Case report
Left main bronchus rupture during video-assisted thoracoscopic surgery resection of a bronchogenic cyst
Rutura do brônquio principal esquerdo durante a cirurgia torácica video-assistida de um quisto broncogénico
E. Peña, M. Blanco
, T. Otero
Corresponding author
Vigo University, Clinical Hospital, Vigo, Spain
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El Hammoumi, A. Traibi, F. El Oueriachi, A. Arsalane, E.H. Kabiri" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "El Hammoumi" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Traibi" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "El Oueriachi" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Arsalane" ] 4 => array:2 [ "nombre" => "E.H." "apellidos" => "Kabiri" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000305?idApp=UINPBA00004E" "url" => "/08732159/0000001900000006/v2_201509041406/S0873215913000305/v2_201509041406/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Left main bronchus rupture during video-assisted thoracoscopic surgery resection of a bronchogenic cyst" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "284" "paginaFinal" => "286" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Peña, M. Blanco, T. Otero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Peña" ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Blanco" "email" => array:1 [ 0 => "montseblancoramos@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Otero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Vigo University, Clinical Hospital, Vigo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Rutura do brônquio principal esquerdo durante a cirurgia torácica video-assistida de um quisto broncogénico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 764 "Ancho" => 1733 "Tamanyo" => 182670 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography showing a large bronchogenic cyst located in the subcarinal region narrowing left main bronchus (asterisk) and displacing esophagus (arrow). (B) Intraoperative thoracoscopy image in which we can observe the correlation with the CT image. Anterior displacement of the esophagus is (arrow) and the azygos vein is sectioned (rhombus).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 42-year-old man with no significant medical history was admitted to our institution, having been referred by his pulmonologist. He presented progressive dyspnea and chest discomfort over the previous three months. Routine chest X-ray showed an enlarged mediastinum. A computed tomography (CT) scan showed a well-circumscribed cyst, of 7<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>cm, in the middle and posterior mediastinum, causing the displacement of neighboring structures (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). We performed a magnetic resonance imaging (MRI) which showed a smooth-contoured cystic subcarinal mass with displacement of trachea and main bronchi and reduced caliber of the left main bronchus. Preoperative bronchoscopy excluded any communication between the cyst and the tracheobronchial tree. The patient was considered eligible for surgical treatment by a minimally invasive technique in the right hemithorax. He was intubated with a left-sided double-lumen endotracheal tube (37ch) to obtain one-lung ventilation. We used two port incisions, one in the seventh intercostal space along the posterior axillary line for the camera, and another of 4 cm on the fifth intercostal space along the anterior axillary line. The lung was trapped with pleural adhesions which had to be released in order to expose the lesion. The cystic mass was firmly attached to the adjacent lung parenchyma and chest wall. Once the cystic lesion was exposed, the mediastinal pleura were opened. The azygos vein was sectioned and the esophagus, which had been anteriorly displaced, was separated from the cyst (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Dissection at the subcarinal level resulted in a sudden, massive air leak. Difficulty in ventilating the patient necessitated conversion to a right thoracotomy. Once the cyst was aspirated and removed, we observed a rupture in the left main bronchus, the wall of which was very thin and had suffered loss of tissue. The rupture extended almost the whole distance from to the carina. We repaired the rupture and the patient was extubated. A fibrobronchoscopy was performed which showed that bronchus reconstruction had been unsuccessful. There was a torsion in the suture with severe stenosis. A few hours later the patient presented hypoxemia and a chest X-ray showed left lung atelectasis. We decided to re-operate through a left thoracotomy to reconstruct the suture. The aortic arch was mobilized and the ductus arteriosus was sectioned to expose the left side of the carina. Despite all our efforts, a safe anastomosis could not be assured so we decided on a left pneumonectomy. The bronchial stump was reinforced with Teflon pledgets (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and the patient recovered uneventfully and was discharged on postoperative day 7.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">Bronchogenic cysts which are rare in the general population are among the most common cystic lesions of the pediatric mediastinum and lung. The term bronchogenic is applied to all cysts originating from or with physical connection to the bronchial tree. Pathologically, BC are lined by respiratory ciliated columnar or cuboidal epithelium containing mucus glands. The accumulation of mucus results in the gradual enlargement of non-communicating BC.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although some BC are asymptomatic and diagnosed as incidental findings on radiographs, most are associated with clinical symptoms such as coughing, dyspnea, chest pain, and sputum.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Surgery is usually the treatment of choice for BC.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There is a general consensus on the need for surgery in symptomatic patients, but there is still controversy as to what is the best course in asymptomatic cases.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> In recent years, routine surgical procedures have evolved from thoracotomy to a thoracoscopic approach, with excellent results. This would seem to confirm that the appropriate treatment is resection of mediastinal cysts using thoracoscopic procedures.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">However, even though in some patients cysts may remain silent forever, once symptoms do arise, it has to be understood that surgery, although advocated, is definitely not an easy option due to the complicating anatomic factors.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Reports of intraoperative complications during removal of a BC show that these can include bleeding and bronchial rupture.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> In our case, the patient presented chest pain and dyspnea and the cyst was associated with severe adhesions to adjacent organs like the esophagus, carina and lung parenchyma. The sharp dissection required led to bronchial damage. This bronchial damage was thought to be related to inflammation due to infection, which generated strong adhesions between the bronchial and cystic wall. The cyst content had not been evacuated prior to removal. Aspiration of mucoidal liquid could have facilitated the exposure and the visualization of the cyst wall at the level of the bronchus rupture. At this stage, a portion of the cyst wall should have been left with ablation of the mucosal lining by electrocautery as reported by Read et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In summary, this report represents an account of a serious complication during the removal of a BC. We would like to emphasize the importance of paying particular attention when resecting mediastinal BC, especially when they are symptomatic and present adhesions.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres547687" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec565566" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres547686" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec565567" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-02-26" "fechaAceptado" => "2013-05-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565566" "palabras" => array:3 [ 0 => "Bronchogenic cyst" 1 => "Complications" 2 => "Thoracoscopy" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565567" "palabras" => array:3 [ 0 => "Quisto broncogénico" 1 => "Complicações" 2 => "Toracoscopia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Video-assisted thoracoscopic surgery (VATS) is an approach to resection of bronchogenic cysts (BC) which is effective and viable. There may be complications as a result of pericystic adhesions to neighboring structures during dissection. This report describes an unusual case of an operative complication, the rupture of the main left bronchus. The initial VATS approach was converted into a right thoracotomy to remove the cyst and suture the bronchus once adequate exposure was obtained. Bronchus reconstruction failed and a few hours later, it was necessary to perform a left thoracotomy. A left pneumonectomy was required after the attempt to reconstruct the anastomosis was ruled out. The conclusion is that great care should be taken when using VATS approach for BC with adhesions.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cirurgia torácica vídeo-assistida (VATS) é uma abordagem eficaz e viável na ressecção de cistos broncogénicos (BC). As complicações durante a dissecção podem dever-se a aderências pericisticas a estruturas vizinhas. Este artigo descreve um caso pouco comum de uma complicação operatória que consiste na rutura do brônquio principal esquerdo. A abordagem inicial VATS foi convertida a uma toracotomia direita para remover o cisto e proceder a sutura do brônquio uma vez obtida a exposição adequada. A reconstrução bronquial fracassou e algumas horas mais tarde foi necessário realizar a toracotomia esquerda. A pneumonectomia esquerda foi inevitável após a tentativa de reconstruir a anastomose ter sido descartada. Em conclusão, a abordagem VATS para o BC com adesões deve ser realizada/planificada com extremo cuidado.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 764 "Ancho" => 1733 "Tamanyo" => 182670 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Computed tomography showing a large bronchogenic cyst located in the subcarinal region narrowing left main bronchus (asterisk) and displacing esophagus (arrow). (B) Intraoperative thoracoscopy image in which we can observe the correlation with the CT image. Anterior displacement of the esophagus is (arrow) and the azygos vein is sectioned (rhombus).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1289 "Ancho" => 1000 "Tamanyo" => 356111 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intraoperative image, were can be observed the bronchial stump reinforced with Teflon pledgets and aortic arch mobilized.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mediastinal cyst and duplications in infants and children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. 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Schmid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2004.03.092" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2004" "volumen" => "78" "paginaInicial" => "987" "paginaFinal" => "991" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15337033" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laceration of the left pulmonary artery during removal of a bronchogenic cyst by right thoracotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.A. Barman" 1 => "A.S. Moideen" 2 => "S.S. Chaudhry" 3 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 58 | 27 | 85 |
| 2024 September | 59 | 27 | 86 |
| 2024 August | 81 | 35 | 116 |
| 2024 July | 68 | 39 | 107 |
| 2024 June | 63 | 52 | 115 |
| 2024 May | 65 | 41 | 106 |
| 2024 April | 72 | 35 | 107 |
| 2024 March | 63 | 23 | 86 |
| 2024 February | 49 | 29 | 78 |
| 2024 January | 42 | 25 | 67 |
| 2023 December | 49 | 26 | 75 |
| 2023 November | 48 | 42 | 90 |
| 2023 October | 47 | 39 | 86 |
| 2023 September | 35 | 30 | 65 |
| 2023 August | 35 | 20 | 55 |
| 2023 July | 33 | 34 | 67 |
| 2023 June | 26 | 16 | 42 |
| 2023 May | 52 | 20 | 72 |
| 2023 April | 44 | 26 | 70 |
| 2023 March | 64 | 21 | 85 |
| 2023 February | 37 | 14 | 51 |
| 2023 January | 32 | 19 | 51 |
| 2022 December | 45 | 16 | 61 |
| 2022 November | 77 | 35 | 112 |
| 2022 October | 60 | 33 | 93 |
| 2022 September | 31 | 32 | 63 |
| 2022 August | 46 | 35 | 81 |
| 2022 July | 49 | 50 | 99 |
| 2022 June | 35 | 34 | 69 |
| 2022 May | 48 | 38 | 86 |
| 2022 April | 37 | 27 | 64 |
| 2022 March | 40 | 57 | 97 |
| 2022 February | 43 | 30 | 73 |
| 2022 January | 41 | 36 | 77 |
| 2021 December | 39 | 40 | 79 |
| 2021 November | 53 | 33 | 86 |
| 2021 October | 28 | 47 | 75 |
| 2021 September | 27 | 25 | 52 |
| 2021 August | 36 | 26 | 62 |
| 2021 July | 33 | 26 | 59 |
| 2021 June | 41 | 30 | 71 |
| 2021 May | 49 | 22 | 71 |
| 2021 April | 66 | 67 | 133 |
| 2021 March | 113 | 20 | 133 |
| 2021 February | 74 | 17 | 91 |
| 2021 January | 51 | 21 | 72 |
| 2020 December | 34 | 13 | 47 |
| 2020 November | 49 | 20 | 69 |
| 2020 October | 59 | 19 | 78 |
| 2020 September | 82 | 27 | 109 |
| 2020 August | 111 | 24 | 135 |
| 2020 July | 154 | 23 | 177 |
| 2020 June | 143 | 20 | 163 |
| 2020 May | 143 | 17 | 160 |
| 2020 April | 136 | 4 | 140 |
| 2020 March | 112 | 12 | 124 |
| 2020 February | 95 | 11 | 106 |
| 2020 January | 129 | 13 | 142 |
| 2019 December | 101 | 16 | 117 |
| 2019 November | 122 | 12 | 134 |
| 2019 October | 131 | 22 | 153 |
| 2019 September | 119 | 19 | 138 |
| 2019 August | 115 | 13 | 128 |
| 2019 July | 125 | 25 | 150 |
| 2019 June | 117 | 14 | 131 |
| 2019 May | 144 | 10 | 154 |
| 2019 April | 133 | 29 | 162 |
| 2019 March | 113 | 14 | 127 |
| 2019 February | 99 | 6 | 105 |
| 2019 January | 137 | 33 | 170 |
| 2018 December | 96 | 4 | 100 |
| 2018 November | 32 | 1 | 33 |
| 2018 October | 59 | 10 | 69 |
| 2018 September | 28 | 6 | 34 |
| 2018 August | 39 | 34 | 73 |
| 2018 July | 46 | 14 | 60 |
| 2018 June | 48 | 17 | 65 |
| 2018 May | 63 | 20 | 83 |
| 2018 April | 82 | 20 | 102 |
| 2018 March | 87 | 21 | 108 |
| 2018 February | 48 | 8 | 56 |
| 2018 January | 43 | 21 | 64 |
| 2017 December | 35 | 5 | 40 |
| 2017 November | 49 | 13 | 62 |
| 2017 October | 47 | 23 | 70 |
| 2017 September | 51 | 22 | 73 |
| 2017 August | 54 | 12 | 66 |
| 2017 July | 39 | 17 | 56 |
| 2017 June | 44 | 25 | 69 |
| 2017 May | 39 | 24 | 63 |
| 2017 April | 23 | 8 | 31 |
| 2017 March | 30 | 10 | 40 |
| 2017 February | 17 | 17 | 34 |
| 2017 January | 20 | 11 | 31 |
| 2016 December | 13 | 11 | 24 |
| 2016 November | 20 | 9 | 29 |
| 2016 October | 26 | 11 | 37 |
| 2016 September | 26 | 7 | 33 |
| 2016 August | 10 | 4 | 14 |
| 2016 July | 8 | 12 | 20 |
| 2016 June | 0 | 3 | 3 |
| 2016 April | 42 | 2 | 44 |
| 2016 March | 59 | 8 | 67 |
| 2016 February | 84 | 18 | 102 |
| 2016 January | 44 | 16 | 60 |
| 2015 December | 63 | 9 | 72 |
| 2015 November | 46 | 11 | 57 |
| 2015 October | 47 | 10 | 57 |
| 2015 September | 48 | 8 | 56 |
| 2015 August | 46 | 29 | 75 |
| 2015 July | 50 | 6 | 56 |
| 2015 June | 36 | 20 | 56 |
| 2015 May | 63 | 8 | 71 |
| 2015 April | 51 | 9 | 60 |
| 2015 March | 58 | 7 | 65 |
| 2015 February | 55 | 3 | 58 |
| 2015 January | 57 | 13 | 70 |
| 2014 December | 67 | 15 | 82 |
| 2014 November | 55 | 14 | 69 |
| 2014 October | 64 | 12 | 76 |
| 2014 September | 54 | 25 | 79 |
| 2014 August | 65 | 14 | 79 |
| 2014 July | 69 | 13 | 82 |
| 2014 June | 62 | 21 | 83 |
| 2014 May | 62 | 22 | 84 |
| 2014 April | 62 | 17 | 79 |
| 2014 March | 72 | 17 | 89 |
| 2014 February | 68 | 30 | 98 |
| 2014 January | 81 | 39 | 120 |
| 2013 December | 91 | 46 | 137 |
| 2013 November | 86 | 29 | 115 |
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