Casuistry
Delayed bleeding after partial nephrectomy. Management with selective embolization
Sangrado diferido después de nefrectomía parcial. Manejo mediante embolización selectiva
A. Ciudin
, J. Huguet, A. García-Larrosa, M. Musquera, J.R. Alvarez-Vijande, M. José Ribal, A. Alcaraz
Corresponding author
Servicio de Urología, Instituto Clínico de Nefrología y Urología, Hospital Clínic, Barcelona, Spain
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"apellidos" => "Pineda-Galán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611002671" "doi" => "10.1016/j.acuro.2011.06.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002671?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000145?idApp=UINPBA00004N" "url" => "/21735786/0000003500000010/v1_201304251733/S2173578612000145/v1_201304251733/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casuistry</span>" "titulo" => "Delayed bleeding after partial nephrectomy. Management with selective embolization" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "615" "paginaFinal" => "619" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Ciudin, J. Huguet, A. García-Larrosa, M. Musquera, J.R. Alvarez-Vijande, M. José Ribal, A. Alcaraz" "autores" => array:7 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Ciudin" "email" => array:1 [ 0 => "alexciudin@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Huguet" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "García-Larrosa" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Musquera" ] 4 => array:2 [ "nombre" => "J.R." "apellidos" => "Alvarez-Vijande" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "José Ribal" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Alcaraz" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, Instituto Clínico de Nefrología y Urología, Hospital Clínic, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sangrado diferido después de nefrectomía parcial. Manejo mediante embolización selectiva" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 741 "Ancho" => 1516 "Tamanyo" => 112592 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pseudoaneurysm before (A) and after (B) coil embolization.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Partial nephrectomy (PN) is the technique of choice in the treatment of renal tumors in clinical stage T1a (≤4<span class="elsevierStyleHsp" style=""></span>cm), and also in selected cases in stage T1b.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Currently, laparoscopic PN is considered a good alternative to open surgery, showing the same oncological results in some long series, reducing the morbidity and complications of the surgical wound.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The complications of PN have been extensively described in the literature. Postoperative hemorrhage is a complication with potentially serious consequences. It is estimated that, including immediate and delayed bleeding, its incidence is between 4 and 6% after laparoscopic PN, and about 1.6% after open PN.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> There are few studies focusing on the diagnosis and performance for delayed bleeding, the one that occurs after the patient's discharge. In this work, we analyze the patients in our PN series who had delayed bleeding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We performed the retrospective study of the clinical histories of the patients in our PN database who had a delayed bleeding as a postoperative complication. We defined delayed bleeding as the one occurred after discharge. We analyzed its presentation, diagnosis, treatment, and evolution.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between 1992 and December 2009, 230 PN were performed at our center. In 136 cases (59.1%), we used the open approach, and in 94 (40.8%), the laparoscopic one. We identified three patients (1.3%), all male, who had a delayed bleeding after PN. All had undergone, without incidents, a PN for tumors between 2 and 3.5<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">They came to casualty with hematuria or lumbar pain between 17 and 25 days after surgery, all requiring blood transfusion (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The diagnosis was made by abdominal ultrasound and/or computed tomography (CT). Given the clinical and radiological suspicion of the existence of active bleeding, a selective arteriography was performed on the three patients. In all of them, the bleeding was attributed to the presence of an aneurysmal dilation at the level of an arterial branch (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Superselective embolization of the arterial branch got the immediate control of the bleeding in all the patients.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Delayed bleeding after PN is rare, and it is usually attributed to the presence of artery pseudoaneurysms (AP).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The incidence of symptomatic AP is over 0.43% after open PN,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and 1.7–7.5% after laparoscopic PN.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> However, we consider that most of the AP do not get to produce clinical manifestations, so it is estimated that their real incidence is much higher.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> AP related to closed or penetrating renal trauma, extracorporeal lithotripsy, after placement of nephrostomy, and percutaneous nephrolithotomy<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–15</span></a> have been reported. In the international literature so far, less than 30 AP have been reported.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The appearance of AP after PN is attributed to the persistence in the surgical site of arterial vessels, partially or completely open not fully sutured during the intervention.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,17,18</span></a> This would create an intraparenchymal hemorrhage, which is initially contained by the vascular adventitia, renal parenchyma and Gerota's fascia, being able to develop even a fibrous capsule.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Finally, bleeding originates coinciding with the increased activity of the patient, of their blood pressure, or due to migration of an arterial suture.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,18</span></a> Higher incidence of pseudoaneurysms after laparoscopic PN (1.7%) than after an open procedure (0.43%) is explained in some series by the occlusive effect of the pneumoperitoneum on bleeding points, and the lowest possible tension that can be applied to hemostatic sutures.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The intraoperative use of hemostatic products appears not to decrease the likelihood of AP onset.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,19</span></a> Most of the arteries involved in this type of injuries are third or fourth order.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,11,20</span></a> Bleeding due to AP can progress to the retroperitoneal space or the collecting system, determining the appearance of a retroperitoneal hematoma or hematuria.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Abdominal or lumbar pain and hemodynamic instability may occur.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,20</span></a> Most bleedings described in the literature appear between the second and the fourth week after the surgery.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,9,17,18</span></a> However, there are cases that have manifested clinically from 3 to 5 months after the intervention.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The initial diagnostic test of choice for the diagnostic suspicion of a delayed bleeding after PN is CT with intravenous contrast. The CT helps (in cases with non-specific clinical manifestations) to set the cause of the process as urological, to identify active bleeding, and to describe the morphology of the AP.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,17,21</span></a> Diagnostic confirmation is made by renal arteriography. The involved artery catheterization allows for the performance of the diagnosis and the treatment of the AP in the same event. Superselective embolization has been consolidating for years as the treatment of choice for delayed bleeding after PN, most of the patients showing satisfactory results. The control of the bleeding is achieved, as well, preserving most of the renal parenchyma practicable.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23</span></a> In our series, endovascular treatment was effective in the three cases. Conservative management is accepted as a potential initial treatment; however, most of the published cases with initial conservative management required further angiographic treatment for persistence or worsening of the symptoms.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,17,18</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The attitude toward the accidental diagnosis of an AP during the follow-up of a patient undergoing PN is usually expectant.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The location next to the pyelocaliceal system, a clear growth in the subsequent imaging, and associated anticoagulant or antiplatelet therapy are risk factors that can make opt for interventionist actions for an asymptomatic AP. There is no consensus on the size from which the asymptomatic AP is at increased risk of bleeding and should be treated.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Selective vascular embolization is the treatment of choice for symptomatic renal pseudoaneurysm after partial nephrectomy in the hemodynamically stable patient, showing good long-term evolution.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres100017" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Material and methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec87182" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres100016" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Material y métodos" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec87181" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec87182" "palabras" => array:4 [ 0 => "Partial nephrectomy" 1 => "Pseudoaneurysm" 2 => "Renal hemorrhage" 3 => "Selective vascular embolization" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec87181" "palabras" => array:4 [ 0 => "Nefrectomía parcial" 1 => "Pseudoaneurisma" 2 => "Hemorragia renal" 3 => "Embolización vascular selectiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bleeding after partial nephrectomy can be immediate or delayed and may have severe consequences. The incidence of this complication is low. The most frequent cause of delayed bleeding is arterial pseudoaneurysm. Superselective embolization is a feasible therapeutic option that has shown good results.</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate treatment and outcomes of delayed bleeding in our series of patients with partial nephrectomy.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of our database of partial nephrectomies. Patients who developed delayed bleeding (after discharge) were identified. Clinical histories were reviewed and data on presentation, diagnosis, treatment and outcomes were analyzed.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Among our series of patients undergoing partial nephrectomy, three developed delayed bleeding (1.3%). Symptom onset occurred 17–25 days after surgery and consisted of hematuria or lumbar pain. Diagnosis was provided through ultrasound, abdominal computed tomography and renal angiography. In all three patients, a complicated pseudoaneurysm was diagnosed and all patients underwent renal artery catheterization with selective renal artery embolization. In all patients, immediate control of bleeding was achieved. Outcome after a follow-up of 61–92 months was favorable.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Selective vascular embolization is the treatment of choice of renal pseudoaneurysm after partial nephrectomy in hemodynamically stable patients.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El sangrado después de una nefrectomía parcial es una complicación con posibles consecuencias graves. Puede ser inmediato o diferido y su incidencia es baja. La causa más frecuente del sangrado diferido es el pseudoaneurisma arterial. La embolización supraselectiva vascular es una opción terapéutica posible que ha demostrado buenos resultados.</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar la evolución y el tratamiento del sangrado diferido en nuestra serie de pacientes con nefrectomías parciales.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio retrospectivo de nuestra base de datos de nefrectomías parciales. Identificamos los pacientes que presentaron sangrado diferido (después del alta). Se revisó la historia clínica, analizando datos sobre la presentación, el diagnóstico, el tratamiento y la evolución de los pacientes.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">De nuestra serie de nefrectomías parciales tres pacientes presentaron sangrado diferido (1,3%). La clínica se inició después de 17 a 25 días de la cirugía por la aparición de hematuria o dolor lumbar. El diagnóstico se realizó mediante ecografía, TAC abdominal y angiografía renal. En todos los pacientes se diagnosticó un pseudoaneurisma arterial complicado, siendo sometidos a cateterismo arterial renal con embolización selectiva del mismo. La evolución fue correcta en todos los pacientes con control inmediato del sangrado. Documentamos un seguimiento posterior favorable de 61 a 92 meses.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La embolización selectiva vascular es el tratamiento de elección del pseudoaneurisma renal sintomático después de nefrectomía parcial en el paciente hemodinámicamente estable.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Ciudin A, et al. Sangrado diferido después de nefrectomía parcial. Manejo mediante embolización selectiva. Actas Urol Esp. 2011;35:615–619.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 742 "Ancho" => 1517 "Tamanyo" => 118312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(A) Central pseudoaneurysm, depending on a third-order branch. (B) Image with the embolized pseudoaneurysm with two coils.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 741 "Ancho" => 1516 "Tamanyo" => 112592 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pseudoaneurysm before (A) and after (B) coil embolization.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CCC: clear cell carcinoma; LPS: laparoscopy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age and sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Tumor</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgery</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pathological anatomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Discharge \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 ♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Upper pole, peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Open \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">250<span class="elsevierStyleHsp" style=""></span>ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT1a Fuhrmann 2 CCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 ♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mesorenal, central \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Open \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">400<span class="elsevierStyleHsp" style=""></span>ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT1a Fuhrmann 2 CCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 ♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Upper pole, peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LPS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">320<span class="elsevierStyleHsp" style=""></span>ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pT1a cromophobe carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 days \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183891.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients undergoing partial nephrectomy and having delayed bleeding.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">PRBC: packed red blood cells; P: patient; RAP: renal artery pseudoaneurysm.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptoms and transfusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time after SI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Diagnosis</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital stay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">TC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Angiography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbar pain, hematuria, 3 PRBC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doppler signal cystic image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mm RAP; 4th order artery; 2 coil embolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbar pain, 2 PRBC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unclear image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Active arterial bleeding, RAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>mm RAP; 3rd order artery; 2 coil embolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hematuria, 2 PRBC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doppler signal cystic image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Active arterial bleeding, RAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mm RAP; 3rd order artery; 1 coil embolization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 months \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183892.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Presentation, diagnosis, and treatment of patients with delayed bleeding after partial nephrectomy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU guidelines on renal cell carcinoma: the 2010 update" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 0 | 4 | 4 |
| 2024 October | 0 | 16 | 16 |
| 2024 September | 0 | 24 | 24 |
| 2024 August | 0 | 23 | 23 |
| 2024 July | 0 | 21 | 21 |
| 2024 June | 0 | 23 | 23 |
| 2024 May | 0 | 16 | 16 |
| 2024 April | 0 | 18 | 18 |
| 2024 March | 0 | 35 | 35 |
| 2024 February | 0 | 39 | 39 |
| 2024 January | 0 | 34 | 34 |
| 2023 December | 0 | 35 | 35 |
| 2023 November | 0 | 49 | 49 |
| 2023 October | 0 | 53 | 53 |
| 2023 September | 0 | 45 | 45 |
| 2023 August | 0 | 34 | 34 |
| 2023 July | 0 | 61 | 61 |
| 2023 June | 0 | 38 | 38 |
| 2023 May | 0 | 26 | 26 |
| 2023 April | 0 | 27 | 27 |
| 2023 March | 0 | 40 | 40 |
| 2023 February | 0 | 35 | 35 |
| 2023 January | 0 | 39 | 39 |
| 2022 December | 0 | 26 | 26 |
| 2022 November | 0 | 37 | 37 |
| 2022 October | 0 | 43 | 43 |
| 2022 September | 0 | 70 | 70 |
| 2022 August | 0 | 43 | 43 |
| 2022 July | 0 | 19 | 19 |
| 2022 June | 0 | 25 | 25 |
| 2022 May | 0 | 26 | 26 |
| 2022 April | 0 | 26 | 26 |
| 2022 March | 0 | 55 | 55 |
| 2022 February | 0 | 49 | 49 |
| 2022 January | 0 | 52 | 52 |
| 2021 December | 0 | 41 | 41 |
| 2021 November | 0 | 35 | 35 |
| 2021 October | 0 | 60 | 60 |
| 2021 September | 0 | 46 | 46 |
| 2021 August | 0 | 37 | 37 |
| 2021 July | 0 | 40 | 40 |
| 2021 June | 0 | 20 | 20 |
| 2021 May | 0 | 36 | 36 |
| 2021 April | 0 | 112 | 112 |
| 2021 March | 0 | 81 | 81 |
| 2021 February | 0 | 44 | 44 |
| 2021 January | 0 | 43 | 43 |
| 2020 December | 0 | 41 | 41 |
| 2020 November | 0 | 31 | 31 |
| 2020 October | 0 | 36 | 36 |
| 2020 September | 0 | 25 | 25 |
| 2020 August | 0 | 30 | 30 |
| 2020 July | 0 | 16 | 16 |
| 2020 June | 0 | 14 | 14 |
| 2020 May | 0 | 13 | 13 |
| 2020 April | 0 | 17 | 17 |
| 2020 March | 0 | 19 | 19 |
| 2020 February | 0 | 13 | 13 |
| 2020 January | 0 | 17 | 17 |
| 2019 December | 0 | 25 | 25 |
| 2019 November | 0 | 19 | 19 |
| 2019 October | 0 | 12 | 12 |
| 2019 September | 0 | 12 | 12 |
| 2019 August | 0 | 8 | 8 |
| 2019 July | 0 | 5 | 5 |
| 2019 June | 0 | 4 | 4 |
| 2019 May | 0 | 51 | 51 |
| 2019 April | 0 | 5 | 5 |
| 2019 March | 0 | 1 | 1 |
| 2019 February | 0 | 2 | 2 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 0 | 3 | 3 |
| 2018 November | 0 | 4 | 4 |
| 2018 February | 10 | 0 | 10 |
| 2018 January | 26 | 1 | 27 |
| 2017 December | 15 | 0 | 15 |
| 2017 November | 22 | 1 | 23 |
| 2017 October | 30 | 5 | 35 |
| 2017 September | 30 | 5 | 35 |
| 2017 August | 34 | 1 | 35 |
| 2017 July | 25 | 1 | 26 |
| 2017 June | 27 | 8 | 35 |
| 2017 May | 35 | 4 | 39 |
| 2017 April | 28 | 2 | 30 |
| 2017 March | 30 | 31 | 61 |
| 2017 February | 30 | 5 | 35 |
| 2017 January | 11 | 0 | 11 |
| 2016 December | 23 | 7 | 30 |
| 2016 November | 39 | 3 | 42 |
| 2016 October | 37 | 6 | 43 |
| 2016 September | 34 | 3 | 37 |
| 2016 August | 25 | 4 | 29 |
| 2016 July | 14 | 1 | 15 |
| 2016 June | 19 | 4 | 23 |
| 2016 May | 20 | 9 | 29 |
| 2016 April | 27 | 10 | 37 |
| 2016 March | 22 | 8 | 30 |
| 2016 February | 39 | 8 | 47 |
| 2016 January | 29 | 15 | 44 |
| 2015 December | 18 | 7 | 25 |
| 2015 November | 16 | 1 | 17 |
| 2015 October | 21 | 4 | 25 |
| 2015 September | 19 | 2 | 21 |
| 2015 August | 47 | 6 | 53 |
| 2015 July | 32 | 1 | 33 |
| 2015 June | 7 | 0 | 7 |
| 2015 May | 15 | 3 | 18 |
| 2015 April | 24 | 6 | 30 |
| 2015 March | 30 | 3 | 33 |
| 2015 February | 11 | 2 | 13 |
| 2015 January | 34 | 6 | 40 |
| 2014 December | 42 | 9 | 51 |
| 2014 November | 23 | 1 | 24 |
| 2014 October | 34 | 10 | 44 |
| 2014 September | 49 | 5 | 54 |
| 2014 August | 38 | 2 | 40 |
| 2014 July | 41 | 4 | 45 |
| 2014 June | 24 | 6 | 30 |
| 2014 May | 31 | 4 | 35 |
| 2014 April | 12 | 3 | 15 |
| 2014 March | 15 | 4 | 19 |
| 2014 February | 20 | 6 | 26 |
| 2014 January | 23 | 5 | 28 |
| 2013 December | 35 | 6 | 41 |
| 2013 November | 30 | 4 | 34 |
| 2013 October | 22 | 4 | 26 |
| 2013 September | 7 | 1 | 8 |
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