Case Report
Bronchovascular Reconstruction With a Bovine Pericardial Conduit and Surgical Reintervention Due to Thrombosis With Revascularisation
Reconstrucción broncovascular con conducto de pericardio bovino y reintervención quirúrgica por trombosis con revascularización
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Secondary Pneumothorax" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "44" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumotórax secundario inducido por quimioterapia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 606 "Ancho" => 1800 "Tamanyo" => 212232 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiograph (A) and computed tomography (B, C) of the chest in which the sarcoma-axillary level right humerus (orange star) mass in the left lung (white arrow), several solid nodules (orange arrows) are visualized and cavitation (blue arrows) and mild bilateral pneumothorax (blue stars).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando Bazan, Ivan Vollmer, Angel Gayete" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "Bazan" ] 1 => array:2 [ "nombre" => "Ivan" "apellidos" => "Vollmer" ] 2 => array:2 [ "nombre" => "Angel" "apellidos" => "Gayete" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613002652" "doi" => "10.1016/j.arbres.2013.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613002652?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913002061?idApp=UINPBA00003Z" "url" => 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"titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad pulmonar venooclusiva en una mujer jardinera" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 510 "Ancho" => 1400 "Tamanyo" => 179327 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pulmonary parenchyma with: (A) Passive capillary congestion and foci of hematic extravasation. (B) Medium caliber vessel with thickened wall due to fibrous proliferation of the tunica media.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paula Rodríguez Rodríguez, Fernando Pedraza Serrano, Liliana Patricia Morán Caicedo, Maria Carmen Rodríguez de Guzmán, María Cebollero Presmanes, Javier de Miguel Díez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Paula" "apellidos" => "Rodríguez Rodríguez" ] 1 => array:2 [ "nombre" => "Fernando" "apellidos" => "Pedraza Serrano" ] 2 => array:2 [ "nombre" => "Liliana Patricia" "apellidos" => "Morán Caicedo" ] 3 => array:2 [ "nombre" => "Maria Carmen" "apellidos" => "Rodríguez de Guzmán" ] 4 => array:2 [ "nombre" => "María" "apellidos" => "Cebollero Presmanes" ] 5 => array:2 [ "nombre" => "Javier" "apellidos" => "de Miguel Díez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613001804" "doi" => "10.1016/j.arbres.2013.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613001804?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913002073?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000001/v1_201402160026/S1579212913002073/v1_201402160026/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Bronchovascular Reconstruction With a Bovine Pericardial Conduit and Surgical Reintervention Due to Thrombosis With Revascularisation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "43" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Emilio Peña, Montserrat Blanco, Teresa Otero" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Emilio" "apellidos" => "Peña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Montserrat" "apellidos" => "Blanco" "email" => array:1 [ 0 => "montseblancoramos@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Teresa" "apellidos" => "Otero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción broncovascular con conducto de pericardio bovino y reintervención quirúrgica por trombosis con revascularización" ] ] "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" => 479 "Ancho" => 1400 "Tamanyo" => 89688 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a) Chest X-ray four days after left lower lobectomy. Alveolar infiltrate can be seen in the remaining lung. (b) Low uptake can be seen on the axial slice of the CT in the left pulmonary artery suggestive of thrombus and changes in lung parenchyma related with interstitial edema.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The use of angioplasty for tumors infiltrating the pulmonary artery can often help avoid pneumonectomy and preserve functioning distal pulmonary parenchyma. However, it is not a risk-free procedure, and diverse complications after this type of intervention have been described in the literature, including bronchopleural fistulas, respiratory distress, pulmonary artery thrombosis, prolonged air leakage and massive hemoptysis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Case</span><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 57-year-old ex-smoker with a history of ischemic heart disease consulting due to hemoptysis. A computed tomography (CT) showed a left hilar mass of 5.6<span class="elsevierStyleHsp" style=""></span>cm in diameter. In the positron emission tomography (PET), the mass had a maximum standard uptake value of 16.7<span class="elsevierStyleHsp" style=""></span>g/ml with lymphadenopathies in stations 4L and 5 and contrast uptake of around 3<span class="elsevierStyleHsp" style=""></span>g/ml. On fiberoptic bronchoscopy, tumoration was observed in the entrance to the upper lobe bronchus. The biopsy returned a diagnosis of epidermoid carcinoma. An EBUS extension study of the lymph node stations 4R and 4L was negative for malignancy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dissection and proximal clamping of the pulmonary artery were performed via a left posterolateral thoracotomy. The sulcus was found to have retracted due to tumoration, but the main pulmonary artery and the segment 6 artery could be dissected and radical resection was performed. The principal bronchus and left lower lobar bronchus were dissected and divided. The distal artery was then clamped and the infiltrated pulmonary artery was sectioned. A bronchial anastomosis was constructed between the main bronchus and the lower lobar bronchus with discontinuous sutures using PDS<span class="elsevierStyleSup">®</span> 3-0. The pulmonary artery was reconstructed with a preformed bovine pericardial conduit with proximal and distal clamping and anastomosis with Prolene™ 5-0. Local and systemic anticoagulation with 5000<span class="elsevierStyleHsp" style=""></span>U heparin sodium was administered before the clamp. When the anastomosis was complete, the air was drained, and the lobe was ventilated and unclamped slowly, ensuring correct flow via the graft.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On day 4 after surgery, the patient was breathing normally with pO<span class="elsevierStyleInf">2</span> of 75 and 30<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>ml<span class="elsevierStyleSup">–1</span> leukocytes. Alveolar infiltrates in the remaining lobe were observed on X-ray (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). CT angiogram was performed, showing graft thrombosis, so an urgent reintervention was programmed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b and c). A proximal clamp was applied and the vascular suture in the distal anastomosis was removed. The clot was extracted and heparin was administered upstream and downstream from the clamped inferior pulmonary vein. The conduit was cut again and the distal anastomosis reconstructed, with good flow being observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient progressed well and a CT-angiogram on day 3 after surgery showed flow through the graft with distal filling defects.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The pathology laboratory report on the resected fragment described moderately differentiated epidermoid carcinoma, 6.5<span class="elsevierStyleHsp" style=""></span>cm in diameter, infiltrating the visceral pleura with metastasis in one peribronchial lymph node (T2bN1). Lymphadenopathies in the aortopulmonar, prevascular, tracheobronchial, subcarinal, hilar, paraesophageal and interlobar windows were negative. The patient was discharged on day 27 after surgery, after correct bronchial anastomosis was observed on fiberoptic bronchoscopy.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The use of bovine pericardium for pulmonary artery reconstruction was first described by Rendina et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 1999. It has great advantages over synthetic material, since it is cheaper, has good resistance and is biocompatible.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> It is, however, more difficult to manage. After suturing, it tends to shrink and bend and when blood pressure increases after the clamp is removed, it usually stretches.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our case, we think that the complication was caused by bending in the distal suture when the lower lobe was replaced in the hemithorax, due to a technical problem caused by the conduit being excessively long. One case of pulmonary artery thrombosis is described in the literature, in a series from Venuta et al.,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which was resolved with a pneumonectomy. In our case, this was our first idea when faced with the problem. However, in view of the patient's good clinical status and the good appearance of the lung parenchyma, we decided to attempt thrombectomy. In conclusion, we would like to highlight that thrombectomy with reconstruction of the anastomosis and lobe revascularization is a valid alternative alongside pneumonectomy as surgical treatment of this complication.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres312885" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec295981" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres312886" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec295982" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-22" "fechaAceptado" => "2013-05-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec295981" "palabras" => array:3 [ 0 => "Angioplasty" 1 => "Complications" 2 => "Thrombosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec295982" "palabras" => array:3 [ 0 => "Angioplastia" 1 => "Complicaciones" 2 => "Trombosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 57-year-old male with left hilar squamous cell carcinoma infiltrating the pulmonary artery and in whom a sleeve bronchoplasty and angioplasty were performed using a bovine pericardial conduit. Three days post-operatively, graft thrombosis was detected; thrombectomy and graft reconstruction were performed with revascularisation of the graft.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un varón de 57<span class="elsevierStyleHsp" style=""></span>años con un carcinoma epidermoide hiliar izquierdo que infiltraba la arteria pulmonar y al que se le realizó una broncoplastia en manguito y una angioplastia mediante un conducto de pericardio bovino. En el tercer día postoperatorio se objetivó una trombosis del injerto, realizándose una trombectomía y reconstrucción del injerto con revascularización del mismo.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Peña E, Blanco M, Otero T. Reconstrucción broncovascular con conducto de pericardio bovino y reintervención quirúrgica por trombosis con revascularización. Arch Bronconeumol. 2014;50:42–43.</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" => 479 "Ancho" => 1400 "Tamanyo" => 89688 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(a) Chest X-ray four days after left lower lobectomy. Alveolar infiltrate can be seen in the remaining lung. (b) Low uptake can be seen on the axial slice of the CT in the left pulmonary artery suggestive of thrombus and changes in lung parenchyma related with interstitial edema.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 633 "Ancho" => 1400 "Tamanyo" => 152022 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(a) Intraoperative image in which the graft can be seen after the suture containing the clots has been removed. (b) Postoperative photograph when the anastomosis has been reconstructed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical experience of lobectomy with pulmonary artery reconstruction for central non-small-cell lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Yin" 1 => "L. Xu" 2 => "B. Ren" 3 => "F. Jiang" 4 => "X. Fan" 5 => "Z. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3816/CLC.2010.n.016" "Revista" => array:6 [ "tituloSerie" => "Clin Lung Cancer" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "120" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20199978" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sleeve resection and prosthetic reconstruction of the pulmonary artery for lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.A. Rendina" 1 => "F. Venuta" 2 => "T. de Giacomo" 3 => "A.M. Ciccone" 4 => "M. Moretti" 5 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 37 | 25 | 62 |
| 2024 September | 40 | 20 | 60 |
| 2024 August | 62 | 46 | 108 |
| 2024 July | 32 | 26 | 58 |
| 2024 June | 43 | 27 | 70 |
| 2024 May | 68 | 24 | 92 |
| 2024 April | 30 | 22 | 52 |
| 2024 March | 44 | 13 | 57 |
| 2024 February | 47 | 20 | 67 |
| 2023 March | 7 | 2 | 9 |
| 2023 February | 32 | 16 | 48 |
| 2023 January | 30 | 23 | 53 |
| 2022 December | 46 | 32 | 78 |
| 2022 November | 44 | 22 | 66 |
| 2022 October | 30 | 20 | 50 |
| 2022 September | 31 | 30 | 61 |
| 2022 August | 32 | 30 | 62 |
| 2022 July | 28 | 37 | 65 |
| 2022 June | 24 | 30 | 54 |
| 2022 May | 35 | 35 | 70 |
| 2022 April | 38 | 23 | 61 |
| 2022 March | 36 | 36 | 72 |
| 2022 February | 35 | 33 | 68 |
| 2022 January | 33 | 23 | 56 |
| 2021 December | 72 | 41 | 113 |
| 2021 November | 36 | 37 | 73 |
| 2021 October | 47 | 42 | 89 |
| 2021 September | 31 | 39 | 70 |
| 2021 August | 21 | 24 | 45 |
| 2021 July | 26 | 24 | 50 |
| 2021 June | 24 | 26 | 50 |
| 2021 May | 34 | 30 | 64 |
| 2021 April | 78 | 42 | 120 |
| 2021 March | 59 | 21 | 80 |
| 2021 February | 25 | 23 | 48 |
| 2021 January | 22 | 10 | 32 |
| 2020 December | 23 | 18 | 41 |
| 2020 November | 25 | 16 | 41 |
| 2020 October | 18 | 12 | 30 |
| 2020 September | 16 | 5 | 21 |
| 2020 August | 22 | 11 | 33 |
| 2020 July | 21 | 16 | 37 |
| 2020 June | 10 | 1 | 11 |
| 2020 May | 15 | 21 | 36 |
| 2020 April | 29 | 18 | 47 |
| 2020 March | 14 | 8 | 22 |
| 2020 February | 40 | 15 | 55 |
| 2020 January | 26 | 16 | 42 |
| 2019 December | 26 | 12 | 38 |
| 2019 November | 18 | 16 | 34 |
| 2019 October | 13 | 7 | 20 |
| 2019 September | 14 | 12 | 26 |
| 2019 August | 20 | 8 | 28 |
| 2019 July | 18 | 18 | 36 |
| 2019 June | 17 | 5 | 22 |
| 2019 May | 20 | 10 | 30 |
| 2019 April | 24 | 36 | 60 |
| 2019 March | 44 | 23 | 67 |
| 2019 February | 32 | 16 | 48 |
| 2019 January | 17 | 11 | 28 |
| 2018 December | 33 | 19 | 52 |
| 2018 November | 60 | 17 | 77 |
| 2018 October | 87 | 19 | 106 |
| 2018 September | 20 | 6 | 26 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 24 | 2 | 26 |
| 2018 March | 18 | 3 | 21 |
| 2018 February | 24 | 4 | 28 |
| 2018 January | 18 | 4 | 22 |
| 2017 December | 34 | 4 | 38 |
| 2017 November | 17 | 4 | 21 |
| 2017 October | 15 | 9 | 24 |
| 2017 September | 30 | 6 | 36 |
| 2017 August | 43 | 9 | 52 |
| 2017 July | 35 | 6 | 41 |
| 2017 June | 61 | 9 | 70 |
| 2017 May | 44 | 2 | 46 |
| 2017 April | 34 | 5 | 39 |
| 2017 March | 22 | 17 | 39 |
| 2017 February | 15 | 3 | 18 |
| 2017 January | 14 | 6 | 20 |
| 2016 December | 26 | 3 | 29 |
| 2016 November | 49 | 8 | 57 |
| 2016 October | 43 | 13 | 56 |
| 2016 September | 31 | 8 | 39 |
| 2016 August | 52 | 8 | 60 |
| 2016 July | 31 | 9 | 40 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 47 | 3 | 50 |
| 2015 September | 57 | 11 | 68 |
| 2015 August | 35 | 17 | 52 |
| 2015 July | 36 | 14 | 50 |
| 2015 June | 32 | 15 | 47 |
| 2015 May | 51 | 19 | 70 |
| 2015 April | 36 | 18 | 54 |
| 2015 March | 33 | 10 | 43 |
| 2015 February | 23 | 5 | 28 |
| 2015 January | 31 | 8 | 39 |
| 2014 December | 32 | 27 | 59 |
| 2014 November | 30 | 7 | 37 |
| 2014 October | 45 | 8 | 53 |
| 2014 September | 24 | 8 | 32 |
| 2014 August | 38 | 13 | 51 |
| 2014 July | 31 | 8 | 39 |
| 2014 June | 45 | 22 | 67 |
| 2014 May | 30 | 7 | 37 |
| 2014 April | 37 | 13 | 50 |
| 2014 March | 0 | 1 | 1 |
| 2014 February | 0 | 2 | 2 |
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