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"resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17718078_t1_p258.jpg" "Alto" => 362 "Ancho" => 401 "Tamanyo" => 39501 ] ] "descripcion" => array:1 [ "en" => "Overall indicators" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "INÉS CASTELLANO CERVIÑO, SANDRA GALLEGO DOMÍNGUEZ, NORA GAD, MIGUEL ÁNGEL SUÁREZ SANTISTEBAN, JUAN RAMÓN GÓMEZ-MARTINO ARROYO, ISABEL MARTÍN MEJÍAS, ANGELINES DOMÍNGUEZ DE LA CALLE" "autores" => array:7 [ 0 => array:2 [ "nombre" => "INÉS" "apellidos" => "CASTELLANO CERVIÑO" ] 1 => array:2 [ "nombre" => "SANDRA" "apellidos" => "GALLEGO DOMÍNGUEZ" ] 2 => array:2 [ "nombre" => "NORA" "apellidos" => "GAD" ] 3 => array:2 [ "nombre" => "MIGUEL ÁNGEL" "apellidos" => "SUÁREZ SANTISTEBAN" ] 4 => array:2 [ "nombre" => "JUAN RAMÓN" "apellidos" => "GÓMEZ-MARTINO ARROYO" ] 5 => array:2 [ "nombre" => "ISABEL" "apellidos" => "MARTÍN MEJÍAS" ] 6 => array:2 [ "nombre" => "ANGELINES" "apellidos" => "DOMÍNGUEZ DE LA CALLE" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699509004665" "doi" => "10.3265/Nefrologia.2009.29.3.5156.en.full" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699509004665?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004662?idApp=UINPBA000064" "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004662/v0_201502091629/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Scintigraphy of the intraperitoneal cavity using technetium 99m as a diagnostic technique for diaphragmatic leaks in peritoneal dialysis: regarding two cases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "265" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "I Gil Carballeira, Rosa Ramos Sánchez, M Antonia Azancot, J Bartolomé Espinosa, M Vilaplana Moltó, J Camps Domènech" "autores" => array:6 [ 0 => array:3 [ "Iniciales" => "I" "apellidos" => "Gil Carballeira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "Rosa" "apellidos" => "Ramos Sánchez" "email" => array:1 [ 0 => "30965rrs@comb.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "M Antonia" "apellidos" => "Azancot" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "J" "apellidos" => "Bartolomé Espinosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "M" "apellidos" => "Vilaplana Moltó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "Iniciales" => "J" "apellidos" => "Camps Domènech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General Universitari Vall d¿Hebron, Barcelona, Barcelona, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La gammagrafía con Tc99m intraperitoneal como técnica diagnóstica de fugas diafragmáticas en pacientes en diálisis peritoneal: a propósito de dos casos." ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17818078_f1_p264.jpg" "Alto" => 502 "Ancho" => 399 "Tamanyo" => 19514 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">The complications associated with peritoneal dialysis include leaks affecting different cavities (pleural, retroperitoneal or inguinal). The prevalence of diaphragmatic leaks is low (2-6% of all peritoneal dialysis patients).<span class="elsevierStyleSup">1</span> They are mainly caused by direct contact between the pleura and peritoneum which is the result of damage to the diaphragmatic barrier (congenital or acquired), mainly on the right side. In the case of acquired defects, the presence of negative pleural pressure with positive intra-abdominal pressure can cause small valves to open which allow the liquid to flow in only one direction. Congenital defects, on the other hand, usually present a bidirectional flow.<span class="elsevierStyleSup">1,2</span></p><p class="elsevierStylePara">If a patient presents a diaphragmatic leak, his/her symptoms are similar to those of left-sided heart failure (dyspnoea, orthopnoea), and on examination he/she also presents signs compatible with the condition.</p><p class="elsevierStylePara">The diagnosis of a diaphragmatic leak can be made using a thoracocentesis (by detecting D-lactate isoform in peritoneal dialysis fluid, or when hyperglycaemia is present), phase contrast x-ray imaging, abdominal CT using intraperitoneal contrast and scintigraphy with intraperitoneal instillation of radioisotopes.<span class="elsevierStyleSup">1-5</span> It can also be diagnosed using a MRI and intraperitoneal administration of gadolinium contrast.<span class="elsevierStyleSup">6,7</span></p><p class="elsevierStylePara">The following two cases involve peritoneal dialysis patients that were admitted into hospital presenting diaphragmatic leaks. A diagnosis was made with scintigraphy using Tc99m.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 1</span></p><p class="elsevierStylePara">A seventy five year-old patient with a history of high blood pressure, dyslipidaemia and stage 5 chronic kidney disease of unknown origin, was admitted into hospital to start manual intermittent peritoneal dialysis after a peritoneal catheter had been inserted. Three days after starting the treatment, the patient described shortness of breath following slight exertion. The examination of symptoms and x-ray tests were compatible with a left sided pleural effusion. Scintigraphy imaging with Tc99m confirmed the suspected leakage of peritoneal dialysis fluid into the pleural cavity. This case was managed by increasing fluid drainage and suspending peritoneal dialysis. An AVF in the left arm constructed from the humeral artery and the cephalic vein wasinserted in preparation for haemodialysis without complications.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE 2</span></p><p class="elsevierStylePara">A 43 year-old patient with a history of stage 5 chronic kidney disease of unknown origin who was undergoing renal replacement therapy with manual intermittent peritoneal dialysis was admitted presenting symptoms including shortness of breath following slight exertion after starting automatic peritoneal dialysis. The symptoms were examined and x-ray tests indicated right sided pleural effusion (figure 1). The suspected diagnosis of a diaphragmatic leak was confirmed by carrying out a gamma ray imaging with Tc99m (figure 2). Peritoneal dialysis was suspended for one month and afterwards low volume, manual continuous peritoneal dialysis was initiated. The patient presented symptoms and x-ray results that were compatible with pleural effusion once again and therefore, the decision was made to suspend peritoneal dialysis and start haemodialysis using a catheter in the internal jugular vein, prior to AVF access.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Some of the aforementioned diagnostic techniques involve certain risks, including ionizing radiation and nephrotoxicity associated with the contrast agent. A diagnostic thoracocentesis is also an invasive technique. In addition, given the risk of complications associated with administering gandolinium to patients with kidney failure, and the lack of follow-up for patients in studies which have involved this technique, this cannot be considered a diagnostic technique of choice at least until more information is available regarding the potential systemic involvement of intraperitoneal gandolinium administration.</p><p class="elsevierStylePara">However, scintigraphy with Tc99m (2-5 mCi) is associated with a number of advantages given that it is a non-invasive technique, it is low-cost and it can provide several images without increasing the radiation that the patient is exposed to. This imaging technique begins with the intraperitoneal administration of the radioisotope. New images are taken two hours after administration (in order to blend the mixture) and then all the contrast is expelled when the peritoneal liquid is drained. The test is positive if the radioisotope is detected in the pleural cavity.<span class="elsevierStyleSup">2,4,5 </span>In the aforementioned cases, a General Electric Millenium MPS gamma camera was used with 1 mCi of Tc99m, and images were acquired 5, 30 and 60 minutes after this was administered. In the cases described, less radioisotope was needed (1 mCi) in comparison with those cases found in the literature. The image quality obtained using this amount was good enough to be able to make a diagnosis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSION</span></p><p class="elsevierStylePara">We believe that scintigraphy and intraperitoneal Tc99m administration is the technique of choice for diagnosing diaphragmatic leaks in peritoneal dialysis patients.</p><p class="elsevierStylePara"><a href="grande/17818078_f1_p264.jpg" class="elsevierStyleCrossRefs"><img src="17818078_f1_p264.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p><p class="elsevierStylePara"><a href="grande/17818078_f2_p265.jpg" class="elsevierStyleCrossRefs"><img src="17818078_f2_p265.jpg"></img></a></p><p class="elsevierStylePara">Figure 2. </p>" "pdfFichero" => "P-E-S-A178-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440083" "palabras" => array:1 [ 0 => "Derrame pleural" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440085" "palabras" => array:1 [ 0 => "Gammagrafía" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440087" "palabras" => array:1 [ 0 => "Fuga peritoneal" ] ] ] "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440084" "palabras" => array:1 [ 0 => "Pleural effusion" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440086" "palabras" => array:1 [ 0 => "Gammagraphy" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440088" "palabras" => array:1 [ 0 => "Peritoneal leak" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">Entre las complicaciones de la diálisis peritoneal, se encuentran las fugas de líquido hacia diferentes cavidades, entre ellas a la cavidad pleural. El diagnóstico de fuga diafragmática puede realizarse mediante toracocentesis o diferentes exploraciones de imagen con administración de contrastes iónicos o de gadolinio, considerándose alguna de ellas técnicas invasivas y no estando exentas de riesgo de toxicidad por contraste. Presentamos dos casos de derrame pleural en diálisis peritoneal en los que la prueba diagnóstica no invasiva mediante gammagrafía con Tc99m intraperitoneal permitió confirmar la sospecha de diagnóstica al mínimo coste. Concluimos que la gammagrafía intraperitoneal es la técnica de elección para el diagnóstico de fugas peritoneales en estos pacientes.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">Pleural effusion secondary to pleuroperitoneal communication is an unusual complication of continuous ambulatory peritoneal dialysis. Many modalities have been used to diagnosis pleuroperitoneal: pleural fluid analysis, chest X- ray, Tc-99m gammagraphy, computed tomography scan and magnetic resonance image. Some of these procedures are invasive or have a high risk of induced-contrast nephrotoxicity. We present two case reports of pleuroperitoneal leak in two patients on peritoneal dialysis diagnosed with Tc-99m gammagraphy. We conclude that Tc-99m gammagraphy is a simple, safe, non invasive, low radiation exposure and cost effective method in the assessment and evaluation of complications related to peritoneal dialysis such as pleuroperitoneal leak.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17818078_f1_p264.jpg" "Alto" => 502 "Ancho" => 399 "Tamanyo" => 19514 ] ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "17818078_f2_p265.jpg" "Alto" => 514 "Ancho" => 398 "Tamanyo" => 13872 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Coche E, Lonneaux M, Goffin E ¿Transdiaphragmatic peritoneal hernia complicating peritoneal dialysis: demostrations with spiral computed tomography peritoneography and peritoneal scintigraphy¿ Eur Radiol 2005; 15: 1667 ¿ 1670." 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MR peritoneography in complications of continuous ambulatory peritoneal dialysis. Abdom Imaging 2005;30(3):361-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15688110" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Prokesch RW, Schima W, Schober E, Vychytil A, Fabrizii V, Bader TR. Complications of continuous ambulatory peritoneal dialysis. AJR 2000; 174:987-991 <a href="http://www.ncbi.nlm.nih.gov/pubmed/10749235" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000003/v0_201502091629/X2013251409004670/v0_201502091629/en/main.assets" "Apartado" => array:4 [ "identificador" => "35448" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Technical Notes" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000003/v0_201502091629/X2013251409004670/v0_201502091629/en/P-E-S-A178-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409004670?idApp=UINPBA000064" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 5 | 8 | 13 |
2024 October | 50 | 40 | 90 |
2024 September | 62 | 25 | 87 |
2024 August | 70 | 74 | 144 |
2024 July | 45 | 26 | 71 |
2024 June | 81 | 42 | 123 |
2024 May | 74 | 39 | 113 |
2024 April | 69 | 36 | 105 |
2024 March | 51 | 33 | 84 |
2024 February | 53 | 34 | 87 |
2024 January | 58 | 26 | 84 |
2023 December | 40 | 33 | 73 |
2023 November | 60 | 23 | 83 |
2023 October | 85 | 45 | 130 |
2023 September | 71 | 38 | 109 |
2023 August | 87 | 23 | 110 |
2023 July | 93 | 38 | 131 |
2023 June | 107 | 29 | 136 |
2023 May | 69 | 40 | 109 |
2023 April | 80 | 26 | 106 |
2023 March | 56 | 26 | 82 |
2023 February | 63 | 34 | 97 |
2023 January | 42 | 30 | 72 |
2022 December | 55 | 38 | 93 |
2022 November | 51 | 28 | 79 |
2022 October | 55 | 32 | 87 |
2022 September | 54 | 35 | 89 |
2022 August | 59 | 49 | 108 |
2022 July | 39 | 46 | 85 |
2022 June | 34 | 30 | 64 |
2022 May | 47 | 33 | 80 |
2022 April | 54 | 48 | 102 |
2022 March | 50 | 50 | 100 |
2022 February | 41 | 40 | 81 |
2022 January | 55 | 33 | 88 |
2021 December | 57 | 41 | 98 |
2021 November | 53 | 52 | 105 |
2021 October | 56 | 45 | 101 |
2021 September | 45 | 36 | 81 |
2021 August | 43 | 39 | 82 |
2021 July | 68 | 23 | 91 |
2021 June | 29 | 30 | 59 |
2021 May | 56 | 20 | 76 |
2021 April | 120 | 55 | 175 |
2021 March | 52 | 23 | 75 |
2021 February | 39 | 15 | 54 |
2021 January | 53 | 10 | 63 |
2020 December | 38 | 18 | 56 |
2020 November | 27 | 6 | 33 |
2020 October | 17 | 13 | 30 |
2020 September | 24 | 13 | 37 |
2020 August | 43 | 10 | 53 |
2020 July | 28 | 15 | 43 |
2020 June | 32 | 24 | 56 |
2020 May | 42 | 24 | 66 |
2020 April | 35 | 16 | 51 |
2020 March | 41 | 6 | 47 |
2020 February | 45 | 18 | 63 |
2020 January | 64 | 20 | 84 |
2019 December | 42 | 11 | 53 |
2019 November | 50 | 20 | 70 |
2019 October | 21 | 6 | 27 |
2019 September | 38 | 6 | 44 |
2019 August | 39 | 5 | 44 |
2019 July | 51 | 22 | 73 |
2019 June | 34 | 5 | 39 |
2019 May | 30 | 19 | 49 |
2019 April | 96 | 23 | 119 |
2019 March | 36 | 15 | 51 |
2019 February | 20 | 10 | 30 |
2019 January | 36 | 20 | 56 |
2018 December | 74 | 24 | 98 |
2018 November | 73 | 11 | 84 |
2018 October | 90 | 14 | 104 |
2018 September | 47 | 7 | 54 |
2018 August | 24 | 11 | 35 |
2018 July | 28 | 8 | 36 |
2018 June | 28 | 10 | 38 |
2018 May | 46 | 12 | 58 |
2018 April | 36 | 8 | 44 |
2018 March | 30 | 6 | 36 |
2018 February | 37 | 5 | 42 |
2018 January | 48 | 7 | 55 |
2017 December | 31 | 7 | 38 |
2017 November | 23 | 8 | 31 |
2017 October | 34 | 8 | 42 |
2017 September | 36 | 10 | 46 |
2017 August | 26 | 8 | 34 |
2017 July | 28 | 15 | 43 |
2017 June | 49 | 17 | 66 |
2017 May | 51 | 13 | 64 |
2017 April | 29 | 13 | 42 |
2017 March | 30 | 10 | 40 |
2017 February | 55 | 5 | 60 |
2017 January | 25 | 14 | 39 |
2016 December | 54 | 9 | 63 |
2016 November | 68 | 8 | 76 |
2016 October | 98 | 11 | 109 |
2016 September | 136 | 8 | 144 |
2016 August | 212 | 10 | 222 |
2016 July | 146 | 9 | 155 |
2016 June | 113 | 0 | 113 |
2016 May | 126 | 0 | 126 |
2016 April | 95 | 0 | 95 |
2016 March | 79 | 0 | 79 |
2016 February | 100 | 0 | 100 |
2016 January | 113 | 0 | 113 |
2015 December | 93 | 0 | 93 |
2015 November | 72 | 0 | 72 |
2015 October | 65 | 0 | 65 |
2015 September | 75 | 0 | 75 |
2015 August | 70 | 0 | 70 |
2015 July | 52 | 0 | 52 |
2015 June | 40 | 0 | 40 |
2015 May | 52 | 0 | 52 |
2015 April | 5 | 0 | 5 |