Letters to the Editor
Pneumomediastinum and Pneumopericardium in a Patient With Squamous Cell Lung Cancer
Neumomediastino y neumopericardio en un paciente con cáncer de pulmón espinocelular
Jan Kara
, Sarka Klimesova, Norbert Pauk
Corresponding author
Department of Pneumology and Thoracic Surgery, Third Faculty of Medicine, Charles University, University Hospital Na Bulovce, Praga, Czech Republic
Read
5951
Timeswas read the article
1693
Total PDF
4258
Total HTML
Share statistics
array:23 [ "pii" => "S157921291500049X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.02.017" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "979" "copyright" => "SEPAR" "copyrightAnyo" => "2014" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:249-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2739 "formatos" => array:3 [ "EPUB" => 117 "HTML" => 2140 "PDF" => 482 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289614001835" "issn" => "03002896" "doi" => "10.1016/j.arbres.2014.04.014" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "979" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:249-50" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3148 "formatos" => array:3 [ "EPUB" => 112 "HTML" => 2496 "PDF" => 540 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Neumomediastino y neumopericardio en un paciente con cáncer de pulmón espinocelular" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "249" "paginaFinal" => "250" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pneumomediastinum and Pneumopericardium in a Patient with Squamous Cell Lung Cancer" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 996 "Ancho" => 1000 "Tamanyo" => 107061 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TC de tórax en la que se observa un gran tumor del pulmón derecho con invasión directa del mediastino; neumomediastino (flecha) en situación anterior al corazón.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jan Kara, Sarka Klimesova, Norbert Pauk" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jan" "apellidos" => "Kara" ] 1 => array:2 [ "nombre" => "Sarka" "apellidos" => "Klimesova" ] 2 => array:2 [ "nombre" => "Norbert" "apellidos" => "Pauk" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157921291500049X" "doi" => "10.1016/j.arbr.2015.02.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500049X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001835?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000005/v2_201504291226/S0300289614001835/v2_201504291226/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212915000397" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.02.007" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "989" "copyright" => "SEPAR" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:250-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2431 "formatos" => array:3 [ "EPUB" => 132 "HTML" => 1727 "PDF" => 572 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Giant Teratoma Presenting With Pregnancy and Causing Respiratory Failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "251" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Teratoma gigante manifestado en el embarazo y causante de insuficiencia respiratoria" ] ] "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" => 1099 "Ancho" => 1696 "Tamanyo" => 324770 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Chest magnetic resonance image of a massive tumor in the left hemithorax, with fat, cystic spaces and organoid structures; (b) perioperative image of the tumor with hair-like structures, and (c) macroscopic image of the fully resected teratoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Massine El Hammoumi, Abdelatif Benosman, El Hassane Kabiri" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Massine" "apellidos" => "El Hammoumi" ] 1 => array:2 [ "nombre" => "Abdelatif" "apellidos" => "Benosman" ] 2 => array:2 [ "nombre" => "El Hassane" "apellidos" => "Kabiri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614001999" "doi" => "10.1016/j.arbres.2014.04.017" "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/S0300289614001999?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000397?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000005/v2_201504270531/S1579212915000397/v2_201504270531/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212915000579" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.02.024" "estado" => "S300" "fechaPublicacion" => "2015-05-01" "aid" => "953" "copyright" => "SEPAR" "documento" => "article" "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2015;51:247-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2166 "formatos" => array:3 [ "EPUB" => 128 "HTML" => 1451 "PDF" => 587 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clincal Image</span>" "titulo" => "Inferior Myocardial Infarction Involving Right Ventricle: Electrocardiogram Suggesting Pulmonary Embolism" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infarto inferior y de ventrículo derecho: electrocardiograma de un tromboembolismo pulmonar" ] ] "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" => 1671 "Ancho" => 2225 "Tamanyo" => 360118 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Electrocardiogram suggestive of acute myocardial infarction with inferior ST segment elevation and right ventricular involvement. (C). ECG showing McGinn–White pattern (S1Q3T3). (D). Pulmonary CT-angiogram, filling defects in the primary branches of the pulmonary arteries (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Fernández-Anguita, Miguel Corbí-Pascual, Arsenio Gallardo-López" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Fernández-Anguita" ] 1 => array:2 [ "nombre" => "Miguel" "apellidos" => "Corbí-Pascual" ] 2 => array:2 [ "nombre" => "Arsenio" "apellidos" => "Gallardo-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614001227" "doi" => "10.1016/j.arbres.2014.03.010" "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/S0300289614001227?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000579?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000005/v2_201504270531/S1579212915000579/v2_201504270531/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letters to the Editor</span>" "titulo" => "Pneumomediastinum and Pneumopericardium in a Patient With Squamous Cell Lung Cancer" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "249" "paginaFinal" => "250" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jan Kara, Sarka Klimesova, Norbert Pauk" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Jan" "apellidos" => "Kara" "email" => array:1 [ 0 => "jan.kara@seznam.cz" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Sarka" "apellidos" => "Klimesova" ] 2 => array:2 [ "nombre" => "Norbert" "apellidos" => "Pauk" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Pneumology and Thoracic Surgery, Third Faculty of Medicine, Charles University, University Hospital Na Bulovce, Praga, Czech Republic" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumomediastino y neumopericardio en un paciente con cáncer de pulmón espinocelular" ] ] "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" => 996 "Ancho" => 1000 "Tamanyo" => 106913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing large tumor in the right lung with direct mediastinal invasion and pneumomediastinum (arrow) anterior to the heart.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Documented cases of lung cancer complicated by pneumomediastinum and pneumopericardium are extremely rare. We report the case of a 55-year-old man with lung cancer complicated by pneumomediastinum and pneumopericardium. The patient was admitted with a 3-month history of dyspnea (Day 1). Computed tomography (CT) was performed and disease staging was established as cT4N3M0, although the tumor was not confirmed by histopathology. Pericardial and tracheal invasion were observed, causing tracheomediastinal fistula, pneumomediastinum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and pneumopericardium. No distant metastases were observed. Bronchoscopy showed significant tumor stenosis on the trachea, approximately 6<span class="elsevierStyleHsp" style=""></span>cm below the glottis. Samples could not be obtained and the procedure had to be terminated prematurely due to dyspnea.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The invasive bronchology team was consulted, but the conclusion was that bronchological intervention was impossible – at that time Y stents were not yet available in the hospital. The patient's condition deteriorated rapidly and he died on Day 10. Autopsy revealed squamous cell lung cancer with direct invasion of the pericardium and trachea, forming a tracheomediastinal fistula, pneumohydropericardium, left lung pneumonia (not present at the time of performing the CT). No distant metastases were observed, so stage pT4 and pM0 was confirmed (no information on N3 lymph node invasion was provided).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Only 4 cases of spontaneous pneumomediastinum in patients with primary lung cancer have been described.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1–4</span></a> In 2 of them, the clinical situation deteriorated rapidly until death,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> 1 patient recovered,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and clinical progress was not reported in the fourth case.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Histological types were large cell carcinoma,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> small cell carcinoma<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a> and undifferentiated carcinoma.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are 2 explanations for poor clinical progress in the cases discussed. Tracheomediastinal fistula carries a high risk for acute mediastinitis and possible development of tension pneumomediastinum. This, like tension pneumothorax, can rapidly be fatal.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We have identified 2 risk factors for the development of pneumomediastinum, both of which were presented by our case: direct tumor invasion of the trachea or the proximal ends of the main bronchi that can cause a leak to the mediastinum and raised airway pressure, occurring, for example, with intense cough or tracheal stenosis. Fistula formation does not appear to be associated with any specific histological type. Recommended treatment is symptomatic and includes high-flow oxygen therapy, analgesics and antibiotics. Preventive measures include treatment of the underlying cause of cough, if present, and endoscopic treatment of stenosis of the large airways. Tension pneumomediastinum is treated with decompression (incision or drainage).</p><p id="par0030" class="elsevierStylePara elsevierViewall">To our knowledge, this is the first report of simultaneous spontaneous pneumomediastinum and spontaneous pneumopericardium in a patient with primary lung cancer. Our hypothesis is that, in this specific case, spontaneous pneumomediastinum was due to 2 circumstances: infiltration of the trachea (providing a less resistant area for fistula formation), and tracheal stenosis 6<span class="elsevierStyleHsp" style=""></span>cm below the glottis (requiring a significantly greater change in intrathoracic pressure to maintain normal respiratory volume). Rapidly progressing respiratory failure was probably due to tracheal stenosis and pneumonia, rather than to spontaneous pneumomediastinum or spontaneous pneumopericardium.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Kara J, Klimesova S, Pauk N. Neumomediastino y neumopericardio en un paciente con cáncer de pulmón espinocelular. Arch Bronconeumol. 2015;51:249–250.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 996 "Ancho" => 1000 "Tamanyo" => 106913 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing large tumor in the right lung with direct mediastinal invasion and pneumomediastinum (arrow) anterior to the heart.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous pneumomediastinum and subcutaneous emphysema: an uncommon complication of lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Barquero-Romero" 1 => "M.J. Redondo-Moralo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2008.10.006" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2009" "volumen" => "45" "paginaInicial" => "310" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19376626" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mediastinal emphysema and small cell lung cancer (SCLC): a case-report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Libeer" 1 => "E. Verbeken" 2 => "W. de Wever" 3 => "J. Vansteenkiste" 4 => "K. Nackaerts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2004.07.041" "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2005" "volumen" => "47" "paginaInicial" => "139" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15603864" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of mediastinal emphysema in a 80-year old male" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2005.10.005" "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2006" "volumen" => "51" "paginaInicial" => "391" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16413946" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumomediastinum: an unusual presentation of carcinoma of the carina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.R. Craig" 1 => "W.S. Walker" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "1995" "volumen" => "89" "paginaInicial" => "385" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7638377" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000005/v2_201504270531/S157921291500049X/v2_201504270531/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000005/v2_201504270531/S157921291500049X/v2_201504270531/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500049X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 56 | 16 | 72 |
| 2024 September | 37 | 25 | 62 |
| 2024 August | 78 | 40 | 118 |
| 2024 July | 48 | 19 | 67 |
| 2024 June | 48 | 33 | 81 |
| 2024 May | 77 | 27 | 104 |
| 2024 April | 43 | 42 | 85 |
| 2024 March | 48 | 18 | 66 |
| 2024 February | 39 | 20 | 59 |
| 2023 March | 10 | 1 | 11 |
| 2023 February | 45 | 19 | 64 |
| 2023 January | 32 | 33 | 65 |
| 2022 December | 51 | 33 | 84 |
| 2022 November | 58 | 38 | 96 |
| 2022 October | 60 | 33 | 93 |
| 2022 September | 42 | 33 | 75 |
| 2022 August | 46 | 32 | 78 |
| 2022 July | 39 | 30 | 69 |
| 2022 June | 35 | 35 | 70 |
| 2022 May | 57 | 41 | 98 |
| 2022 April | 43 | 24 | 67 |
| 2022 March | 50 | 41 | 91 |
| 2022 February | 47 | 31 | 78 |
| 2022 January | 41 | 28 | 69 |
| 2021 December | 45 | 31 | 76 |
| 2021 November | 49 | 37 | 86 |
| 2021 October | 49 | 42 | 91 |
| 2021 September | 39 | 54 | 93 |
| 2021 August | 42 | 30 | 72 |
| 2021 July | 68 | 24 | 92 |
| 2021 June | 51 | 19 | 70 |
| 2021 May | 46 | 31 | 77 |
| 2021 April | 92 | 63 | 155 |
| 2021 March | 52 | 16 | 68 |
| 2021 February | 46 | 14 | 60 |
| 2021 January | 45 | 16 | 61 |
| 2020 December | 28 | 10 | 38 |
| 2020 November | 45 | 22 | 67 |
| 2020 October | 42 | 11 | 53 |
| 2020 September | 37 | 12 | 49 |
| 2020 August | 27 | 8 | 35 |
| 2020 July | 30 | 20 | 50 |
| 2020 June | 25 | 7 | 32 |
| 2020 May | 31 | 17 | 48 |
| 2020 April | 39 | 20 | 59 |
| 2020 March | 38 | 11 | 49 |
| 2020 February | 46 | 15 | 61 |
| 2020 January | 52 | 18 | 70 |
| 2019 December | 53 | 13 | 66 |
| 2019 November | 63 | 20 | 83 |
| 2019 October | 710 | 10 | 720 |
| 2019 September | 30 | 7 | 37 |
| 2019 August | 28 | 10 | 38 |
| 2019 July | 32 | 17 | 49 |
| 2019 June | 37 | 9 | 46 |
| 2019 May | 62 | 12 | 74 |
| 2019 April | 55 | 32 | 87 |
| 2019 March | 53 | 24 | 77 |
| 2019 February | 28 | 18 | 46 |
| 2019 January | 31 | 22 | 53 |
| 2018 December | 34 | 14 | 48 |
| 2018 November | 38 | 16 | 54 |
| 2018 October | 50 | 18 | 68 |
| 2018 September | 31 | 12 | 43 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 37 | 7 | 44 |
| 2018 March | 20 | 2 | 22 |
| 2018 February | 22 | 7 | 29 |
| 2018 January | 20 | 6 | 26 |
| 2017 December | 27 | 8 | 35 |
| 2017 November | 22 | 5 | 27 |
| 2017 October | 21 | 5 | 26 |
| 2017 September | 27 | 4 | 31 |
| 2017 August | 24 | 9 | 33 |
| 2017 July | 21 | 4 | 25 |
| 2017 June | 29 | 15 | 44 |
| 2017 May | 26 | 4 | 30 |
| 2017 April | 21 | 7 | 28 |
| 2017 March | 14 | 7 | 21 |
| 2017 February | 15 | 7 | 22 |
| 2017 January | 15 | 2 | 17 |
| 2016 December | 31 | 4 | 35 |
| 2016 November | 43 | 10 | 53 |
| 2016 October | 52 | 18 | 70 |
| 2016 September | 34 | 8 | 42 |
| 2016 August | 48 | 8 | 56 |
| 2016 July | 26 | 10 | 36 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 30 | 3 | 33 |
| 2015 September | 30 | 10 | 40 |
| 2015 August | 49 | 27 | 76 |
| 2015 July | 4 | 2 | 6 |
| 2015 June | 1 | 0 | 1 |
| 2015 April | 2 | 0 | 2 |
Show all
