Case report
Dermatomyositis and meningioma in the same patient
Dermatomiositis y meningioma en el mismo paciente
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Report of two cases with good response to infliximab" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "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" => 699 "Ancho" => 1500 "Tamanyo" => 122298 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A) Pioderma gangrenoso en tobillo derecho. B) Mejoría de la lesión tras tratamiento con infliximab.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen Carrasco Cubero, M. 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=> array:1 [ 0 => array:2 [ "paginaInicial" => "87" "paginaFinal" => "89" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raquel Almodóvar, Daniel Paul Lindo, Helena Martín, Ramón Mazzuchelli, Javier Pardo, Francisco Javier Quirós, Pedro Zarco" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Raquel" "apellidos" => "Almodóvar" "email" => array:1 [ 0 => "ralmodovar@fhalcorcon.es" ] "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" => "Daniel Paul" "apellidos" => "Lindo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Helena" "apellidos" => "Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Ramón" "apellidos" => "Mazzuchelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Javier" "apellidos" => "Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Quirós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Pedro" "apellidos" => "Zarco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Rheumathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatomiositis y meningioma en el mismo paciente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 983 "Ancho" => 950 "Tamanyo" => 89684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial cranial T1 magnetic resonance imaging after the administration of intravenous gadolinium that shows the presence of a left frontal mass of 3.5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm with heterogeneous peripheral enhancement.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The link between DM and malignancies has been clarified.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The reported rate of malignant diseases in DM has varied from 6 to 60%, with most large population-based cohort studies reporting a rate of 20–25%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The most common cancers are those of the ovaries, gastrointestinal tract, lung, breast, and non-Hodgkin lymphomas.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> A review of the literature revealed only two cases of meningioma in patients with DM.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old woman was admitted to the hospital because of cutaneous rash and muscle weakness. She had been well until three months before; she noted weakness in her legs, while climbing stairs, and in her arms. The physical examination revealed a violaceous periorbital oedema. There were areas of erythema over the proximal and distal interphalangeal joints. Neurological examination revealed bilateral symmetric muscle weakness affecting the shoulders and hip girdle muscles, with strength assessed at 3 of 5 bilaterally. The patient could not stand up from a sitting position. The deep-tendon reflexes were normal and symmetric in arms and legs. The rest of the examination did not reveal abnormalities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">General laboratory investigations are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The results of urinalysis were normal. An antinuclear-antibody test was positive at 1:1560 in a homogeneous pattern; anti-double stranded DNA, anti-ENA, anti Jo-1 antibodies and ANCA were negative. Radiographs of the chest and ultrasonography of the abdomen were normal. A barium study of the oesophagus, stomach, and duodenum only showed decreased motility in the proximal oesophagus. The electromyography showed profuse denervation activity (fibrillations and positive waves) in all the muscles explored, especially in proximal muscles of upper limbs. Polyphasic motor unit, low amplitude and average duration, high-frequency complex potential abnormalities, consistent with myositis. Histological examination of a biopsy from deltoid muscle demonstrated necrosis of types I and II muscle fibres, phagocytosis, regeneration with basophilia, and atrophy in a perifascicular distribution. Treatment with prednisone (60<span class="elsevierStyleHsp" style=""></span>mg/day) was started with subjective improvement in muscle strength and dysphagia. The patient was discharged from hospital, however, with inability to stand up from a sitting position without help. Following clinical improvement, the dosage of prednisone was slowly tapered during the successive months to a daily maintenance dose of 10<span class="elsevierStyleHsp" style=""></span>mg/day; azathioprine was added early to save corticosteroids, however, muscle strength was not totally recovered.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Ten months after the onset of the disease, a flare requiring hospitalisation appeared. The laboratory test results at that point are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The electromyography showed a severe myopathic pattern. All tumoral markers were negative; chest, abdomen and pelvic scanner only showed renal litiasis. Consequently, the dose of prednisone was increased to 60<span class="elsevierStyleHsp" style=""></span>mg/day without any clinical or biochemical improvement. The patient was treated with three bolus of methylprednisolone (1<span class="elsevierStyleHsp" style=""></span>g/day) but her muscle strength did not increase. Three weeks after the admission, the patient developed right facial central paresis, right arm hyperreflexia, and disartria. MRI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed the presence of a left frontal mass that was removed. The histology showed a fibroblastic type meningioma. After the surgical removal of the tumour, the patient improved dramatically and the muscle enzyme levels returned to normality. The patient continued her treatment with methotrexate (10<span class="elsevierStyleHsp" style=""></span>mg weekly) and prednisone (10<span class="elsevierStyleHsp" style=""></span>mg/day), being asymptomatic so far.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The association between DM and cancer has been recognized for many years; several studies in large populations have shown that patients with DM have a risk of cancer three to six times higher than the general population.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a> Generalized cancer screening is now recommended for all patients with inflammatory myositis, especially for those who are at increased risk such as older patients, those suffering dermatomyositis rather than polymyositis, cases with evidence of capillary damage detected by muscle biopsy, dermatomyositis complicated with cutaneous necrosis of the trunk, presence of cutaneous leukocytoclastic vasculitis, elevated erythrocyte sedimentation rate, presence of antinuclear antibodies, and in patients with weight loss.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Malignant diseases may occur before the onset of DM, concurrently or after the onset of the symptoms. In addition, the DM might follow the course of the malignant disease (a paraneoplasic course) or may follow its own course independently of the treatment of the tumour. Studies showing benefits of cancer surgery on DM and those showing no link have been reported.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">About 15% of adults with DM have been found to develop a tumour. Meningioma also has a frequency of 13–26% among the various intracraneal tumours affecting the general population.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, despite the fact of the relatively high incidence of meningioma, the combination of this tumour and DM has been described in two reports.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> There is not even a described association between primary brain tumours and DM.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our report does not prove the association between these two entities, but the patient's improvement after the removal of meningioma and the difficulty to control her disease activity previously suggest that these two entities might be associated in this case.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The association between dermatomyositis (DM) and neoplasms has been widely described, but there is no clear association with central nervous system tumours. In this paper, we show a not previously described case of meningioma in a patient with DM.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres342614" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec324228" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres342615" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec324229" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-02-11" "fechaAceptado" => "2011-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec324228" "palabras" => array:3 [ 0 => "Dermatomyositis" 1 => "Meningioma" 2 => "Neoplasms" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec324229" "palabras" => array:3 [ 0 => "Dermatomiositis" 1 => "Meningioma" 2 => "Neoplasma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The association between dermatomyositis (DM) and neoplasm has been widely described, especially in elder patients; this entity can be associated with many different types of tumours, more frequently lung, ovary, and gastric cancers. There is no clear association with central nervous system tumours. We present the case of a 64-year-old woman diagnosed simultaneously of DM with a difficult clinical control and a meningioma, being the course of the two illnesses linked. The activity of the DM was controlled after the meningioma was removed.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La asociación entre la dermatomiositis (DM) y las neoplasias ha sido ampliamente descrita, especialmente en pacientes de edad avanzada; esta entidad puede estar asociada con diferentes tipos de tumores, especialmente con cáncer de pulmón, ovario y estómago. No existe una clara asociación con tumores en el sistema nervioso. Se presenta el caso de una mujer de 64 años a la que se diagnosticó simultáneamente DM de difícil control clínico y un meningioma, estando el curso de ambas enfermedades vinculadas. La actividad de la DM fue controlada tras la extracción del meningioma.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 983 "Ancho" => 950 "Tamanyo" => 89684 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial cranial T1 magnetic resonance imaging after the administration of intravenous gadolinium that shows the presence of a left frontal mass of 3.5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm with heterogeneous peripheral enhancement.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">WBC: white blood cells; ALT: alanine-aminotransferase; AST: aspartate-aminotransferase; CK: creatine-kinase; ESR: erythrocyte sedimentation rate.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">First admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Two months after discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Second admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">After surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">WBC (per mm<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6560 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11460 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9910 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8630 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemoglobin (g/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelets (per mm<span class="elsevierStyleSup">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">377,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">332,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">344,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">307,000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CK (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11713 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6779 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3801 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">181 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALT (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">209 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AST (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">447 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">365 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">194 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aldolase (U/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2086 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">688 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1747 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">559 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR (mm/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab508307.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Laboratory tests.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatomyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. Callen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(99)05157-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2000" "volumen" => "355" "paginaInicial" => "53" "paginaFinal" => "57" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10615903" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relation between dermatomyositis and polymyositis and cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. Callen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(00)03535-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2001" "volumen" => "357" "paginaInicial" => "85" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11197441" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyositis and dermatomyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Dalakas" 1 => "R. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 12 | 13 | 25 |
| 2024 Octubre | 43 | 25 | 68 |
| 2024 Septiembre | 50 | 20 | 70 |
| 2024 Agosto | 93 | 45 | 138 |
| 2024 Julio | 50 | 18 | 68 |
| 2024 Junio | 82 | 28 | 110 |
| 2024 Mayo | 84 | 33 | 117 |
| 2024 Abril | 55 | 30 | 85 |
| 2024 Marzo | 58 | 37 | 95 |
| 2024 Febrero | 61 | 31 | 92 |
| 2024 Enero | 45 | 21 | 66 |
| 2023 Diciembre | 32 | 29 | 61 |
| 2023 Noviembre | 46 | 36 | 82 |
| 2023 Octubre | 42 | 23 | 65 |
| 2023 Septiembre | 100 | 37 | 137 |
| 2023 Agosto | 28 | 11 | 39 |
| 2023 Julio | 40 | 33 | 73 |
| 2023 Junio | 35 | 20 | 55 |
| 2023 Mayo | 50 | 27 | 77 |
| 2023 Abril | 21 | 10 | 31 |
| 2023 Marzo | 46 | 33 | 79 |
| 2023 Febrero | 45 | 33 | 78 |
| 2023 Enero | 26 | 27 | 53 |
| 2022 Diciembre | 71 | 42 | 113 |
| 2022 Noviembre | 70 | 32 | 102 |
| 2022 Octubre | 64 | 34 | 98 |
| 2022 Septiembre | 45 | 44 | 89 |
| 2022 Agosto | 69 | 56 | 125 |
| 2022 Julio | 36 | 39 | 75 |
| 2022 Junio | 49 | 46 | 95 |
| 2022 Mayo | 53 | 51 | 104 |
| 2022 Abril | 42 | 53 | 95 |
| 2022 Marzo | 60 | 52 | 112 |
| 2022 Febrero | 42 | 45 | 87 |
| 2022 Enero | 60 | 40 | 100 |
| 2021 Diciembre | 24 | 36 | 60 |
| 2021 Noviembre | 39 | 42 | 81 |
| 2021 Octubre | 139 | 69 | 208 |
| 2021 Septiembre | 43 | 59 | 102 |
| 2021 Agosto | 35 | 69 | 104 |
| 2021 Julio | 30 | 44 | 74 |
| 2021 Junio | 40 | 56 | 96 |
| 2021 Mayo | 58 | 55 | 113 |
| 2021 Abril | 109 | 93 | 202 |
| 2021 Marzo | 75 | 51 | 126 |
| 2021 Febrero | 60 | 41 | 101 |
| 2021 Enero | 54 | 28 | 82 |
| 2020 Diciembre | 44 | 32 | 76 |
| 2020 Noviembre | 55 | 25 | 80 |
| 2020 Octubre | 50 | 27 | 77 |
| 2020 Septiembre | 59 | 37 | 96 |
| 2020 Agosto | 32 | 25 | 57 |
| 2020 Julio | 36 | 34 | 70 |
| 2020 Junio | 43 | 40 | 83 |
| 2020 Mayo | 43 | 29 | 72 |
| 2020 Abril | 29 | 32 | 61 |
| 2020 Marzo | 50 | 32 | 82 |
| 2020 Febrero | 56 | 34 | 90 |
| 2020 Enero | 37 | 26 | 63 |
| 2019 Diciembre | 26 | 29 | 55 |
| 2019 Noviembre | 38 | 13 | 51 |
| 2019 Octubre | 60 | 32 | 92 |
| 2019 Septiembre | 47 | 32 | 79 |
| 2019 Agosto | 36 | 25 | 61 |
| 2019 Julio | 37 | 30 | 67 |
| 2019 Junio | 26 | 47 | 73 |
| 2019 Mayo | 50 | 70 | 120 |
| 2019 Abril | 47 | 31 | 78 |
| 2019 Marzo | 38 | 23 | 61 |
| 2019 Febrero | 36 | 19 | 55 |
| 2019 Enero | 37 | 30 | 67 |
| 2018 Diciembre | 102 | 60 | 162 |
| 2018 Noviembre | 155 | 14 | 169 |
| 2018 Octubre | 96 | 11 | 107 |
| 2018 Septiembre | 34 | 12 | 46 |
| 2018 Agosto | 43 | 10 | 53 |
| 2018 Julio | 17 | 4 | 21 |
| 2018 Mayo | 5 | 0 | 5 |
| 2018 Abril | 48 | 9 | 57 |
| 2018 Marzo | 86 | 3 | 89 |
| 2018 Febrero | 39 | 7 | 46 |
| 2018 Enero | 57 | 7 | 64 |
| 2017 Diciembre | 39 | 10 | 49 |
| 2017 Noviembre | 32 | 5 | 37 |
| 2017 Octubre | 21 | 4 | 25 |
| 2017 Septiembre | 36 | 16 | 52 |
| 2017 Agosto | 57 | 8 | 65 |
| 2017 Julio | 50 | 12 | 62 |
| 2017 Junio | 62 | 10 | 72 |
| 2017 Mayo | 55 | 13 | 68 |
| 2017 Abril | 45 | 7 | 52 |
| 2017 Marzo | 51 | 13 | 64 |
| 2017 Febrero | 38 | 6 | 44 |
| 2017 Enero | 34 | 6 | 40 |
| 2016 Diciembre | 68 | 15 | 83 |
| 2016 Noviembre | 34 | 10 | 44 |
| 2016 Octubre | 63 | 20 | 83 |
| 2016 Septiembre | 62 | 9 | 71 |
| 2016 Agosto | 23 | 9 | 32 |
| 2016 Julio | 6 | 7 | 13 |
| 2016 Junio | 0 | 8 | 8 |
| 2016 Mayo | 0 | 13 | 13 |
| 2016 Abril | 0 | 6 | 6 |
| 2016 Marzo | 0 | 6 | 6 |
| 2016 Febrero | 1 | 13 | 14 |
| 2016 Enero | 1 | 0 | 1 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Noviembre | 1 | 0 | 1 |
| 2015 Octubre | 0 | 7 | 7 |
| 2015 Septiembre | 3 | 0 | 3 |
| 2015 Agosto | 1 | 0 | 1 |
| 2015 Julio | 28 | 4 | 32 |
| 2015 Junio | 31 | 9 | 40 |
| 2015 Mayo | 49 | 16 | 65 |
| 2015 Abril | 32 | 14 | 46 |
| 2015 Marzo | 35 | 13 | 48 |
| 2015 Febrero | 24 | 0 | 24 |
| 2015 Enero | 26 | 0 | 26 |
| 2014 Diciembre | 36 | 0 | 36 |
| 2014 Noviembre | 27 | 0 | 27 |
| 2014 Octubre | 30 | 0 | 30 |
| 2014 Septiembre | 26 | 0 | 26 |
| 2014 Agosto | 37 | 0 | 37 |
| 2014 Julio | 33 | 0 | 33 |
| 2014 Junio | 50 | 0 | 50 |
| 2014 Mayo | 55 | 0 | 55 |
| 2014 Abril | 32 | 0 | 32 |
| 2014 Marzo | 53 | 12 | 65 |
| 2014 Febrero | 49 | 14 | 63 |
| 2014 Enero | 43 | 8 | 51 |
| 2013 Diciembre | 30 | 9 | 39 |
| 2013 Noviembre | 31 | 9 | 40 |
| 2013 Octubre | 45 | 9 | 54 |
| 2013 Septiembre | 47 | 15 | 62 |
| 2013 Agosto | 34 | 14 | 48 |
| 2013 Julio | 37 | 7 | 44 |
| 2013 Junio | 30 | 9 | 39 |
| 2013 Mayo | 41 | 6 | 47 |
| 2013 Abril | 35 | 11 | 46 |
| 2013 Marzo | 37 | 14 | 51 |
| 2013 Febrero | 31 | 5 | 36 |
| 2013 Enero | 37 | 7 | 44 |
| 2012 Diciembre | 24 | 7 | 31 |
| 2012 Noviembre | 19 | 12 | 31 |
| 2012 Octubre | 12 | 13 | 25 |
| 2012 Septiembre | 17 | 13 | 30 |
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