Scientific letter
Symptomatic giant liver cysts: When and how to treat
Cuándo y cómo tratar los quistes hepáticos gigantes sintomáticos
Marta Allue
, Pilar Palacios, Alfredo Jimenez
Corresponding author
Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Read
3208
Timeswas read the article
193
Total PDF
3015
Total HTML
Share statistics
array:24 [ "pii" => "S2444382421000511" "issn" => "24443824" "doi" => "10.1016/j.gastre.2020.06.014" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1614" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2021;44:226-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S021057052030279X" "issn" => "02105705" "doi" => "10.1016/j.gastrohep.2020.06.018" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1614" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2021;44:226-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Cuándo y cómo tratar los quistes hepáticos gigantes sintomáticos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "226" "paginaFinal" => "228" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Symptomatic giant liver cysts: When and how to treat" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1275 "Ancho" => 1500 "Tamanyo" => 188300 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caso 1. RM abdominal: quiste hepático de 20<span class="elsevierStyleHsp" style=""></span>cm en segmento <span class="elsevierStyleSmallCaps">vi</span>. No presenta realce de pared tras la administración de contraste (arriba izquierda). Caso 2. TAC abdominal: quiste de 14<span class="elsevierStyleHsp" style=""></span>cm entre segmentos <span class="elsevierStyleSmallCaps">vii</span> y <span class="elsevierStyleSmallCaps">viii (</span>arriba derecha<span class="elsevierStyleSmallCaps">)</span>. Caso 3. TAC abdominal: quiste de 18<span class="elsevierStyleHsp" style=""></span>cm. En la porción superior contiene tabicaciones que hacen sospechar un posible quiste hidatídico (abajo izquierda). Caso 4. TAC abdominal: multiquistosis hepática. El mayor presenta un diámetro de 12<span class="elsevierStyleHsp" style=""></span>cm (abajo derecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Allue, Pilar Palacios, Alfredo Jimenez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Allue" ] 1 => array:2 [ "nombre" => "Pilar" "apellidos" => "Palacios" ] 2 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Jimenez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2444382421000511" "doi" => "10.1016/j.gastre.2020.06.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382421000511?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021057052030279X?idApp=UINPBA00004N" "url" => "/02105705/0000004400000003/v1_202102240917/S021057052030279X/v1_202102240917/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2444382421000596" "issn" => "24443824" "doi" => "10.1016/j.gastre.2020.06.017" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1616" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2021;44:228-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Intestinal obstruction secondary to jejunal intussusception in an adult" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "228" "paginaFinal" => "229" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Obstrucción intestinal secundaria a invaginación yeyunal en el adulto" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 564 "Ancho" => 1250 "Tamanyo" => 86299 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT scan. Jejunal intussusception (marked with arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tatiana Gómez-Sánchez, Sergio Cerrato Delgado, Violeta Camacho Marente, Javier Varela Recio, José Manuel Pacheco García" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Tatiana" "apellidos" => "Gómez-Sánchez" ] 1 => array:2 [ "nombre" => "Sergio" "apellidos" => "Cerrato Delgado" ] 2 => array:2 [ "nombre" => "Violeta" "apellidos" => "Camacho Marente" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Varela Recio" ] 4 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Pacheco García" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021057052030296X" "doi" => "10.1016/j.gastrohep.2020.06.020" "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/S021057052030296X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382421000596?idApp=UINPBA00004N" "url" => "/24443824/0000004400000003/v1_202103190829/S2444382421000596/v1_202103190829/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S244438242100050X" "issn" => "24443824" "doi" => "10.1016/j.gastre.2020.06.013" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1613" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Gastroenterol Hepatol. 2021;44:225-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Portal and mesenteric thrombosis secondary to acute cytomegalovirus infection in an immunocompetent patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "225" "paginaFinal" => "226" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis portal y mesentérica secundaria a infección aguda por citomegalovirus en paciente inmunocompetente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 575 "Ancho" => 750 "Tamanyo" => 66171 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Coronal slice from the abdominal CT scan showing the filling defect in the splenic vein.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María del Carmen García Gavilán, Roque Miguel Gálvez Fernández, Alfonso del Arco Jiménez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María del Carmen" "apellidos" => "García Gavilán" ] 1 => array:2 [ "nombre" => "Roque Miguel" "apellidos" => "Gálvez Fernández" ] 2 => array:2 [ "nombre" => "Alfonso" "apellidos" => "del Arco Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570520302788" "doi" => "10.1016/j.gastrohep.2020.06.017" "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/S0210570520302788?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244438242100050X?idApp=UINPBA00004N" "url" => "/24443824/0000004400000003/v1_202103190829/S244438242100050X/v1_202103190829/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Symptomatic giant liver cysts: When and how to treat" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "226" "paginaFinal" => "228" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta Allue, Pilar Palacios, Alfredo Jimenez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Allue" "email" => array:1 [ 0 => "martitaallue@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Pilar" "apellidos" => "Palacios" ] 2 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Jimenez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuándo y cómo tratar los quistes hepáticos gigantes sintomáticos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1275 "Ancho" => 1500 "Tamanyo" => 188300 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. Abdominal MRI: liver cyst measuring 20 cm in liver segment 6. It shows no wall enhancement following contrast administration (upper left). Case 2. Abdominal CT: cyst measuring 14 cm between liver segments 7 and 8 (upper right). Case 3. Abdominal CT: cyst measuring 18 cm. The upper portion features septations that raise suspicion of a hydatid cyst (lower left). Case 4. Abdominal CT: multiple liver cysts. The largest has a diameter of 12 cm (lower right).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Liver cysts comprise a mixed group of diseases with different aetiologies and incidences but similar clinical signs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report four cases of symptomatic giant liver cysts treated by means of laparoscopic deroofing with excellent outcomes.</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1.</span> A 53-year-old woman visited the emergency department for pain in her right hypochondrium for a week, initially thought to be nephritic colitis. Ultrasound and magnetic resonance imaging showed a simple cyst measuring 20 cm in liver segment 6. The cyst was hypointense in T1 and showed no wall enhancement following contrast administration.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2.</span> A 77-year-old man sought treatment for bilious vomiting and pain in his right hypochondrium for some months. An abdominal CT scan showed a cyst measuring 14 cm between liver segments 7 and 8, which, given the density of its contents, raised a differential diagnosis between a simple cyst, cystadenoma and/or biloma. A decision was made to perform exploratory laparoscopy. After the contents of the cyst were aspirated and it was confirmed that they were not of a biliary nature, deroofing was done.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 3.</span> A 75-year-old man visited the emergency department due to a feeling of a mass in the epigastrium. An abdominal CT scan revealed a cyst measuring 18 cm that appeared to depend on the left liver lobe, occupying its entirety, with septations in its upper portion that raised suspicion that it might be a hydatid cyst. Serology tests ruled out this possibility and during the intervention it was observed that the cyst contained transformed blood.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 4.</span> A 68-year-old man with a diagnosis of asymptomatic polycystic liver disease in follow-up for the past 5 years sought treatment for abdominal pain. A CT scan showed multiple cysts, the largest of which measured 12 cm and was causing displacement of the left portal branch (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The mean postoperative stay was 3 days. None of the patients experienced complications, and after a 5-year follow-up period none of them showed any recurrence of symptoms.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Both solitary and polycystic lesions grow slowly and are relatively asymptomatic. When they exceed 5 cm, they can cause symptoms due to compression of the hepatic veins, vena cava or bile ducts, or they can cause acute abdominal pain in the event of complications such as rupture, torsion or intracystic haemorrhage.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Imaging tests (CT and/or magnetic resonance imaging) must be done to confirm a diagnosis of a simple cyst. Cystadenoma and cystadenocarcinoma should be ruled out, since laparoscopic fenestration would not be indicated. CT may aid in showing thick and irregular walls, septa, papillary inclusions and loculations. In endemic areas for hydatid disease, such as in our area, hydatid disease should be ruled out by means of serology (90–95% sensitivity), ultrasound and CT (95% specificity).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Simple liver cysts generally require neither treatment nor follow-up, unless they are giant (10−20 cm) and cause symptoms and/or complications. Various techniques have been reported for the treatment of such cysts, depending on their number, location, relationship to other structures and contents: aspiration with or without injection of sclerosing agents<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>, argon plasma coagulation in the cyst cavity wall (contraindicated if it is in contact with the biliary tract)<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>, deroofing and connection with the peritoneal cavity, cystojejunostomy, complete cyst excision, partial hepatectomy, liver lobectomy (in cases of suspected cyst malignancy) and even liver transplantation (in cases of liver dysfunction due to advanced polycystosis).</p><p id="par0055" class="elsevierStylePara elsevierViewall">At present, laparoscopic deroofing is the technique of choice, as reported by a recent systematic review of 62 studies with 1314 patients<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>, with a relapse rate similar to open surgery (25%), but with all the advantages a laparoscopic approach offers.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Laparoscopic deroofing is the technique of choice in symptomatic and/or complicated simple giant liver cysts.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Allue M, Palacios P, Jimenez A. Cuándo y cómo tratar los quistes hepáticos gigantes sintomáticos. Gastroenterol Hepatol. 2021;44:226–228.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1275 "Ancho" => 1500 "Tamanyo" => 188300 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1. Abdominal MRI: liver cyst measuring 20 cm in liver segment 6. It shows no wall enhancement following contrast administration (upper left). Case 2. Abdominal CT: cyst measuring 14 cm between liver segments 7 and 8 (upper right). Case 3. Abdominal CT: cyst measuring 18 cm. The upper portion features septations that raise suspicion of a hydatid cyst (lower left). Case 4. Abdominal CT: multiple liver cysts. The largest has a diameter of 12 cm (lower right).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Congenital simple hepatic cyst: a diagnostic and management challenge] Spanish" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Antunes" 1 => "H. Braga-Tavares" 2 => "I. Cunha" 3 => "V. Mendes" 4 => "A. Cadilhe" 5 => "J. Matos-Cruz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gastrohep.2008.09.014" "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Hepatol" "fecha" => "2009" "volumen" => "32" "paginaInicial" => "92" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19231681" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical management of a giant hepatic cyst with suspicious radiological features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Clancy" 1 => "C. Gibbons" 2 => "P.F. Ridgway" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1308/rcsann.2018.0206" "Revista" => array:7 [ "tituloSerie" => "Ann R Coll Surg Engl" "fecha" => "2019" "volumen" => "101" "paginaInicial" => "e76" "paginaFinal" => "e78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30482032" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0090825800957834" "estado" => "S300" "issn" => "00908258" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of aspiration sclerotherapy of simple hepatic cysts: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.F. Wijnands" 1 => "A.P. Görtjes" 2 => "T.J. Gevers" 3 => "S.F. Jenniskens" 4 => "L.J. Kool" 5 => "A. Potthoff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/AJR.16.16130" "Revista" => array:7 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2017" "volumen" => "208" "paginaInicial" => "201" "paginaFinal" => "207" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27824501" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028208048310" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Argon plasma coagulation therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Manner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MOG.0b013e32830bf825" "Revista" => array:7 [ "tituloSerie" => "Curr Opin Gastroenterol" "fecha" => "2008" "volumen" => "24" "paginaInicial" => "612" "paginaFinal" => "616" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19122503" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028202032272" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical response after laparoscopic fenestration of symptomatic hepatic cysts: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.H.P. Bernts" 1 => "S.G. Echternach" 2 => "W. Kievit" 3 => "C. Rosman" 4 => "J.P.H. Drenth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-018-6490-8" "Revista" => array:6 [ "tituloSerie" => "Surg Endosc" "fecha" => "2019" "volumen" => "33" "paginaInicial" => "691" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30334152" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004400000003/v1_202103190829/S2444382421000511/v1_202103190829/en/main.assets" "Apartado" => array:4 [ "identificador" => "77930" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004400000003/v1_202103190829/S2444382421000511/v1_202103190829/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382421000511?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 370 | 12 | 382 |
| 2024 September | 472 | 28 | 500 |
| 2024 August | 500 | 15 | 515 |
| 2024 July | 223 | 6 | 229 |
| 2024 June | 134 | 7 | 141 |
| 2024 May | 173 | 17 | 190 |
| 2024 April | 196 | 34 | 230 |
| 2024 March | 170 | 7 | 177 |
| 2024 February | 210 | 3 | 213 |
| 2024 January | 153 | 3 | 156 |
| 2023 December | 112 | 2 | 114 |
| 2023 November | 91 | 12 | 103 |
| 2023 October | 95 | 7 | 102 |
| 2023 September | 60 | 3 | 63 |
| 2023 August | 24 | 0 | 24 |
| 2023 July | 11 | 1 | 12 |
| 2023 June | 5 | 1 | 6 |
| 2023 May | 6 | 0 | 6 |
| 2023 April | 2 | 2 | 4 |
| 2023 March | 8 | 1 | 9 |
| 2023 February | 0 | 1 | 1 |
| 2023 January | 0 | 1 | 1 |
| 2022 December | 0 | 1 | 1 |
| 2022 October | 0 | 1 | 1 |
| 2022 September | 0 | 1 | 1 |
| 2022 July | 0 | 1 | 1 |
| 2022 June | 0 | 1 | 1 |
| 2022 April | 0 | 1 | 1 |
| 2022 March | 0 | 1 | 1 |
| 2022 January | 0 | 1 | 1 |
| 2021 December | 0 | 1 | 1 |
| 2021 November | 0 | 1 | 1 |
| 2021 July | 0 | 1 | 1 |
| 2021 May | 0 | 1 | 1 |
| 2021 April | 0 | 8 | 8 |
| 2021 March | 0 | 8 | 8 |
| 2021 February | 0 | 2 | 2 |
Show all
