Case and Research Letters
Penile Paraffinoma
Parafinoma de pene
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"apellidos" => "Marcoval" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219014002868" "doi" => "10.1016/j.adengl.2014.04.027" "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/S1578219014002868?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014002208?idApp=UINPBA000044" "url" => "/00017310/0000010500000010/v1_201411260044/S0001731014002208/v1_201411260044/es/main.assets" ] ] "itemAnterior" => array:18 [ "pii" => "S1578219014002856" "issn" => "15782190" "doi" => "10.1016/j.adengl.2014.04.026" "estado" => "S300" "fechaPublicacion" => "2014-12-01" "aid" => "1012" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2014;105:955-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1366 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 920 "PDF" => 407 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Scarring Alopecia in Classic Adult Type I Pityriasis Rubra Pilaris" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "955" "paginaFinal" => "957" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alopecia cicatricial en pitiriasis rubra pilaris tipo I clásica del adulto" ] ] "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" => 1168 "Ancho" => 1600 "Tamanyo" => 616465 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Skin biopsy of a pityriasis rubra pilaris lesion showing hyperkeratosis alternating with parakeratosis. A, Hematoxylin-eosin, original magnification ×4. B, Hematoxylin-eosin, original magnification ×10. C and D, Scalp biopsy with stellate perifollicular dermal fibrosis. No perifollicular inflammatory infiltrate is seen. C, Hematoxylin-eosin, original magnification ×10. D, Hematoxylin-eosin, original magnification ×20.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Martín Callizo, J. Molinero Caturla, J. Sánchez Sánchez, R.M. Penín Mosquera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Martín Callizo" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Molinero Caturla" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez Sánchez" ] 3 => array:2 [ "nombre" => "R.M." "apellidos" => "Penín Mosquera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014002191" "doi" => "10.1016/j.ad.2014.04.008" "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/S0001731014002191?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002856?idApp=UINPBA000044" "url" => "/15782190/0000010500000010/v1_201411260035/S1578219014002856/v1_201411260035/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Penile Paraffinoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "957" "paginaFinal" => "959" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Gómez-Armayones, R.M. Penín, J. Marcoval" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Gómez-Armayones" "email" => array:1 [ 0 => "sara.gomez.armayones@gmail.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" => "R.M." "apellidos" => "Penín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Marcoval" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parafinoma de pene" ] ] "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" => 675 "Ancho" => 900 "Tamanyo" => 307182 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Photomicrograph showing fibrosis in the papillary and reticular dermis, in addition to multiple empty vacuoles that had contained the paraffin. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Penile paraffinoma is a skin reaction that develops after the injection of paraffin or mineral oil into the penis in order to increase its size. The condition is relatively common in some eastern European and Asian countries and we believe immigration will cause its frequency in Spain to rise. The procedure is usually performed by nonmedically qualified persons and under poor hygienic conditions. The skin reaction to the exogenous material typically develops months or years after the injection.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 27-year-old man from Romania who consulted for ulcerated lesions on the penis. Although the patient initially omitted the fact, he later stated that for the previous 4 years until 2 months prior to consultation he had undergone repeated injections of a viscous material into the shaft of the penis in order to increase its size. He also stated that progressively enlarging ulcerated lesions had appeared on the penis and that they had worsened in appearance over the previous months. He had therefore applied the contents of oral antibiotic capsules to the area, but with no improvement. On physical examination there was a marked deformity of the shaft of the penis, which was indurated on palpation, and there were 2 ulcerated lesions with maximum diameters of 3 and 2<span class="elsevierStyleHsp" style=""></span>cm, respectively, located on the lateral surfaces of the penis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Fistulous tracts were present on the ventral surface, with no visible secretion. The glans was not affected. Histopathology of the larger lesion showed an epithelial ulcer with dermal fibrosis and empty vacuoles, consistent with paraffinoma (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). Staining with periodic acid-Schiff, silver methenamine, and Ziehl-Neelsen was negative. Blood tests were normal and a swab from the ulcers isolated a large number of different colonies, with no predominant microorganism. Culture for fungi was negative. Serology was negative for hepatitis C and human immunodeficiency virus and positive for hepatitis B, herpes simplex virus type 1, herpes simplex virus type 2, and syphilis (VDRL titer 1:2; TPHA, 1:10 240). The patient was diagnosed with penile paraffinoma, and topical therapy was applied with potassium permanganate poultices. The lesions showed some improvement, and the necrotic areas healed. However, after offering the patient surgical reconstruction, he stopped coming to the visits, and we were therefore unable to repeat the serology and we considered the syphilis cured.<span class="elsevierStyleVsp" style="height:0.5px"></span></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Penile paraffinoma is also known as sclerosing lipogranuloma of the penis. The most common etiology of this condition is the injection of highly viscous materials, such as mineral oils, petrolatum, or paraffin, and this is still being performed in eastern Europe, Asia, and Russia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The practice was first performed, however, in 1899 by an Austrian surgeon called Robert Gersuny, who injected mineral oils into a child after orchiectomy for genital tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The motivation for patients to undergo this intervention include a desire to increase the size of the penis, to treat erectile dysfunction, and to satisfy their sexual partners.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0020" class="elsevierStylePara elsevierViewall">The mean age of affected patients is around 28 years, and symptoms typically develop a year after implantation of the material. Clinical manifestations usually consist of deformity, impotence, erythema, and edema leading to paraphimosis and pain. The main complications are infection, ulceration, necrosis, and the formation of fistulas.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> There have also been reports of migration of the material, with invasion of the corpora cavernosa<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and regional lymphadenitis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0025" class="elsevierStylePara elsevierViewall">As stated above, histology shows multiple pseudocystic spaces associated with signs of a foreign body reaction. This response is almost always present, as the human body has no enzymes that metabolize mineral oils.<span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0030" class="elsevierStylePara elsevierViewall">The differential diagnosis should include infectious diseases, both sexually transmitted and others, and it is usually therefore necessary to biopsy the lesion and take samples for culture and serology. Diseases such as lupus vulgaris and atypical mycobacterial infection secondary to the injection of sterile material must be excluded. Squamous cell carcinoma must be considered in the case of ulcerated lesions with hard serpiginous borders. A history of injection of paraffin into the penis is the key to clinical diagnosis.<span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0035" class="elsevierStylePara elsevierViewall">First-line treatment consists of early complete surgical excision of the foreign body and of the associated reaction, with closure by first intention when possible.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Antiseptics and antibiotics will only treat secondary infections of the lesions. Cases with a good response to systemic corticosteroid therapy have been reported.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleVsp" style="height:0.5px"></span></p><p id="par0040" class="elsevierStylePara elsevierViewall">Penile paraffinoma is a condition with an increasing incidence in Spain due to the rise in the number of patients from eastern European and Asian countries. As patients usually deny having had these injections, dermatologists and urologists must suspect this diagnosis when examining genital ulcers that do not correlate with other diseases.<span class="elsevierStyleVsp" style="height:0.5px"></span></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: Gómez-Armayones S, Penín R, Marcoval J. Parafinoma de pene. Actas Dermosifiliogr. 2014;105:957–959</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" => 599 "Ancho" => 900 "Tamanyo" => 125696 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcerated lesion of about 3<span class="elsevierStyleHsp" style=""></span>cm diameter on the right lateral surface of the penile shaft.</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" => 675 "Ancho" => 900 "Tamanyo" => 307182 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Photomicrograph showing fibrosis in the papillary and reticular dermis, in addition to multiple empty vacuoles that had contained the paraffin. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.</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" => 675 "Ancho" => 900 "Tamanyo" => 289442 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photomicrograph showing the empty vacuoles at greater magnification. The histiocytes are also seen in greater detail and some multinucleated giant cells are present due to the foreign body reaction. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Bayraktar" 1 => "I. 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Henderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1973" "volumen" => "1" "paginaInicial" => "775" "paginaFinal" => "776" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2895308" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Sejben" 1 => "A. Racz" 2 => "M. Svebis" 3 => "M. Patyi" 4 => "G. Cserni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5489/cuaj.11146" "Revista" => array:6 [ "tituloSerie" => "Can Urol Assoc J" "fecha" => "2012" "volumen" => "6" "paginaInicial" => "E137" "paginaFinal" => "E139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23093564" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New reconstructive surgery for penile paraffinoma to prevent necrosis of ventral penile skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.S. Shin" 1 => "C. Zhao" 2 => "J.K. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2012.10.017" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2013" "volumen" => "81" "paginaInicial" => "437" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23374825" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000010/v1_201411260035/S1578219014002868/v1_201411260035/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000010/v1_201411260035/S1578219014002868/v1_201411260035/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002868?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 24 | 8 | 32 |
| 2024 October | 167 | 60 | 227 |
| 2024 September | 180 | 40 | 220 |
| 2024 August | 213 | 87 | 300 |
| 2024 July | 190 | 45 | 235 |
| 2024 June | 153 | 38 | 191 |
| 2024 May | 137 | 39 | 176 |
| 2024 April | 135 | 20 | 155 |
| 2024 March | 133 | 29 | 162 |
| 2024 February | 138 | 50 | 188 |
| 2024 January | 136 | 60 | 196 |
| 2023 December | 145 | 27 | 172 |
| 2023 November | 195 | 37 | 232 |
| 2023 October | 135 | 27 | 162 |
| 2023 September | 134 | 35 | 169 |
| 2023 August | 76 | 22 | 98 |
| 2023 July | 80 | 26 | 106 |
| 2023 June | 82 | 29 | 111 |
| 2023 May | 117 | 28 | 145 |
| 2023 April | 125 | 24 | 149 |
| 2023 March | 138 | 17 | 155 |
| 2023 February | 75 | 19 | 94 |
| 2023 January | 67 | 47 | 114 |
| 2022 December | 75 | 41 | 116 |
| 2022 November | 43 | 25 | 68 |
| 2022 October | 65 | 14 | 79 |
| 2022 September | 76 | 34 | 110 |
| 2022 August | 46 | 40 | 86 |
| 2022 July | 54 | 34 | 88 |
| 2022 June | 51 | 24 | 75 |
| 2022 May | 103 | 45 | 148 |
| 2022 April | 107 | 22 | 129 |
| 2022 March | 89 | 38 | 127 |
| 2022 February | 109 | 27 | 136 |
| 2022 January | 139 | 31 | 170 |
| 2021 December | 80 | 38 | 118 |
| 2021 November | 75 | 46 | 121 |
| 2021 October | 72 | 51 | 123 |
| 2021 September | 94 | 41 | 135 |
| 2021 August | 64 | 22 | 86 |
| 2021 July | 92 | 40 | 132 |
| 2021 June | 57 | 32 | 89 |
| 2021 May | 63 | 40 | 103 |
| 2021 April | 135 | 74 | 209 |
| 2021 March | 88 | 31 | 119 |
| 2021 February | 145 | 56 | 201 |
| 2021 January | 87 | 21 | 108 |
| 2020 December | 66 | 21 | 87 |
| 2020 November | 63 | 26 | 89 |
| 2020 October | 80 | 22 | 102 |
| 2020 September | 155 | 18 | 173 |
| 2020 August | 72 | 23 | 95 |
| 2020 July | 56 | 22 | 78 |
| 2020 June | 58 | 36 | 94 |
| 2020 May | 52 | 27 | 79 |
| 2020 April | 46 | 24 | 70 |
| 2020 March | 24 | 32 | 56 |
| 2020 February | 3 | 9 | 12 |
| 2020 January | 0 | 5 | 5 |
| 2019 December | 4 | 15 | 19 |
| 2019 November | 0 | 6 | 6 |
| 2019 October | 0 | 17 | 17 |
| 2019 September | 0 | 29 | 29 |
| 2019 August | 0 | 26 | 26 |
| 2019 July | 4 | 30 | 34 |
| 2019 June | 0 | 44 | 44 |
| 2019 May | 3 | 67 | 70 |
| 2019 April | 2 | 69 | 71 |
| 2019 March | 0 | 19 | 19 |
| 2019 February | 4 | 17 | 21 |
| 2019 January | 0 | 22 | 22 |
| 2018 December | 2 | 12 | 14 |
| 2018 November | 2 | 9 | 11 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 8 | 10 |
| 2018 August | 0 | 19 | 19 |
| 2018 July | 0 | 24 | 24 |
| 2018 June | 0 | 19 | 19 |
| 2018 May | 1 | 7 | 8 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 5 | 13 | 18 |
| 2018 February | 97 | 18 | 115 |
| 2018 January | 94 | 20 | 114 |
| 2017 December | 95 | 22 | 117 |
| 2017 November | 55 | 17 | 72 |
| 2017 October | 62 | 19 | 81 |
| 2017 September | 44 | 17 | 61 |
| 2017 August | 40 | 12 | 52 |
| 2017 July | 44 | 18 | 62 |
| 2017 June | 32 | 31 | 63 |
| 2017 May | 26 | 28 | 54 |
| 2017 April | 14 | 8 | 22 |
| 2017 March | 12 | 29 | 41 |
| 2017 February | 17 | 19 | 36 |
| 2017 January | 18 | 21 | 39 |
| 2016 December | 22 | 24 | 46 |
| 2016 November | 31 | 25 | 56 |
| 2016 October | 28 | 26 | 54 |
| 2016 September | 0 | 13 | 13 |
| 2016 August | 0 | 13 | 13 |
| 2016 July | 10 | 1 | 11 |
| 2016 June | 21 | 14 | 35 |
| 2016 May | 15 | 1 | 16 |
| 2016 April | 11 | 28 | 39 |
| 2016 March | 12 | 1 | 13 |
| 2016 February | 8 | 4 | 12 |
| 2016 January | 12 | 2 | 14 |
| 2015 December | 11 | 2 | 13 |
| 2015 November | 11 | 1 | 12 |
| 2015 October | 18 | 1 | 19 |
| 2015 September | 13 | 9 | 22 |
| 2015 August | 17 | 1 | 18 |
| 2015 July | 29 | 8 | 37 |
| 2015 June | 16 | 5 | 21 |
| 2015 May | 9 | 5 | 14 |
| 2015 April | 7 | 2 | 9 |
| 2015 March | 17 | 6 | 23 |
| 2015 February | 5 | 2 | 7 |
| 2015 January | 1 | 3 | 4 |
| 2014 December | 4 | 4 | 8 |
| 2014 November | 1 | 0 | 1 |
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