Foco solitario hepático no neoplástico en el rastreo corporal con 131-yodo de un paciente con cáncer de tiroides
Solitary focus in the liver in a thyroid cancer patient after a whole body scan with 131 iodine
Read
3214
Timeswas read the article
394
Total PDF
2820
Total HTML
Share statistics
array:20 [ "pii" => "13109144" "issn" => "2253654X" "doi" => "10.1157/13109144" "estado" => "S300" "fechaPublicacion" => "2007-09-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2007;26:294-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3230 "formatos" => array:3 [ "EPUB" => 21 "HTML" => 2815 "PDF" => 394 ] ] "itemSiguiente" => array:16 [ "pii" => "13109151" "issn" => "2253654X" "doi" => "10.1157/13109151" "estado" => "S300" "fechaPublicacion" => "2007-09-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2007;26:297-302" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 7392 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 6748 "PDF" => 636 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Metástasis óseas de tumor primario desconocido. Detección mediante PET-FDG de dos tumores sincrónicos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "297" "paginaFinal" => "302" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bone metastases from unknown primary. FDG-PET detection of two sincronic tumors" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "125v26n05-13109151fig01.jpg" "Alto" => 1049 "Ancho" => 945 "Tamanyo" => 235518 ] ] "descripcion" => array:1 [ "es" => "--Gammagrafía ósea de cuerpo completo. Se observan depósitos focales del trazador en ambas parrillas costales, vértebra D9 y pala ilíaca izquierda." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "JI Cuenca Cuenca, I Borrego Dorado, JR Rodríguez Rodríguez, E Navarro González, R Vázquez Albertino" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "JI" "apellidos" => "Cuenca Cuenca" ] 1 => array:2 [ "Iniciales" => "I" "apellidos" => "Borrego Dorado" ] 2 => array:2 [ "Iniciales" => "JR" "apellidos" => "Rodríguez Rodríguez" ] 3 => array:2 [ "Iniciales" => "E" "apellidos" => "Navarro González" ] 4 => array:2 [ "Iniciales" => "R" "apellidos" => "Vázquez Albertino" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13109151?idApp=UINPBA00004N" "url" => "/2253654X/0000002600000005/v0_201308011112/13109151/v0_201308011113/es/main.assets" ] "itemAnterior" => array:16 [ "pii" => "13109143" "issn" => "2253654X" "doi" => "10.1157/13109143" "estado" => "S300" "fechaPublicacion" => "2007-09-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Med Nucl Imagen Mol. 2007;26:286-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3552 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 2903 "PDF" => 643 ] ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "¿Se solicitan las gammagrafías óseas en pacientes oncológicos según criterios clínicos reconocidos?" "tienePdf" => array:2 [ 0 => "es" 1 => "en" ] "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "286" "paginaFinal" => "293" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Are bone scintigraphy examinations requested in oncologic patients according to established indications?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:2 [ "es" => true "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M Cortés Romera, MP Talavera Rubio, AM García Vicente, S Ruiz Solís, VM Poblete García, B Rodríguez Alfonso, A Palomar Muñoz, A Soriano Castrejón" "autores" => array:8 [ 0 => array:2 [ "Iniciales" => "M" "apellidos" => "Cortés Romera" ] 1 => array:2 [ "Iniciales" => "MP" "apellidos" => "Talavera Rubio" ] 2 => array:2 [ "Iniciales" => "AM" "apellidos" => "García Vicente" ] 3 => array:2 [ "Iniciales" => "S" "apellidos" => "Ruiz Solís" ] 4 => array:2 [ "Iniciales" => "VM" "apellidos" => "Poblete García" ] 5 => array:2 [ "Iniciales" => "B" "apellidos" => "Rodríguez Alfonso" ] 6 => array:2 [ "Iniciales" => "A" "apellidos" => "Palomar Muñoz" ] 7 => array:2 [ "Iniciales" => "A" "apellidos" => "Soriano Castrejón" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13109143?idApp=UINPBA00004N" "url" => "/2253654X/0000002600000005/v0_201308011112/13109143/v0_201308011112/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Foco solitario hepático no neoplástico en el rastreo corporal con 131-yodo de un paciente con cáncer de tiroides" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "294" "paginaFinal" => "296" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "FJ Pena Pardo, A Crespo de la Jara, FJ Fernández Morejón, M Sureda González, J Forteza Vila, A Brugarolas Masllorens" "autores" => array:6 [ 0 => array:3 [ "Iniciales" => "FJ" "apellidos" => "Pena Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "A" "apellidos" => "Crespo de la Jara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "FJ" "apellidos" => "Fernández Morejón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 3 => array:3 [ "Iniciales" => "M" "apellidos" => "Sureda González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 4 => array:3 [ "Iniciales" => "J" "apellidos" => "Forteza Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 5 => array:3 [ "Iniciales" => "A" "apellidos" => "Brugarolas Masllorens" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Medicina Nuclear. Plataforma de Oncología. USP Hospital San Jaime. Torrevieja. Alicante. España." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Anatomía Patológica. Plataforma de Oncología. USP Hospital San Jaime. Torrevieja. Alicante. España." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Oncología Médica. Plataforma de Oncología. USP Hospital San Jaime. Torrevieja. Alicante. España." "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Solitary focus in the liver in a thyroid cancer patient after a whole body scan with 131 iodine" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "125v26n05-13109144fig01.jpg" "Alto" => 1137 "Ancho" => 1469 "Tamanyo" => 534274 ] ] "descripcion" => array:1 [ "en" => "--Posterior view of whole body scan after therapeutic dose of 131I. A focal uptake close to liver dome was shown together with locoregional uptake at thyroid bed and neck in the post-ablation scan (A). Another scan six months after did not show liver uptake (B)." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Total or near-total thyroidectomy followed by ablation of remnants with <span class="elsevierStyleSup">131</span>I is the established method for treatment of well-differentiated thyroid cancer. The whole body iodine scan is a sensitive tool for detecting metastases from that kind of tumor. The normal pattern of <span class="elsevierStyleSup">131</span>I distribution is widely known and any abnormal uptake ­ remnants in thyroid bed apart - usually means a metastasis. Nevertheless, the possibility of false positive findings exists and we must take it into account. We report the case of a liver abscess presented as iodine focal uptake mimicking a metastasis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CASE REPORT</span></p><p class="elsevierStylePara">A 51-year-old woman diagnosed with follicular variant of papillary thyroid carcinoma underwent a total thyroidectomy followed four weeks later by an ablative dose of 3.7 GBq of <span class="elsevierStyleSup">131</span>I. A whole body scan 5 days after showed an intense uptake within the thyroid bed and another two deposits on the right lateral cervical and submaxillary areas. It was also evident in the posterior view of the scan a focal uptake localized at right lung base or liver dome (fig. 1A). A further computed tomography (CT) revealed a hypodense hepatic node of 18 mm in the segment VII resembling a liver metastasis (fig. 2). Pathology from an ultrasound-guided fine-needle aspiration showed necrotic areas with polymorphonuclear leukocytes and granulation tissue with fibroblastic proliferation. There were no malignant cells. Surrounding hepatic parenchyma presented reactive hepatitis and minimal peliotic changes. Although specific staining techniques (PAS, Grocott, Giemsa, and Ziehl-Neelsen) were negative, a diagnosis of liver abscess was established.</p><p class="elsevierStylePara"><img src="125v26n05-13109144fig01.jpg"></img></p><p class="elsevierStylePara"> Fig. 1.--<span class="elsevierStyleItalic">Posterior view of whole body scan after therapeutic dose of <span class="elsevierStyleSup">131</span>I. A focal uptake close to liver dome was shown together with locoregional uptake at thyroid bed and neck in the post-ablation scan (A). Another scan six months after did not show liver uptake (B).</span></p><p class="elsevierStylePara"><img src="125v26n05-13109144fig02.jpg"></img></p><p class="elsevierStylePara"> Fig. 2.--<span class="elsevierStyleItalic">A computed tomography scan confirmed the liver location of the aforementioned lesion.</span></p><p class="elsevierStylePara">The patient received antibiotherapy with Trimethoprim/ sulphamethoxazole at doses of 160/800 mg every 12 hours for three weeks. The control CT showed a decrease in the size of the lesion. An iodine whole body scan six months after revealed only a local focus at neck ­ the liver uptake had disappeared ­ (fig. 1B).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">Liver metastases from papillary thyroid carcinoma are uncommon. In fact, in a large series at the Mayo Clinic, only 1 % of patients presented distant metastases localized at liver<span class="elsevierStyleSup">1</span>.</p><p class="elsevierStylePara">On the other hand, false positive findings for malignancies of <span class="elsevierStyleSup">131</span>I whole body scans have been described previously. There are four major causes of false positive scans: physiological secretions, pathological exudates or transudates, infection/inflammation, and non-thyroid tumors. The diffuse hepatic uptake on late post-therapy scans is physiological and probably represents accumulation of iodoproteins due to the metabolism of thyroid hormones. A focal uptake might represent a metastasis (rare in papillary carcinomas) or be a pitfall related to other causes (cysts, inflammation or infection, non-thyroidal neoplasms, etc.)<span class="elsevierStyleSup">2-5</span>. The gallbladder may lead to misinterpretations too; nevertheless, this was not the case because the focus ­localized at the top of the liver­ was shown only in the posterior view.</p><p class="elsevierStylePara">Besides pathological analysis, the reduction in CT lesion size, the absence of similar uptake in the control <span class="elsevierStyleSup">131</span>I whole body scan six months after antibiotherapy, and the lack of specific cancer treatment support our diagnosis.</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleItalic"> Correspondence:</span><br></br> F.J. Pena Pardo.<br></br> Partida de la Loma, s/n.<br></br> 03180 Torrevieja. Alicante. España.<br></br> Correo electrónico: <a href="mailto:patxi.pena@usphospitales.com" class="elsevierStyleCrossRefs"> patxi.pena@usphospitales.com</a>/ <a href="mailto:aurora.crespo@usphospitales.com" class="elsevierStyleCrossRefs"> aurora.crespo@usphospitales.com</a></p>" "pdfFichero" => "125v26n05a13109144pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec233046" "palabras" => array:1 [ 0 => "iodine, pitfalls, liver abscess, thyroid cancer, papillary thyroid carcinoma" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec233047" "palabras" => array:1 [ 0 => "yodo, falsos positivos, absceso hepático, cáncer de tiroides, carcinoma papilar de tiroides" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Se presenta el caso de una mujer de 51 años diagnosticada de carcinoma papilar de tiroides, variante folicular, sometida a tiroidectomía total seguida 4 semanas después por una dosis ablativa de 3,7 GBq de <span class="elsevierStyleSup">131</span>I. El rastreo corporal total a los 5 días mostró una intensa captación en el lecho tiroideo, y una captación focal localizada en la base del pulmón derecho o la cúpula hepática. La tomografía axial computarizada subsecuente reveló un nódulo hipodenso en el segmento VII hepático, sugestivo de metástasis. El estudio patológico del material obtenido mediante punción-aspiración con aguja fina (PAAF) lo caracterizó como absceso hepático. Tras tratamiento antibiótico se objetivó regresión del mismo. Las metástasis hepáticas de carcinoma papilar de tiroides son infrecuentes y, por otro lado, se han descrito con anterioridad falsos positivos del rastreo con <span class="elsevierStyleSup">131</span>I. Una captación focal hepática podría representar una metástasis (rara en carcinomas papilares) o estar relacionada con otras causas (quistes, inflamación o infección, tumores no tiroideos, etc.)" ] "en" => array:1 [ "resumen" => "A 51-year-old woman diagnosed with follicular variant of papillary thyroid carcinoma underwent a total thyroidectomy followed four weeks later by an ablative dose of 3.7 GBq of <span class="elsevierStyleSup">131</span>I. A whole body scan 5 days after ablation showed an intense uptake within the thyroid bed and a focal uptake located in the right lung base or liver dome. Computed tomography examination revealed a hypodense hepatic node in segment VII resembling a liver metastasis. Histological examination after ultrasound-guided fine-needle aspiration characterized the lesion as a liver abscess. The abscess regressed after antibiotic therapy. Liver metastases from papillary thyroid carcinoma are uncommon. On the other hand, false positive findings of <span class="elsevierStyleSup">131</span>I whole body scans have been described. A focal hepatic uptake might represent a metastasis (rare in papillary carcinomas) or be related to other causes (cysts, inflammation or infection, non-thyroidal neoplasms, etc.)." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "125v26n05-13109144fig01.jpg" "Alto" => 1137 "Ancho" => 1469 "Tamanyo" => 534274 ] ] "descripcion" => array:1 [ "en" => "--Posterior view of whole body scan after therapeutic dose of 131I. A focal uptake close to liver dome was shown together with locoregional uptake at thyroid bed and neck in the post-ablation scan (A). Another scan six months after did not show liver uptake (B)." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "125v26n05-13109144fig02.jpg" "Alto" => 747 "Ancho" => 945 "Tamanyo" => 207981 ] ] "descripcion" => array:1 [ "en" => "--A computed tomography scan confirmed the liver location of the aforementioned lesion." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Dinneen SF" 1 => "Valimaki MJ" 2 => "Bergstralh EJ" 3 => "Goellner JR" 4 => "Gorman CA" 5 => "Hay ID." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jcem.80.7.7608252" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "1995" "volumen" => "80" "paginaInicial" => "2041" "paginaFinal" => "5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7608252" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The scope of false-positive iodine-131 images for thyroid carcinoma." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Greenler DP" 1 => "Klein HA." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "1989" "volumen" => "14" "paginaInicial" => "111" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2731388" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "False positive 131I whole body scans in thyroid cancer." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Mitchell G" 1 => "Pratt BE" 2 => "Vini L" 3 => "McCready VR" 4 => "Harmer CL." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr.73.870.10911786" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2000" "volumen" => "73" "paginaInicial" => "627" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10911786" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The interpretation of 131I scans in the evaluation of thyroid cancer, with an emphasis on false positive findings." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Carlisle MR" 1 => "Lu C" 2 => "McDougall IR." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.mnm.0000075202.18521.ab" "Revista" => array:6 [ "tituloSerie" => "Nucl Med Commun" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "715" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12766609" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "False-positive I-131 accumulation in a liver cyst in a patient with thyroid carcinoma." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Okuyama C" 1 => "Ushijima Y" 2 => "Kikkawa M" 3 => "Yamagami T" 4 => "Nakamura T" 5 => "Kobayashi K" 6 => "et al." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "198" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11245109" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2253654X/0000002600000005/v0_201308011112/13109144/v0_201308011112/en/main.assets" "Apartado" => array:4 [ "identificador" => "17616" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Notas clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000002600000005/v0_201308011112/13109144/v0_201308011112/en/125v26n05a13109144pdf001.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13109144?idApp=UINPBA00004N" ]
Article information
ISSN: 2253654XOriginal language: English
DOI:10.1157/13109144
The statistics are updated each day
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2023 February | 1 | 0 | 1 |
| 2022 January | 3 | 0 | 3 |
| 2018 September | 1 | 2 | 3 |
| 2018 February | 11 | 1 | 12 |
| 2018 January | 16 | 0 | 16 |
| 2017 December | 10 | 3 | 13 |
| 2017 November | 15 | 8 | 23 |
| 2017 October | 19 | 4 | 23 |
| 2017 September | 23 | 20 | 43 |
| 2017 August | 17 | 17 | 34 |
| 2017 July | 20 | 22 | 42 |
| 2017 June | 24 | 28 | 52 |
| 2017 May | 30 | 9 | 39 |
| 2017 April | 39 | 10 | 49 |
| 2017 March | 60 | 3 | 63 |
| 2017 February | 40 | 10 | 50 |
| 2017 January | 31 | 3 | 34 |
| 2016 December | 38 | 4 | 42 |
| 2016 November | 41 | 3 | 44 |
| 2016 October | 36 | 9 | 45 |
| 2016 September | 32 | 3 | 35 |
| 2016 August | 24 | 7 | 31 |
| 2016 July | 39 | 1 | 40 |
| 2016 June | 35 | 14 | 49 |
| 2016 May | 40 | 20 | 60 |
| 2016 April | 25 | 14 | 39 |
| 2016 March | 36 | 15 | 51 |
| 2016 February | 28 | 18 | 46 |
| 2016 January | 23 | 24 | 47 |
| 2015 December | 24 | 7 | 31 |
| 2015 November | 44 | 13 | 57 |
| 2015 October | 42 | 14 | 56 |
| 2015 September | 26 | 10 | 36 |
| 2015 August | 37 | 7 | 44 |
| 2015 July | 17 | 5 | 22 |
| 2015 June | 17 | 1 | 18 |
| 2015 May | 18 | 6 | 24 |
| 2015 April | 31 | 11 | 42 |
| 2015 March | 29 | 9 | 38 |
| 2015 February | 24 | 7 | 31 |
| 2015 January | 29 | 1 | 30 |
| 2014 December | 47 | 5 | 52 |
| 2014 November | 36 | 1 | 37 |
| 2014 October | 45 | 3 | 48 |
| 2014 September | 27 | 2 | 29 |
| 2014 August | 34 | 1 | 35 |
| 2014 July | 38 | 1 | 39 |
| 2014 June | 45 | 0 | 45 |
| 2014 May | 38 | 0 | 38 |
| 2014 April | 31 | 1 | 32 |
| 2014 March | 34 | 1 | 35 |
| 2014 February | 15 | 1 | 16 |
| 2014 January | 24 | 2 | 26 |
| 2013 December | 20 | 2 | 22 |
| 2013 November | 16 | 1 | 17 |
| 2013 October | 26 | 1 | 27 |
| 2013 September | 17 | 5 | 22 |
| 2013 August | 20 | 4 | 24 |
| 2013 July | 9 | 0 | 9 |
| 2007 August | 1202 | 0 | 1202 |
Show all
