Case and Research Letter
Successful Treatment of Leiomyoma of the Nipple With Carbon Dioxide Laser
Buenos resultados tras tratamiento con láser CO2 de leiomioma en el pezón
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Epidermis hiperqueratósica bajo la que se observa una tumoración dérmica no encapsulada formada por haces entremezclados de células fusiformes y eosinófilas (H-E ×<span class="elsevierStyleHsp" style=""></span>5). B. Positividad a la tinción de actina de músculo liso (×<span class="elsevierStyleHsp" style=""></span>5).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. López, I. López, J. Alcacer, J.M. Ricart" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "López" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "López" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Alcacer" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Ricart" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219013002461" "doi" => "10.1016/j.adengl.2013.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002461?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013002068?idApp=UINPBA000044" "url" => "/00017310/0000010400000010/v1_201311281152/S0001731013002068/v1_201311281152/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219013002473" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.10.019" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "756" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:930-1" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2052 "formatos" => array:3 [ "EPUB" => 47 "HTML" => 1388 "PDF" => 617 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Acute Generalized Exanthematous Pustulosis Induced by Galantamine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "930" "paginaFinal" => "931" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pustulosis exantemática aguda generalizada inducida por galantamina" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 227994 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Subcorneal pustule and perivascular infiltrate of lymphocytes and eosinophils. Hematoxylin-eosin, original magnification ×40.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.P. Pérez-García, J.M. Sánchez Motillas, A. Mateu-Puchades, T. Díaz-Corpas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.P." "apellidos" => "Pérez-García" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Sánchez Motillas" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Mateu-Puchades" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Díaz-Corpas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731012004863" "doi" => "10.1016/j.ad.2012.10.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731012004863?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013002473?idApp=UINPBA000044" "url" => "/15782190/0000010400000010/v1_201311281142/S1578219013002473/v1_201311281142/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157821901300245X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.12.011" "estado" => "S300" "fechaPublicacion" => "2013-12-01" "aid" => "794" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2013;104:926-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2766 "formatos" => array:3 [ "EPUB" => 44 "HTML" => 2386 "PDF" => 336 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Usefulness of Immunohistochemial Staining With Antitrepenomal Antibodies in the Diagnosis of Syphilis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "926" "paginaFinal" => "928" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la inmunohistoquímica con anticuerpos antitreponema en el diagnóstico de la sífilis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 950 "Ancho" => 951 "Tamanyo" => 233516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Biopsy of the lesion shown in Figure 1. Upper image: intense inflammatory infiltrate with a predominance of plasma cells (hematoxylin-eosin, original magnification × 50). Lower panel: IHC of the same biopsy (original magnification × 400) showing infiltration of treponemata, which appear as brownish bead-like structures.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Hernández, R. Fúnez, B. Repiso, M. Frieyro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Hernández" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Fúnez" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Repiso" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Frieyro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731013000161" "doi" => "10.1016/j.ad.2012.12.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013000161?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300245X?idApp=UINPBA000044" "url" => "/15782190/0000010400000010/v1_201311281142/S157821901300245X/v1_201311281142/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Successful Treatment of Leiomyoma of the Nipple With Carbon Dioxide Laser" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "928" "paginaFinal" => "930" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. López, I. López, J. Alcacer, J.M. Ricart" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "López" "email" => array:2 [ 0 => "veronica_17@live.com" 1 => "veronical_c@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Alcacer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Ricart" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Dermiláser, Hospital Quirón, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Quirón, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Buenos resultados tras tratamiento con láser CO<span class="elsevierStyleInf">2</span> de leiomioma en el pezón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 982 "Ancho" => 1488 "Tamanyo" => 614107 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratotic epidermis under which there is an unencapsulated dermal tumor composed of interwoven bundles of eosinophilic spindle cells (hematoxylin-eosin, original magnification ×100; inset, further magnification ×5). B, Positive staining for smooth muscle actin (hematoxylin-eosin, original magnification ×100; inset, further magnification ×5).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Genital leiomyomas are the least common type of leiomyomas and those located on the nipple or areola are extremely rare.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> To date, their treatment with carbon dioxide (CO<span class="elsevierStyleInf">2</span>) laser has not been reported in the literature.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 33-year-old woman with no relevant past medical history who presented with a skin lesion on the left nipple; the lesion had been stable since its appearance in adolescence. The patient reported mild tenderness and great impact on personal appearance as the reasons for seeking treatment. The examination revealed elongation of the left nipple secondary to the presence of a well-defined, firm nodular lesion that was the same color as the nipple and about 15<span class="elsevierStyleHsp" style=""></span>mm in diameter; there were no signs of nipple retraction (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The rest of the left breast and the right breast revealed no significant findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology of the lesion revealed a hyperkeratotic epidermis with increased pigmentation of the basal layer and, in the dermis, the presence of a poorly defined, unencapsulated tumor composed of multiple interwoven bundles of smooth muscle formed by cells with ovoid nuclei and eosinophilic cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). No atypical cells or mitoses were observed. Staining for smooth muscle actin was positive (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). In view of these clinical and histologic findings, the lesions was diagnosed as a genital leiomyoma. Under local anesthesia with mepivacaine 2%, the rest of the lesion was removed with a Sharplan CO<span class="elsevierStyleInf">2</span> laser in unfocused mode with an irradiance of 55<span class="elsevierStyleHsp" style=""></span>W/cm<span class="elsevierStyleSup">2</span> and a spot size of 3<span class="elsevierStyleHsp" style=""></span>mm. The lesion was treated in a single session with 5 to 8 passes; between each pass the coagulated tissue was removed until there was no visible sign of the leiomyoma. After 1 treatment session much of the lesion had been removed with good cosmetic and functional results. No recurrence was detected 20 months after treatment (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Cutaneous leiomyomas are rare, benign tumors. They are classified into 3 categories according to the muscle fibers from which they originate: piloleiomyoma, originating from the smooth muscle fibers of the arrector pili muscle; angioleiomyoma, originating from the tunica media of the blood vessels; and dartoic or genital leiomyoma, originating from the smooth muscles of the scrotum, vulva, nipple, or areola. Genital leiomyomas are the least common type and those located on the nipple or areola are extremely rare.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Leiomyomas of the nipple and areola, first described in 1854 by Virchow, present as small, solitary nodular lesions covered with healthy skin that can exceptionally cause nipple retraction and spread to the underlying breast tissue.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The lesions are usually asymptomatic but in rare cases can cause pain spontaneously or in response to stimuli such as cold, pressure, or emotional stress.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Histologically, they are poorly defined, unencapsulated skin tumors composed of bundles of spindle cells with abundant eosinophilic cytoplasm and elongated nuclei with blunt ends, arranged in an interwoven pattern. The epidermis is usually unaffected because it is separated from the tumors by a free zone of dermis; cellular mitosis and atypia are rare.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Leiomyomas are positive for vimentin, desmin, and smooth muscle actin.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Differential diagnosis with the following diseases should be considered: Paget disease, fibroma, adenoma of the nipple, lymphadenosis benigna cutis, leiomyosarcoma of the areola, erosive adenomatosis of the nipple, and myoid hamartoma.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Several treatment modalities are used. In cases involving pain it can be useful to use calcium channel blockers or α–blockers, which inhibit contraction of muscle fibers. Isolated cases have been treated with cryotherapy, nitroglycerin, hyoscine hydrobromide, lidocaine, and analgesics.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In addition to medical treatment, surgical excision is also an option. However, surgery is sometimes contraindicated because of patient factors or because the lesions, as in our patient, are located in areas that require a good cosmetic result. CO<span class="elsevierStyleInf">2</span> laser removal has been used to treat cutaneous leiomyoma with good results,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but to date no cases of genital leiomyoma treated with this modality have been reported. CO<span class="elsevierStyleInf">2</span> laser emits light in the infrared spectrum at a wavelength of 10 600<span class="elsevierStyleHsp" style=""></span>nm, which is absorbed by water. The laser vaporizes the skin and causes coagulative necrosis in the remaining dermis. CO<span class="elsevierStyleInf">2</span> laser treatment is advantageous mainly because the procedure is rapid and enables precise selection of tissue. The technique is safe, as tissue damage is specific, with highly localized destruction, minimal damage to surrounding tissue, and minimal bleeding because it promotes coagulation. An alternative to the CO<span class="elsevierStyleInf">2</span> laser is the erbium-doped yttrium aluminum garnet (Er:YAG) laser, which emits light in the infrared spectrum at a wavelength of 2900<span class="elsevierStyleHsp" style=""></span>nm and can vaporize the skin at a lower penetration depth than the CO<span class="elsevierStyleInf">2</span> laser. The Er:YAG laser produces little thermal damage to the underlying tissue because of its high water absorption coefficient. However, this effective absorption limits the transmission of heat to the deep layers, where it may be insufficient to promote coagulation and prevent bleeding during surgery.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a case of a rare disease in which CO<span class="elsevierStyleInf">2</span> laser treatment provided very satisfactory cosmetic results. We believe that this technique can be considered a good option in cases in which surgery is not possible or is contraindicated.</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: López V, López I, Alcacer J, Ricart JM. Buenos resultados tras tratamiento con láser CO<span class="elsevierStyleInf">2</span> de leiomioma en el pezón. Actas Dermosifiliogr. 2013;104:928–930.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 707 "Ancho" => 1001 "Tamanyo" => 87636 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Skin lesion located on the patient's left nipple.</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" => 982 "Ancho" => 1488 "Tamanyo" => 614107 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratotic epidermis under which there is an unencapsulated dermal tumor composed of interwoven bundles of eosinophilic spindle cells (hematoxylin-eosin, original magnification ×100; inset, further magnification ×5). B, Positive staining for smooth muscle actin (hematoxylin-eosin, original magnification ×100; inset, further magnification ×5).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 375 "Ancho" => 1001 "Tamanyo" => 53715 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Excellent result 12 months after treatment with CO<span class="elsevierStyleInf">2</span> laser.</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" => "Multiple cutaneous leiomyomas of the nipple" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 8 | 26 |
| 2024 October | 123 | 56 | 179 |
| 2024 September | 148 | 24 | 172 |
| 2024 August | 164 | 58 | 222 |
| 2024 July | 118 | 42 | 160 |
| 2024 June | 124 | 35 | 159 |
| 2024 May | 105 | 28 | 133 |
| 2024 April | 96 | 26 | 122 |
| 2024 March | 90 | 27 | 117 |
| 2024 February | 101 | 39 | 140 |
| 2024 January | 83 | 34 | 117 |
| 2023 December | 82 | 12 | 94 |
| 2023 November | 98 | 28 | 126 |
| 2023 October | 84 | 15 | 99 |
| 2023 September | 83 | 32 | 115 |
| 2023 August | 55 | 23 | 78 |
| 2023 July | 75 | 38 | 113 |
| 2023 June | 67 | 33 | 100 |
| 2023 May | 69 | 31 | 100 |
| 2023 April | 72 | 25 | 97 |
| 2023 March | 75 | 29 | 104 |
| 2023 February | 82 | 27 | 109 |
| 2023 January | 72 | 32 | 104 |
| 2022 December | 87 | 49 | 136 |
| 2022 November | 57 | 29 | 86 |
| 2022 October | 56 | 22 | 78 |
| 2022 September | 57 | 42 | 99 |
| 2022 August | 69 | 52 | 121 |
| 2022 July | 60 | 37 | 97 |
| 2022 June | 77 | 22 | 99 |
| 2022 May | 163 | 45 | 208 |
| 2022 April | 124 | 41 | 165 |
| 2022 March | 122 | 51 | 173 |
| 2022 February | 75 | 22 | 97 |
| 2022 January | 114 | 40 | 154 |
| 2021 December | 97 | 33 | 130 |
| 2021 November | 108 | 57 | 165 |
| 2021 October | 92 | 60 | 152 |
| 2021 September | 78 | 45 | 123 |
| 2021 August | 83 | 28 | 111 |
| 2021 July | 77 | 39 | 116 |
| 2021 June | 78 | 20 | 98 |
| 2021 May | 92 | 33 | 125 |
| 2021 April | 161 | 53 | 214 |
| 2021 March | 141 | 22 | 163 |
| 2021 February | 72 | 17 | 89 |
| 2021 January | 51 | 22 | 73 |
| 2020 December | 82 | 15 | 97 |
| 2020 November | 32 | 11 | 43 |
| 2020 October | 38 | 5 | 43 |
| 2020 September | 54 | 5 | 59 |
| 2020 August | 27 | 21 | 48 |
| 2020 July | 28 | 14 | 42 |
| 2020 June | 28 | 25 | 53 |
| 2020 May | 27 | 19 | 46 |
| 2020 April | 29 | 14 | 43 |
| 2020 March | 37 | 16 | 53 |
| 2020 February | 4 | 6 | 10 |
| 2019 December | 4 | 1 | 5 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 6 | 2 | 8 |
| 2019 August | 0 | 4 | 4 |
| 2019 July | 0 | 2 | 2 |
| 2019 June | 0 | 6 | 6 |
| 2019 May | 3 | 8 | 11 |
| 2019 April | 0 | 8 | 8 |
| 2019 March | 0 | 5 | 5 |
| 2019 February | 2 | 1 | 3 |
| 2018 December | 0 | 6 | 6 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 2 | 0 | 2 |
| 2018 June | 0 | 2 | 2 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 28 | 3 | 31 |
| 2018 January | 23 | 5 | 28 |
| 2017 December | 47 | 8 | 55 |
| 2017 November | 20 | 5 | 25 |
| 2017 October | 26 | 1 | 27 |
| 2017 September | 33 | 15 | 48 |
| 2017 August | 38 | 9 | 47 |
| 2017 July | 25 | 9 | 34 |
| 2017 June | 52 | 22 | 74 |
| 2017 May | 28 | 12 | 40 |
| 2017 April | 28 | 12 | 40 |
| 2017 March | 27 | 48 | 75 |
| 2017 February | 20 | 6 | 26 |
| 2017 January | 32 | 7 | 39 |
| 2016 December | 49 | 7 | 56 |
| 2016 November | 64 | 18 | 82 |
| 2016 October | 77 | 20 | 97 |
| 2016 September | 94 | 2 | 96 |
| 2016 August | 53 | 5 | 58 |
| 2016 July | 33 | 5 | 38 |
| 2016 June | 7 | 4 | 11 |
| 2016 May | 6 | 3 | 9 |
| 2016 April | 4 | 11 | 15 |
| 2016 March | 15 | 8 | 23 |
| 2016 February | 11 | 10 | 21 |
| 2016 January | 6 | 1 | 7 |
| 2015 December | 13 | 5 | 18 |
| 2015 November | 12 | 1 | 13 |
| 2015 October | 7 | 5 | 12 |
| 2015 September | 10 | 1 | 11 |
| 2015 August | 8 | 1 | 9 |
| 2015 July | 195 | 3 | 198 |
| 2015 June | 159 | 3 | 162 |
| 2015 May | 188 | 5 | 193 |
| 2015 April | 143 | 13 | 156 |
| 2015 March | 197 | 3 | 200 |
| 2015 February | 167 | 1 | 168 |
| 2015 January | 140 | 4 | 144 |
| 2014 December | 120 | 4 | 124 |
| 2014 November | 102 | 3 | 105 |
| 2014 October | 132 | 6 | 138 |
| 2014 September | 105 | 1 | 106 |
| 2014 August | 116 | 9 | 125 |
| 2014 July | 165 | 4 | 169 |
| 2014 June | 122 | 4 | 126 |
| 2014 May | 102 | 12 | 114 |
| 2014 April | 100 | 7 | 107 |
| 2014 March | 106 | 4 | 110 |
| 2014 February | 66 | 7 | 73 |
| 2014 January | 55 | 5 | 60 |
| 2013 December | 39 | 5 | 44 |
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