Letter to the Editor
Chylous ascites secondary to diffuse large B cell lymphoma. A case report
Ascitis quilosa secundaria a linfoma difuso de células grandes B. A propósito de un caso
Read
159
Timeswas read the article
18
Total PDF
141
Total HTML
Share statistics
array:24 [ "pii" => "S2444382422000967" "issn" => "24443824" "doi" => "10.1016/j.gastre.2022.06.001" "estado" => "S300" "fechaPublicacion" => "2022-06-01" "aid" => "1854" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2022;45:488-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210570521002156" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2021.06.010" "estado" => "S300" "fechaPublicacion" => "2022-06-01" "aid" => "1854" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2022;45:488-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Ascitis quilosa secundaria a linfoma difuso de células grandes B. A propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "488" "paginaFinal" => "489" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Chylous ascites secondary to diffuse large B cell lynphoma. A case report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 632 "Ancho" => 1250 "Tamanyo" => 84710 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">TAC abdomen. Corte coronal y transversal respectivamente.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Irati Gorroño Zamalloa, Mireia Markuleta Iñurritegi, Leire Urtasun Arlegui, Aitor Orive Calzada" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Irati" "apellidos" => "Gorroño Zamalloa" ] 1 => array:2 [ "nombre" => "Mireia" "apellidos" => "Markuleta Iñurritegi" ] 2 => array:2 [ "nombre" => "Leire" "apellidos" => "Urtasun Arlegui" ] 3 => array:2 [ "nombre" => "Aitor" "apellidos" => "Orive Calzada" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2444382422000967" "doi" => "10.1016/j.gastre.2022.06.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422000967?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521002156?idApp=UINPBA00004N" "url" => "/02105705/0000004500000006/v1_202205180628/S0210570521002156/v1_202205180628/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2444382422000979" "issn" => "24443824" "doi" => "10.1016/j.gastre.2021.07.002" "estado" => "S300" "fechaPublicacion" => "2022-06-01" "aid" => "1860" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Gastroenterol Hepatol. 2022;45:490-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Neoadjuvant combined strategy to surgery based on chemoembolization and lenvatinib in hepatocellular carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "491" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estrategia combinada de neoadyuvancia a cirugía con quimioembolización y lenvatinib en carcinoma hepatocelular" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 381 "Ancho" => 1500 "Tamanyo" => 96688 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Pre-treatment index CT scan. HCC closely related to the middle and left suprahepatic veins. (B) Post-TACE PET-CT scan. Absence of metabolic uptake in the HCC with slightly hypermetabolic margins. (C) Post-surgical follow-up CT after one and a half months. Vascular permeability in the suprahepatic veins, with no residual tumour.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Arturo Colón Rodríguez, Enrique Velasco Sánchez, Luis Rodríguez-Bachiller, Benjamín Díaz-Zorita, José Ángel López Baena, Arturo Álvarez Luque, Diego Rincón Rodríguez, Ana María Matilla Peña" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Arturo" "apellidos" => "Colón Rodríguez" ] 1 => array:2 [ "nombre" => "Enrique" "apellidos" => "Velasco Sánchez" ] 2 => array:2 [ "nombre" => "Luis" "apellidos" => "Rodríguez-Bachiller" ] 3 => array:2 [ "nombre" => "Benjamín" "apellidos" => "Díaz-Zorita" ] 4 => array:2 [ "nombre" => "José Ángel" "apellidos" => "López Baena" ] 5 => array:2 [ "nombre" => "Arturo" "apellidos" => "Álvarez Luque" ] 6 => array:2 [ "nombre" => "Diego" "apellidos" => "Rincón Rodríguez" ] 7 => array:2 [ "nombre" => "Ana María" "apellidos" => "Matilla Peña" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570521002247" "doi" => "10.1016/j.gastrohep.2021.07.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521002247?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422000979?idApp=UINPBA00004N" "url" => "/24443824/0000004500000006/v1_202206220657/S2444382422000979/v1_202206220657/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2444382422001079" "issn" => "24443824" "doi" => "10.1016/j.gastre.2021.11.002" "estado" => "S300" "fechaPublicacion" => "2022-06-01" "aid" => "1890" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Gastroenterol Hepatol. 2022;45:474-87" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "474" "paginaFinal" => "487" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vigilancia tras resección de pólipos de colon: ¿podemos mejorar el rendimiento diagnóstico?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 990 "Ancho" => 2508 "Tamanyo" => 348502 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of the different risk factors for metachronous advanced neoplasia. <span class="elsevierStyleSup">a</span>The presence of villous component is a controversial risk factor.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gemma Ibáñez-Sanz, Rebeca Sanz-Pamplona, Montse Garcia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Gemma" "apellidos" => "Ibáñez-Sanz" ] 1 => array:2 [ "nombre" => "Rebeca" "apellidos" => "Sanz-Pamplona" ] 2 => array:2 [ "nombre" => "Montse" "apellidos" => "Garcia" ] 3 => array:1 [ "colaborador" => "PhD on behalf of the MSIC-SC research group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0210570521003137" "doi" => "10.1016/j.gastrohep.2021.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521003137?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422001079?idApp=UINPBA00004N" "url" => "/24443824/0000004500000006/v1_202206220657/S2444382422001079/v1_202206220657/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Chylous ascites secondary to diffuse large B cell lymphoma. A case report" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "488" "paginaFinal" => "489" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Irati Gorroño Zamalloa, Mireia Markuleta Iñurritegi, Leire Urtasun Arlegui, Aitor Orive Calzada" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Irati" "apellidos" => "Gorroño Zamalloa" "email" => array:1 [ 0 => "iratigo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mireia" "apellidos" => "Markuleta Iñurritegi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Leire" "apellidos" => "Urtasun Arlegui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Aitor" "apellidos" => "Orive Calzada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Universitario de Araba, Vitoria-Gasteiz, Araba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Universitario de Araba, Vitoria-Gasteiz, Araba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ascitis quilosa secundaria a linfoma difuso de células grandes B. A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 632 "Ancho" => 1250 "Tamanyo" => 84774 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT scan. Coronal and transverse plane, respectively.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chylous ascites is an uncommon form of ascites (<1% of the total) that is characterised by a high triglyceride concentration >200 mg/dl. There are no recent publications on its epidemiology, although a previous study reported an incidence of one case per 20,000 hospitalisations.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 78-year-old male with arterial hypertension on diuretic treatment, with atrial flutter, anticoagulated and with chronic kidney disease.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient reported a three-month history of clinical symptoms of asthenia, a progressive increase in waist circumference and weight gain. The physical examination revealed moderate ascitic signs with the palpation of a large abdominal mass and oedema in the lower limbs.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The blood test results were: creatinine 1.65 mg/dl, GOT 24 U/l, GPT 16 U/l, bilirubin 1.2 mg/dl, CRP 116 mg/l, LDH 269 U/l, Fe 28 μg/dl, transferrin 163 mg/dl, IS 12%, B12 167 pg/mL, ESR 54, alpha-1 globulin 6.7%, alpha-2 globulin 18.7%, gammaglobulin 7.9%, beta-2 microglobulin 10.4 mg/dl.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The ultrasound study showed moderate ascites, as well as a large solid-looking mass attached to the mesentery.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Following a diagnostic paracentesis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), the ascitic fluid analysis was as follows: glucose 120 mg/dl, proteins 5.6 g/dl, albumin 2.9 g/dl, LDH 139 U/l, amylase 20 U/l, adenosine deaminase (ADA) 34, triglycerides 1,236 mg/dl, red blood cells 4,000, leukocytes 1,950 (lymphocytes 39%, neutrophils 24%).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The cytology was negative for malignancy and the cultures ruled out any infectious cause. The study was completed by a chest-abdomen-pelvis CT scan (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which showed a major solid mass in the mesentery of 11 × 17 × 26 cm and a retroperitoneal adenopathic conglomerate continuing from the aforementioned mass, consistent with a lymphoproliferative process.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A CT-guided percutaneous biopsy was performed, resulting in the pathological diagnosis of diffuse large B-cell lymphoma GC phenotype on follicular lymphoma.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient was given nutritional supplements with medium-chain triglycerides (MCT) and R-mini-CHOP chemotherapy, and the ascites resolved after eight weeks of treatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Chylous ascites is caused by a disruption of the lymphatic system. Browse et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> propose three mechanisms, depending on the aetiology:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Obstruction and disruption of the thoracic duct following trauma, surgery or radiation therapy, autoimmune or infectious aetiology (tuberculosis, filariasis) or through an increase in lymphatic production (cirrhosis, cardiovascular disease).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Invasion and destruction of the lymphatic system secondary to a malignant process. In descending frequency: lymphomas, neuroendocrine tumours, sarcomas, leukaemias, solid tumours.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Congenital dilation of the lymphatic ducts. For example, Klippel–Trenaunay syndrome.</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">In a systematic review<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> of 190 patients with non-traumatic chylous ascites, the most common cause was lymphatic anomalies (32%), followed by malignant diseases (17%), cirrhosis (11%) and mycobacteria infections (15%). Lymphoma accounted for at least one third of the cases of malignant chylous ascites.</p><p id="par0075" class="elsevierStylePara elsevierViewall">With regard to diagnosis, besides the medical history, physical examination and blood tests, the performance of a paracentesis is mandatory. A turbid-milky looking ascitic fluid is obtained, with a concentration of triglycerides >200 mg/dl. A complete study of the ascitic fluid must be performed, including total proteins, albumin, LDH, glucose, amylase, triglycerides, ADA (if tuberculosis is suspected), cell count, Gram staining, culture and cytology. Radiological examinations play a fundamental role in the diagnosis of chylous ascites, particularly when there is no history of recent trauma or surgery, since they make it possible to rule out an underlying malignant cause.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Treatment of the causal condition is fundamental from the therapeutic standpoint. Although evidence on the specific treatment of chylous ascites is limited, a protein-rich, low-fat diet supplemented with MCT is recommended to reduce the production of chyle. In the event of treatment failure, somatostatin and its analogue octreotide (dose 100 ug/8 h sc), normally combined with total parenteral nutrition, have proven to be effective, particularly in the management of post-surgical chylous ascites.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Surgery is a recourse for salvage therapy.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In patients with cirrhosis, besides diuretic treatment, which continues to be the cornerstone, orlistat, a reversible inhibitor of gastric and pancreatic lipase, reduces triglyceride levels in the ascitic fluid, with subsequent improvement in ascites.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Treatment with MCT in advanced cirrhosis is not recommended. In the event of resistance to medical treatment, the use of transjugular intrahepatic portosystemic shunt (TIPS) is known to be safe and effective in this patient subgroup.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorroño Zamalloa I, Markuleta Iñurritegi M, Urtasun Arlegui L, Orive Calzada A, Ascitis quilosa secundaria a linfoma difuso de células grandes B. A propósito de un caso, Gastroenterología y Hepatología. 2022;96:488–489.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 42667 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chylous ascites.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 632 "Ancho" => 1250 "Tamanyo" => 84774 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT scan. Coronal and transverse plane, respectively.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation and management of chylous ascites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O.W. Press" 1 => "N.O. Press" 2 => "S.D. Kaufman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Ann Intern Med." "fecha" => "1982" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aetiology and treatment of chylous ascites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.L. Browse" 1 => "N.M. Wilson" 2 => "F. Russo" 3 => "H. al-Hassan" 4 => "D.R. Allen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.11746" "Revista" => array:3 [ "tituloSerie" => "Br J Surg." "fecha" => "1992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32395848" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atraumatic chylous ascites: systematic review if synthoms and causes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.C. Steinemann" 1 => "D. Dindo" 2 => "P.A. Clavien" 3 => "A. Nocito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Am Coll Surg" "fecha" => "2011" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment options for chylous ascites after major abdominal surgery: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Weniger" 1 => "J.G. D’Haese" 2 => "M.K. Angele" 3 => "A. Kleespies" 4 => "J. Werner" 5 => "W. Hartwig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9610(99)80127-5" "Revista" => array:3 [ "tituloSerie" => "Am J Surg" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7817987" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of orlistat (xenical) to treat chylous ascites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Chen" 1 => "R.K. Lin" 2 => "T. Hassanein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2005" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004500000006/v1_202206220657/S2444382422000967/v1_202206220657/en/main.assets" "Apartado" => array:4 [ "identificador" => "48445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004500000006/v1_202206220657/S2444382422000967/v1_202206220657/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422000967?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 28 | 5 | 33 |
| 2024 September | 35 | 5 | 40 |
| 2024 August | 39 | 3 | 42 |
| 2024 July | 18 | 4 | 22 |
| 2024 June | 9 | 1 | 10 |
| 2024 March | 1 | 0 | 1 |
| 2023 December | 1 | 0 | 1 |
| 2023 November | 2 | 0 | 2 |
| 2022 September | 1 | 0 | 1 |
| 2022 July | 1 | 0 | 1 |
