding for this study.ResultsA total of 22 patients operated on for cholangiohydatido-sis were recruited in this period. Two were not included in the final analysis due to a lack of follow-up (<a class="elsevierStyleCrossRef" href="#f0020">Figure 3</a>).<elsevierMultimedia ident="f0020"></elsevierMultimedia>The patients comprising the series are characterized by a median age of 53 years, 50.0% female and 20.0% of them having two or more cysts with a mean diameter of 13.3 ± 6.3 cm (<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>).<elsevierMultimedia ident="t0010"></elsevierMultimedia>Two patients (10.0%) had a history of previous surgery for hepatic hydatid disease and another due to pulmonary hydatid disease. Five patients (25.0%) had comorbidities: heart disease (2 cases), diabetes mellitus (2 cases) and cholelithiasis (1 case).Nine subjects (45.0%) had concomitant parasitic diseases: hepatic abscess of hydatid origin (7 cases, 35.0%), and hepatothoracic transit (2 cases, 10.0%).Laboratory tests revealed anemia (5 cases, 25.0%), leu-kocytosis (11 cases, 55.0%), signs of cholestasis (17 cases, 85.0%) and hepatocyte cytolysis (17 cases, 85.0%) (<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>).The existence of concomitant hydatid disease in the peritoneum (2 cases) and spleen (one case) was verified. The most common location of cysts communicated to the bile duct was the right hepatic lobe (12 cases, 60.0%) (<a class="elsevierStyleCrossRef" href="#t0015">Table 2</a>).<elsevierMultimedia ident="t0015"></elsevierMultimedia>The mean diameter of the common bile duct was 18.5 ± 2.1 mm and biliary communications were found in all patients (<a class="elsevierStyleCrossRefs" href="#t0010">Tables 1 and 3</a>).A median hospital stay of six days was recorded with a median follow-up of 34 months (<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>), 30.0% morbidity and a re-intervention rate of 10.0% (<a class="elsevierStyleCrossRef" href="#t0015">Table 2</a>). The related morbidity was secondary to pulmonary, cardiac and metabolic complications (1 case of each), infection at the surgical site, incisional hernia, biliary fistula (1 case of each) (<a class="elsevierStyleCrossRef" href="#t0020">Table 3</a>).<elsevierMultimedia ident="t0020"></elsevierMultimedia>Mortality rate was 5.0%. This was a 76-year-old patient with a coronary cardiopathy who presented episodes of projectile vomiting, and then developed aspiration pneumonia, secondary respiratory insufficiency and finally multiple organ failure.All the diagnosed cases of acute cholangitis due to cholangiohydatidosis in the reported period were treated according to the protocol described in material and methods section. There were no cases of medical or endoscop-ic treatment.DiscussionThere are few reports regarding the study of cholan-giohydatidosis as an associated factor for POM in HE surgery, and most are retrospective case series, contributing evidence level 4. Reports in the literature are scarce because it is a rare entity, with a low incidence among patients who have undergone surgery for HE. In general, there have only been isolated case reports and small case series (single case report,<a class="elsevierStyleCrossRefs" href="#bib0070">13,15,16,18-20,22,23</a> between 4 and 6 cases of endoscopic treatment<a class="elsevierStyleCrossRefs" href="#bib0055">10-12,21</a>), 13 cases reported by our group in 20013, 25 cases treated endoscopically14 and the most numerous series (80 cases).<a class="elsevierStyleCrossRef" href="#bib0090">17</a> However, secondary cholangitis is not clearly reported in any of them.In addition to being a rare entity, the biggest problems are the complications which cholangiohydatidosis can cause: biliary obstructive syndrome,<a class="elsevierStyleCrossRefs" href="#bib0020">3,14</a> acute suppurated cholangitis,<a class="elsevierStyleCrossRefs" href="#bib0020">3,13,14</a> and even acute secondary pancreatitis.<a class="elsevierStyleCrossRefs" href="#bib0070">13,15</a>The fact that 35.0% of cases concomitantly presented a liver abscess of hydatid origin,<a class="elsevierStyleCrossRef" href="#bib0025">4</a> and 10.0% also had a hepatotho-racic transit,<a class="elsevierStyleCrossRef" href="#bib0140">27</a> underscores these patients’ severe condition.The mean diameter of the cysts was 19.0 ± 9.0 cm, with a mostly heterogeneous sonographic appearance, and these were generally complicated cysts. This fact at least partly undermines the thesis of exclusive endoscopic treatment for this problema,<a class="elsevierStyleCrossRefs" href="#bib0065">12,14</a> because if so, we would be rendering treatment for the original lesion null, which, as discussed in this manuscript, in more than 30% of cases can be found abscessed as well. For this reason, we believe that surgery remains the treatment of choice for cholan-giohydatidosis and secondary cholangitis, and endoscopic drainage may be useful only in select cases,<a class="elsevierStyleCrossRefs" href="#bib0085">16,28,29</a> and more as a bridge procedure to drain the bile duct while awaiting definitive surgery.Clinical presentation and laboratory findings are not specific, and may simulate an obstructive jaundice and acute cholangitis (predominantly lithiasic in Chile), which is similar to that reported by other groups.<a class="elsevierStyleCrossRefs" href="#bib0085">16,29</a>The existence of biliary communications in all patients explains the genesis of cholangiohydatidosis, because it is through these communications that parasitic structures migrate into the bile duct.<a class="elsevierStyleCrossRef" href="#bib0020">3</a>Treatment of cholangiohydatidosis and secondary cholangitis is to drain and clean the bile duct, which can be performed by open (conventional) surgery or closed surgery (endoscopic papillotomy); however, as discussed above, while it is true that endoscopic papillotomy offers all the advantages of a minimally invasive surgery (particularly useful in high-risk patients), it does not allow a rational and definitive treatment of the whole problem. Therefore, in general, surgery remains the option of choice through biliary drainage (choledochostomy or choledocoduodenoanastomosis) and simultaneous resection of the hydatid cyst.<a class="elsevierStyleCrossRefs" href="#bib0085">16,28,29</a>It would be of great interest to ascertain the effectiveness of endoscopic and laparoscopic treatments in patients with cholangitis secondary to cholangiohydatidosis. However, the actual number of available cases is insufficient to conduct a comparative study with a methodologically adequate power and level of confidence.We believe that the reported morbidity (30.0%) is relevant; however, the clinical severity in these patients and their concomitant comorbidities must also be consid-ered3,17, as should the mortality of the series (5.0%), which guides a clinical entity of poor prognosis for which no effort should be spared to make an early diagnosis and take prompt and appropriate action.<a class="elsevierStyleCrossRefs" href="#bib0020">3,28</a>However, we are aware that the study presents some potential sources of bias that merit comment. One of these has to do with the heterogeneity of the population. Another is related to the sample size, because there are no more cases to report. The loss of follow-up at less than 10% and an extensive follow-up time, however, are tools that increase the quality of the data.With respect to the external validity of this study, it is worth noting that the study results correspond to the reality of one center of reference for hepatobiliary surgery located in an endemic region of echinococcosis; therefore, the reader must assess the external validity and reproduci-bility of the results with caution.The protocol treatment did not include surgery prophylaxis with chemotherapy for Echinococcus Granulosus. This is a controversial point; however, we chose not to use it because of a previous study where we described al-bendazole as having no effect on the viability of proto-scoleces in patients treated with this drug preoperatively.<a class="elsevierStyleCrossRef" href="#bib0155">30</a> With respect to medical treatment with albendazole, there is strong evidence (systematic reviews and clinical trials) that indicate that anthelmintic treatment alone is not ideal for liver hydatid cysts.<a class="elsevierStyleCrossRefs" href="#bib0160">31-33</a> On the other hand, the World Health Organization carried out multicenter trials in Europe to compare albendazole and mebendazole and verified that both drugs had similar efficacy, but mebendazole required higher doses and a different treatment with longer periods of adverse reactions.<a class="elsevierStyleCrossRefs" href="#bib0175">34,35</a>Finally, it is important to note that cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with important rates of POM and mortality which occurs in the context of complex patients, so it must be treated in centers with experience in such diseases.Abbreviations<ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0010">•HE: hepatic echinococcosis.</li><li class="elsevierStyleListItem" id="u0015">•POM: post-operative morbidity.</li></ul>Financial SupportNone." 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The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Material and methodCase series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bi-lirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. ResultsA total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. ConclusionCholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abs0010" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abs0015" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abs0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abs0025" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 576 "Ancho" => 2074 "Tamanyo" => 122034 ] ] "descripcion" => array:1 [ "en" => "Female 66-year-old patient presented with four days’ evolution of right upper abdominal pain, fever and jaundice. Abdominal CT scan verified a heterogeneous cystic mass that represented germinative membrane residues and some daughter vesicles. The intimate relation between the cyst and the right biliary tree can also be seen, specifically with its anterior branches. The biliary communication at this level (segment VI) gave rise to cholangiohydatidosis and secondary acute cholangitis." ] ] 1 => array:7 [ "identificador" => "f0015" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 724 "Ancho" => 999 "Tamanyo" => 79225 ] ] "descripcion" => array:1 [ "en" => "Open bile duct and the appearance of daughter vesicles." ] ] 2 => array:7 [ "identificador" => "f0020" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 685 "Ancho" => 1001 "Tamanyo" => 81517 ] ] "descripcion" => array:1 [ "en" => "Flowchart of the study participants." ] ] 3 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ASAT: aspartate aminotransferase. ALAT: alanine aminotransferase." "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean ±SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Min \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Max \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.0 ± 19.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hematocrits (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.4 ± 3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leukocytes (x mm3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13,507.6 ± 7,281.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10,850.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3,500 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31,900 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilirubin (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6 ± 3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alkaline phosphatase (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">940.3 ± 636.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">762.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">228 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2,260 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ASAT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">178.4± 224.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">147.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALAT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">205.9 ± 179.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">162.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">738 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyst diameter (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.0 ± 9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bile duct diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.0 ± 2.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital stay (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.0 ± 17.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow-up (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.0 ± 28.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2045069.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of clinical data in the study patients (N = 20)." ] ] 4 => array:7 [ "identificador" => "t0015" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other evolutionary complication in the cyst (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of cysts (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">One \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two or more \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery performed (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lobectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morbidity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Need for re-operation (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mortality (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2045071.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of clinical data and surgical characteristics in the study patients (N = 20)." ] ] 5 => array:7 [ "identificador" => "t0020" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Location of the cyst (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right lobe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left lobe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Biliary communications (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">One \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Two \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Three or more \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment of the residual cavity (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Capitonnage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Omentoplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other surgeries performed concomitantly (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cholecystectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cholecystectomy and choledocostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cholecystectomy + choledocostomy + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">splenectomy and peritoneal hydatidosis surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morbidity according to Dindo & Clavien \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2045070.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of surgical characteristics in the study patients (N = 20)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" 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Carlos Manterola

,**,

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carlos.manterola@ufrontera.cl

Corresponce and reprint request:

, Tamara Otzen**,***

* Department of Surgery and CEMyQ (Center of Morphological and Surgical Studies), Universidad de La Frontera, Chile

** Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile

*** Universidad de Tarapacá, Chile

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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Female 66-year-old patient presented with four days&#8217; evolution of right upper abdominal pain&#44; fever and jaundice&#46; Abdominal CT scan verified a heterogeneous cystic mass that represented germinative membrane residues and some daughter vesicles&#46; The intimate relation between the cyst and the right biliary tree can also be seen&#44; specifically with its anterior branches&#46; The biliary communication at this level &#40;segment VI&#41; gave rise to cholangiohydatidosis and secondary acute cholangitis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Introduction</span><p id="p0010" class="elsevierStylePara elsevierViewall">Intrabiliary rupture of hepatic echinococcosis &#40;HE&#41; is one of the most frequent evolutionary complications of this pathological entity&#46; Once this rupture occurs and there is communication between a cyst and the biliary tree&#44; the conditions are created that allow the further migration of the parasitic structures &#40;pieces of germinal layer or daughter vesicles&#41; into the biliary tract&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">1&#44;2</span></a> This situation &#40;cholangiohydatidosis&#41; may produce a secondary cholan-gitis<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> and even infection of the cyst with liver abscess&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a> Obviously&#44; any of these situations might increase the risk of post-operative morbidity &#40;POM&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3-5</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">The reported prevalence of intrabiliary rupture of HE is between 9&#46;0&#37; and 42&#46;0&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">2&#44;6-9</span></a> but the frequency of cholangiohydatidosis and secondary cholangitis is unclear&#46; There are few related reports&#59; most are about intrabiliary rupture&#44; but not about cholangiohydatidosis and secondary cholangitis&#44; about which we found only 15 articles&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3&#44;10-23</span></a> The information available is scarce and with a low level of evidence&#44; so collecting specific data regarding the prevalence or incidence of cholangitis due to cholangiohydati-dosis is virtually impossible&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">However&#44; a preoperative diagnosis of cholangiohy-datidosis and secondary cholangitis is difficult unless it can be observed in images such as those in <a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>&#46; Diagnosis is usually intraoperative once a dilatation of the bile duct has been confirmed&#44; where tension bile or bilious pus and parasite remnants may be flowing in the interior &#40;<a class="elsevierStyleCrossRef" href="#f0015">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia><p id="p0025" class="elsevierStylePara elsevierViewall">The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohy-datidosis and secondary cholangitis in terms of POM&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">This report was written on the basis of the MINCIR Statement &#40;Methodology and Investigation in Surgery&#41; for reporting observational descriptive studies&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">24</span></a></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Material and Methods</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Study design</span><p id="p0035" class="elsevierStylePara elsevierViewall">A case series of patients operated on for cholangiohy-datidosis and secondary cholangitis&#44; who are part of a concurrent cohort of subjects operated on for HE&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Setting</span><p id="p0040" class="elsevierStylePara elsevierViewall">The study was conducted at the Department of Surgery of the Universidad de La Frontera and the Cl&#237;nica Mayor in Temuco&#44; Chile&#46; The recruitment period was between January 2004 and December 2014&#46; The minimum follow-up time was six months&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Participants</span><p id="p0045" class="elsevierStylePara elsevierViewall">Patients operated on for HE &#40;only <span class="elsevierStyleItalic">E&#46; granulosus</span> variety&#41; by the first author &#40;CM&#41; during the study period were included&#46; Patients with a history of prior surgery for HE or other concomitant hepatic pathologies were excluded&#46; A non-probabilistic sampling of consecutive cases was used&#46;</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Diagnostic criteria</span><p id="p0050" class="elsevierStylePara elsevierViewall">Diagnosis of cholangiohydatidosis and secondary cholangitis was suspected by images &#40;abdominal CT-Scan or IMR&#41; in all patients and confirmed intraoperatively by the observation of a solution of continuity in the bile duct and the existence of pus and parasitic structures in the biliary ducts&#46; Typification of echinococcosis was made post-operatively at a parasitology laboratory&#44; using direct microscope observation of protoscolices&#44; and histological study of surgical specimens confirmed the preoperative diagnosis in all the patients&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Surgical procedure</span><p id="p0055" class="elsevierStylePara elsevierViewall">All patients underwent emergency surgery with prior antibiotic prophylaxis&#46; The criterion for open surgery in acute cholangitis in our center is&#58; patient with Charcot triad associated with dilatation of the biliary tract verified by abdomi-<span class="elsevierStyleInf">atio</span>n<span class="elsevierStyleInf">n&#46;</span>al ultrasonography when endoscopic surgery is not available&#46; Surgery consisted of the exploration of the bile duct&#44; removal of hydatid structures&#44; choledochal drainage &#40;Kehr drain&#41; and concomitant treatment of the cyst with pericystectomy or liver resection&#46; Then&#44; all patients continued with antibiotics postoperatively for seven days&#46;</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Study protocol</span><p id="p0060" class="elsevierStylePara elsevierViewall">After hospital discharge&#44; all patients were followed with strict check-ups at least at months 1 and 6 and then once per year &#40;where possible&#41;&#46; At these check-ups&#44; clinical evaluation was performed as well as general laboratory and liver function tests&#44; immunodiagnostics and abdominal ultrasound&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Variables</span><p id="p0065" class="elsevierStylePara elsevierViewall">The principal outcome variable was &#8220;development of POM&#8221;&#44; measured at least six months after surgery&#46; This was considered dichotomously &#40;present or absent&#41;&#44; and from the point of view of the severity of POM&#44; applying the Clavien-Dindo surgical complications classification&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">25</span></a> Other variables of interest were age&#44; sex&#44; cyst diameter&#44; hematocrit&#44; leukocytes&#44; total bilirubin&#44; alkaline phos-phatase and transaminases&#44; type of surgery &#40;categorized in pericystectomy and liver resection&#41;&#44; existence of concomitant evolutionary complications in the cyst &#40;dichotomized as yes or no&#41;&#44; length of hospital stay&#44; need for surgical re-intervention and operative mortality&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Biases</span><p id="p0070" class="elsevierStylePara elsevierViewall">In the recruitment and follow-up stage&#44; biases were reduced with a complete follow-up and blinded data collection&#46; Then&#44; data were encoded and not revealed until the analysis period was complete&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Study size</span><p id="p0075" class="elsevierStylePara elsevierViewall">Since it is an observational and descriptive study&#44; no sample size was estimated&#46;</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Statistical methods</span><p id="p0080" class="elsevierStylePara elsevierViewall">The data were analyzed with the Stata 11&#46;0&#47;SE<span class="elsevierStyleSup">&#174;</span> program&#46; Descriptive statistics were used to calculate percentages&#44; averages and standard deviations&#44; medians and extreme values&#46;</p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Ethics</span><p id="p0085" class="elsevierStylePara elsevierViewall">Written informed consent was obtained from each patient&#46; All the ethical guidelines for research on human beings as defined by the Helsinki Declaration<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">26</span></a> were observed&#46;</p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Funding</span><p id="p0090" class="elsevierStylePara elsevierViewall">There was no special funding for this study&#46;</p></span></span><span id="s0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Results</span><p id="p0095" class="elsevierStylePara elsevierViewall">A total of 22 patients operated on for cholangiohydatido-sis were recruited in this period&#46; Two were not included in the final analysis due to a lack of follow-up &#40;<a class="elsevierStyleCrossRef" href="#f0020">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="f0020"></elsevierMultimedia><p id="p0100" class="elsevierStylePara elsevierViewall">The patients comprising the series are characterized by a median age of 53 years&#44; 50&#46;0&#37; female and 20&#46;0&#37; of them having two or more cysts with a mean diameter of 13&#46;3 &#177; 6&#46;3 cm &#40;<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0105" class="elsevierStylePara elsevierViewall">Two patients &#40;10&#46;0&#37;&#41; had a history of previous surgery for hepatic hydatid disease and another due to pulmonary hydatid disease&#46; Five patients &#40;25&#46;0&#37;&#41; had comorbidities&#58; heart disease &#40;2 cases&#41;&#44; diabetes mellitus &#40;2 cases&#41; and cholelithiasis &#40;1 case&#41;&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">Nine subjects &#40;45&#46;0&#37;&#41; had concomitant parasitic diseases&#58; hepatic abscess of hydatid origin &#40;7 cases&#44; 35&#46;0&#37;&#41;&#44; and hepatothoracic transit &#40;2 cases&#44; 10&#46;0&#37;&#41;&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">Laboratory tests revealed anemia &#40;5 cases&#44; 25&#46;0&#37;&#41;&#44; leu-kocytosis &#40;11 cases&#44; 55&#46;0&#37;&#41;&#44; signs of cholestasis &#40;17 cases&#44; 85&#46;0&#37;&#41; and hepatocyte cytolysis &#40;17 cases&#44; 85&#46;0&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>&#41;&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">The existence of concomitant hydatid disease in the peritoneum &#40;2 cases&#41; and spleen &#40;one case&#41; was verified&#46; The most common location of cysts communicated to the bile duct was the right hepatic lobe &#40;12 cases&#44; 60&#46;0&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0125" class="elsevierStylePara elsevierViewall">The mean diameter of the common bile duct was 18&#46;5 &#177; 2&#46;1 mm and biliary communications were found in all patients &#40;<a class="elsevierStyleCrossRefs" href="#t0010">Tables 1 and 3</a>&#41;&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">A median hospital stay of six days was recorded with a median follow-up of 34 months &#40;<a class="elsevierStyleCrossRef" href="#t0010">Table 1</a>&#41;&#44; 30&#46;0&#37; morbidity and a re-intervention rate of 10&#46;0&#37; &#40;<a class="elsevierStyleCrossRef" href="#t0015">Table 2</a>&#41;&#46; The related morbidity was secondary to pulmonary&#44; cardiac and metabolic complications &#40;1 case of each&#41;&#44; infection at the surgical site&#44; incisional hernia&#44; biliary fistula &#40;1 case of each&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0020">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia><p id="p0135" class="elsevierStylePara elsevierViewall">Mortality rate was 5&#46;0&#37;&#46; This was a 76-year-old patient with a coronary cardiopathy who presented episodes of projectile vomiting&#44; and then developed aspiration pneumonia&#44; secondary respiratory insufficiency and finally multiple organ failure&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">All the diagnosed cases of acute cholangitis due to cholangiohydatidosis in the reported period were treated according to the protocol described in material and methods section&#46; There were no cases of medical or endoscop-ic treatment&#46;</p></span><span id="s0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Discussion</span><p id="p0145" class="elsevierStylePara elsevierViewall">There are few reports regarding the study of cholan-giohydatidosis as an associated factor for POM in HE surgery&#44; and most are retrospective case series&#44; contributing evidence level 4&#46; Reports in the literature are scarce because it is a rare entity&#44; with a low incidence among patients who have undergone surgery for HE&#46; In general&#44; there have only been isolated case reports and small case series &#40;single case report&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">13&#44;15&#44;16&#44;18-20&#44;22&#44;23</span></a> between 4 and 6 cases of endoscopic treatment<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">10-12&#44;21</span></a>&#41;&#44; 13 cases reported by our group in 20013&#44; 25 cases treated endoscopically14 and the most numerous series &#40;80 cases&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">17</span></a> However&#44; secondary cholangitis is not clearly reported in any of them&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">In addition to being a rare entity&#44; the biggest problems are the complications which cholangiohydatidosis can cause&#58; biliary obstructive syndrome&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3&#44;14</span></a> acute suppurated cholangitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3&#44;13&#44;14</span></a> and even acute secondary pancreatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">13&#44;15</span></a></p><p id="p0155" class="elsevierStylePara elsevierViewall">The fact that 35&#46;0&#37; of cases concomitantly presented a liver abscess of hydatid origin&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a> and 10&#46;0&#37; also had a hepatotho-racic transit&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a> underscores these patients&#8217; severe condition&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">The mean diameter of the cysts was 19&#46;0 &#177; 9&#46;0 cm&#44; with a mostly heterogeneous sonographic appearance&#44; and these were generally complicated cysts&#46; This fact at least partly undermines the thesis of exclusive endoscopic treatment for this problema&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">12&#44;14</span></a> because if so&#44; we would be rendering treatment for the original lesion null&#44; which&#44; as discussed in this manuscript&#44; in more than 30&#37; of cases can be found abscessed as well&#46; For this reason&#44; we believe that surgery remains the treatment of choice for cholan-giohydatidosis and secondary cholangitis&#44; and endoscopic drainage may be useful only in select cases&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">16&#44;28&#44;29</span></a> and more as a bridge procedure to drain the bile duct while awaiting definitive surgery&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">Clinical presentation and laboratory findings are not specific&#44; and may simulate an obstructive jaundice and acute cholangitis &#40;predominantly lithiasic in Chile&#41;&#44; which is similar to that reported by other groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">16&#44;29</span></a></p><p id="p0170" class="elsevierStylePara elsevierViewall">The existence of biliary communications in all patients explains the genesis of cholangiohydatidosis&#44; because it is through these communications that parasitic structures migrate into the bile duct&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a></p><p id="p0175" class="elsevierStylePara elsevierViewall">Treatment of cholangiohydatidosis and secondary cholangitis is to drain and clean the bile duct&#44; which can be performed by open &#40;conventional&#41; surgery or closed surgery &#40;endoscopic papillotomy&#41;&#59; however&#44; as discussed above&#44; while it is true that endoscopic papillotomy offers all the advantages of a minimally invasive surgery &#40;particularly useful in high-risk patients&#41;&#44; it does not allow a rational and definitive treatment of the whole problem&#46; Therefore&#44; in general&#44; surgery remains the option of choice through biliary drainage &#40;choledochostomy or choledocoduodenoanastomosis&#41; and simultaneous resection of the hydatid cyst&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">16&#44;28&#44;29</span></a></p><p id="p0180" class="elsevierStylePara elsevierViewall">It would be of great interest to ascertain the effectiveness of endoscopic and laparoscopic treatments in patients with cholangitis secondary to cholangiohydatidosis&#46; However&#44; the actual number of available cases is insufficient to conduct a comparative study with a methodologically adequate power and level of confidence&#46;</p><p id="p0185" class="elsevierStylePara elsevierViewall">We believe that the reported morbidity &#40;30&#46;0&#37;&#41; is relevant&#59; however&#44; the clinical severity in these patients and their concomitant comorbidities must also be consid-ered3&#44;17&#44; as should the mortality of the series &#40;5&#46;0&#37;&#41;&#44; which guides a clinical entity of poor prognosis for which no effort should be spared to make an early diagnosis and take prompt and appropriate action&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3&#44;28</span></a></p><p id="p0190" class="elsevierStylePara elsevierViewall">However&#44; we are aware that the study presents some potential sources of bias that merit comment&#46; One of these has to do with the heterogeneity of the population&#46; Another is related to the sample size&#44; because there are no more cases to report&#46; The loss of follow-up at less than 10&#37; and an extensive follow-up time&#44; however&#44; are tools that increase the quality of the data&#46;</p><p id="p0195" class="elsevierStylePara elsevierViewall">With respect to the external validity of this study&#44; it is worth noting that the study results correspond to the reality of one center of reference for hepatobiliary surgery located in an endemic region of echinococcosis&#59; therefore&#44; the reader must assess the external validity and reproduci-bility of the results with caution&#46;</p><p id="p0200" class="elsevierStylePara elsevierViewall">The protocol treatment did not include surgery prophylaxis with chemotherapy for Echinococcus Granulosus&#46; This is a controversial point&#59; however&#44; we chose not to use it because of a previous study where we described al-bendazole as having no effect on the viability of proto-scoleces in patients treated with this drug preoperatively&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">30</span></a> With respect to medical treatment with albendazole&#44; there is strong evidence &#40;systematic reviews and clinical trials&#41; that indicate that anthelmintic treatment alone is not ideal for liver hydatid cysts&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">31-33</span></a> On the other hand&#44; the World Health Organization carried out multicenter trials in Europe to compare albendazole and mebendazole and verified that both drugs had similar efficacy&#44; but mebendazole required higher doses and a different treatment with longer periods of adverse reactions&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">34&#44;35</span></a></p><p id="p0205" class="elsevierStylePara elsevierViewall">Finally&#44; it is important to note that cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with important rates of POM and mortality which occurs in the context of complex patients&#44; so it must be treated in centers with experience in such diseases&#46;</p></span><span id="s0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0120">Abbreviations</span><p id="p0210" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HE&#58;</span> hepatic echinococcosis&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">POM&#58;</span> post-operative morbidity&#46;</p></li></ul></p><p id="p0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Financial Support</span></p><p id="p0230" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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    "fechaRecibido" => "2016-05-06"
    "fechaAceptado" => "2016-08-08"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1116228"
          "palabras" => array:7 [
            0 => "Echinococcosis &#91;MeSH&#93;"
            1 => "Hydatidosis &#91;Multi&#93;"
            2 => "Echinococcosis"
            3 => "Hepatic &#91;Mesh&#93;"
            4 => "Hepatic Hydatid Cyst"
            5 => "Echinococco-sis"
            6 => "Hepatic&#47;complications &#91;MeSH&#93;"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015"><span class="elsevierStyleBold">Background</span></span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">One of the evolutionary complications of hepatic echinococcosis &#40;HE&#41; is cholangiohydatidosis&#44; a rare cause of obstructive jaundice and cholangitis&#46; The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity &#40;POM&#41;&#46;</p></span> <span id="abs0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020"><span class="elsevierStyleBold">Material and method</span></span><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Cl&#237;nica Mayor in Temuco&#44; Chile between 2004 and 2014&#46; The minimum follow-up time was six months&#46; The principal outcome variable was the development of POM&#46; Other variables of interest were age&#44; sex&#44; cyst diameter&#44; hematocrit&#44; leukocytes&#44; total bi-lirubin&#44; alkaline phosphatase and transaminases&#44; type of surgery&#44; existence of concomitant evolutionary complications in the cyst&#44; length of hospital stay&#44; need for surgical re-intervention and mortality&#46; Descriptive statistics were calculated&#46;</p></span> <span id="abs0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025"><span class="elsevierStyleBold">Results</span></span><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall">A total of 20 patients were studied characterized by a median age of 53 years&#44; 50&#46;0&#37; female and 20&#46;0&#37; having two or more cysts with a mean diameter of 13&#46;3 &#177; 6&#46;3 cm&#46; A median hospital stay of six days and follow-up of 34 months was recorded&#46; POM was 30&#46;0&#37;&#44; re-intervention rate was 10&#46;0&#37; and mortality rate was 5&#46;0&#37;&#46;</p></span> <span id="abs0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030"><span class="elsevierStyleBold">Conclusion</span></span><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abs0010"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abs0015"
            "titulo" => "Material and method"
          ]
          2 => array:2 [
            "identificador" => "abs0020"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abs0025"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "f0010"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 576
            "Ancho" => 2074
            "Tamanyo" => 122034
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Female 66-year-old patient presented with four days&#8217; evolution of right upper abdominal pain&#44; fever and jaundice&#46; Abdominal CT scan verified a heterogeneous cystic mass that represented germinative membrane residues and some daughter vesicles&#46; The intimate relation between the cyst and the right biliary tree can also be seen&#44; specifically with its anterior branches&#46; The biliary communication at this level &#40;segment VI&#41; gave rise to cholangiohydatidosis and secondary acute cholangitis&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "f0015"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 724
            "Ancho" => 999
            "Tamanyo" => 79225
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Open bile duct and the appearance of daughter vesicles&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "f0020"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 685
            "Ancho" => 1001
            "Tamanyo" => 81517
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the study participants&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">ASAT&#58; aspartate aminotransferase&#46; ALAT&#58; alanine aminotransferase&#46;</p>"
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#177;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Max&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;0 &#177; 19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematocrits &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;4 &#177; 3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytes &#40;x mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;507&#46;6 &#177; 7&#44;281&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;850&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;900&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilirubin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;6 &#177; 3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alkaline phosphatase &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">940&#46;3 &#177; 636&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">762&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASAT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&#46;4&#177; 224&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALAT &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&#46;9 &#177; 179&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">162&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cyst diameter &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;0 &#177; 9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bile duct diameter &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;0 &#177; 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospital stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;0 &#177; 17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follow-up &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;0 &#177; 28&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2045069.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Distribution of clinical data in the study patients &#40;N &#61; 20&#41;&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "t0015"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other evolutionary complication in the cyst &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of cysts &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">One&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Two or more&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery performed &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lobectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morbidity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Need for re-operation &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortality &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2045071.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Distribution of clinical data and surgical characteristics in the study patients &#40;N &#61; 20&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "t0020"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Location of the cyst &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right lobe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Left lobe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biliary communications &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">One&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Two&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Three or more&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Treatment of the residual cavity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Capitonnage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Omentoplasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other surgeries performed concomitantly &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cholecystectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cholecystectomy and choledocostomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cholecystectomy &#43; choledocostomy &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">splenectomy and peritoneal hydatidosis surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Morbidity according to Dindo &#38; Clavien&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Distribution of surgical characteristics in the study patients &#40;N &#61; 20&#41;&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
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            3 => array:3 [
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            4 => array:3 [
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                  "contribucion" => array:1 [
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            6 => array:3 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Management of intrabiliary ruptured hydatid disease of the liver"
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            7 => array:3 [
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                  "contribucion" => array:1 [
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            8 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
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                  "host" => array:1 [
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            9 => array:3 [
              "identificador" => "bib0055"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Common bile duct obstruction caused by hydatid daughter cysts&#8212;management by endoscopic retrograde sphincterotomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Shemesh E&#46;"
                            1 => "Klein E&#46;"
                            2 => "Abramowich D&#46;"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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Article information

ISSN: 16652681
Original language: English

DOI:10.5604/01.3001.0009.8599

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Year/Month	Html	Pdf	Total

2024 November	5	1	6
2024 October	33	7	40
2024 September	24	4	28
2024 August	37	10	47
2024 July	21	5	26
2024 June	28	2	30
2024 May	12	2	14
2024 April	27	10	37
2024 March	30	6	36
2024 February	21	5	26
2024 January	21	6	27
2023 December	22	4	26
2023 November	20	3	23
2023 October	17	4	21
2023 September	19	6	25
2023 August	10	5	15
2023 July	13	6	19
2023 June	25	2	27
2023 May	48	8	56
2023 April	23	1	24
2023 March	43	3	46
2023 February	19	12	31
2023 January	22	8	30
2022 December	24	12	36
2022 November	23	9	32
2022 October	21	6	27
2022 September	22	3	25
2022 August	24	13	37
2022 July	30	8	38
2022 June	16	6	22
2022 May	13	5	18
2022 April	39	9	48
2022 March	47	13	60
2022 February	37	5	42
2022 January	56	8	64
2021 December	23	11	34
2021 November	33	6	39
2021 October	71	6	77
2021 September	51	8	59
2021 August	46	6	52
2021 July	22	16	38
2021 June	29	12	41
2021 May	24	8	32
2021 April	61	4	65
2021 March	44	9	53
2021 February	14	9	23
2021 January	12	9	21
2020 December	6	5	11
2020 November	13	2	15
2020 October	9	3	12
2020 September	9	7	16
2020 August	19	6	25
2020 July	20	7	27
2020 June	8	4	12
2020 May	12	7	19
2020 April	9	7	16
2020 March	7	4	11
2020 February	12	7	19
2020 January	7	4	11
2019 December	14	4	18
2019 November	8	5	13
2019 October	7	3	10
2019 September	8	2	10
2019 August	5	5	10
2019 July	3	7	10
2019 June	5	10	15
2019 May	2	6	8

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