Letter to the Editor
Uncommon Ectopic Parathyroid Adenoma
Adenoma paratiroideo ectópico poco frecuente
Fayçal El Oueriachi
, Adil Arsalane, El Hassane Kabiri
Corresponding author
Departamento de Cirugía Torácica, Mohamed V Military Teaching Hospital, Mohamed V Souissi University, Rabat, Morocco
Read
7463
Timeswas read the article
2255
Total PDF
5208
Total HTML
Share statistics
array:24 [ "pii" => "S157921291500066X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.03.001" "estado" => "S300" "fechaPublicacion" => "2015-06-01" "aid" => "1022" "copyright" => "SEPAR" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:301-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2765 "formatos" => array:3 [ "EPUB" => 136 "HTML" => 1996 "PDF" => 633 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289614003202" "issn" => "03002896" "doi" => "10.1016/j.arbres.2014.06.019" "estado" => "S300" "fechaPublicacion" => "2015-06-01" "aid" => "1022" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:301-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8422 "formatos" => array:3 [ "EPUB" => 118 "HTML" => 7560 "PDF" => 744 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Adenoma paratiroideo ectópico poco frecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "302" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Uncommon Ectopic Parathyroid Adenoma" ] ] "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" => 1044 "Ancho" => 1400 "Tamanyo" => 245575 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Estudio preoperatorio con <span class="elsevierStyleSup">99m</span>Tc-MIBI mostrando un foco voluminoso de hipercaptación en el mediastino. B) TAC de tórax que muestra una gran masa situada en el área del timo del mediastino anterior. C) Imagen postoperatoria tras la timectomía total que muestra el adenoma paratiroideo ocupando casi todo el lóbulo izquierdo del timo. D) Histopatología postoperatoria donde se observa el adenoma paratiroideo rodeado de tejido normal del timo. Inmunotinción positiva para hormona paratiroidea (recuadro).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fayçal El Oueriachi, Adil Arsalane, El Hassane Kabiri" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fayçal" "apellidos" => "El Oueriachi" ] 1 => array:2 [ "nombre" => "Adil" "apellidos" => "Arsalane" ] 2 => array:2 [ "nombre" => "El Hassane" "apellidos" => "Kabiri" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157921291500066X" "doi" => "10.1016/j.arbr.2015.03.001" "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/S157921291500066X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614003202?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000006/v1_201505280239/S0300289614003202/v1_201505280239/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212915000683" "issn" => "15792129" "doi" => "10.1016/j.arbr.2015.03.003" "estado" => "S300" "fechaPublicacion" => "2015-06-01" "aid" => "1024" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:302-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3302 "formatos" => array:3 [ "EPUB" => 149 "HTML" => 2319 "PDF" => 834 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Intraparenchymal Pulmonary Lipoma Clinically Mimicking Malignant Neoplasm" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "302" "paginaFinal" => "303" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lipoma pulmonar intraparenquimatoso con comportamiento clínico de neoplasia maligna" ] ] "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" => 990 "Ancho" => 990 "Tamanyo" => 98799 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multislice computed tomography showing round, homogeneous, intraparenchymal pulmonary nodule, located in the periphery of the left pulmonary lingula, in contact with the pericardium and the parietal pleura.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jasna Bacalja, Igor Nikolić, Luka Brčić" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jasna" "apellidos" => "Bacalja" ] 1 => array:2 [ "nombre" => "Igor" "apellidos" => "Nikolić" ] 2 => array:2 [ "nombre" => "Luka" "apellidos" => "Brčić" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614003226" "doi" => "10.1016/j.arbres.2014.06.021" "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/S0300289614003226?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915000683?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212915000683/v1_201505280222/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212914003280" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.11.009" "estado" => "S300" "fechaPublicacion" => "2015-06-01" "aid" => "871" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2015;51:299-300" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1956 "formatos" => array:3 [ "EPUB" => 135 "HTML" => 1361 "PDF" => 460 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Giant Dermatofibrosarcoma Protuberans of the Anterior Chest Wall" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "300" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatofibrosarcoma gigante de la pared torácica anterior" ] ] "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" => 918 "Ancho" => 1300 "Tamanyo" => 204382 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pedunculated tumor in the anterior chest wall (A). Chest computed tomography showing a pedunculated mass in the chest and right breast, with additional invasion of the chest wall (B and C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mohammed Massine el Hammoumi, Abdjalil Abouchadi, El Hassane Kabiri" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Mohammed Massine" "apellidos" => "el Hammoumi" ] 1 => array:2 [ "nombre" => "Abdjalil" "apellidos" => "Abouchadi" ] 2 => array:2 [ "nombre" => "El Hassane" "apellidos" => "Kabiri" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613003517" "doi" => "10.1016/j.arbres.2013.10.012" "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/S0300289613003517?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914003280?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000006/v1_201505280222/S1579212914003280/v1_201505280222/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Uncommon Ectopic Parathyroid Adenoma" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "302" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fayçal El Oueriachi, Adil Arsalane, El Hassane Kabiri" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Fayçal" "apellidos" => "El Oueriachi" "email" => array:1 [ 0 => "faycaldr@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Adil" "apellidos" => "Arsalane" ] 2 => array:2 [ "nombre" => "El Hassane" "apellidos" => "Kabiri" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Cirugía Torácica, Mohamed V Military Teaching Hospital, Mohamed V Souissi University, Rabat, Morocco" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adenoma paratiroideo ectópico poco frecuente" ] ] "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" => 1044 "Ancho" => 1400 "Tamanyo" => 264538 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Preoperative <span class="elsevierStyleSup">99m</span>Tc-MIBI scan showing a large area of increased uptake in the mediastinum. (B) Chest computed tomography showing a large mass in the area of the anterior thymus. (C) Postoperative image after complete thymectomy showing the parathyroid adenoma occupying almost all the left thymus lobe. (D) Postoperative histopathology examination showing parathyroid adenoma surrounded by normal thymus tissue. Immunostaining positive for parathyroid hormone (inset).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary hyperparathyroidism (PHPT) caused by ectopic parathyroid adenomas in the mediastinum is uncommon. The main indications for resection are glandular hyperfunction, complications from hypercalcemia, and young age of the patient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 20-year-old man was admitted due to several sudden pathologic fractures. Permanent tachycardia was found on clinical examination and standard X-ray revealed multiple fractures at varying stages, clear evidence of osteolysis and multiple bone tumors. Preoperative biochemistry results showed very high blood calcium: 170<span class="elsevierStyleHsp" style=""></span>mg/l (90–100<span class="elsevierStyleHsp" style=""></span>mg/l) and PTHi: 4000<span class="elsevierStyleHsp" style=""></span>pg/ml (15–65<span class="elsevierStyleHsp" style=""></span>pg/ml).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Technetium (<span class="elsevierStyleSup">99m</span>Tc) sestamibi (MIBI) scintigraphy showed extensive uptake in the upper mediastinum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A computed tomography (CT) was performed for more accurate localization of the mass, which was determined to be in the area of the thymus in close contact with the aortic arch (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Diagnosis was PHPT caused by a hyperfunctioning ectopic parathyroid mass in the mediastinum.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Median sternotomy revealed a tumor in the left lobe of the thymus that could be fully resected (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). To confirm the success of the resection, calcium and PTHi serum levels were monitored before and after surgery: levels fell gradually to 77<span class="elsevierStyleHsp" style=""></span>mg/l and 7.6<span class="elsevierStyleHsp" style=""></span>pg/ml, respectively, 3 days after the intervention. Low calcium blood levels, causing tachycardia, were detected in the postoperative period, and managed with intravenous administration of calcium.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Pathology examination determined that the lesion measured 5.5×4×4<span class="elsevierStyleHsp" style=""></span>cm and the histological diagnosis was parathyroid adenoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Six months after surgery, the patient's serum calcium and PTHi had returned to normal.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Mediastinal ectopic parathyroid adenoma causes hyperparathyroidism in approximately 20% of cases. When the thymus descends into the chest in the 5th week of embryonic development, it is accompanied by the lower parathyroid glands, as they take up their normal position. Occasionally, however, they move to the chest, along with the thymus.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Most patients with hyperparathyroidism are asymptomatic, but any symptoms that do appear are generally caused by hypercalcemia, and include nausea, vomiting, excessive thirst, constipation, polyuria, lethargy, and cardiac anomalies. Kidney stones, bone resorption and pathologic fractures may also occur. Severity of symptoms correlates with the size of the hyperfunctioning adenoma.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> When PHPT is suspected, preoperative localization of the tumor by imaging studies is essential for planning the surgical approach and allowing the surgeon to select the most appropriate technique. Ectopic parathyroid adenomas of less than 10<span class="elsevierStyleHsp" style=""></span>mm in diameter are best detected with <span class="elsevierStyleSup">99m</span>Tc-MIBI scintigraphy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Cervical ultrasound, CT and magnetic resonance imaging are used to determine the exact anatomical site of the mass.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Conventional approaches for a parathyroid adenoma located deep in the mediastinum are median sternotomy, manubriotomy or thoracotomy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Thanks to recent advances, however, video-assisted thoracoscopy is now more widely used for the resection of mediastinal ectopic parathyroid adenomas.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Large parathyroid adenomas are exceptional, and masses weighing more than 70<span class="elsevierStyleHsp" style=""></span>g have occasionally been reported.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In our case, the adenoma measured 5.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm, and weighed 95<span class="elsevierStyleHsp" style=""></span>g, making it one of the largest masses described in the literature, the largest being 145<span class="elsevierStyleHsp" style=""></span>g.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors state that they had no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: El Oueriachi F, Arsalane A, Kabiri EH. Adenoma paratiroideo ectópico poco frecuente. Arch Bronconeumol. 2015;51:301-302.</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" => 1044 "Ancho" => 1400 "Tamanyo" => 264538 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Preoperative <span class="elsevierStyleSup">99m</span>Tc-MIBI scan showing a large area of increased uptake in the mediastinum. (B) Chest computed tomography showing a large mass in the area of the anterior thymus. (C) Postoperative image after complete thymectomy showing the parathyroid adenoma occupying almost all the left thymus lobe. (D) Postoperative histopathology examination showing parathyroid adenoma surrounded by normal thymus tissue. Immunostaining positive for parathyroid hormone (inset).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Embryology and surgical anatomy of the thyroid and parathyroid glands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.B. Stewart" 1 => "L.J. Rizzolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Surgery of the thyroid and parathyroid glands" "paginaInicial" => "15" "paginaFinal" => "23" "edicion" => "2nd ed." "serieFecha" => "2012" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenoma weight: a predictor of transient hypocalcemia after parathyroidectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.A. Zamboni" 1 => "R. Folse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "1986" "volumen" => "152" "paginaInicial" => "611" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3789284" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Less invasive surgery for primary hyperparathyroidism based on preoperative <span class="elsevierStyleSup">99m</span>Tc-hexakis-2 methoxyisobutylisonitrile imaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Taira" 1 => "H. Doihara" 2 => "F. Hara" 3 => "T. Shien" 4 => "D. Takabatake" 5 => "H. Takahashi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00595-003-2687-z" "Revista" => array:6 [ "tituloSerie" => "Surg Today" "fecha" => "2004" "volumen" => "34" "paginaInicial" => "197" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14999529" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracoscopic resection of ectopic parathyroid glands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Medrano" 1 => "S.R. Hazelrigg" 2 => "R.J. Landreneau" 3 => "T.M. Boley" 4 => "T. Shawgo" 5 => "A. Grasch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2000" "volumen" => "69" "paginaInicial" => "221" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10654517" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022347602955812" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant adenoma of the parathyroid: report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Tsuchiya" 1 => "S. Endo" 2 => "R. Abe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surg Today" "fecha" => "1993" "volumen" => "23" "paginaInicial" => "465" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8324343" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000006/v1_201505280222/S157921291500066X/v1_201505280222/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/15792129/0000005100000006/v1_201505280222/S157921291500066X/v1_201505280222/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291500066X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 57 | 22 | 79 |
| 2024 September | 46 | 14 | 60 |
| 2024 August | 63 | 33 | 96 |
| 2024 July | 51 | 20 | 71 |
| 2024 June | 86 | 44 | 130 |
| 2024 May | 77 | 32 | 109 |
| 2024 April | 65 | 21 | 86 |
| 2024 March | 44 | 17 | 61 |
| 2024 February | 42 | 22 | 64 |
| 2023 March | 15 | 6 | 21 |
| 2023 February | 53 | 26 | 79 |
| 2023 January | 55 | 36 | 91 |
| 2022 December | 74 | 46 | 120 |
| 2022 November | 70 | 34 | 104 |
| 2022 October | 62 | 65 | 127 |
| 2022 September | 72 | 28 | 100 |
| 2022 August | 68 | 39 | 107 |
| 2022 July | 63 | 42 | 105 |
| 2022 June | 94 | 32 | 126 |
| 2022 May | 82 | 46 | 128 |
| 2022 April | 68 | 39 | 107 |
| 2022 March | 82 | 57 | 139 |
| 2022 February | 79 | 66 | 145 |
| 2022 January | 95 | 54 | 149 |
| 2021 December | 70 | 50 | 120 |
| 2021 November | 61 | 40 | 101 |
| 2021 October | 76 | 38 | 114 |
| 2021 September | 70 | 56 | 126 |
| 2021 August | 50 | 38 | 88 |
| 2021 July | 65 | 41 | 106 |
| 2021 June | 99 | 41 | 140 |
| 2021 May | 69 | 33 | 102 |
| 2021 April | 138 | 145 | 283 |
| 2021 March | 107 | 30 | 137 |
| 2021 February | 85 | 36 | 121 |
| 2021 January | 66 | 19 | 85 |
| 2020 December | 63 | 21 | 84 |
| 2020 November | 45 | 14 | 59 |
| 2020 October | 56 | 17 | 73 |
| 2020 September | 65 | 18 | 83 |
| 2020 August | 65 | 23 | 88 |
| 2020 July | 65 | 29 | 94 |
| 2020 June | 67 | 22 | 89 |
| 2020 May | 75 | 14 | 89 |
| 2020 April | 75 | 28 | 103 |
| 2020 March | 84 | 20 | 104 |
| 2020 February | 71 | 18 | 89 |
| 2020 January | 67 | 27 | 94 |
| 2019 December | 75 | 15 | 90 |
| 2019 November | 67 | 24 | 91 |
| 2019 October | 71 | 17 | 88 |
| 2019 September | 78 | 14 | 92 |
| 2019 August | 55 | 20 | 75 |
| 2019 July | 67 | 23 | 90 |
| 2019 June | 73 | 31 | 104 |
| 2019 May | 91 | 54 | 145 |
| 2019 April | 92 | 28 | 120 |
| 2019 March | 92 | 19 | 111 |
| 2019 February | 88 | 28 | 116 |
| 2019 January | 78 | 13 | 91 |
| 2018 December | 76 | 23 | 99 |
| 2018 November | 72 | 25 | 97 |
| 2018 October | 70 | 33 | 103 |
| 2018 September | 36 | 15 | 51 |
| 2018 May | 14 | 2 | 16 |
| 2018 April | 36 | 6 | 42 |
| 2018 March | 16 | 8 | 24 |
| 2018 February | 31 | 8 | 39 |
| 2018 January | 91 | 4 | 95 |
| 2017 December | 75 | 3 | 78 |
| 2017 November | 32 | 3 | 35 |
| 2017 October | 32 | 8 | 40 |
| 2017 September | 19 | 12 | 31 |
| 2017 August | 15 | 8 | 23 |
| 2017 July | 16 | 6 | 22 |
| 2017 June | 23 | 10 | 33 |
| 2017 May | 19 | 12 | 31 |
| 2017 April | 17 | 7 | 24 |
| 2017 March | 13 | 9 | 22 |
| 2017 February | 16 | 8 | 24 |
| 2017 January | 14 | 4 | 18 |
| 2016 December | 27 | 7 | 34 |
| 2016 November | 33 | 12 | 45 |
| 2016 October | 29 | 15 | 44 |
| 2016 September | 31 | 19 | 50 |
| 2016 August | 37 | 9 | 46 |
| 2016 July | 19 | 9 | 28 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 3 | 0 | 3 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 29 | 10 | 39 |
| 2015 September | 14 | 12 | 26 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 0 | 1 | 1 |
| 2015 June | 0 | 1 | 1 |
Show all
