Derrame pleural complicado na criança – Abordagem terapêutica

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Oliveira, A. Barroso, A. Conde, B. Parente" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Diva" "apellidos" => "Ferreira" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Barroso" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Conde" ] 4 => array:2 [ "nombre" => "B." 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Gomes Pedro, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 LISBOA" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Complicated pleural effusion in children – Therapeutical approach" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-10-28" "fechaAceptado" => "2006-09-08" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec567927" "palabras" => array:3 [ 0 => "Derrame pleural" 1 => "empiema pleural" 2 => "criança" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec567926" "palabras" => array:3 [ 0 => "Pleural effusion" 1 => "pleural empyema" 2 => "child" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "A abordagem do derrame pleural parapneumónico complicado, em idade pediátrica, permanece controversa. As opções terapêuticas incluem antibioticoterapia e drenagem pleural contínua, instilação intrapleural de fibrinolíticos, videotoracoscopia e toracotomia com descorticação. O objectivo deste estudo foi rever, avaliar e actualizar a abordagem ao derrame pleural complicado. Procedeu-se à revisão retrospectiva dos processos clínicos das crianças internadas na UPP por derrame pleural complicado entre 1992 e 2003. Foram incluídos 25 doentes, com idade média (±DP): 37,4 (± 37,0) meses, sendo 15/25 (60%) do sexo masculino. A identificação do agente foi possível em 17/25 (68%) casos [S. aureus6/17 (35%), St. pneumoniae 5/17 (29%)], no líquido pleural em 16/17 (94%) casos. Todos os doentes realizaram toracocentese e antibioticoterapia sistémica. A drenagem pleural contínua foi instituída em 22/25 (88%) casos com duração média (±DP): 14,2 (± 7,8) dias; em 1 caso houve instilação de fibrinolíticos intrapleurais e em 11/25 (44%) realizou-se toracotomia com descorticação. Um doente foi submetido a videotoracoscopia primária. A duração média de internamento (±DP) foi de 30,4 (± 15,1) dias e não ocorreram óbitos. A experiência do centro é determinante na abordagem escolhida e na rapidez de actuação. Provavelmente ambas influenciam o prognóstico imediato.Rev Port Pneumol 2007; XIII (1): 53-70" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Pediatric management of complicated pleural effusion (CPE) remains controversial. Different approaches include antibiotics and chest tube drainage alone or the use of fibrinolitics, videothorascoscopy (VTC) and surgical decortication through thoracotomy.The aim of the present study was to review, evaluate and update technical approach to CPE. We retrospectively reviewed the clinical files of children admitted to the Pediatric Respiratory Ward between 1992 and 2003 with the diagnosis of CPE. Twenty-five patients were included [15 male (60%)]. Mean (±SD) age was 37,4 (±37,0) months. Bacteria were identified in 17/25 (68%) [S. aureus in 6/17 (35%), St. pneumoniae in 5/17 (29%)], 16/17 (94%)in the pleural fluid. Twenty-five children were treated with antibiotics and thoracocentesis (100%). Chest tube drainage was required in 22/25 (88%) with mean (±DP) duration of 14,2 (±7,8) days. Fibrinolitics were employed in 1 only case and surgical decortication in 11/25 (44%). One patient (4%) was submitted to primary VTC. Median length of stay was 30,4 (±15,1) days and no deaths were recorded. Center skills in CPE management are critical on the choice of the technique and the timing of approach. This seems to influence immediate prognosis.Rev Port Pneumol 2007; XIII (1): 53-70" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "Bibliografia / Bibliography" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:48 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Seddon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2003" "volumen" => "88" "paginaInicial" => "918" "paginaFinal" => "921" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14500315" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bb0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of urokinase in childhood pleural empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Barbato" 1 => "C. Panizzolo" 2 => "C. 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Barbieri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.151.6.7767510" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1995" "volumen" => "151" "paginaInicial" => "1700" "paginaFinal" => "1708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7767510" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bb0050" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.L. Colice" 1 => "A. Curtis" 2 => "J. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.R. Ramnath" 1 => "R.M. Heller" 2 => "T. Ben-Ami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "1998" "volumen" => "101" "paginaInicial" => "68" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9417153" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bb0065" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence based paediatrics: review of BTS guidelines for the management of community-acquired pneumonia in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. 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Artigo Original / Original Article

Derrame pleural complicado na criança – Abordagem terapêutica

Complicated pleural effusion in children – Therapeutical approach

Sara Martins1, Sandra Valente1, Teresa Nunes David2, Luísa Pereira2, Celeste Barreto3, Teresa Bandeira3,

Corresponding author

teresa.bandeira@hsm.min-saude.pt

Correspondência/Correspondence to: Teresa Bandeira, Unidade de Pneumologia Pediátrica (UPP), Clínica Universitária de Pediatria, Director de Serviço: Prof. Doutor J. Gomes Pedro, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 LISBOA

1 Interna de Internato Complementar de Pediatria / Resident of Paediatrics

2 Assistente Hospitalar de Pediatria / Hospital Assistant, Paediatrics

3 Assistente Hospitalar Graduada de Pediatria / Hospital Assistant, Consultant Paediatrics

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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">A abordagem do derrame pleural parapneum&#243;nico complicado&#44; em idade pedi&#225;trica&#44; permanece controversa&#46; As op&#231;&#245;es terap&#234;uticas incluem antibioticoterapia e drenagem pleural cont&#237;nua&#44; instila&#231;&#227;o intrapleural de fibrinol&#237;ticos&#44; videotoracoscopia e toracotomia com descortica&#231;&#227;o&#46; O objectivo deste estudo foi rever&#44; avaliar e actualizar a abordagem ao derrame pleural complicado&#46; Procedeu-se &#224; revis&#227;o retrospectiva dos processos cl&#237;nicos das crian&#231;as internadas na UPP por derrame pleural complicado entre 1992 e 2003&#46; Foram inclu&#237;dos 25 doentes&#44; com idade m&#233;dia &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;&#58; 37&#44;4 &#40;&#177; 37&#44;0&#41; meses&#44; sendo 15&#47;25 &#40;60&#37;&#41; do sexo masculino&#46; A identifica&#231;&#227;o do agente foi poss&#237;vel em 17&#47;25 &#40;68&#37;&#41; casos &#91;<span class="elsevierStyleItalic">S</span>&#46; <span class="elsevierStyleItalic">aureus</span>6&#47;17 &#40;35&#37;&#41;&#44; <span class="elsevierStyleItalic">St</span>&#46; <span class="elsevierStyleItalic">pneumoniae</span> 5&#47;17 &#40;29&#37;&#41;&#93;&#44; no l&#237;quido pleural em 16&#47;17 &#40;94&#37;&#41; casos&#46; Todos os doentes realizaram toracocentese e antibioticoterapia sist&#233;mica&#46; A drenagem pleural cont&#237;nua foi institu&#237;da em 22&#47;25 &#40;88&#37;&#41; casos com dura&#231;&#227;o m&#233;dia &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41;&#58; 14&#44;2 &#40;&#177; 7&#44;8&#41; dias&#59; em 1 caso houve instila&#231;&#227;o de fibrinol&#237;ticos intrapleurais e em 11&#47;25 &#40;44&#37;&#41; realizou-se toracotomia com descortica&#231;&#227;o&#46; Um doente foi submetido a videotoracoscopia prim&#225;ria&#46; A dura&#231;&#227;o m&#233;dia de internamento &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41; foi de 30&#44;4 &#40;&#177; 15&#44;1&#41; dias e n&#227;o ocorreram &#243;bitos&#46; A experi&#234;ncia do centro &#233; determinante na abordagem escolhida e na rapidez de actua&#231;&#227;o&#46; Provavelmente ambas influenciam o progn&#243;stico imediato&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007&#59; XIII &#40;1&#41;&#58; 53-70</span></p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Pediatric management of complicated pleural effusion &#40;CPE&#41; remains controversial&#46; Different approaches include antibiotics and chest tube drainage alone or the use of fibrinolitics&#44; videothorascoscopy &#40;VTC&#41; and surgical decortication through thoracotomy&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">The aim of the present study was to review&#44; evaluate and update technical approach to CPE&#46; We retrospectively reviewed the clinical files of children admitted to the Pediatric Respiratory Ward between 1992 and 2003 with the diagnosis of CPE&#46; Twenty-five patients were included &#91;15 male &#40;60&#37;&#41;&#93;&#46; Mean &#40;&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; age was 37&#44;4 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>37&#44;0&#41; months&#46; Bacteria were identified in 17&#47;25 &#40;68&#37;&#41; &#91;<span class="elsevierStyleItalic">S</span>&#46; <span class="elsevierStyleItalic">aureus</span> in 6&#47;17 &#40;35&#37;&#41;&#44; <span class="elsevierStyleItalic">St</span>&#46; <span class="elsevierStyleItalic">pneumoniae</span> in 5&#47;17 &#40;29&#37;&#41;&#93;&#44; 16&#47;17 &#40;94&#37;&#41;in the pleural fluid&#46; Twenty-five children were treated with antibiotics and thoracocentesis &#40;100&#37;&#41;&#46; Chest tube drainage was required in 22&#47;25 &#40;88&#37;&#41; with mean &#40;&#177;<span class="elsevierStyleHsp" style=""></span>DP&#41; duration of 14&#44;2 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;8&#41; days&#46; Fibrinolitics were employed in 1 only case and surgical decortication in 11&#47;25 &#40;44&#37;&#41;&#46; One patient &#40;4&#37;&#41; was submitted to primary VTC&#46; Median length of stay was 30&#44;4 &#40;&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;1&#41; days and no deaths were recorded&#46; Center skills in CPE management are critical on the choice of the technique and the timing of approach&#46; This seems to influence immediate prognosis&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007&#59; XIII &#40;1&#41;&#58; 53-70</span></p></span>"
      ]
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        "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia &#47; Bibliography</span>"
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              0 => array:3 [
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                  0 => array:2 [
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                      0 => array:2 [
                        "titulo" => "Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "I&#46;C&#46; Michelow"
                              1 => "K&#46; Olsen"
                              2 => "J&#46; Lozano"
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                      ]
                    ]
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                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Pediatrics"
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                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15060215"
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                  0 => array:2 [
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                      0 => array:1 [
                        "titulo" => "BTS Guidelines for the management of community-acquired pneumonia in childhood"
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Thorax"
                          "fecha" => "2002"
                          "volumen" => "57"
                          "numero" => "Suppl"
                          "paginaInicial" => "1"
                          "paginaFinal" => "24"
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                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11809978"
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                      0 => array:2 [
                        "titulo" => "Management of nontuberculous empyema"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "American Thoracic Society"
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                          ]
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                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Am Rev Respir Dis"
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                          "paginaInicial" => "935"
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                      0 => array:2 [
                        "titulo" => "Short-term course and outcome of treatments of pleural empyema in pediatric patients"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "D&#46; Shoseyov"
                              1 => "H&#46; Bibi"
                              2 => "G&#46; Shatzberg"
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                          ]
                        ]
                      ]
                    ]
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                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "2002"
                          "volumen" => "121"
                          "paginaInicial" => "836"
                          "paginaFinal" => "840"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11888969"
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                "identificador" => "bb0025"
                "etiqueta" => "5&#46;"
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                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Management of thoracic empyema in childhood&#58; does the pleural thickening matter&#63;"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "B&#46; Satish"
                              1 => "M&#46; Bunker"
                              2 => "P&#46; Seddon"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Arch Dis Child"
                          "fecha" => "2003"
                          "volumen" => "88"
                          "paginaInicial" => "918"
                          "paginaFinal" => "921"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14500315"
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                "identificador" => "bb0030"
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                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Use of urokinase in childhood pleural empyema"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "A&#46; Barbato"
                              1 => "C&#46; Panizzolo"
                              2 => "C&#46; Monciotti"
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                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1002/ppul.10212"
                        "Revista" => array:6 [
                          "tituloSerie" => "Pediatr Pulmonol"
                          "fecha" => "2003"
                          "volumen" => "35"
                          "paginaInicial" => "50"
                          "paginaFinal" => "55"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12461739"
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                "identificador" => "bb0035"
                "etiqueta" => "7&#46;"
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                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "C&#46;T&#46; Yao"
                              1 => "J&#46;M&#46; Wu"
                              2 => "C&#46;C&#46; Liu"
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                          ]
                        ]
                      ]
                    ]
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                      0 => array:2 [
                        "titulo" => "Management of late-stage parapneumonic empyema"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "L&#46;E&#46; Chen"
                              1 => "J&#46;C&#46; Langer"
                              2 => "P&#46;A&#46; Dillom"
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                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "J Pediatr Surg"
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                          "volumen" => "37"
                          "numero" => "3"
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                          "paginaFinal" => "374"
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                "etiqueta" => "9&#46;"
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                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Pleural fluid chemical analysis in parapneumonic effusions&#58; a metaanalysis"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "J&#46;E&#46; Heffner"
                              1 => "L&#46;K&#46; Brown"
                              2 => "C&#46; Barbieri"
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                      0 => array:2 [
                        "doi" => "10.1164/ajrccm.151.6.7767510"
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                          "tituloSerie" => "Am J Respir Crit Care Med"
                          "fecha" => "1995"
                          "volumen" => "151"
                          "paginaInicial" => "1700"
                          "paginaFinal" => "1708"
                          "link" => array:1 [
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                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Medical and surgical treatment of parapneumonic effusions&#58; an evidence-based guideline"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "G&#46;L&#46; Colice"
                              1 => "A&#46; Curtis"
                              2 => "J&#46; Deslauriers"
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                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
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                          "tituloSerie" => "Chest"
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                "identificador" => "bb0055"
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                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Maximizing the usefulness of imaging in children with community-acquired pneumonia"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "L&#46;F&#46; Donnelly"
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                      0 => array:2 [
                        "doi" => "10.2214/ajr.172.2.9930814"
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                          "tituloSerie" => "AJR"
                          "fecha" => "1999"
                          "volumen" => "172"
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                          "paginaFinal" => "512"
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                "etiqueta" => "12&#46;"
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                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "R&#46;R&#46; Ramnath"
                              1 => "R&#46;M&#46; Heller"
                              2 => "T&#46; Ben-Ami"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Pediatrics"
                          "fecha" => "1998"
                          "volumen" => "101"
                          "paginaInicial" => "68"
                          "paginaFinal" => "71"
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                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9417153"
                              "web" => "Medline"
                            ]
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                    ]
                  ]
                ]
              ]
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                "identificador" => "bb0065"
                "etiqueta" => "13&#46;"
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                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Evidence based paediatrics&#58; review of BTS guidelines for the management of community-acquired pneumonia in children"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "P&#46; Kumar"
                              1 => "M&#46;C&#46; McKean"
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                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "J Infect"
                          "fecha" => "2004"
                          "volumen" => "48"
                          "paginaInicial" => "134"
                          "paginaFinal" => "138"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14720488"
                              "web" => "Medline"
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                          ]
                        ]
                      ]
                    ]
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                ]
              ]
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                "etiqueta" => "14&#46;"
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                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Surgical treatment of parapneumonic empyema"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "G&#46;A&#46; Khakoo"
                              1 => "P&#46; Goldtraw"
                              2 => "D&#46;M&#46; Hansell"
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                          ]
                        ]
                      ]
                    ]
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                        "doi" => "10.1002/(SICI)1099-0496(199612)22:6<348::AID-PPUL3>3.0.CO;2-F"
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                          "tituloSerie" => "Pediatr Pulmonol"
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                          "volumen" => "22"
                          "paginaInicial" => "348"
                          "paginaFinal" => "356"
                          "link" => array:1 [
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                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9016468"
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                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Surgical versus nonsurgical management of pleural empyema"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "N&#46; Coote"
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                      0 => array:2 [
                        "doi" => "10.1002/14651858.CD003881.pub3"
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                          "tituloSerie" => "Cochrane Database Syst Rev"
                          "fecha" => "2002"
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                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22336797"
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                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Rational treatment of empyema in children"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "A&#46;H&#46; Meier"
                              1 => "B&#46; Smith"
                              2 => "A&#46; Raghavan"
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                          ]
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                      ]
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Article information

ISSN: 08732159
Original language: Portuguese

DOI:10.1016/S0873-2159(15)30337-8

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Year/Month	Html	Pdf	Total

2024 November	11	5	16
2024 October	91	47	138
2024 September	73	47	120
2024 August	87	54	141
2024 July	49	47	96
2024 June	53	51	104
2024 May	41	29	70
2024 April	45	48	93
2024 March	55	38	93
2024 February	47	24	71
2024 January	27	23	50
2023 December	37	34	71
2023 November	40	30	70
2023 October	31	37	68
2023 September	36	36	72
2023 August	37	15	52
2023 July	25	46	71
2023 June	30	52	82
2023 May	32	62	94
2023 April	17	47	64
2023 March	29	93	122
2023 February	39	47	86
2023 January	38	36	74
2022 December	29	37	66
2022 November	46	81	127
2022 October	34	66	100
2022 September	20	74	94
2022 August	40	96	136
2022 July	28	85	113
2022 June	19	83	102
2022 May	44	108	152
2022 April	22	95	117
2022 March	25	65	90
2022 February	22	52	74
2022 January	27	62	89
2021 December	28	46	74
2021 November	29	57	86
2021 October	91	67	158
2021 September	26	53	79
2021 August	34	37	71
2021 July	34	27	61
2021 June	25	45	70
2021 May	26	45	71
2021 April	81	89	170
2021 March	34	24	58
2021 February	38	28	66
2021 January	32	15	47
2020 December	23	24	47
2020 November	47	32	79
2020 October	23	33	56
2020 September	60	19	79
2020 August	41	30	71
2020 July	65	32	97
2020 June	49	26	75
2020 May	55	22	77
2020 April	51	29	80
2020 March	49	25	74
2020 February	39	91	130
2020 January	54	39	93
2019 December	43	35	78
2019 November	65	35	100
2019 October	44	30	74
2019 September	54	75	129
2019 August	56	24	80
2019 July	51	17	68
2019 June	49	31	80
2019 May	56	43	99
2019 April	46	28	74
2019 March	58	25	83
2019 February	60	24	84
2019 January	49	22	71
2018 December	19	14	33
2018 November	9	0	9
2018 October	11	0	11
2018 September	20	17	37
2018 August	43	39	82
2018 July	37	25	62
2018 June	48	20	68
2018 May	50	22	72
2018 April	71	34	105
2018 March	49	30	79
2018 February	17	8	25
2018 January	38	10	48
2017 December	43	16	59
2017 November	38	9	47
2017 October	27	12	39
2017 September	27	10	37
2017 August	19	16	35
2017 July	27	13	40
2017 June	28	17	45
2017 May	36	19	55
2017 April	9	33	42
2017 March	12	40	52
2017 February	6	5	11
2017 January	16	8	24
2016 December	10	2	12
2016 November	11	5	16
2016 October	13	13	26
2016 September	5	4	9
2016 August	3	2	5
2016 July	5	7	12
2016 June	0	8	8
2016 May	5	14	19
2016 April	7	1	8
2016 March	5	12	17
2016 February	5	11	16
2016 January	8	4	12
2015 December	6	4	10
2015 November	1	2	3
2015 October	6	2	8

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