Original Article
Use of Gastrografin® in the Management of Adhesion Intestinal Obstruction
El uso de Gastrografin® en el manejo del cuadro de oclusión intestinal adherencial
Laura Mora López
, Xavier Serra-Aracil, Heura Llaquet Bayo, Salvador Navarro Soto
Corresponding author
Servicio de Cirugía General y del Aparato Digestivo, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Barcelona, Spain
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It has recently been demonstrated that this rate is much lower in laparoscopic procedures, although the exact percentage is not known.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Before the 1990s, the mortality rate associated with intestinal obstruction was 30%–50%, depending on the series.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Nowadays, the correct diagnosis of symptoms and adequate treatment can lower the mortality rate to 3%–5%.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">During the management of intestinal obstruction, the patient should initially be made to fast and intravenous therapy should be administered, in addition to intestinal decompression with a nasogastric tube. Most of the symptoms will respond to conservative treatment. The indication for surgery is clear when there are data to suspect ischemia or intestinal suffering: fever, tachycardia, abdominal pain, peritonitis and acidosis. The problem lies in knowing how much time should pass before we decide whether the patient is responding to conservative treatment and, therefore, when surgery should be indicated.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There have been several attempts at trying to improve the management of this entity: one of the most well-known has been the administration of water-soluble contrast.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The use of these contrasts gives a more precise diagnosis of the partial or complete obstruction<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> according to whether the contrast passes into the colon and, therefore, facilitates the decision for surgery in those obstructions that do not improve with medical treatment.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The therapeutic effect of these water-soluble contrasts is not clear, although some studies say they can demonstrate it when the contrasts are administered more than 24<span class="elsevierStyleHsp" style=""></span>h after the conservative treatment.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Based on these studies, our department has used an algorithm for cases of adhesive intestinal obstruction (AIO) in order to demonstrate that it provides safe management of the symptoms, is able to improve surgical indication time and also improves hospitalization times, without increasing adverse effects.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This descriptive, prospective and observational study was carried out from January 2009 to December 2011. Following the protocol described in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> at our hospital, when a patient presents with clinical symptoms compatible with intestinal obstruction (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and has a history of surgery, the first suspected diagnosis is AIO. All patients undergo detailed abdominal examination in order to rule out the presence of other causes for the obstruction. Afterwards, an abdominal radiograph is ordered along with analyses including blood work-up, biochemistry and acid-base balance. If the patient fulfills the inclusion criteria (symptoms and radiology compatible with obstruction and history of abdominal surgery with an interval of more than one month), he/she is included in the AIO protocol. If, contrarily, the patient presents exclusion criteria (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), he/she is not included in the protocol and management is determined by the characteristics of each case.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In cases of AIO, the water-soluble contrast Gastrografin<span class="elsevierStyleSup">®</span> was administered in our center. Prior to the administration of Gastrografin<span class="elsevierStyleSup">®</span>, gastric decompression was performed with the placement of a nasogastric tube for approximately 2<span class="elsevierStyleHsp" style=""></span>h in order to reduce the risk of vomiting and aspiration after the administration of the contrast. At the follow-up controls (at 8, 12, 24<span class="elsevierStyleHsp" style=""></span>h), oral intake was initiated when the patient presented passage of the contrast material to the colon (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), regardless of the time of the control.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The variables that were collected and analyzed were: age, sex, types and number of previous surgical interventions, need for surgery, need for intestinal resection during the episode and hospital stay.</p><p id="par0035" class="elsevierStylePara elsevierViewall">For the statistical analysis, we used the SPSS 17.0 program. The quantitative variables are reported by means and standard deviation or median and range when the distribution was not normal. The categorical variables are described in absolute numbers and percentages.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">During the study period, 211 episodes of AIO were diagnosed in our hospital in 164 patients: 61 ♀ and 103 ♂, with a mean age of 70 (range 24–93).</p><p id="par0045" class="elsevierStylePara elsevierViewall">As recorded in the medical files of the 164 patients, 105 (64.6%) had undergone lower abdominal surgery, 25 (40%) had a single previous surgery and only 4 patients out of the 164 (2.4%) had had prior laparoscopic surgery (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The time between the surgery and the episode of intestinal obstruction was very variable, ranging from 1 month to 10 years with a mean of 55 months.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Mean hospital stay was 5.5 days, and 48<span class="elsevierStyleHsp" style=""></span>h in those patients in whom the contrast passed into the colon.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Contrast material was administered in 170 of the cases diagnosed. In the 41 episodes when contrast was not used, the causes were: rapid resolution of the symptoms in 29 episodes (72%), deterioration of the patient with signs of intestinal ischemia in 5 episodes (12%), transfer of the patient or voluntary hospital discharge in 6 cases (14%) and contrast allergy in one patient (2%). No adverse effects were observed related to the administration of the contrast.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the 170 episodes in which contrast was administered, it passed to the colon in 142 (83%). The contrast was observed in the colon after 8<span class="elsevierStyleHsp" style=""></span>h in 104 episodes out of the 142 (73%), after 12<span class="elsevierStyleHsp" style=""></span>h in 11 episodes (8%) and after 24<span class="elsevierStyleHsp" style=""></span>h in 27 episodes (19%). In 28 episodes out of the 170 (17%), the contrast had not passed into the colon after 24<span class="elsevierStyleHsp" style=""></span>h and the patients presented no improvement in their symptoms, requiring surgery (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> reports the recurrence of the obstructive symptoms in our group.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Thirty-three patients required surgery: 28 cases due to failure of the conservative treatment and 5 cases in which, upon hospitalization or during their stay in the ER, the patients presented clinical or analytical signs of intestinal ischemia. Surgical findings included the presence of a solitary adhesion/band in 16 episodes out of 33 (48%) and multiple adhesions in 17 episodes (52%). Intestinal resection was only needed in 5 patients out of the 33 (3%).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">We know that AIO is a frequent pathology seen in the Emergency Department. It presents an important mortality rate that can be reduced to 3%–5% with proper management of symptoms.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> It initially requires a conservative management with fluid therapy, fasting and decompression. More than 70% of cases will have a good response to this initial conservative management.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">When we observe the results obtained with the application of the protocol, we can confirm that our results corroborate the results of studies that administer water-soluble contrast medium after the diagnosis of AIO. The most important studies on the application of water-soluble media in intestinal obstruction due to bands and adhesions were initiated in the 1990s, and studies still continue today.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> They all try to demonstrate the diagnostic utility of contrasts and also their therapeutic utility. As for the diagnostic utility of these contrast materials, the studies all concur that they are able to determine the type of obstruction (either partial or complete) with a high sensitivity, specificity and positive and negative predictive value (87.5, 100, 100 and 97.9%, respectively).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This high diagnostic precision enables physicians to improve the management of AIO from its initial diagnosis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In these studies, there are differences with regard to radiological control times after the administration of the contrast. Some studies indicate surgery in the first radiological control after 4<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This seems an aggressive measure, however, especially when studies with a longer waiting period,<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16–19</span></a> like our study, have observed that most patients (104 patients out of 142 [73%]) who present partial obstruction respond within the first 8<span class="elsevierStyleHsp" style=""></span>h. But there is a percentage, 28 episodes out of 142 (17%), that may respond within the first 24<span class="elsevierStyleHsp" style=""></span>h and, therefore, surgery may be avoided in these cases. It is not recommended to lengthen the control times for longer than 24<span class="elsevierStyleHsp" style=""></span>h because this has not been shown to improve the results and may increase patient morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The diagnostic effect is able to streamline the treatment of partial obstructions, which shortens the hospital stays of patients, as observed in our case and in reports by other groups.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> Furthermore, the adverse effects related with hospital stay are also minimized. With regard to complete obstruction, the use of these contrasts is able to shorten the time between the hospitalization of the patient until the indication of surgery.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Until now, contrast material has not been shown to have a therapeutic effect (meaning that they reduce the number of episodes requiring surgery), although in some studies it seems to do so.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,23</span></a> What we can affirm is that, although the reduction in the number of surgeries in this pathology is not clear, we do see a reduction in the number of patients requiring intestinal resection. Only 5 out of the 33 surgical patients (3%) required intestinal resection. This may be related to the rapid indication of surgery when conservative treatment fails. In our study, the patients who required surgery presented solitary as well as multiple bands with similar percentages.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Until now, we have not seen any adverse effects related with the administration of contrast material in our patients. Allergic reactions and aspiration pneumonitis have been reported<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> related with the use of orally administered water-soluble contrast media. Of all the studies reviewed, there was only one report of an allergic reaction.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> We can therefore confirm that the administration of water-soluble contrast material in the management of AIO is safe.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion, the protocol that we apply in our hospital is a safe protocol that provides proper management of AIO. In cases of partial obstruction, it reduces hospital stays and, in cases of total obstruction, it shortens the time before the indication of surgery. This leads to a lower percentage of intestinal resection in cases requiring surgery.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres296754" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Aim" 3 => "Material and methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec280377" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres296755" "titulo" => array:6 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivo" 3 => "Material y método" 4 => "Resultados" 5 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec280376" "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" => "Conflict of Interest" ] 9 => array:2 [ "identificador" => "xack69417" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-08-18" "fechaAceptado" => "2012-10-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec280377" "palabras" => array:3 [ 0 => "Intestinal obstruction" 1 => "Adhesions" 2 => "Gastrografin<span class="elsevierStyleSup">®</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec280376" "palabras" => array:3 [ 0 => "Oclusión intestinal" 1 => "Adherencias" 2 => "Gastrografin<span class="elsevierStyleSup">®</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Adhesions are the most important cause of intestinal obstruction. Approximately 25% of surgical admissions for acute abdominal conditions are due to intestinal obstruction. Better diagnostic and treatment methods of intestinal obstruction could potentially reduce mortality rate to 5%–10%. Gastrografin<span class="elsevierStyleSup">®</span> could contribute to this achieve this.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To present a protocol to treat adhesion intestinal obstruction with Gastrografin<span class="elsevierStyleSup">®</span> that is safe, and allows shorter hospital stays and shorter time between admission and surgery.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">All patients with adhesion intestinal obstruction without symptoms of strangulation were treated with Gastrografin<span class="elsevierStyleSup">®</span>, intravenous fluids and nasogastric tube. Those in whom contrast reach the colon in 8, 12 or 24<span class="elsevierStyleHsp" style=""></span>h were considered to have partial obstruction, and were fed orally. If Gastrografin<span class="elsevierStyleSup">®</span> failed in the following 24<span class="elsevierStyleHsp" style=""></span>h, a laparotomy was performed.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Out of a total of 211 episodes (164 patients), 170 episodes received contrast and in 142 cases Gastrografin<span class="elsevierStyleSup">®</span> reached the colon (104 episodes at 8<span class="elsevierStyleHsp" style=""></span>h, 11 at 12<span class="elsevierStyleHsp" style=""></span>h, and 27 at 24<span class="elsevierStyleHsp" style=""></span>h). A laparotomy was required in 28 patients because of failed treatment, and in another 5 for other causes.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A management protocol for adhesion intestinal obstruction with Gastrografin<span class="elsevierStyleSup">®</span> is safe, reduces morbidity and mortality, and leads to a shorter hospital stay.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las adherencias son la causa más importante de oclusión intestinal, suponen un 25% de las consultas por dolor abdominal. Con un correcto manejo de este cuadro, la mortalidad asociada puede ser menor de un 5–10%. El Gastrografin<span class="elsevierStyleSup">®</span> puede ayudar a ello.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La aplicación de un protocolo de manejo de la oclusión intestinal adherencial con Gastrografin<span class="elsevierStyleSup">®</span> es segura y permite disminuir la estancia hospitalaria y el tiempo de indicación de cirugía por fallo del tratamiento conservador.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Material y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo observacional, siguiendo un protocolo preestablecido. Una vez diagnosticado el cuadro, descartadas otras causas de oclusión y la presencia de sufrimiento intestinal, se administra Gastrografin<span class="elsevierStyleSup">®</span> y se inicia tratamiento conservador. Si el Gastrografin<span class="elsevierStyleSup">®</span> pasa al colon en el control de las 8, 12 o 24<span class="elsevierStyleHsp" style=""></span>h posteriores a su administración, se considera la oclusión como parcial, se inicia dieta oral y se evalúa el alta. Si no pasa el contraste a las 24 h, se indica cirugía.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2009 hasta diciembre de 2011, se trataron 211 episodios (164 pacientes). En 170 episodios se administró contraste con llegada del mismo al colon en 142 episodios (104 episodios a las 8<span class="elsevierStyleHsp" style=""></span>h, 11 a las 12<span class="elsevierStyleHsp" style=""></span>h y 27 a las 24<span class="elsevierStyleHsp" style=""></span>h) Se intervien a 28 pacientes por fallo del tratamiento conservador y a 5 por otras causas.</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La aplicación de un protocolo en el que se incluye el uso de Gastrografin<span class="elsevierStyleSup">®</span> en la oclusión intestinal adherencial es seguro y permite tomar decisiones terapéuticas con mayor celeridad y con una menor estancia hospitalaria.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Mora López L, Serra-Aracil X, Llaquet Bayo H, Navarro Soto S. El uso de Gastrografin<span class="elsevierStyleSup">®</span> en el manejo del cuadro de oclusión intestinal adherencial. Cir Esp. 2013;91:384–388.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1503 "Ancho" => 1658 "Tamanyo" => 162264 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the protocol in cases of intestinal obstruction due to adhesions.</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" => 878 "Ancho" => 950 "Tamanyo" => 73339 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Initial image of intestinal obstruction due to adhesions.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 940 "Ancho" => 950 "Tamanyo" => 85839 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Intestinal obstruction after the administration of Gastrografin<span class="elsevierStyleSup">®</span> with resolution of symptoms.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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=""><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. Age<18 \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. Gestation \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. Iodine allergy \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">4. Previous radiotherapy \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">5. Digestive vascular disease \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">6. Early post-operative obstruction \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">7. Incarcerated ventral hernia \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab432763.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Exclusion Criteria of the Protocol.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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=""><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"><span class="elsevierStyleItalic">Total</span> \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">211 episodes \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"><span class="elsevierStyleItalic">Sex</span> \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 ♀/103 ♂ \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"><span class="elsevierStyleItalic">Mean age</span> \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">70 (24–93) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Surgical history</span></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"><span class="elsevierStyleHsp" style=""></span>Lower abdomen \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">105 episodes (64.4%) \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"><span class="elsevierStyleHsp" style=""></span>Single surgery \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 episodes (40%) \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"><span class="elsevierStyleHsp" style=""></span>Laparoscopic surgery \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 episodes (2.4%) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleItalic">Time since surgery – AIO</span> \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">1 month–10 years \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean hospital stay</span></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"><span class="elsevierStyleHsp" style=""></span>Global \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">5.5 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"><span class="elsevierStyleHsp" style=""></span>Passage of contrast \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">48<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab432766.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient Characteristics.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Administration of contrast (170 episodes)</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Contrast in colon (142 episodes, 83%)</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>h control \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">104 episodes (73%) \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>h control \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">11 episodes (8%) \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h control \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">27 episodes (19%) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No contrast in colon after 24 h (28 episodes, 17%)</span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">No administration of contrast (41 episodes)</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rapid resolution AIO: 29 episodes (72%)</span> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Signs of intestinal ischemia: 5 episodes (12%)</span> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Transfer or voluntary discharge: 6 episodes (14%)</span> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Allergy to iodinated contrast: 1 episode (2%)</span> \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab432765.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Results of Application of the AIO Protocol.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">All patients were treated according to the AIO protocol.</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" style="border-bottom: 2px solid black">No. of Episodes \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients \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="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgery \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="char" 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (22%) \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="char" 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (12%)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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="char" 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="char" 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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="char" 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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab432764.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Both after the second episode.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Recurrences.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of patients diagnosed as acute intestinal obstructions secondary to adhesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Sosa" 1 => "B. Gardner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Surg" "fecha" => "1993" "volumen" => "63" "paginaInicial" => "367" "paginaFinal" => "371" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9124762" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small intestinal obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Mucha Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surg Clin North Am" "fecha" => "1987" "volumen" => "67" "paginaInicial" => "597" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3296252" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence and risk factors of post-laparotomy adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Bamparas" 1 => "B.C. Branco" 2 => "B. Schüriger" 3 => "L. Lam" 4 => "K. Inaba" 5 => "D. Demetriades" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11605-010-1189-8" "Revista" => array:6 [ "tituloSerie" => "J Gastrointest Surg" "fecha" => "2010" "volumen" => "14" "paginaInicial" => "1619" "paginaFinal" => "1628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20352368" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current spectrum of intestinal obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. McEntee" 1 => "D. Pender" 2 => "D. Mulvin" 3 => "M. McCullough" 4 => "S. Naeeder" 5 => "S. Farah" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "1987" "volumen" => "74" "paginaInicial" => "976" "paginaFinal" => "980" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3690244" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Natural history of patients with adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Miller" 1 => "J. Boman" 2 => "I. Shrier" 3 => "Gordon PH" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2168.2000.01329-7.x" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2000" "volumen" => "87" "paginaInicial" => "124" "paginaFinal" => "1247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10660352" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications and death after surgical treatment of mall bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.T. Fevang" 1 => "J. Fevang" 2 => "L. Stangeland" 3 => "O. Soreide" 4 => "K. Svanes" 5 => "A. Viste" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2000" "volumen" => "231" "paginaInicial" => "529" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10749614" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of gastrografin in the differential diagnosis of paralytic ileus versus mechanical intestinal obstruction: a critical review and report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Zer" 1 => "D. Kaznelson" 2 => "Z. Feigenberg" 3 => "M. Dintsman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dis Colon Rectum" "fecha" => "1977" "volumen" => "20" "paginaInicial" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/578790" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.C. Branco" 1 => "G. Barmparas" 2 => "B. Schnüriger" 3 => "K. Inaba" 4 => "L.S. Chan" 5 => "D. Demetriades" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.7019" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2010" "volumen" => "97" "paginaInicial" => "470" "paginaFinal" => "478" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20205228" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Upper gastrointestinal contrast study in the management of small bowel obstruction: a prospective randomised study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.T. Fevang" 1 => "D. Jensen" 2 => "J. Fevang" 3 => "K. Søndenaa" 4 => "K. Ovrebø" 5 => "O. Rokk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/110241500750009681" "Revista" => array:6 [ "tituloSerie" => "Eur J Surg" "fecha" => "2000" "volumen" => "166" "paginaInicial" => "39" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10688215" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intestinal obstruction from adhesions: how big is the problem?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Menzies" 1 => "H. Ellis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Ann Coll Surg Engl" "fecha" => "1990" "volumen" => "72" "paginaInicial" => "60" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current management of small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.N. Bass" 1 => "B. Jones" 2 => "G.B. Buckley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Surg" "fecha" => "1997" "volumen" => "31" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9408486" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.E. Brolin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Surgery" "fecha" => "1984" "paginaInicial" => "95" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Water-soluble contrast medium (Gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Di Saverio" 1 => "F. Catena" 2 => "L. Ansaloni" 3 => "M. Gavioli" 4 => "M. Valentino" 5 => "A.D. Pinna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00268-008-9694-6" "Revista" => array:6 [ "tituloSerie" => "World J Surg" "fecha" => "2008" "volumen" => "32" "paginaInicial" => "2293" "paginaFinal" => "2304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18688562" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical impacts of oral gastrografin follow-through in adhesive small bowel obstruction (SBO)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Farid" 1 => "A. Fikry" 2 => "A. El Nakeeb" 3 => "E. Fouda" 4 => "T. Elmetwally" 5 => "M. Yousef" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jss.2009.03.092" "Revista" => array:6 [ "tituloSerie" => "J Surg Res" "fecha" => "2010" "volumen" => "162" "paginaInicial" => "170" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19524265" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of water-soluble contrast radiology in the management of acute small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.P. Joyce" 1 => "P.V. Delaney" 2 => "T.F. Gorey" 3 => "J.M. Fitzpatrick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann R Coll Surg Engl" "fecha" => "1992" "volumen" => "74" "paginaInicial" => "422" "paginaFinal" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1306666" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Feigin" 1 => "D. Seror" 2 => "A. Szold" 3 => "M. Carmon" 4 => "T.M. Allweis" 5 => "A. Nissan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0002-9610(97)89553-0" "Revista" => array:6 [ "tituloSerie" => "Am J Surg" "fecha" => "1996" "volumen" => "171" "paginaInicial" => "227" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8619455" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Water-soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.C. Chen" 1 => "F.Y. Lin" 2 => "P.H. Lee" 3 => "S.C. Yu" 4 => "S.M. Wang" 5 => "K.J. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2168.1998.00919.x" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "1998" "volumen" => "85" "paginaInicial" => "1692" "paginaFinal" => "1694" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9876076" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of contrast radiology for postoperative adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Onoue" 1 => "T. Katoh" 2 => "Y. Shibata" 3 => "K. Matsuo" 4 => "M. Suzuki" 5 => "H. Chigira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hepatogastroenterology" "fecha" => "2002" "volumen" => "49" "paginaInicial" => "1576" "paginaFinal" => "1578" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12397739" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of Gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective evaluation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.K. Choi" 1 => "W.L. Law" 2 => "J.W. Ho" 3 => "K.W. Chu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2005" "volumen" => "11" "paginaInicial" => "3742" "paginaFinal" => "3745" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15968731" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized controlled trial of Gastrografin in adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Burge" 1 => "S.M. Abbas" 2 => "G. Roadley" 3 => "J. Donald" 4 => "A. Connolly" 5 => "I.P. Bissett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1445-2197.2005.03491.x" "Revista" => array:6 [ "tituloSerie" => "ANZ J Surg" "fecha" => "2005" "volumen" => "75" "paginaInicial" => "672" "paginaFinal" => "674" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16076330" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Abbas" 1 => "I.P. Bissett" 2 => "B.R. Parry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.5775" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2007" "volumen" => "94" "paginaInicial" => "404" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17380561" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Assalia" 1 => "M. Schein" 2 => "D. Kopelman" 3 => "A. Hirshberg" 4 => "M. Hashmonai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surgery" "fecha" => "1994" "volumen" => "115" "paginaInicial" => "433" "paginaFinal" => "437" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8165534" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral water soluble contrast for the management of adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Abbas" 1 => "I.P. Bissett" 2 => "B.R. Parry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2007" "paginaInicial" => "CD004651" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic reactions to oral iodinated contrast agents: reactions to oral contrast" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L.J. Ridley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Australas Radiol" "fecha" => "1998" "volumen" => "42" "paginaInicial" => "114" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9599824" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective evaluation of oral Gastrografin in postoperative small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Kapoor" 1 => "G. Jain" 2 => "A. Sewkani" 3 => "S. Sharma" 4 => "K. Patel" 5 => "S. Varshney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jss.2005.12.008" "Revista" => array:6 [ "tituloSerie" => "J Surg Res" "fecha" => "2004" "volumen" => "131" "paginaInicial" => "256" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16457844" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized clinical study of Gastrografin administration in patients with adhesive small bowel obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Biondo" 1 => "D. Parés" 2 => "L. Mora" 3 => "J. Martí Ragué" 4 => "E. Jaurrieta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/bjs.4150" "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "2003" "volumen" => "90" "paginaInicial" => "542" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12734858" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack69417" "titulo" => "Acknowledgements" "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">We would like to thank all the members of the General Surgery Department, and especially the on-call teams, for their collaboration in carrying out this protocol. Thanks also to the Diagnostic Radiology Department for their participation in the radiological controls of these patients.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009100000006/v1_201312060036/S2173507713001816/v1_201312060036/en/main.assets" "Apartado" => array:4 [ "identificador" => "7417" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009100000006/v1_201312060036/S2173507713001816/v1_201312060036/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713001816?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 0 | 11 |
| 2024 October | 83 | 5 | 88 |
| 2024 September | 67 | 3 | 70 |
| 2024 August | 73 | 9 | 82 |
| 2024 July | 94 | 53 | 147 |
| 2024 June | 90 | 6 | 96 |
| 2024 May | 130 | 13 | 143 |
| 2024 April | 89 | 12 | 101 |
| 2024 March | 120 | 6 | 126 |
| 2024 February | 149 | 11 | 160 |
| 2024 January | 146 | 12 | 158 |
| 2023 December | 160 | 3 | 163 |
| 2023 November | 215 | 9 | 224 |
| 2023 October | 176 | 9 | 185 |
| 2023 September | 98 | 25 | 123 |
| 2023 August | 78 | 9 | 87 |
| 2023 July | 123 | 13 | 136 |
| 2023 June | 92 | 9 | 101 |
| 2023 May | 114 | 6 | 120 |
| 2023 April | 116 | 5 | 121 |
| 2023 March | 159 | 7 | 166 |
| 2023 February | 81 | 10 | 91 |
| 2023 January | 103 | 7 | 110 |
| 2022 December | 81 | 11 | 92 |
| 2022 November | 79 | 18 | 97 |
| 2022 October | 72 | 9 | 81 |
| 2022 September | 61 | 19 | 80 |
| 2022 August | 72 | 24 | 96 |
| 2022 July | 77 | 11 | 88 |
| 2022 June | 112 | 7 | 119 |
| 2022 May | 90 | 14 | 104 |
| 2022 April | 84 | 19 | 103 |
| 2022 March | 115 | 17 | 132 |
| 2022 February | 88 | 12 | 100 |
| 2022 January | 113 | 23 | 136 |
| 2021 December | 89 | 15 | 104 |
| 2021 November | 101 | 26 | 127 |
| 2021 October | 94 | 18 | 112 |
| 2021 September | 86 | 13 | 99 |
| 2021 August | 102 | 22 | 124 |
| 2021 July | 82 | 12 | 94 |
| 2021 June | 87 | 17 | 104 |
| 2021 May | 110 | 12 | 122 |
| 2021 April | 338 | 41 | 379 |
| 2021 March | 164 | 25 | 189 |
| 2021 February | 123 | 22 | 145 |
| 2021 January | 81 | 15 | 96 |
| 2020 December | 89 | 16 | 105 |
| 2020 November | 133 | 19 | 152 |
| 2020 October | 85 | 9 | 94 |
| 2020 September | 83 | 15 | 98 |
| 2020 August | 91 | 3 | 94 |
| 2020 July | 83 | 15 | 98 |
| 2020 June | 107 | 14 | 121 |
| 2020 May | 73 | 9 | 82 |
| 2020 April | 82 | 31 | 113 |
| 2020 March | 103 | 10 | 113 |
| 2020 February | 76 | 10 | 86 |
| 2020 January | 111 | 13 | 124 |
| 2019 December | 91 | 11 | 102 |
| 2019 November | 89 | 10 | 99 |
| 2019 October | 95 | 15 | 110 |
| 2019 September | 81 | 17 | 98 |
| 2019 August | 64 | 3 | 67 |
| 2019 July | 61 | 8 | 69 |
| 2019 June | 123 | 11 | 134 |
| 2019 May | 245 | 28 | 273 |
| 2019 April | 128 | 4 | 132 |
| 2019 March | 51 | 2 | 53 |
| 2019 February | 49 | 5 | 54 |
| 2019 January | 43 | 2 | 45 |
| 2018 December | 44 | 5 | 49 |
| 2018 November | 54 | 7 | 61 |
| 2018 October | 100 | 8 | 108 |
| 2018 September | 168 | 6 | 174 |
| 2018 August | 83 | 2 | 85 |
| 2018 July | 87 | 2 | 89 |
| 2018 June | 37 | 4 | 41 |
| 2018 May | 66 | 0 | 66 |
| 2018 April | 37 | 3 | 40 |
| 2018 March | 56 | 2 | 58 |
| 2018 February | 27 | 0 | 27 |
| 2018 January | 43 | 0 | 43 |
| 2017 December | 22 | 0 | 22 |
| 2017 November | 38 | 0 | 38 |
| 2017 October | 47 | 4 | 51 |
| 2017 September | 40 | 3 | 43 |
| 2017 August | 36 | 6 | 42 |
| 2017 July | 54 | 7 | 61 |
| 2017 June | 46 | 3 | 49 |
| 2017 May | 76 | 1 | 77 |
| 2017 April | 33 | 4 | 37 |
| 2017 March | 54 | 49 | 103 |
| 2017 February | 121 | 1 | 122 |
| 2017 January | 38 | 2 | 40 |
| 2016 December | 37 | 9 | 46 |
| 2016 November | 53 | 4 | 57 |
| 2016 October | 84 | 13 | 97 |
| 2016 September | 198 | 11 | 209 |
| 2016 August | 134 | 4 | 138 |
| 2016 July | 68 | 3 | 71 |
| 2016 June | 54 | 6 | 60 |
| 2016 May | 49 | 9 | 58 |
| 2016 April | 80 | 9 | 89 |
| 2016 March | 51 | 21 | 72 |
| 2016 February | 56 | 11 | 67 |
| 2016 January | 28 | 7 | 35 |
| 2015 December | 25 | 4 | 29 |
| 2015 November | 42 | 9 | 51 |
| 2015 October | 33 | 10 | 43 |
| 2015 September | 29 | 6 | 35 |
| 2015 August | 50 | 5 | 55 |
| 2015 July | 43 | 3 | 46 |
| 2015 June | 22 | 3 | 25 |
| 2015 May | 32 | 3 | 35 |
| 2015 April | 52 | 9 | 61 |
| 2015 March | 46 | 6 | 52 |
| 2015 February | 26 | 4 | 30 |
| 2015 January | 34 | 3 | 37 |
| 2014 December | 49 | 11 | 60 |
| 2014 November | 44 | 7 | 51 |
| 2014 October | 31 | 4 | 35 |
| 2014 September | 36 | 4 | 40 |
| 2014 August | 25 | 4 | 29 |
| 2014 July | 35 | 5 | 40 |
| 2014 June | 28 | 2 | 30 |
| 2014 May | 28 | 4 | 32 |
| 2014 April | 21 | 1 | 22 |
| 2014 March | 15 | 4 | 19 |
| 2014 February | 23 | 2 | 25 |
| 2014 January | 53 | 6 | 59 |
| 2013 December | 56 | 1 | 57 |
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