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"documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2023;160:143" "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">Image in medicine</span>" "titulo" => "Skin ulcers associated with dermatomyositis MDA5" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "143" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlceras cutáneas asociadas a dermatomiositis MDA5" ] ] "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" => 975 "Ancho" => 1600 "Tamanyo" => 263758 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Martínez-Díaz, Laura Jiménez-de la Cruz, Marta Moret-Rueda, Ismael Calero-Paniagua" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Martínez-Díaz" ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Jiménez-de la Cruz" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Moret-Rueda" ] 3 => array:2 [ "nombre" => "Ismael" "apellidos" => "Calero-Paniagua" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775322005474" "doi" => "10.1016/j.medcli.2022.09.021" "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/S0025775322005474?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000074?idApp=UINPBA00004N" "url" => "/23870206/0000016000000003/v1_202302051543/S2387020623000074/v1_202302051543/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020623000244" "issn" => "23870206" "doi" => "10.1016/j.medcle.2022.10.008" "estado" => "S300" "fechaPublicacion" => "2023-02-10" "aid" => "6111" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2023;160:140-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reply" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "140" "paginaFinal" => "141" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andreu Fernández-Codina, Abiu Sempere-González, Esperanza Cañas-Ruano" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Andreu" "apellidos" => "Fernández-Codina" ] 1 => array:2 [ "nombre" => "Abiu" "apellidos" => "Sempere-González" ] 2 => array:2 [ "nombre" => "Esperanza" "apellidos" => "Cañas-Ruano" ] 3 => array:1 [ "colaborador" => "for the Vall d’Hebron University Hospital COVID 19 ED research group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000244?idApp=UINPBA00004N" "url" => "/23870206/0000016000000003/v1_202302051543/S2387020623000244/v1_202302051543/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pleuroperitoneal communication as a complication of peritoneal dialysis" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "141" "paginaFinal" => "142" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Ramírez Gómez, Vanesa García Chumillas, María Peña Ortega" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "Ramírez Gómez" "email" => array:1 [ 0 => "marago_87@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Vanesa" "apellidos" => "García Chumillas" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Peña Ortega" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Hospital Universitario San Cecilio, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comunicación pleuroperitoneal como complicación de la diálisis peritoneal" ] ] "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" => 1140 "Ancho" => 1262 "Tamanyo" => 147350 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Peritoneal scintigraphy with <span class="elsevierStyleSup">99m</span>Tc-labelled macroaggregated albumin. Abnormal radiotracer accumulation is observed in the right pleural cavity (*).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pleuroperitoneal communication or hydrothorax is one of the mechanical complications of peritoneal dialysis (PD), associated with increased intra-abdominal pressure and, to a lesser extent, with the occurrence of peritoneal infection (PI) episodes.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is a rare complication whose prevalence varies between 1.6–10%,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> with a higher prevalence in patients with hepatorenal polycystic disease<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and continuous ambulatory peritoneal dialysis (CAPD). In most cases it also involves definitive transfer to haemodialysis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a patient with recurrent episodes of PI on automated peritoneal dialysis (APD) for a year, who developed a massive acute hydrothorax and who, thanks to an early diagnosis by means of <span class="elsevierStyleSup">99m</span>Tc scintigraphy and temporary transfer to haemodialysis, had a favourable course, resuming the technique two months later.</p><p id="par0015" class="elsevierStylePara elsevierViewall">31-year-old woman with chronic kidney disease secondary to IgA nephropathy, with no other history of interest. Laparoscopic implantation of a Tenckhoff-type catheter without complications with the usual regimen of three 2-liter nocturnal exchanges 6 days a week. During this period, she had episodes of PI due to <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> which were satisfactorily managed with vancomycin and intraperitoneal daptomycin together with oral moxifloxacin in the last episode due to possible biofilm, with no new episodes.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient came to the emergency department with general malaise triggered by physical exertion, progressive dyspnoea and pleuritic pain, together with reduced ultrafiltration in the last few days. Physical examination revealed good general condition with mild tachypnoea and severe generalised hypophonesis in the right hemithorax. The chest X-ray shows a pleural effusion in the right hemithorax up to the upper lung field. On suspicion of hydrothorax, a peritoneal rest was decided and a peritoneal scintigraphy was performed with <span class="elsevierStyleSup">99m</span>Tc-labelled albumin macroaggregates, which confirmed the suspicion. The radiotracer was detected in the right hemithorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Peritoneal fluid culture was negative. Following diagnostic confirmation, thoracentesis was performed to remove 2500 ml of pleural fluid with clinical improvement, a control chest X-ray showed disappearance of pleural effusion, and it was decided to temporarily suspend PD for two months and transfer the patient to haemodialysis. Subsequently, APD was restarted without complications and a new scintigraphy was performed, ruling out pleuroperitoneal communication.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Hydrothorax is caused by a diaphragmatic structural defect that allows the passage of peritoneal fluid into the pleural space. It can be congenital or acquired due to increased intra-abdominal pressure. However, specific cases secondary to episodes of PI have also been described.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is more common in females, located in the right hemithorax and usually manifests early when starting PD.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> The symptoms are variable depending on the extent of the pleural effusion and the time course of the disease. Patients may remain asymptomatic in up to 25% of cases or present with clinical features such as irritative cough, dyspnoea, pleuritic pain or decreased ultrafiltration, together with signs of pleural effusion on examination.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Chest X-ray and pleural fluid analysis after thoracentesis are commonly used in its diagnosis. However, the technique of choice most commonly used at present to confirm the diagnosis where pleuroperitoneal communication is detected is a peritoneogram or peritoneal scintigraphy with <span class="elsevierStyleSup">99m</span>Tc-labelled albumin macroaggregates, as it is a simple and safe technique. With regard to the treatment of this disease, various therapeutic options have been described, such as a conservative approach with peritoneal rest and temporary transfer to haemodialysis, mechanical or chemical pleurodesis, and some authors favour surgical repair by thoracoscopy as a definitive solution. However, most patients do not achieve the expected results and require a definitive transfer to haemodialysis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">What is interesting in our case is the possible causal relationship of the episodes of recurrent PI in the pathogenesis, since our patient was not present at the start of the technique and was undergoing APD, which is associated with a lower increase in intra-abdominal pressure, a key factor in the development of this rare complication. On the other hand, despite the high rate of therapeutic failure after a conservative approach, our patient responded satisfactorily, resuming the technique months later, thanks to an early diagnosis by <span class="elsevierStyleSup">99m</span>Tc scintigraphy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">No funding has been received for this research.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1140 "Ancho" => 1262 "Tamanyo" => 147350 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Peritoneal scintigraphy with <span class="elsevierStyleSup">99m</span>Tc-labelled macroaggregated albumin. Abnormal radiotracer accumulation is observed in the right pleural cavity (*).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of peritoneal dialysis related to increased intra–abdominal pressure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Mahale" 1 => "A. Katyal" 2 => "R. Khanna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Adv Perit Dial" "fecha" => "2003" "volumen" => "19" "paginaInicial" => "130" "paginaFinal" => "135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14763049" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hidrotórax en diálisis peritoneal: una rara complicación de la peritonitis [Hydrothorax in peritoneal dialysis: a rare peritonitis complication]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Oviedo Gómez" 1 => "I. Sánchez García" 2 => "P. Martín Escuer" 3 => "E. Hernández García" 4 => "J. Martín Gago" 5 => "F. Sousa Pérez" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2010.Jun.10435" "Revista" => array:7 [ "tituloSerie" => "Nefrologia." "fecha" => "2010" "volumen" => "30" "numero" => "5" "paginaInicial" => "594" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20882101" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.3265/Nefrologia.pre2010.Jun.10435" "WWW" => array:1 [ "link" => "https://doi.org/10.3265/Nefrologia.pre2010.Jun.10435" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comunicación pleuroperitoneal en paciente con diálisis peritoneal: un caso de interés para el cirujano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.F. Reoyo Pascual" 1 => "C. Cartón Hernández" 2 => "R. León Miranda" 3 => "V. Camarero Temiño" 4 => "J. Sánchez Manuel" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2017.08.010" "Revista" => array:5 [ "tituloSerie" => "Cir Esp" "fecha" => "2018" "volumen" => "96" "paginaInicial" => "311" "paginaFinal" => "312" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.sciencedirect.com/science/article/pii/S0009739X17301896" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comunicación pleuro-peritoneal en pacientes en diálisis peritoneal: Experiencia en un centro y revisión de la literatura" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Díaz Mancebo" 1 => "G. Peso Gilsanz" 2 => "M. Rodríguez" 3 => "B. Fernández" 4 => "M. Ossorio González" 5 => "M.A. Bajo Rubio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2011.Jan.10762" "Revista" => array:7 [ "tituloSerie" => "Nefrología" "fecha" => "2011" "volumen" => "31" "numero" => "2" "paginaInicial" => "213" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21461016" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000003/v1_202302051543/S2387020623000049/v1_202302051543/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000003/v1_202302051543/S2387020623000049/v1_202302051543/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000049?idApp=UINPBA00004N" ]
