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Hospital La Paz. Madrid. Spain." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aerofagia por ventilación mecánica no invasiva: primera manifestación de un carcinoma gástrico silente" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction</span></p><p class="elsevierStylePara">Noninvasive mechanical ventilation (NIV) techniques have proven useful in treating patients with respiratory insufficiency of various etiologies<span class="elsevierStyleSup">1</span>. It has been clearly established<span class="elsevierStyleSup">2-6</span> that NIV is indicated in neuromuscular patients, patients with thoracic deformities, obesity hypoventilation syndrome and chronic obstructive disease, as well as other diseases and situations favoring the development of respiratory insufficiency. NIV is usually well tolerated but problems related primarily to the appearance of nasal and oropharyngeal dryness, pressure sores where the nasal mask touches the skin, ocular irritation due to air leakage and epistaxis<span class="elsevierStyleSup">2,4,7</span> may occur. Approximately half of the patients complain of aerophagia. Most of the time the discomfort is slight and well tolerated, but in some cases gastrointestinal distension is excessive and may constitute a medical emergency or lead to the discontinuance of ventilation<span class="elsevierStyleSup">8</span>. Treatment of the problem includes using drugs to accelerate digestive transit, adjusting the respirator settings, or changing the ventilatory modality or the respirator itself. The problem sometimes disappears a few weeks after initiating NIV<span class="elsevierStyleSup">9-11</span>.</p><p class="elsevierStylePara">We report the cases of two patients who experienced abdominal distension after initiating treatment with NIV through a nasal mask and in whom the usual measures to ameliorate the problem failed. The intensity and persistence of the symptoms led us to perform exploration of the digestive tract, which revealed the existence of gastric adenocarcinoma. The initiation of NIV was the precipitating factor in providing clinical evidence of silent stomach cancer.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Clinical observations</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Case 1</span></p><p class="elsevierStylePara">A 49-year-old nonsmoking male with a right thoracoplasty because of tuberculosis in his youth was diagnosed with chronic respiratory insufficiency secondary to a chest restriction. There was no other relevant personal history. Lung function tests were performed. Forced vital capacity (FVC) was 890 ml (39% of predicted) and basal arterial blood gas measurement showed pH to be 7.42, PaO<span class="elsevierStyleInf">2</span> 53 mmHg and PaCO<span class="elsevierStyleInf">2</span> 67 mmHg. Adaptation to NIV via nasal mask with a volumetric respirator was initiated in a hospital setting following the standard protocol<span class="elsevierStyleSup">4</span>. The patient presented significant aerophagia in the first days of treatment with abdominal distension, pain which required the interruption of the nasal ventilation and occasional vomiting. Different therapeutic strategies were adopted to relieve the patient's discomfort, but without success. Treatment with drugs to accelerate intestinal transit and successive changes in the regulation of ventilator settings did not significantly improve the symptoms arising from abdominal distension. When the patient underwent exploration of the digestive tract, a mamelonated gastric lesion with irregular margins was found, which biopsy revealed to be adenocarcinoma. The patient had no history of digestive symptoms such as acidity, pain or pyrosis and showed no signs of weight loss, general malaise, fever or other related symptoms. Entry of air in the stomach as a consequence of starting treatment with NIV brought on the initial symptoms prompting the decision to perform a gastroscopy, which led to an early diagnosis of malignancy. The patient underwent a partial gastrectomy. After six months of NIV treatment the patient had no further symptoms of abdominal distension and his tolerance of NIV was optimal. Basal arterial blood gas measurement at follow-up showed pH to be 7.39, PaO<span class="elsevierStyleInf">2</span> 69 mmHg and PaCO<span class="elsevierStyleInf">2</span> 42 mmHg.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Case 2</span></p><p class="elsevierStylePara">A 58-year old male smoker of 35 pack-years was diagnosed with chronic respiratory insufficiency secondary to sequelae of pulmonary tuberculosis (fibrothorax) in his youth. He had no history of gastrointestinal disease or any symptoms of digestive pathology. Lung function testing showed FVC to be 990 ml (44%); basal blood gas measurement showed pH to be 7.36, PaO<span class="elsevierStyleInf">2</span> 50 mmHg and PaCO<span class="elsevierStyleInf">2</span> 73 mmHg. He was hospitalized to initiate adaptation to NIV and began to experience discomfort arising from aerophagia two days after starting bilevel positive airway pressure treatment, with epigastric pain and a sensation of stomach fullness. Despite taking recommended therapeutic measures, which included switching to a volumetric respirator, the patient continued to suffer discomfort, which made effective ventilation impossible. The symptoms disappeared when ventilation was discontinued. Exploration of the digestive tract was performed and revealed the presence of a polypoid lesion in the pylorus. Histological examination revealed it to be gastric adenocarcinoma. As in the first case, the passage of air to the stomach when NIV was initiated contributed to the appearance of gastric symptoms and facilitated the early diagnosis of tumor formation. The patient underwent a subtotal gastrectomy, with good postoperative outcome. In the two years since surgery, he has had no problems tolerating NIV, diurnal respiratory insufficiency is under control, and problems related to aerophagia have not reappeared.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">Aerophagia is an important NIV­related problem. In a study by Leger et al<span class="elsevierStyleSup">8</span>, with 276 patients, 50% presented abdominal distension secondary to the passage of air to the stomach. In two patients, both diagnosed with Duchenne muscular dystrophy, aerophagia even led to the discontinuance of noninvasive ventilatory support, giving an indication of just how important the problem is.</p><p class="elsevierStylePara">Treatment of abdominal distension includes drugs such as domperidone to accelerate intestinal transit and adjusting the ventilatory settings<span class="elsevierStyleSup">2,8,11</span>. Reducing the volume released by the respirator can relieve the patient's discomfort, though at the cost of using lower insufflation pressure resulting in a certain loss of ventilatory efficiency. Peak pressure can also be regulated by increasing the pressure ramp slope on ventilators equipped with that function or by adjusting the inspiratory to expiratory flow rate. Our group has observed that changing the patient's respirator may solve the problem, given that the different devices we use can reach different peak pressures at the same flow volume<span class="elsevierStyleSup">10</span>. Alternating ventilatory modalities (pressure and volume) can also help to correct problems of aerophagia. Finally, it has been documented that the problem may disappear after a few weeks of treatment, either spontaneously or because the patient has learned to handle and eliminate intestinal gas more effectively<span class="elsevierStyleSup">8,9</span>.</p><p class="elsevierStylePara">When these measures do not correct the problem, it is reasonable to rule out gastric disease before considering withdrawing the respirator or performing a tracheostomy in order to switch to invasive ventilation<span class="elsevierStyleSup">9,12</span>, as illustrated in the cases we report. It must be borne in mind that the passage of air to the stomach secondary to NIV may bring to light digestive symptoms caused by silent gastrointestinal problems of which the patient is unaware, as we believe occurred in our two patients. Consequently, we must exercise caution with patients we start on NIV who experience aerophagia that does not respond to the usual therapeutic measures. We consider exploration of the digestive tract to be a good practical option before considering other ventilatory alternatives or even altogether discontinuing noninvasive ventilation. We would also recommend gastroscopy for those patients who have tolerated NIV well for a more or less prolonged period of time but who, at a given point in the course of their disease, begin to experience digestive symptoms arising from aerophagia. Symptoms may occur for logical reasons, as in the case of a patient with progressing bulbar dysfunction related to amyotrophic lateral sclerosis. However, outside of this context, such symptoms should trigger suspicion of digestive disease which would need to be ruled out. In our experience, gastroscopy is a technique that should be included in the management of abdominal distension secondary to NIV, especially when conventional therapeutic measures fail.</p><hr></hr><p class="elsevierStylePara">Correspondence to: Dr. S. Mayoralas Alises.<br></br> Federico García Lorca, 2, portal 7, 2º A. Madrid. Spain<br></br> E-mail: <a href="mailto:sme01m@nacom.es" class="elsevierStyleCrossRefs">sme01m@nacom.es</a></p><p class="elsevierStylePara">Manuscript received 14 November 2002.<br></br> Accepted for publication 26 November 2002.</p>" "pdfFichero" => "260v39n07a13046508pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec191517" "palabras" => array:5 [ 0 => "Noninvasive mechanical ventilation" 1 => "Aerophagia" 2 => "Abdominal distension" 3 => "Stomach cancer" 4 => "Gastroscopy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec191518" "palabras" => array:5 [ 0 => "Ventilación mecánica no invasiva" 1 => "Aerofagia" 2 => "Distensión abdominal" 3 => "Cáncer gástrico" 4 => "Gastroscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Noninvasive mechanical ventilation (NIV) techniques have proven useful in treating patients with respiratory insufficiency of various etiologies. The problems most frequently associated with this ventilatory technique are the appearance of nasal and oropharyngeal dryness, pressure sores where the nasal mask touches the skin, ocular irritation due to air leakage and epistaxis. Aerophagia appears in up to half the patients with NIV and may lead to discontinuing treatment. Drugs that accelerate gastrointestinal transit, changes in the respirator settings or changing the ventilatory modality may help to ameliorate the problem. When the symptoms arising from abdominal distension due to NIV are intense and persistent, the coexistence of an underlying abdominal pathology must be ruled out. We report the cases of two patients with these characteristics in whom gastroscopy revealed gastric carcinoma. We think that patients with persistent symptoms of aerophagia that cannot be controlled by the usual measures should undergo endoscopic exploration to rule out silent gastric disease." ] "es" => array:1 [ "resumen" => "Las técnicas de ventilación mecánica no invasiva (VNI) han demostrado su utilidad en el tratamiento de pacientes con insuficiencia respiratoria de diverso origen. Los problemas más frecuentemente relacionados con esta modalidad ventilatoria son la aparición de sequedad nasal y orofaríngea, lesiones cutáneas en los puntos de apoyo de la mascarilla nasal, irritación ocular por fuga aérea y epistaxis. La aerofagia aparece hasta en la mitad de los pacientes con VNI y puede ser motivo de abandono del tratamiento. Fármacos que aceleran el tránsito gastrointestinal, modificaciones en la regulación del respirador y cambios de la modalidad ventilatoria pueden ayudar a mejorar este problema. Cuando los síntomas derivados de la distensión abdominal por VNI son intensos y persistentes, se debe excluir la coexistencia de patología abdominal subyacente. Presentamos el caso de dos pacientes con estas características a quienes se les realizó una gastroscopia que objetivó la existencia de un carcinoma gástrico. Pensamos que en los pacientes con síntomas persistentes por aerofagia, que no se controlan con las medidas habituales, es preciso realizar una endoscopia digestiva con objeto de descartar la existencia de patología gástrica silente." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "¿Ventilación mecánica no invasiva o no invasora?" "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Díaz Lobato S" 1 => "Gómez Mendieta MA" 2 => "Mayoralas Alises S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "52" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11181234" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD and nocturnal hypoventilation. A Consensus Conference Report." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Consensus Conference." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1999" "volumen" => "116" "paginaInicial" => "521" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10453883" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Noninvasive ventilation." "idioma" => "fi" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Mehta S" 1 => "Hill NS." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.163.2.9906116" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2001" "volumen" => "163" "paginaInicial" => "540" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11179136" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Normativa sobre la ventilación mecánica a domicilio." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Estopá Miró R" 1 => "Villasante Fernández-Montes C" 2 => "De Lucas Ramos P" 3 => "Ponce de León Martínez L" 4 => "Mosteiro M" 5 => "Masa Jiménez JF" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "142" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11333540" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Enfermedad pulmonar obstructiva crónica y ventilación no invasiva: una evidencia creciente." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Marrades RM" 1 => "Rodríguez Roisín R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "88" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11181244" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Ventilación mecánica en hospitalización neumológica. Evolución en el período 1994-2000." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Echave-Sustaeta J" 1 => "Pérez González V" 2 => "Verdugo M" 3 => "García Cosío FJ" 4 => "Villena V" 5 => "Álvarez Martínez C" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "160" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11953267" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Nonivasive positive pressure ventilation in acute respiratory failure." "idioma" => "it" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "International Consensus Conference in Intensive Care Medicine." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.163.1.ats1000" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2001" "volumen" => "163" "paginaInicial" => "283" "paginaFinal" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11208659" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Nasal intermittent positive pressure ventilation. Long-term follow-up in patients with severe chronic respiratory insufficiency." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Leger P" 1 => "Bedicam JM" 2 => "Cornette A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1994" "volumen" => "105" "paginaInicial" => "100" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8275718" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Tracheal versus noninvasive mechanical ventilation in neuromuscular patients: experience and evaluation." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Soudon PH." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Monaldi Arch Chest Dis" "fecha" => "1995" "volumen" => "3" "paginaInicial" => "228" "paginaFinal" => "31" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Changing ventilator: an option to take into account in the treatment of persisting vomiting during nasal ventilation." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Díaz-Lobato S" 1 => "García Tejero MT" 2 => "Ruiz Cobos MA" 3 => "Villasante C." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "1998" "volumen" => "65" "paginaInicial" => "481" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9817964" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Non-invasive and domiciliary ventilation: positive pressure techniques." "idioma" => "fr" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Branthwaite MA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1991" "volumen" => "46" "paginaInicial" => "208" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2028436" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Aplicaciones de la ventilación mecánica no invasiva en pacientes que reciben ventilación endotraqueal." 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Original language: English
Year/Month | Html | Total | |
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2024 November | 10 | 5 | 15 |
2024 October | 140 | 41 | 181 |
2024 September | 156 | 40 | 196 |
2024 August | 170 | 73 | 243 |
2024 July | 127 | 29 | 156 |
2024 June | 158 | 32 | 190 |
2024 May | 119 | 33 | 152 |
2024 April | 83 | 17 | 100 |
2024 March | 60 | 22 | 82 |
2024 February | 42 | 37 | 79 |
2023 March | 16 | 4 | 20 |
2023 February | 101 | 27 | 128 |
2023 January | 83 | 34 | 117 |
2022 December | 89 | 30 | 119 |
2022 November | 116 | 30 | 146 |
2022 October | 141 | 23 | 164 |
2022 September | 122 | 46 | 168 |
2022 August | 120 | 34 | 154 |
2022 July | 118 | 43 | 161 |
2022 June | 94 | 23 | 117 |
2022 May | 88 | 31 | 119 |
2022 April | 132 | 27 | 159 |
2022 March | 119 | 48 | 167 |
2022 February | 138 | 31 | 169 |
2022 January | 171 | 38 | 209 |
2021 December | 136 | 32 | 168 |
2021 November | 154 | 37 | 191 |
2021 October | 182 | 58 | 240 |
2021 September | 137 | 61 | 198 |
2021 August | 150 | 36 | 186 |
2021 July | 170 | 33 | 203 |
2021 June | 222 | 34 | 256 |
2021 May | 305 | 43 | 348 |
2021 April | 351 | 108 | 459 |
2021 March | 199 | 28 | 227 |
2021 February | 151 | 23 | 174 |
2021 January | 153 | 23 | 176 |
2020 December | 125 | 21 | 146 |
2020 November | 87 | 18 | 105 |
2020 October | 90 | 16 | 106 |
2020 September | 94 | 16 | 110 |
2020 August | 125 | 11 | 136 |
2020 July | 139 | 22 | 161 |
2020 June | 129 | 4 | 133 |
2020 May | 157 | 31 | 188 |
2020 April | 133 | 15 | 148 |
2020 March | 122 | 14 | 136 |
2020 February | 126 | 14 | 140 |
2020 January | 123 | 21 | 144 |
2019 December | 95 | 17 | 112 |
2019 November | 130 | 21 | 151 |
2019 October | 89 | 10 | 99 |
2019 September | 110 | 22 | 132 |
2019 August | 78 | 17 | 95 |
2019 July | 90 | 11 | 101 |
2019 June | 81 | 17 | 98 |
2019 May | 117 | 31 | 148 |
2019 April | 100 | 19 | 119 |
2019 March | 100 | 36 | 136 |
2019 February | 120 | 18 | 138 |
2019 January | 97 | 29 | 126 |
2018 December | 98 | 34 | 132 |
2018 November | 73 | 21 | 94 |
2018 October | 93 | 23 | 116 |
2018 September | 56 | 19 | 75 |
2018 May | 28 | 4 | 32 |
2018 April | 64 | 14 | 78 |
2018 March | 59 | 7 | 66 |
2018 February | 50 | 9 | 59 |
2018 January | 84 | 15 | 99 |
2017 December | 57 | 8 | 65 |
2017 November | 60 | 11 | 71 |
2017 October | 51 | 17 | 68 |
2017 September | 59 | 25 | 84 |
2017 August | 72 | 29 | 101 |
2017 July | 86 | 13 | 99 |
2017 June | 71 | 24 | 95 |
2017 May | 82 | 22 | 104 |
2017 April | 94 | 21 | 115 |
2017 March | 71 | 30 | 101 |
2017 February | 64 | 19 | 83 |
2017 January | 39 | 15 | 54 |
2016 December | 66 | 14 | 80 |
2016 November | 70 | 16 | 86 |
2016 October | 90 | 25 | 115 |
2016 September | 94 | 14 | 108 |
2016 August | 81 | 17 | 98 |
2016 July | 61 | 21 | 82 |
2016 March | 4 | 0 | 4 |
2016 February | 1 | 0 | 1 |
2015 December | 2 | 0 | 2 |
2015 October | 50 | 5 | 55 |
2015 September | 75 | 114 | 189 |
2015 August | 53 | 12 | 65 |
2015 July | 53 | 13 | 66 |
2015 June | 63 | 15 | 78 |
2015 May | 71 | 22 | 93 |
2015 April | 50 | 26 | 76 |
2015 March | 67 | 12 | 79 |
2015 February | 50 | 11 | 61 |
2015 January | 55 | 9 | 64 |
2014 December | 55 | 5 | 60 |
2014 November | 55 | 8 | 63 |
2014 October | 52 | 12 | 64 |
2014 September | 47 | 8 | 55 |
2014 August | 57 | 13 | 70 |
2014 July | 47 | 11 | 58 |
2014 June | 52 | 11 | 63 |
2014 May | 65 | 10 | 75 |
2014 April | 55 | 16 | 71 |
2014 March | 70 | 17 | 87 |
2014 February | 65 | 17 | 82 |
2014 January | 46 | 14 | 60 |
2013 December | 46 | 15 | 61 |
2013 November | 30 | 10 | 40 |
2013 October | 48 | 19 | 67 |
2013 September | 43 | 12 | 55 |
2013 August | 44 | 21 | 65 |
2013 July | 39 | 33 | 72 |
2013 June | 37 | 13 | 50 |
2013 May | 32 | 14 | 46 |
2013 April | 30 | 6 | 36 |
2013 March | 15 | 3 | 18 |