Original Article
Video-Assisted Thoracoscopic Thymectomy for the Treatment of My asthenia Gravis
J. Loscertales
, J. Ayarra Jarne, M. Congregado, A. Arroyo Tristán, R. Jiménez Merchán, J.C. Girón Arjona, C. Arenas Linares
Corresponding author
jloscert@us.es
Correspondence: Dr. J. Loscertales. Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena. Avda. Dr. Fedriani, 3. 41074 Sevilla. España
Correspondence: Dr. J. Loscertales. Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena. Avda. Dr. Fedriani, 3. 41074 Sevilla. España
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
Read
5015
Timeswas read the article
2436
Total PDF
2579
Total HTML
Share statistics
array:23 [ "pii" => "S1579212906603443" "issn" => "15792129" "doi" => "10.1016/S1579-2129(06)60344-3" "estado" => "S300" "fechaPublicacion" => "2004-09-01" "aid" => "60344" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "copyrightAnyo" => "2004" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2004;40:409-13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3132 "formatos" => array:3 [ "EPUB" => 87 "HTML" => 1769 "PDF" => 1276 ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212906603455" "issn" => "15792129" "doi" => "10.1016/S1579-2129(06)60345-5" "estado" => "S300" "fechaPublicacion" => "2004-09-01" "aid" => "60345" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "documento" => "article" "crossmark" => 0 "subdocumento" => "rev" "cita" => "Arch Bronconeumol. 2004;40:414-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2031 "formatos" => array:3 [ "EPUB" => 72 "HTML" => 1204 "PDF" => 755 ] ] "en" => array:8 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Asthma and Tobacco Smoke" "tienePdf" => "en" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "414" "paginaFinal" => "418" ] ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P.J. Romero Palacios" "autores" => array:1 [ 0 => array:3 [ "preGrado" => "Dr." "nombre" => "P.J." "apellidos" => "Romero Palacios" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906603455?idApp=UINPBA00003Z" "url" => "/15792129/0000004000000009/v1_201305150126/S1579212906603455/v1_201305150126/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212906603431" "issn" => "15792129" "doi" => "10.1016/S1579-2129(06)60343-1" "estado" => "S300" "fechaPublicacion" => "2004-09-01" "aid" => "60343" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2004;40:403-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2424 "formatos" => array:3 [ "EPUB" => 85 "HTML" => 1730 "PDF" => 609 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>" "titulo" => "Smoking Habits Among Sixth-Year Medical Students in Spain" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "408" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Mas, I. Nerín, M. Barrueco, J. Cordero, D. Guillén, C. Jiménez-Ruiz, V. Sobradillo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Mas" ] 1 => array:3 [ "preGrado" => "Dra" "nombre" => "I." "apellidos" => "Nerín" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Barrueco" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cordero" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Guillén" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Jiménez-Ruiz" ] 6 => array:2 [ "nombre" => "V." "apellidos" => "Sobradillo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906603431?idApp=UINPBA00003Z" "url" => "/15792129/0000004000000009/v1_201305150126/S1579212906603431/v1_201305150126/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Video-Assisted Thoracoscopic Thymectomy for the Treatment of My asthenia Gravis" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "409" "paginaFinal" => "413" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Loscertales, J. Ayarra Jarne, M. Congregado, A. Arroyo Tristán, R. Jiménez Merchán, J.C. Girón Arjona, C. Arenas Linares" "autores" => array:7 [ 0 => array:5 [ "preGrado" => "Dr." "nombre" => "J." "apellidos" => "Loscertales" "email" => array:1 [ 0 => "jloscert@us.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Ayarra Jarne" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Congregado" ] 3 => array:2 [ "nombre" => "A. Arroyo" "apellidos" => "Tristán" ] 4 => array:2 [ "nombre" => "R. Jiménez" "apellidos" => "Merchán" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "Girón Arjona" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Arenas Linares" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. J. Loscertales. Servicio de Cirugía General y Torácica. Hospital Universitario Virgen Macarena. Avda. Dr. Fedriani, 3. 41074 Sevilla. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-09-25" "fechaAceptado" => "2004-04-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec153615" "palabras" => array:3 [ 0 => "Myasthenia gravis" 1 => "Thymectomy" 2 => "Video-assisted thoracoscopy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153616" "palabras" => array:3 [ 0 => "Miastenia gravis" 1 => "Timectomía" 2 => "Videotoracoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Traditionally, thymectomy for myasthenia gravis has been performed using either a transcervical approach or a median sternotomy. However, excision of the thymic tissue by video-assisted thoracoscopic surgery is less aggressive and recovery is faster. The aim of this study was to evaluate the usefulness and outcomes of video-assisted thoracoscopic thymectomy.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Over the past 10 years, we have performed 25 video-assisted thoracoscopic thymectomies on patients with myasthenia gravis at our unit. This study included 16 women and 9 men, with a mean age of 48.1 years (range, 14-74 years). Right-side (22 cases) or left-side (3 cases) thoracoscopic surgery was performed, with a mean intervention time of 110 minutes (range, 60-193 minutes).</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">No patient required assisted ventilation for more than 4 hours and the maximum stay in intensive care was less than 24 hours. Complications from surgery included 3 cases of contralateral pneumothorax, 1 pleural effusion, and 2 intraoperative hemorrhages from the thymic vein, all of which were resolved by video-assisted thoracoscopy. Likewise, 3 cases required conversion (due to hemorrhaging in 2 patients and technical difficulties in 1) and 2 required a second thoracoscopic intervention. No deaths occurred and clinical outcome was excellent in 11 cases (medical treatment no longer required), good in 10 (reduced medical treatment), and poor in 4 (no changes).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Video-assisted thoracoscopic thymectomy is effective in the treatment of myasthenia gravis and improves patient recovery. In addition, the excellent surgical view allows the thymectomy to be performed with absolute safety.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Tradicionalmente la timectomía en el tratamiento de la miastenia <span class="elsevierStyleItalic">gravis</span> se ha realizado por esternotomía media o transcervical; técnicamente, la cirugía videotoracoscópica permite la extirpación del tejido tímico con menor agresión quirúrgica y una recuperación temprana. El objetivo de este estudio es valorar la utilidad y los resultados de la timectomía videotoracoscópica.</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">En los últimos 10 años, hemos practicado 25 timectomías por videotoracoscopia en nuestro servicio a pacientes con miastenia <span class="elsevierStyleItalic">gravis.</span> Los pacientes incluidos en este estudio son 16 mujeres y 9 varones, con una edad media de 48,1 años (intervalo: 14-74). La intervención se realizó por toracoscopia (derecha en 22 casos e izquierda en los 3 restantes) y tuvo una duración media de 110 min (intervalo: 60-193 min).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Ningún paciente precisó ventilación asistida durante más de 4 h y la estancia en la unidad de cuidados intensivos fue siempre menor de 24 h. En cuanto a las complicaciones de la intervención, hubo 3 casos de neumotórax contralateral, uno de derrame pleural y 2 de hemorragias intraoperatorias de la vena tímica, que se controlaron por videotoracoscopia. Asimismo, en 3 ocasiones hubo que recurrir a una conversión (en 2 por hemorragia y en la tercera por dificultades técnicas) y se practicaron 2 reintervenciones (por toracoscopia). La mortalidad fue nula y los resultados clínicos excelentes en 11 casos (supresión del tratamiento médico), buenos en 10 (reducción) y regulares en 4 (sin cambios).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La timectomía videotoracoscópica es útil en el tratamiento de la miastenia <span class="elsevierStyleItalic">gravis</span> y tiene como ventaja una mejor recuperación del paciente. Además, ofrece una visión quirúrgica perfecta, por lo que permite realizar la timectomía con absoluta seguridad.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathologish-anatomischer Beitrag zur Erbschen Krankheit (myastenia gravis)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C Weigert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Zentrolbl Neurol" "fecha" => "1901" "volumen" => "20" "paginaInicial" => "597" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Historical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J-C Givel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Surgery of the thymus" "paginaInicial" => "1" "serieFecha" => "1990" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A Blalock" 1 => "MF Mason" 2 => "HJ Morgan" 3 => "SS Riven" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1939" "volumen" => "110" "paginaInicial" => "544" "paginaFinal" => "561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17857470" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "GS Gronseth" 1 => "RJ Barohn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "7" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10891896" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "JM Ponseti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Miastenia gravis: manual terapéutico" "paginaInicial" => "71" "paginaFinal" => "72" "serieFecha" => "1995" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of ectopic thymic tissue in myasthenia gravis and its clinical significance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M Ashour" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0022-5223(95)70343-8" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1995" "volumen" => "109" "paginaInicial" => "632" "paginaFinal" => "635" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7715209" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended thymectomy for myasthenia gravis patients: a 20-year review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A Masaoka" 1 => "Y Yamakawa" 2 => "H Niwa" 3 => "I Fukai" 4 => "S Kondo" 5 => "M Kobayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1996" "volumen" => "62" "paginaInicial" => "853" "paginaFinal" => "859" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8784019" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended transsternal thymectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "DG Mulder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest Surg Clin N Am" "fecha" => "1996" "volumen" => "6" "paginaInicial" => "95" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8646507" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended trans-sternal thymectomy for myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A Masaoka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest Surg Clin N Am" "fecha" => "2001" "volumen" => "11" "paginaInicial" => "369" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11413762" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "KE Osserman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Myasthenia gravis" "paginaInicial" => "165" "paginaFinal" => "183" "serieFecha" => "1958" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Matched-pair comparison of three different approaches for thymectomy in myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "JC Ruckert" 1 => "HK Sobel" 2 => "S Gohring" 3 => "KM Einhaupl" 4 => "JM Muller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-002-9162-6" "Revista" => array:6 [ "tituloSerie" => "Surg Endosc" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "711" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12616395" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extended trans-sternal thymectomy for myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A Masaoka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest Surg Clin N Am" "fecha" => "2001" "volumen" => "11" "paginaInicial" => "369" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11413762" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term evaluation of extended thymectomy with anterior mediastinal dissection for myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "LE Stern" 1 => "MS Nussbaum" 2 => "JG Quinlan" 3 => "JE Fischer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/msy.2001.116674" "Revista" => array:6 [ "tituloSerie" => "Surgery" "fecha" => "2001" "volumen" => "130" "paginaInicial" => "774" "paginaFinal" => "780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11602911" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymectomy for myasthenia gravis: analysis of controversies-patient management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A Jaretzki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurolog" "fecha" => "2003" "volumen" => "9" "paginaInicial" => "77" "paginaFinal" => "92" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term clinical outcome after transcervical thymectomy for myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V Bril" 1 => "J Kojic" 2 => "WK Ilse" 3 => "JD Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1998" "volumen" => "65" "paginaInicial" => "1520" "paginaFinal" => "1522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9647051" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "RF Calhoun" 1 => "JH Ritter" 2 => "TJ Guthrie" 3 => "A Pestronk" 4 => "BF Meyers" 5 => "GA Patterson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "1999" "volumen" => "230" "paginaInicial" => "555" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10522725" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of transsternal thymectomy after failed transcervical “thymectomy”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R Pirskanen" 1 => "G Matell" 2 => "A Henze" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann NY Acad Sci" "fecha" => "1987" "volumen" => "505" "paginaInicial" => "866" "paginaFinal" => "867" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H Hamelmann" 1 => "M Thermann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Procedures on the mediastinum: procedures on the thymus. Thoracic surgery" "fecha" => "1989" "editorial" => "Springer-Verlag" "editorialLocalizacion" => "Berlin-Heidelberg" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Extended” thymectomy, without sternotomy, performed by cervicotomy and thoracoscopic technique in the treatment of myasthenia gravis. Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L Novellino" 1 => "M Longoni" 2 => "L Spinelli" 3 => "M Andretta" 4 => "M Cozzi" 5 => "G Faillace" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int Surg" "fecha" => "1994" "volumen" => "79" "paginaInicial" => "378" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7713713" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A Uchiyama" 1 => "S Shimizu" 2 => "H Murai" 3 => "S Kuroki" 4 => "M Okido" 5 => "M Tanaka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2001" "volumen" => "72" "paginaInicial" => "1902" "paginaFinal" => "1905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11789768" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maximal thymectomy for myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "MH Ashour" 1 => "SK Jain" 2 => "KM Kattan" 3 => "AQ Al Daeef" 4 => "MS Abdal Jabbar" 5 => "AR Al Tahan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "1995" "volumen" => "9" "paginaInicial" => "461" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7495591" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of video-assisted thymectomy in patients with myasthenia gravis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "MJ Mack" 1 => "RJ Landreneau" 2 => "AP Yim" 3 => "SR Hazelrigg" 4 => "GR Scruggs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1996" "volumen" => "112" "paginaInicial" => "1352" "paginaFinal" => "1359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8911334" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento de la miastenia gravis mediante timectomía toracoscópica. Técnica y resultados iniciales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J Loscertales" 1 => "MR Jiménez" 2 => "CJ Arenas Linares" 3 => "DF García" 4 => "JC Girón Arjona" 5 => "M Congregado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "1999" "volumen" => "35" "paginaInicial" => "9" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10326644" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "VATS lobectomy reduces cytokine responses compared with conventional surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "AP Yim" 1 => "S Wan" 2 => "TW Lee" 3 => "AA Arifi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2000" "volumen" => "70" "paginaInicial" => "243" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10921716" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "VATS approach to the thymus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:2 [ 0 => "APC Yim" 1 => "MB Izzat" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Minimal access cardiothoracic surgery" "paginaInicial" => "209" "paginaFinal" => "220" "serieFecha" => "2000" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004000000009/v1_201305150126/S1579212906603443/v1_201305150126/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004000000009/v1_201305150126/S1579212906603443/v1_201305150126/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906603443?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 27 | 17 | 44 |
| 2024 September | 31 | 17 | 48 |
| 2024 August | 44 | 42 | 86 |
| 2024 July | 23 | 25 | 48 |
| 2024 June | 40 | 32 | 72 |
| 2024 May | 33 | 28 | 61 |
| 2024 April | 13 | 23 | 36 |
| 2024 March | 25 | 16 | 41 |
| 2024 February | 21 | 23 | 44 |
| 2023 March | 3 | 5 | 8 |
| 2023 February | 17 | 25 | 42 |
| 2023 January | 13 | 41 | 54 |
| 2022 December | 19 | 33 | 52 |
| 2022 November | 16 | 25 | 41 |
| 2022 October | 20 | 41 | 61 |
| 2022 September | 14 | 21 | 35 |
| 2022 August | 18 | 35 | 53 |
| 2022 July | 13 | 44 | 57 |
| 2022 June | 15 | 32 | 47 |
| 2022 May | 20 | 41 | 61 |
| 2022 April | 17 | 50 | 67 |
| 2022 March | 19 | 39 | 58 |
| 2022 February | 14 | 37 | 51 |
| 2022 January | 13 | 22 | 35 |
| 2021 December | 13 | 53 | 66 |
| 2021 November | 11 | 37 | 48 |
| 2021 October | 37 | 35 | 72 |
| 2021 September | 29 | 38 | 67 |
| 2021 August | 20 | 33 | 53 |
| 2021 July | 17 | 19 | 36 |
| 2021 June | 13 | 38 | 51 |
| 2021 May | 7 | 18 | 25 |
| 2021 April | 26 | 38 | 64 |
| 2021 March | 22 | 25 | 47 |
| 2021 February | 13 | 10 | 23 |
| 2021 January | 7 | 13 | 20 |
| 2020 December | 6 | 10 | 16 |
| 2020 November | 7 | 12 | 19 |
| 2020 October | 9 | 4 | 13 |
| 2020 September | 1 | 3 | 4 |
| 2020 August | 14 | 4 | 18 |
| 2020 July | 17 | 16 | 33 |
| 2020 June | 5 | 6 | 11 |
| 2020 May | 13 | 9 | 22 |
| 2020 April | 21 | 9 | 30 |
| 2020 March | 8 | 10 | 18 |
| 2020 February | 9 | 15 | 24 |
| 2020 January | 17 | 13 | 30 |
| 2019 December | 17 | 15 | 32 |
| 2019 November | 11 | 14 | 25 |
| 2019 October | 6 | 630 | 636 |
| 2019 September | 6 | 12 | 18 |
| 2019 August | 11 | 10 | 21 |
| 2019 July | 12 | 13 | 25 |
| 2019 June | 6 | 10 | 16 |
| 2019 May | 10 | 24 | 34 |
| 2019 April | 25 | 20 | 45 |
| 2019 March | 6 | 16 | 22 |
| 2019 February | 9 | 13 | 22 |
| 2019 January | 3 | 10 | 13 |
| 2018 December | 7 | 12 | 19 |
| 2018 November | 10 | 6 | 16 |
| 2018 October | 10 | 18 | 28 |
| 2018 September | 13 | 12 | 25 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 10 | 5 | 15 |
| 2018 March | 3 | 3 | 6 |
| 2018 February | 8 | 9 | 17 |
| 2018 January | 2 | 7 | 9 |
| 2017 December | 4 | 6 | 10 |
| 2017 November | 4 | 6 | 10 |
| 2017 October | 6 | 12 | 18 |
| 2017 September | 2 | 7 | 9 |
| 2017 August | 8 | 13 | 21 |
| 2017 July | 4 | 7 | 11 |
| 2017 June | 7 | 9 | 16 |
| 2017 May | 8 | 15 | 23 |
| 2017 April | 3 | 4 | 7 |
| 2017 March | 3 | 5 | 8 |
| 2017 February | 0 | 3 | 3 |
| 2017 January | 1 | 0 | 1 |
| 2016 December | 9 | 11 | 20 |
| 2016 November | 15 | 17 | 32 |
| 2016 October | 27 | 14 | 41 |
| 2016 September | 15 | 8 | 23 |
| 2016 August | 6 | 3 | 9 |
| 2016 July | 5 | 2 | 7 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 53 | 1 | 54 |
| 2015 September | 63 | 14 | 77 |
| 2015 August | 45 | 9 | 54 |
| 2015 July | 58 | 6 | 64 |
| 2015 June | 65 | 12 | 77 |
| 2015 May | 52 | 11 | 63 |
| 2015 April | 30 | 8 | 38 |
| 2015 March | 43 | 7 | 50 |
| 2015 February | 38 | 4 | 42 |
| 2015 January | 43 | 6 | 49 |
| 2014 December | 48 | 12 | 60 |
| 2014 November | 46 | 2 | 48 |
| 2014 October | 71 | 10 | 81 |
| 2014 September | 59 | 8 | 67 |
| 2014 August | 30 | 5 | 35 |
| 2014 July | 37 | 4 | 41 |
| 2014 June | 42 | 5 | 47 |
| 2014 May | 53 | 4 | 57 |
| 2014 April | 45 | 5 | 50 |
| 2014 March | 56 | 13 | 69 |
| 2014 February | 53 | 8 | 61 |
| 2014 January | 42 | 8 | 50 |
| 2013 December | 42 | 10 | 52 |
| 2013 November | 44 | 12 | 56 |
| 2013 October | 34 | 3 | 37 |
| 2013 September | 37 | 10 | 47 |
| 2013 August | 41 | 7 | 48 |
| 2013 July | 54 | 15 | 69 |
| 2013 June | 47 | 20 | 67 |
| 2013 May | 37 | 6 | 43 |
| 2013 April | 12 | 4 | 16 |
| 2013 March | 6 | 2 | 8 |
Show all
