diff --git "a/data/train.conll" "b/data/train.conll" new file mode 100644--- /dev/null +++ "b/data/train.conll" @@ -0,0 +1,80031 @@ +En B-PRESENT_ILLNESS +Mayo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1997, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +intervenida, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +centro, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +glándula I-PRESENT_ILLNESS +suprarrenal I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +clínicamente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +funcionante I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +manifestó I-PRESENT_ILLNESS +clínicamente I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +molestias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +poco I-PRESENT_ILLNESS +específicas, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +postparto I-PRESENT_ILLNESS +inmediato; I-PRESENT_ILLNESS +la B-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +abdominales I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +suprarrenal I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cmts., I-EXPLORATION +sólida I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +calcificación I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +siendo I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +análisis, I-EXPLORATION +presentaba I-EXPLORATION +ligero I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cortisoluria I-EXPLORATION +(284.5 I-EXPLORATION +mcgr./24h.) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +17-OH-esteroides I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +(12.7 I-EXPLORATION +mcg./24h.), I-EXPLORATION +sin I-EXPLORATION +síntomas I-EXPLORATION +de I-EXPLORATION +hipercortisolismo I-EXPLORATION +sistémico. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +resección I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +histológico I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +suprarrenal I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +x I-TREATMENT +7 I-TREATMENT +x I-TREATMENT +5 I-TREATMENT +cmts. I-TREATMENT +(215 I-TREATMENT +grs.) I-TREATMENT +bien I-TREATMENT +encapsulado, I-TREATMENT +aunque I-TREATMENT +con I-TREATMENT +invasión I-TREATMENT +vascular, I-TREATMENT +amplias I-TREATMENT +zonas I-TREATMENT +de I-TREATMENT +necrosis I-TREATMENT +y I-TREATMENT +un I-TREATMENT +índice I-TREATMENT +mitótico I-TREATMENT +de I-TREATMENT +5.8/50; I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +histoquímico I-TREATMENT +fue I-TREATMENT +(+) I-TREATMENT +para I-TREATMENT +Vimentina I-TREATMENT +y I-TREATMENT +(-) I-TREATMENT +para I-TREATMENT +Citoqueratina, I-TREATMENT +EMA, I-TREATMENT +Cromogranina I-TREATMENT +y I-TREATMENT +Sm- I-TREATMENT +100. I-TREATMENT +Se I-TREATMENT +etiquetó I-TREATMENT +como I-TREATMENT +Estadio I-TREATMENT +II I-TREATMENT +y I-TREATMENT +Grado I-TREATMENT +II. I-TREATMENT +Treinta B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +estudios I-EVOLUTION +radiológicos I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +una I-EVOLUTION +masa I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +lecho I-EVOLUTION +de I-EVOLUTION +resección I-EVOLUTION +previo I-EVOLUTION +de I-EVOLUTION +7 I-EVOLUTION +cmts., I-EVOLUTION +en I-EVOLUTION +contacto I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +hilio I-EVOLUTION +renal I-EVOLUTION +izquierdo I-EVOLUTION +y I-EVOLUTION +técnicamente I-EVOLUTION +resecable; I-EVOLUTION +se B-TREATMENT +reintervino I-TREATMENT +y I-TREATMENT +se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +recidiva I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +nefrectomía I-TREATMENT +izquierda, I-TREATMENT +esplenectomía I-TREATMENT +y I-TREATMENT +pancreatectomía I-TREATMENT +distal I-TREATMENT +(radical I-TREATMENT +completa I-TREATMENT +y I-TREATMENT +con I-TREATMENT +márgenes I-TREATMENT +libres). I-TREATMENT +Posteriormente, I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +sistémico I-TREATMENT +adyuvante I-TREATMENT +con I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +completos I-TREATMENT +de I-TREATMENT +cisplatino I-TREATMENT +(CDDP) I-TREATMENT +y I-TREATMENT +etopósido I-TREATMENT +(VP-16) I-TREATMENT +en I-TREATMENT +régimen I-TREATMENT +adyuvante. I-TREATMENT + I-TREATMENT +Cuatro B-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +once I-EVOLUTION +meses I-EVOLUTION +tras I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +inicial, I-EVOLUTION +se I-EVOLUTION +detecta I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +radiológico I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +varios I-EVOLUTION +nódulos I-EVOLUTION +hepáticos I-EVOLUTION +sugerentes I-EVOLUTION +de I-EVOLUTION +metástasis. I-EVOLUTION +Se B-TREATMENT +sometió I-TREATMENT +de I-TREATMENT +nuevo I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +abdominal I-TREATMENT +realizándose, I-TREATMENT +previo I-TREATMENT +control I-TREATMENT +con I-TREATMENT +ecografía I-TREATMENT +hepática I-TREATMENT +intraoperatoria, I-TREATMENT +una I-TREATMENT +bisegmentectomía I-TREATMENT +IV-B I-TREATMENT +y I-TREATMENT +V I-TREATMENT +y I-TREATMENT +una I-TREATMENT +resección I-TREATMENT +limitada I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +VIII; I-TREATMENT +el B-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +anatomía-patológica I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +nódulos I-EXPLORATION +(de I-EXPLORATION +tamaño I-EXPLORATION +variable I-EXPLORATION +entre I-EXPLORATION +0.5 I-EXPLORATION +y I-EXPLORATION +1.5 I-EXPLORATION +cmts.) I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +suprarrenal. I-EXPLORATION + I-EXPLORATION +Diez B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +se I-EVOLUTION +detecta I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +recidiva I-EVOLUTION +tumoral I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +subdiafragmático I-EVOLUTION +izquierdo I-EVOLUTION +(de I-EVOLUTION +6 I-EVOLUTION +x I-EVOLUTION +4 I-EVOLUTION +cmts. I-EVOLUTION +según I-EVOLUTION +la I-EVOLUTION +TAC) I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +raiz I-EVOLUTION +del I-EVOLUTION +mesenterio, I-EVOLUTION +esta I-EVOLUTION +última I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +x I-EVOLUTION +3 I-EVOLUTION +cmts. I-EVOLUTION +y I-EVOLUTION +localizada I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +salida I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +arteria I-EVOLUTION +mesentérica I-EVOLUTION +superior I-EVOLUTION +(AMS). I-EVOLUTION +Dada B-TREATMENT +la I-TREATMENT +difícil I-TREATMENT +resecabilidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +nueva I-TREATMENT +recidiva I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +con I-TREATMENT +intención I-TREATMENT +neoadyuvante I-TREATMENT +( I-TREATMENT +5 I-TREATMENT +ciclos I-TREATMENT +completos I-TREATMENT +de I-TREATMENT +CDDP I-TREATMENT +y I-TREATMENT +VP-16), I-TREATMENT +decidiéndose I-TREATMENT +por I-TREATMENT +regresión I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +exploración I-TREATMENT +quirúrgica. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +masas I-TREATMENT +tumorales, I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +incluyendo I-TREATMENT +el I-TREATMENT +pilar I-TREATMENT +izquierdo I-TREATMENT +del I-TREATMENT +diafragma I-TREATMENT +y I-TREATMENT +una I-TREATMENT +pastilla I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +cmts. I-TREATMENT +de I-TREATMENT +dicho I-TREATMENT +músculo, I-TREATMENT +y I-TREATMENT +la I-TREATMENT +segunda I-TREATMENT +disecando I-TREATMENT +en I-TREATMENT +su I-TREATMENT +origen I-TREATMENT +el I-TREATMENT +tronco I-TREATMENT +celíaco I-TREATMENT +y I-TREATMENT +la I-TREATMENT +AMS I-TREATMENT +y I-TREATMENT +resecando I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +tumoral I-TREATMENT +entre I-TREATMENT +ambos I-TREATMENT +vasos. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +recidiva, I-EXPLORATION +estando I-EXPLORATION +los I-EXPLORATION +bordes I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +no I-EXPLORATION +afectos. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +satisfactoria. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra, I-EVOLUTION +tras I-EVOLUTION +7 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +del I-EVOLUTION +tumor I-EVOLUTION +primario, I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +aceptable, I-EVOLUTION +mínimamente I-EVOLUTION +limitada I-EVOLUTION +por I-EVOLUTION +las I-EVOLUTION +deposiciones I-EVOLUTION +diarreicas I-EVOLUTION +secundarias I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +denervación I-EVOLUTION +simpática I-EVOLUTION +celíaca. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +controlado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Consultas I-PRESENT_ILLNESS +Externas I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hipertrofia I-PRESENT_ILLNESS +benigna I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +próstata. I-PRESENT_ILLNESS +Presenta I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +monosintomática I-PRESENT_ILLNESS +autolimitada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +urinocultivos I-PRESENT_ILLNESS +negativos. I-PRESENT_ILLNESS +En B-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +ureteropielocaliectasia I-EXPLORATION +grado I-EXPLORATION +II I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +U.I.V. I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +anulación I-EXPLORATION +funcional I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho, I-EXPLORATION +motivo B-TREATMENT +por I-TREATMENT +el I-TREATMENT +cuál, I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +nefrostomia I-TREATMENT +percutánea I-TREATMENT +derecha, I-TREATMENT +que I-TREATMENT +confirma I-TREATMENT +el I-TREATMENT +hallazgo I-TREATMENT +urográfico. I-TREATMENT +Ocho B-EXPLORATION +meses I-EXPLORATION +antes, I-EXPLORATION +est: I-EXPLORATION +udio I-EXPLORATION +ecográfico I-EXPLORATION +y I-EXPLORATION +U.I.V. I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +cabe I-PAST_MEDICAL_HISTORY +destacar: I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +conocidas. I-PAST_MEDICAL_HISTORY +HTA. I-PAST_MEDICAL_HISTORY +Diabetes I-PAST_MEDICAL_HISTORY +Mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II. I-PAST_MEDICAL_HISTORY +Miocardiopatía I-PAST_MEDICAL_HISTORY +hipertrófica. I-PAST_MEDICAL_HISTORY +Aneurisma I-PAST_MEDICAL_HISTORY +carotídeo I-PAST_MEDICAL_HISTORY +intracerebral I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +secuelas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +practicada I-EXPLORATION +es I-EXPLORATION +la I-EXPLORATION +siguiente: I-EXPLORATION +Abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible, I-EXPLORATION +no I-EXPLORATION +doloroso, I-EXPLORATION +no I-EXPLORATION +megalias, I-EXPLORATION +Fosas I-EXPLORATION +renales I-EXPLORATION +libres I-EXPLORATION +indoloras. I-EXPLORATION +Genitales I-EXPLORATION +externos I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +patológicos. I-EXPLORATION +Tacto I-EXPLORATION +rectal I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +HBP I-EXPLORATION +grado I-EXPLORATION +I-II. I-EXPLORATION +Se I-EXPLORATION +llevan I-EXPLORATION +a I-EXPLORATION +cabo I-EXPLORATION +las I-EXPLORATION +siguientes I-EXPLORATION +EXPLORACIONES I-EXPLORATION +COMPLEMENTARIAS: I-EXPLORATION + I-EXPLORATION +ANALISIS: I-EXPLORATION +Glucemia I-EXPLORATION +145 I-EXPLORATION +mg/dl, I-EXPLORATION +Creatinina I-EXPLORATION +1.4 I-EXPLORATION +mg/dl. I-EXPLORATION +Resto I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +CITOLOGIA I-EXPLORATION +URINARIA: I-EXPLORATION +Compatible I-EXPLORATION +con I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +transicionales I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado. I-EXPLORATION + I-EXPLORATION +PIELOGRAFIA I-EXPLORATION +DESCENDENTE I-EXPLORATION +a I-EXPLORATION +traves I-EXPLORATION +de I-EXPLORATION +Nefrostomia: I-EXPLORATION +Defecto I-EXPLORATION +de I-EXPLORATION +replección I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +uréter I-EXPLORATION +sacro-ilíaco I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +20 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +longitud, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared. I-EXPLORATION + I-EXPLORATION +ESTUDIO I-EXPLORATION +FUNCIONAL I-EXPLORATION +DE I-EXPLORATION +RIÑON I-EXPLORATION +DERECHO: I-EXPLORATION +Aclaramiento I-EXPLORATION +de I-EXPLORATION +Creatinina I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +ml/minuto. I-EXPLORATION + I-EXPLORATION +TAC I-EXPLORATION +ABDOMINO-PELVICO: I-EXPLORATION +Aneurisma I-EXPLORATION +de I-EXPLORATION +Aorta I-EXPLORATION +infrarrenal. I-EXPLORATION +Atrofia I-EXPLORATION +hidronefrótica I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +visualizarse I-EXPLORATION +imágenes I-EXPLORATION +endoluminales I-EXPLORATION +intraureterales. I-EXPLORATION +Dudosas I-EXPLORATION +adenopatías I-EXPLORATION +paravesicales. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +estos I-TREATMENT +hallazgos I-TREATMENT +y I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +de I-TREATMENT +vías I-TREATMENT +de I-TREATMENT +uréter I-TREATMENT +derecho, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenido I-TREATMENT +quirúrgicamente I-TREATMENT +practicándose I-TREATMENT +nefroureterectomía I-TREATMENT +radical I-TREATMENT +derecha I-TREATMENT +con I-TREATMENT +evolución I-TREATMENT +postoperatoria I-TREATMENT +satisfactoria. I-TREATMENT +El B-EXPLORATION +dictamen I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +nos I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +pielonefritis I-EXPLORATION +crónica I-EXPLORATION +y I-EXPLORATION +cambios I-EXPLORATION +de I-EXPLORATION +arteriosclerosis, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +lesión I-EXPLORATION +inflamatoria I-EXPLORATION +ureteral I-EXPLORATION +que I-EXPLORATION +oblitera I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +en I-EXPLORATION +capas I-EXPLORATION +musculares, I-EXPLORATION +erosión I-EXPLORATION +de I-EXPLORATION +urotelio I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Actinomices. I-EXPLORATION +Tras B-EVOLUTION +9 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +mantiene I-EVOLUTION +una I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +aceptable I-EVOLUTION +(Creatinina I-EVOLUTION +sérica I-EVOLUTION +2.1 I-EVOLUTION +mg/dl I-EVOLUTION +) I-EVOLUTION +y I-EVOLUTION +es I-EVOLUTION +controlado I-EVOLUTION +por I-EVOLUTION +HBP I-EVOLUTION +sintomática. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +monorrena I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +incluída I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +programa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemodiálisis I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +trasplante I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +IRC I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pielonefritis I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +nefrectomía I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +absceso I-PAST_MEDICAL_HISTORY +pararrenal I-PAST_MEDICAL_HISTORY +secundario I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +rotura I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +riñón I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +contenía I-PAST_MEDICAL_HISTORY +cálculo I-PAST_MEDICAL_HISTORY +coraliforme I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ureteroscopia I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cálculo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +uréter I-PAST_MEDICAL_HISTORY +pelviano I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +febrero I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1990. I-PAST_MEDICAL_HISTORY +Hígado I-PAST_MEDICAL_HISTORY +graso I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Digestivo, I-PAST_MEDICAL_HISTORY +HTA, I-PAST_MEDICAL_HISTORY +hipertrigliceridemia, I-PAST_MEDICAL_HISTORY +sobrepeso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +gota. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Trasplante I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riñón I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +fosa I-PAST_MEDICAL_HISTORY +ilíaca I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +incidencias I-PAST_MEDICAL_HISTORY +(también I-PAST_MEDICAL_HISTORY +arteria I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +parche I-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anastomosis I-PAST_MEDICAL_HISTORY +vasculares I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ilíacas I-PAST_MEDICAL_HISTORY +externas, I-PAST_MEDICAL_HISTORY +implante I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +uréter I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +vejiga I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +Paquin). I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY ++5 I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +rechazo I-PAST_MEDICAL_HISTORY +agudo I-PAST_MEDICAL_HISTORY +siendo I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +pulses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +6-Metil-Prednisolona I-PAST_MEDICAL_HISTORY +(400mg/día, I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +días) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +dada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +niveles I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2'3 I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +progresivamente I-PAST_MEDICAL_HISTORY +descenderán I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +mantendrán I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +actualidad I-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +0'8-1'1. I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +inmunosupresor I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ciclosporina I-PAST_MEDICAL_HISTORY +8mg/Kg, I-PAST_MEDICAL_HISTORY +micofenolato I-PAST_MEDICAL_HISTORY +mofetilo I-PAST_MEDICAL_HISTORY +2gr/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +prednisona I-PAST_MEDICAL_HISTORY +1mg/Kg. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +abril I-PAST_MEDICAL_HISTORY +de1999, I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +trasplante, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +temblor I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ambas I-PAST_MEDICAL_HISTORY +manos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +inicialmente I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +atribuído I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +toxicidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ciclosporina I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +descenso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pauta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +corticoides. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +embargo, I-PAST_MEDICAL_HISTORY +ante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +empeoramiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cuadro, I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +asintomática, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Neurología. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +momento, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +trasplante I-PRESENT_ILLNESS +(marzo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2000) I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +inestabilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha, I-PRESENT_ILLNESS +temblores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +parestesias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetivaron I-EXPLORATION +moderados I-EXPLORATION +signos I-EXPLORATION +piramidales I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +EEII, I-EXPLORATION +más I-EXPLORATION +acusados I-EXPLORATION +en I-EXPLORATION +eI I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +claro I-EXPLORATION +déficit I-EXPLORATION +motor; I-EXPLORATION +la I-EXPLORATION +sensibilidad I-EXPLORATION +profunda I-EXPLORATION +estaba I-EXPLORATION +también I-EXPLORATION +levemente I-EXPLORATION +alterada. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +ayudaron I-EXPLORATION +a I-EXPLORATION +esclarecer I-EXPLORATION +el I-EXPLORATION +diagnóstico: I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +RMN I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +2 I-EXPLORATION +lesiones I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +mielitis I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cervical I-EXPLORATION +C2-C4 I-EXPLORATION +y I-EXPLORATION +dorsal I-EXPLORATION +alto I-EXPLORATION +D1. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +potenciales I-EXPLORATION +evocados I-EXPLORATION +demostraron I-EXPLORATION +retraso I-EXPLORATION +significativo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +latencia I-EXPLORATION +del I-EXPLORATION +nervio I-EXPLORATION +tibial. I-EXPLORATION + I-EXPLORATION +LCR: I-EXPLORATION +leve I-EXPLORATION +pleocitosis I-EXPLORATION +linfocítica, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +bandas I-EXPLORATION +IgG I-EXPLORATION +oligoclonales. I-EXPLORATION + I-EXPLORATION +Pruebas I-EXPLORATION +serológicas, I-EXPLORATION +ELISA I-EXPLORATION +y I-EXPLORATION +Western I-EXPLORATION +Blot, I-EXPLORATION +resultaron I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +HTLV-I I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +y I-EXPLORATION +sangre. I-EXPLORATION + I-EXPLORATION +PCR I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +positiva I-EXPLORATION +también I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +virus I-EXPLORATION +detectándose I-EXPLORATION +también I-EXPLORATION +en I-EXPLORATION +este I-EXPLORATION +caso I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +elevada. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +pulses I-TREATMENT +de I-TREATMENT +6-Metil-Prednisolona I-TREATMENT +en I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +de I-TREATMENT +agudización I-TREATMENT +del I-TREATMENT +proceso I-TREATMENT +y I-TREATMENT +pauta I-TREATMENT +descendente I-TREATMENT +progresivamente I-TREATMENT +de I-TREATMENT +corticoides. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +hábito I-EVOLUTION +cushingoide, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +audición I-EVOLUTION +progresiva, I-EVOLUTION +incontinencia I-EVOLUTION +de I-EVOLUTION +orina I-EVOLUTION +de I-EVOLUTION +predominio I-EVOLUTION +nocturno I-EVOLUTION +que I-EVOLUTION +ha I-EVOLUTION +mejorado I-EVOLUTION +con I-EVOLUTION +Tolterodina I-EVOLUTION +(pendiente I-EVOLUTION +de I-EVOLUTION +estudio I-EVOLUTION +urodinámico I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +actual) I-EVOLUTION +y I-EVOLUTION +evoluciona I-EVOLUTION +hacia I-EVOLUTION +discreta I-EVOLUTION +invalidez. I-EVOLUTION + I-EVOLUTION + +Nuestra B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +conocidas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +dilatada, I-PAST_MEDICAL_HISTORY +artrosis, I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +histerectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +anexectomía I-PAST_MEDICAL_HISTORY +junto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +quimio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +radioterapia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +tumoración I-PAST_MEDICAL_HISTORY +ginecológica I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocho I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +lumbar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +derechos I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +aumentando I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +deambulación. I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +vez, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompaña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nauseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +picos I-PRESENT_ILLNESS +febriles I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +profusa I-PRESENT_ILLNESS +aunque I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encuentra I-PRESENT_ILLNESS +afebril I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presenta: I-EXPLORATION +soplo I-EXPLORATION +protomesosistólico I-EXPLORATION +en I-EXPLORATION +ápex, I-EXPLORATION +abdomen I-EXPLORATION +blando I-EXPLORATION +y I-EXPLORATION +depresible, I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +y I-EXPLORATION +flanco I-EXPLORATION +derechos. I-EXPLORATION +También I-EXPLORATION +destaca I-EXPLORATION +dolor I-EXPLORATION +espontáneo I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +muslo I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +aumenta I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +movilidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +extremidad. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +Urgencias I-EXPLORATION +destaca I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +izquierda I-EXPLORATION +(17.200 I-EXPLORATION +leucocitos I-EXPLORATION +con I-EXPLORATION +84% I-EXPLORATION +de I-EXPLORATION +neutrófilos), I-EXPLORATION +567.000 I-EXPLORATION +plaquetas, I-EXPLORATION +urea I-EXPLORATION +1.35, I-EXPLORATION +creatinina I-EXPLORATION +1.80. I-EXPLORATION + I-EXPLORATION +Como I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +se I-EXPLORATION +solicitan I-EXPLORATION +Rx. I-EXPLORATION +de I-EXPLORATION +vías I-EXPLORATION +urinarias I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +imagen I-EXPLORATION +cálcica I-EXPLORATION +en I-EXPLORATION +silueta I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +ectasia I-EXPLORATION +pielocalicial I-EXPLORATION +derecha I-EXPLORATION +respectivamente. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnostico I-TREATMENT +de I-TREATMENT +cólico I-TREATMENT +nefrítico I-TREATMENT +derecho I-TREATMENT +complicado I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +ingreso I-TREATMENT +para I-TREATMENT +derivación I-TREATMENT +urinaria I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +intravenoso. I-TREATMENT +Se I-TREATMENT +coloca I-TREATMENT +en I-TREATMENT +quirófano I-TREATMENT +catéter I-TREATMENT +externo I-TREATMENT +en I-TREATMENT +uréter I-TREATMENT +derecho I-TREATMENT +con I-TREATMENT +salida I-TREATMENT +de I-TREATMENT +abundante I-TREATMENT +orina I-TREATMENT +limpia. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +lo I-EVOLUTION +largo I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +cólico I-EVOLUTION +va I-EVOLUTION +cediendo I-EVOLUTION +aunque I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +dolor I-EVOLUTION +sordo I-EVOLUTION +en I-EVOLUTION +fosa I-EVOLUTION +lumbar I-EVOLUTION +y I-EVOLUTION +continúa I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +muslo I-EVOLUTION +derecho. I-EVOLUTION +Es B-TREATMENT +valorada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +Traumatología I-TREATMENT +pautando I-TREATMENT +tratamiento I-TREATMENT +antiinflamatorio I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +rotura I-TREATMENT +fibrilar I-TREATMENT +del I-TREATMENT +cuadriceps. I-TREATMENT + I-TREATMENT +Debido B-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +del I-EXPLORATION +dolor I-EXPLORATION +lumbar I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +revisión I-EXPLORATION +ecográfica I-EXPLORATION +objetivándose I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +músculo I-EXPLORATION +psoas I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +5.5 I-EXPLORATION +cm. I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +un I-EXPLORATION +TAC. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +absceso I-EXPLORATION +retroperitoneal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +compartimento I-EXPLORATION +del I-EXPLORATION +músculo I-EXPLORATION +psoas I-EXPLORATION +iliaco I-EXPLORATION +derecho I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +L2-L3 I-EXPLORATION +sin I-EXPLORATION +perder I-EXPLORATION +la I-EXPLORATION +continuidad I-EXPLORATION +hasta I-EXPLORATION +anillo I-EXPLORATION +inguinal I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartar I-EXPLORATION +la I-EXPLORATION +participación I-EXPLORATION +del I-EXPLORATION +uréter I-EXPLORATION +derecho I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +tercio I-EXPLORATION +medio. I-EXPLORATION + I-EXPLORATION +Una B-DERIVED_FROM/TO +vez I-DERIVED_FROM/TO +confirmado I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +nos I-DERIVED_FROM/TO +ponemos I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +contacto I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Radiología I-DERIVED_FROM/TO +Intervensionista I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +drenaje I-DERIVED_FROM/TO +percutáneo. I-DERIVED_FROM/TO +Mediante B-EXPLORATION +ecografía I-EXPLORATION +se I-EXPLORATION +coloca I-EXPLORATION +catéter I-EXPLORATION +10 I-EXPLORATION +fr. I-EXPLORATION +evacuando I-EXPLORATION +200 I-EXPLORATION +cc. I-EXPLORATION +material I-EXPLORATION +purulento, I-EXPLORATION +del I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +envía I-EXPLORATION +muestra I-EXPLORATION +microbiológica I-EXPLORATION +(en I-EXPLORATION +los I-EXPLORATION +días I-EXPLORATION +sucesivos I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Bacteriodes I-EXPLORATION +fragilis I-EXPLORATION +y I-EXPLORATION +Streptococcus I-EXPLORATION +sanguis). I-EXPLORATION +El I-EXPLORATION +débito I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +drenaje I-EXPLORATION +es I-EXPLORATION +progresivamente I-EXPLORATION +menor I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +nuevo I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +TAC, I-EXPLORATION +evidenciándose I-EXPLORATION +la I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +volumen I-EXPLORATION +del I-EXPLORATION +absceso. I-EXPLORATION +Se B-EVOLUTION +decide I-EVOLUTION +retirar I-EVOLUTION +el I-EVOLUTION +tubo I-EVOLUTION +de I-EVOLUTION +drenaje I-EVOLUTION +al I-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +colocación I-EVOLUTION +pero I-EVOLUTION +es I-EVOLUTION +necesario I-EVOLUTION +recolocación I-EVOLUTION +de I-EVOLUTION +catéter I-EVOLUTION +14 I-EVOLUTION +fr. I-EVOLUTION +por I-EVOLUTION +empeoramiento I-EVOLUTION +clínico. I-EVOLUTION + I-EVOLUTION +Se B-EXPLORATION +desconoce I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +foco I-EXPLORATION +primario I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +ingreso, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +colonoscopia I-EXPLORATION +para I-EXPLORATION +intentar I-EXPLORATION +buscar I-EXPLORATION +un I-EXPLORATION +origen I-EXPLORATION +digestivo I-EXPLORATION +del I-EXPLORATION +problema. I-EXPLORATION +No I-EXPLORATION +es I-EXPLORATION +posible I-EXPLORATION +sobrepasar I-EXPLORATION +el I-EXPLORATION +ángulo I-EXPLORATION +esplénico I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +halla I-EXPLORATION +un I-EXPLORATION +foco I-EXPLORATION +primario. I-EXPLORATION +Desde I-EXPLORATION +el I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +vista I-EXPLORATION +urológico I-EXPLORATION +tampoco I-EXPLORATION +se I-EXPLORATION +justifica I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +del I-EXPLORATION +absceso. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +hace I-EXPLORATION +cavitograma I-EXPLORATION +para I-EXPLORATION +estudiar I-EXPLORATION +la I-EXPLORATION +morfología I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tamaño I-EXPLORATION +del I-EXPLORATION +absceso I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +indica I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +lavados I-EXPLORATION +con I-EXPLORATION +fibrinolíticos I-EXPLORATION +intracavitarios I-EXPLORATION +(100.000 I-EXPLORATION +unidades I-EXPLORATION +de I-EXPLORATION +urokinasa I-EXPLORATION +en I-EXPLORATION +10 I-EXPLORATION +cc I-EXPLORATION +de I-EXPLORATION +suero I-EXPLORATION +fisiológico). I-EXPLORATION + I-EXPLORATION +Después B-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +y I-EVOLUTION +diez I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +ingreso, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +confirmada I-EVOLUTION +mediante I-EVOLUTION +técnicas I-EVOLUTION +de I-EVOLUTION +imagen. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +en I-EVOLUTION +nuestras I-EVOLUTION +consultas, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +con I-EVOLUTION +resolución I-EVOLUTION +total I-EVOLUTION +del I-EVOLUTION +proceso. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +obesidad, I-PAST_MEDICAL_HISTORY +brucelosis, I-PAST_MEDICAL_HISTORY +lumboartrosis, I-PAST_MEDICAL_HISTORY +litiasis I-PAST_MEDICAL_HISTORY +biliar, I-PAST_MEDICAL_HISTORY +apendicectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cesárea. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar, I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +casual, I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm. I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +confirma I-EXPLORATION +este I-EXPLORATION +hallazgo I-EXPLORATION +evidenciándose I-EXPLORATION +masa I-EXPLORATION +sólida I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho; I-EXPLORATION +comprobándose I-EXPLORATION +realce I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +infusión I-EXPLORATION +de I-EXPLORATION +contraste, I-EXPLORATION +no I-EXPLORATION +objetivándose I-EXPLORATION +adenopatías I-EXPLORATION +hiliares, I-EXPLORATION +ni I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +órganos I-EXPLORATION +de I-EXPLORATION +vecindad. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +masa I-TREATMENT +sólida I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +adenocarcinoma I-TREATMENT +renal I-TREATMENT +es I-TREATMENT +intervenida, I-TREATMENT +realizándose I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +lumbar I-TREATMENT +oblícua I-TREATMENT +nefrectomía I-TREATMENT +radical, I-TREATMENT +siendo I-TREATMENT +el I-TREATMENT +curso I-TREATMENT +postoperatorio I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +tumoración I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +invade I-EXPLORATION +cápsula, I-EXPLORATION +su I-EXPLORATION +aspecto I-EXPLORATION +al I-EXPLORATION +corte I-EXPLORATION +es I-EXPLORATION +homogéneo, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blancogrisaceo. I-EXPLORATION +La I-EXPLORATION +pelvis I-EXPLORATION +y I-EXPLORATION +cálices I-EXPLORATION +no I-EXPLORATION +están I-EXPLORATION +afectados I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +renal I-EXPLORATION +esta I-EXPLORATION +libre. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +tumoración I-EXPLORATION +redondeada I-EXPLORATION +de I-EXPLORATION +márgenes I-EXPLORATION +bien I-EXPLORATION +definidos, I-EXPLORATION +que I-EXPLORATION +crece I-EXPLORATION +por I-EXPLORATION +expansión I-EXPLORATION +sin I-EXPLORATION +invadir, I-EXPLORATION +de I-EXPLORATION +naturaleza I-EXPLORATION +mesenquimal, I-EXPLORATION +compuesta I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +dispuestas I-EXPLORATION +en I-EXPLORATION +fascículos I-EXPLORATION +entrelazados, I-EXPLORATION +los I-EXPLORATION +núcleos I-EXPLORATION +presentan I-EXPLORATION +ligera I-EXPLORATION +variación I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +forma, I-EXPLORATION +la I-EXPLORATION +actividad I-EXPLORATION +mitótica I-EXPLORATION +es I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +mitosis I-EXPLORATION +por I-EXPLORATION +50 I-EXPLORATION +CGA, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +hemorragias I-EXPLORATION +ni I-EXPLORATION +necrosis. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +queratinas I-EXPLORATION +(AE-1,AE-3), I-EXPLORATION +EMA I-EXPLORATION +(anfígeno I-EXPLORATION +epitelial I-EXPLORATION +de I-EXPLORATION +membrana) I-EXPLORATION +con I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +excluye I-EXPLORATION +la I-EXPLORATION +naturaleza I-EXPLORATION +epitelial I-EXPLORATION +del I-EXPLORATION +tumor. I-EXPLORATION +Negatividad I-EXPLORATION +para I-EXPLORATION +vimentina, I-EXPLORATION +HMB45, I-EXPLORATION +S-100. I-EXPLORATION +Positividad I-EXPLORATION +para I-EXPLORATION +marcadores I-EXPLORATION +vasculares I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +trama I-EXPLORATION +vascular I-EXPLORATION +y I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +actino. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Neurolues, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +secuelas I-PAST_MEDICAL_HISTORY +establecidas I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +trastornos I-PAST_MEDICAL_HISTORY +mnésicos I-PAST_MEDICAL_HISTORY +visuales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +verbales, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +radiculoneuropatía I-PAST_MEDICAL_HISTORY +múltiple. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +radiología I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +presentaba I-EXPLORATION +elongación I-EXPLORATION +aórtica I-EXPLORATION +sin I-EXPLORATION +repercusión I-EXPLORATION +clínica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +electroencefalograma I-EXPLORATION +con I-EXPLORATION +trazado I-EXPLORATION +normal, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +TC I-EXPLORATION +craneal I-EXPLORATION +con I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +contraste I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +morfología I-EXPLORATION +cerebral I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +Lues I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +test I-EXPLORATION +RPR I-EXPLORATION +y I-EXPLORATION +TPHA I-EXPLORATION +fueron I-EXPLORATION +positivos. I-EXPLORATION +El I-EXPLORATION +ácido I-EXPLORATION +fólico I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +rango I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestras I-DERIVED_FROM/TO +consultas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Urodinámica I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +trastornos I-DERIVED_FROM/TO +miccionales I-DERIVED_FROM/TO +refiriendo I-DERIVED_FROM/TO +incontinencia I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +urgencia, I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +precisando I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +prensa I-DERIVED_FROM/TO +abdominal I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +vaciado I-DERIVED_FROM/TO +vesical. I-DERIVED_FROM/TO +Se B-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +urodinámico I-EXPLORATION +objetivándose I-EXPLORATION +un I-EXPLORATION +detrusor I-EXPLORATION +hiperrefléxico I-EXPLORATION +con I-EXPLORATION +presiones I-EXPLORATION +altas I-EXPLORATION +y I-EXPLORATION +contracciones I-EXPLORATION +involuntarias I-EXPLORATION +no I-EXPLORATION +inhibidas I-EXPLORATION +que I-EXPLORATION +ocasionaban I-EXPLORATION +escapes; I-EXPLORATION +la I-EXPLORATION +curva I-EXPLORATION +de I-EXPLORATION +Presión/ I-EXPLORATION +Flujo I-EXPLORATION +no I-EXPLORATION +mostraba I-EXPLORATION +alteraciones. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +detrusor I-TREATMENT +hiperactivo I-TREATMENT +de I-TREATMENT +causa I-TREATMENT +neurogénica I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anticolinérgicos, I-TREATMENT +estando B-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +estable I-EVOLUTION +clínicamente I-EVOLUTION +con I-EVOLUTION +urgencia I-EVOLUTION +ocasional I-EVOLUTION +sin I-EVOLUTION +incontinencia. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenina, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +27 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +blanca, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +nefrítico I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Se B-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +ultrasonido I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +doble I-EXPLORATION +sistema I-EXPLORATION +pieloureteral I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +litiasis I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +cáliz I-EXPLORATION +medio, I-EXPLORATION +doble I-EXPLORATION +sistema I-EXPLORATION +pieloureteral I-EXPLORATION +izquierdo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +urografía I-EXPLORATION +excretora I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +litiasis I-EXPLORATION +renal I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +doble I-EXPLORATION +sistema I-EXPLORATION +pieloureteral I-EXPLORATION +derecho I-EXPLORATION +e I-EXPLORATION +hidronefrosis I-EXPLORATION +derecha, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +tres I-EXPLORATION +sistemas I-EXPLORATION +ureteropielocaliciales. I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +objetivo I-EXPLORATION +de I-EXPLORATION +poder I-EXPLORATION +visualizar I-EXPLORATION +la I-EXPLORATION +desembocadura I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +uréteres I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vejiga I-EXPLORATION +realizamos I-EXPLORATION +urografía I-EXPLORATION +excretora I-EXPLORATION +por I-EXPLORATION +venoclisis I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +en I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +sistemas I-EXPLORATION +ureteropielocaliciales I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +uréteres I-EXPLORATION +desembocando I-EXPLORATION +independientes I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vejiga. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +triple I-EXPLORATION +sistema I-EXPLORATION +ureteropielocalicial I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +entrada I-EXPLORATION +independiente I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +uréteres I-EXPLORATION +en I-EXPLORATION +vejiga. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cistoscopia I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +tres I-EXPLORATION +meatos I-EXPLORATION +ureterales I-EXPLORATION +del I-EXPLORATION +lado I-EXPLORATION +izquierdo, I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +por I-EXPLORATION +delante I-EXPLORATION +del I-EXPLORATION +trígono, I-EXPLORATION +cerca I-EXPLORATION +del I-EXPLORATION +cuello, I-EXPLORATION +otro I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trígono I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +último I-EXPLORATION +por I-EXPLORATION +encima I-EXPLORATION +del I-EXPLORATION +mismo, I-EXPLORATION +del I-EXPLORATION +lado I-EXPLORATION +derecho I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +dos I-EXPLORATION +meatos I-EXPLORATION +ureterales. I-EXPLORATION +Todos I-EXPLORATION +eyaculando I-EXPLORATION +orinas I-EXPLORATION +claras I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +'hoyo I-EXPLORATION +de I-EXPLORATION +golf'. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +intervenido B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hipospadias I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +correcta I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +micción I-PAST_MEDICAL_HISTORY +confortable. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +urólogo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +sordo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ingle I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +testículo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +un I-EXPLORATION +testículo I-EXPLORATION +izquierdo I-EXPLORATION +muy I-EXPLORATION +aumentado I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +totalidad, I-EXPLORATION +irregular I-EXPLORATION +e I-EXPLORATION +indurado I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +testicular I-EXPLORATION +con I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +exploración I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +testicular I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +describe I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +quístico I-EXPLORATION +con I-EXPLORATION +tabiques I-EXPLORATION +finos I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +granuloma I-EXPLORATION +con I-EXPLORATION +calcificaciones I-EXPLORATION +intratesticular I-EXPLORATION +y I-EXPLORATION +fuera I-EXPLORATION +del I-EXPLORATION +testículo I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +otro I-EXPLORATION +quiste I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +ecos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior I-EXPLORATION +a I-EXPLORATION +descartar I-EXPLORATION +quiste I-EXPLORATION +epidermoide I-EXPLORATION +o I-EXPLORATION +hidatídico. I-EXPLORATION +Los I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +alfa I-EXPLORATION +fetoproteína I-EXPLORATION +y I-EXPLORATION +BHCG I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +TAC I-EXPLORATION +solicitado I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +del I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +sólida I-EXPLORATION +retroperitoneal I-EXPLORATION +izquierda I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hilio I-EXPLORATION +renal I-EXPLORATION +lateroaórtica I-EXPLORATION +y I-EXPLORATION +prerrenal I-EXPLORATION +de I-EXPLORATION +54x51x90 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +una I-TREATMENT +orquiectomía I-TREATMENT +inguinal I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +resultado I-TREATMENT +anatomo-patológico I-TREATMENT +de I-TREATMENT +teratoma I-TREATMENT +maduro I-TREATMENT +puro I-TREATMENT +poco I-TREATMENT +diferenciado I-TREATMENT +limitado I-TREATMENT +a I-TREATMENT +testículo I-TREATMENT +sin I-TREATMENT +invasión I-TREATMENT +vascular I-TREATMENT +que I-TREATMENT +afectaba I-TREATMENT +a I-TREATMENT +túnica I-TREATMENT +albugínea I-TREATMENT +pero I-TREATMENT +no I-TREATMENT +a I-TREATMENT +vaginal, I-TREATMENT +sin I-TREATMENT +afectación I-TREATMENT +de I-TREATMENT +rete I-TREATMENT +testis I-TREATMENT +de I-TREATMENT +5x3x3 I-TREATMENT +mm. I-TREATMENT +de I-TREATMENT +tamaño. I-TREATMENT +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +adyuvante. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Nos B-EXPLORATION +encontramos I-EXPLORATION +ante I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +testicular I-EXPLORATION +no I-EXPLORATION +seminomatoso I-EXPLORATION +estadio I-EXPLORATION +pT2 I-EXPLORATION +N3, I-EXPLORATION +M0 I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +clasificación I-EXPLORATION +TNM I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +estadio I-EXPLORATION +II I-EXPLORATION +c I-EXPLORATION +sin I-EXPLORATION +factores I-EXPLORATION +de I-EXPLORATION +mal I-EXPLORATION +pronóstico. I-EXPLORATION +En B-TREATMENT +esta I-TREATMENT +situación I-TREATMENT +se I-TREATMENT +plantean I-TREATMENT +dos I-TREATMENT +opciones, I-TREATMENT +comenzar I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +y I-TREATMENT +plantear I-TREATMENT +resección I-TREATMENT +si I-TREATMENT +persistía I-TREATMENT +masa I-TREATMENT +residual I-TREATMENT +o I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +linfadenectomia I-TREATMENT +retroperitoneal. I-TREATMENT + I-TREATMENT +Dada I-TREATMENT +la I-TREATMENT +negatividad I-TREATMENT +de I-TREATMENT +los I-TREATMENT +marcadores I-TREATMENT +tumorales I-TREATMENT +y I-TREATMENT +la I-TREATMENT +anatomía I-TREATMENT +patológica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +testicular I-TREATMENT +y I-TREATMENT +la I-TREATMENT +conocida I-TREATMENT +quimioresistencia I-TREATMENT +del I-TREATMENT +teratoma I-TREATMENT +maduro I-TREATMENT +puro I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +linfadenectomía I-TREATMENT +retroperitoneal I-TREATMENT +por I-TREATMENT +las I-TREATMENT +posibilidades I-TREATMENT +de I-TREATMENT +ser I-TREATMENT +curativa I-TREATMENT +si I-TREATMENT +la I-TREATMENT +histología I-TREATMENT +era I-TREATMENT +coincidente I-TREATMENT +con I-TREATMENT +el I-TREATMENT +primario I-TREATMENT +sin I-TREATMENT +existir I-TREATMENT +otros I-TREATMENT +componentes I-TREATMENT +tumorales I-TREATMENT +no I-TREATMENT +seminomatosos. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +linfadenectomía I-TREATMENT +retroperitoneal I-TREATMENT +hasta I-TREATMENT +vasos I-TREATMENT +iliacos I-TREATMENT +obteniendo I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +observada I-TREATMENT +en I-TREATMENT +Figura I-TREATMENT +2. I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +anatomo-patológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +teratoma I-EXPLORATION +maduro I-EXPLORATION +puro I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +componentes I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +capas I-EXPLORATION +embrionarias I-EXPLORATION +sin I-EXPLORATION +invasión I-EXPLORATION +linfovascular. I-EXPLORATION +EL B-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +vigilancia I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +mediante I-EVOLUTION +marcadores, I-EVOLUTION +TAC I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +radiografía I-EVOLUTION +de I-EVOLUTION +tórax I-EVOLUTION +periódicas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +blanco, B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +llevando I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +prostatismo I-PAST_MEDICAL_HISTORY +caracterizado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +polaquiuria I-PAST_MEDICAL_HISTORY +nocturna I-PAST_MEDICAL_HISTORY +(3-4 I-PAST_MEDICAL_HISTORY +veces I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +noche), I-PAST_MEDICAL_HISTORY +disuria, I-PAST_MEDICAL_HISTORY +chorro I-PAST_MEDICAL_HISTORY +débil, I-PAST_MEDICAL_HISTORY +micción I-PAST_MEDICAL_HISTORY +demorada, I-PAST_MEDICAL_HISTORY +micciones I-PAST_MEDICAL_HISTORY +imperiosas, I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +aproximadamente I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +mejorando I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +impuesto I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cabecera I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +llegando I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +RAO. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +sonda I-PRESENT_ILLNESS +vesical I-PRESENT_ILLNESS +permanente I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +RAO, I-PRESENT_ILLNESS +fracasando I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +intentos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +retirar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +misma, I-PRESENT_ILLNESS +al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +constata I-EXPLORATION +mucosas: I-EXPLORATION +húmedas I-EXPLORATION +y I-EXPLORATION +normocoloreadas, I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +no I-EXPLORATION +infiltrado, I-EXPLORATION +auscultación I-EXPLORATION +cardiorespiratoria I-EXPLORATION +normal, I-EXPLORATION +abdomen I-EXPLORATION +negativo, I-EXPLORATION +fosas I-EXPLORATION +lumbares I-EXPLORATION +libres, I-EXPLORATION +puntos I-EXPLORATION +pielorreno-ureterales I-EXPLORATION +no I-EXPLORATION +dolorosos, I-EXPLORATION +genitales I-EXPLORATION +externos I-EXPLORATION +y I-EXPLORATION +regiones I-EXPLORATION +inguinales I-EXPLORATION +normales, I-EXPLORATION +al I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +una I-EXPLORATION +próstata I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +volumen, I-EXPLORATION +superficie I-EXPLORATION +regular, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +consistencia I-EXPLORATION +fibroadenomatosa, I-EXPLORATION +grado I-EXPLORATION +III, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +hiperplasia I-EXPLORATION +benigna I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +(HBP). I-EXPLORATION +Analítica I-EXPLORATION +sanguínea I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +hemoglobina, I-EXPLORATION +hematocrito, I-EXPLORATION +leucocitos I-EXPLORATION +totales, I-EXPLORATION +urea I-EXPLORATION +creatinina, I-EXPLORATION +PSA I-EXPLORATION +y I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina, I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Ecográfícamente I-EXPLORATION +llamó I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +el I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +prostático I-EXPLORATION +con I-EXPLORATION +ecogenicidad I-EXPLORATION +heterogénea. I-EXPLORATION + I-EXPLORATION +Dado B-TREATMENT +el I-TREATMENT +cuadro I-TREATMENT +clínico I-TREATMENT +y I-TREATMENT +los I-TREATMENT +antecedentes, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +tratamiento I-TREATMENT +quirúrgico, I-TREATMENT +realizándosele I-TREATMENT +una I-TREATMENT +prostatectomía I-TREATMENT +retropúbica. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +describe I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +linfocitario I-EXPLORATION +monomorfo, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +corresponde I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +linfocítico I-EXPLORATION +bien I-EXPLORATION +diferenciado. I-EXPLORATION +Posteriormente B-TREATMENT +es I-TREATMENT +remitido I-TREATMENT +al I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +Oncología I-TREATMENT +donde I-TREATMENT +la I-TREATMENT +aplican I-TREATMENT +tratamiento I-TREATMENT +radioterapia. I-TREATMENT +Actualmente B-EVOLUTION +continúa I-EVOLUTION +seguimiento I-EVOLUTION +en I-EVOLUTION +consulta I-EVOLUTION +de I-EVOLUTION +Urología. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +solicitar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +realización I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +vasectomía. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +los I-EXPLORATION +testes I-EXPLORATION +eran I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +y I-EXPLORATION +tamaño I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +pene I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +torsión I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +60 I-EXPLORATION +grados. I-EXPLORATION +Hasta I-EXPLORATION +la I-EXPLORATION +fecha, I-EXPLORATION +dicha I-EXPLORATION +alteración I-EXPLORATION +no I-EXPLORATION +le I-EXPLORATION +había I-EXPLORATION +producido I-EXPLORATION +sintomatología I-EXPLORATION +alguna. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +escrotal I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +aparecida I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +ido I-PRESENT_ILLNESS +creciendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño I-PRESENT_ILLNESS +muy I-PRESENT_ILLNESS +lentamente I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hernia I-PRESENT_ILLNESS +inguinal I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +el I-EXPLORATION +testículo I-EXPLORATION +derecho I-EXPLORATION +parecía I-EXPLORATION +situarse I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +raíz I-EXPLORATION +escrotal, I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +móvil I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +suave I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +15 I-EXPLORATION +cm I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +hemiescroto. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +clínico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +lipoma I-EXPLORATION +escrotal. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +orina, I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +electrocardiograma I-EXPLORATION +fueron I-EXPLORATION +todos I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +escrotal I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +intervención. I-TREATMENT + I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +operación, I-TREATMENT +en I-TREATMENT +primer I-TREATMENT +lugar, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +reparación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hernia I-TREATMENT +inguinal I-TREATMENT +izquierda I-TREATMENT +con I-TREATMENT +malla I-TREATMENT +de I-TREATMENT +prolene I-TREATMENT +y I-TREATMENT +después I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exploración I-TREATMENT +del I-TREATMENT +hemiescroto I-TREATMENT +derecho. I-TREATMENT + I-TREATMENT +A I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +primera I-TREATMENT +incisión I-TREATMENT +cutánea I-TREATMENT +escrotal I-TREATMENT +derecha I-TREATMENT +intentamos I-TREATMENT +aislar I-TREATMENT +una I-TREATMENT +voluminosa I-TREATMENT +masa I-TREATMENT +blanquecina. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +por I-TREATMENT +la I-TREATMENT +dificultad I-TREATMENT +que I-TREATMENT +teníamos I-TREATMENT +en I-TREATMENT +separar I-TREATMENT +la I-TREATMENT +neoformación I-TREATMENT +de I-TREATMENT +los I-TREATMENT +tejidos I-TREATMENT +circundantes I-TREATMENT +y I-TREATMENT +encontrar I-TREATMENT +el I-TREATMENT +testículo I-TREATMENT +derecho, I-TREATMENT +que I-TREATMENT +estaba I-TREATMENT +envuelto I-TREATMENT +por I-TREATMENT +la I-TREATMENT +masa, I-TREATMENT +decidimos I-TREATMENT +eligir I-TREATMENT +otra I-TREATMENT +vía. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +incisión I-TREATMENT +inguinoescrotál I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cual, I-TREATMENT +mediante I-TREATMENT +disección I-TREATMENT +roma I-TREATMENT +fue I-TREATMENT +más I-TREATMENT +fácil I-TREATMENT +aislar I-TREATMENT +la I-TREATMENT +neoformación, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +extendía I-TREATMENT +superiormente I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +altura I-TREATMENT +del I-TREATMENT +anillo I-TREATMENT +inguinal I-TREATMENT +externo. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +aislado I-TREATMENT +el I-TREATMENT +cordón I-TREATMENT +espermático I-TREATMENT +conseguimos I-TREATMENT +traer I-TREATMENT +fuera I-TREATMENT +el I-TREATMENT +testículo, I-TREATMENT +que I-TREATMENT +tenía I-TREATMENT +aspecto I-TREATMENT +hipotrófico I-TREATMENT +pero I-TREATMENT +no I-TREATMENT +resultaba I-TREATMENT +afectado. I-TREATMENT +También I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +resultaba I-TREATMENT +más I-TREATMENT +facil I-TREATMENT +y I-TREATMENT +segura. I-TREATMENT +Los I-TREATMENT +márgenes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +estaban I-TREATMENT +bien I-TREATMENT +delimitados I-TREATMENT +y I-TREATMENT +fáciles I-TREATMENT +de I-TREATMENT +separarse I-TREATMENT +a I-TREATMENT +excepción I-TREATMENT +de I-TREATMENT +una I-TREATMENT +zona I-TREATMENT +del I-TREATMENT +fondo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +bolsa I-TREATMENT +escrotal, I-TREATMENT +donde I-TREATMENT +la I-TREATMENT +neoformación I-TREATMENT +tenía I-TREATMENT +más I-TREATMENT +adherencia I-TREATMENT +con I-TREATMENT +el I-TREATMENT +dartos. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +aspecto I-EXPLORATION +macroscópico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neoformación I-EXPLORATION +extirpada I-EXPLORATION +era I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +alongada I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +x I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +5cm I-EXPLORATION +y I-EXPLORATION +peso I-EXPLORATION +de I-EXPLORATION +140 I-EXPLORATION +gr I-EXPLORATION +aparentemente I-EXPLORATION +encapsulada I-EXPLORATION +con I-EXPLORATION +superficie I-EXPLORATION +externa I-EXPLORATION +lisa I-EXPLORATION +y I-EXPLORATION +regular. I-EXPLORATION +Al I-EXPLORATION +corte I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +se I-EXPLORATION +presentaba I-EXPLORATION +uniforme, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +denso I-EXPLORATION +y I-EXPLORATION +fibroso, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +degeneración I-EXPLORATION +mixoide I-EXPLORATION +o I-EXPLORATION +necrosis. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +microscópico I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +grupos I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +fusiformes, I-EXPLORATION +onduladas I-EXPLORATION +e I-EXPLORATION +hipercrómicas, I-EXPLORATION +estrechamente I-EXPLORATION +interpuestas I-EXPLORATION +en I-EXPLORATION +haces I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +de I-EXPLORATION +colágeno. I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +inmunohistoquímica I-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +positividad I-EXPLORATION +citoplásmica I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +S-100. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +documentaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +necrosis, I-EXPLORATION +mitosis I-EXPLORATION +ni I-EXPLORATION +atipias I-EXPLORATION +nucleares. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +histopatológico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +neurofibroma. I-EXPLORATION + I-EXPLORATION +Un B-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +revelado I-EVOLUTION +signos I-EVOLUTION +objetivos I-EVOLUTION +de I-EVOLUTION +recidiva. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +RTU I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +próstata. I-PRESENT_ILLNESS +Desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +medio I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +prostático. I-PRESENT_ILLNESS +Estudiado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urología, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +diagnostica I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hipertrofia I-PRESENT_ILLNESS +benigna I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +próstata. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +preoperatorio I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +alteraciones I-EXPLORATION +(electrocardiograma, I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +bioquímica I-EXPLORATION +normales). I-EXPLORATION +Se B-TREATMENT +programa I-TREATMENT +para I-TREATMENT +RTU. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +realizo I-TREATMENT +premedicación. I-TREATMENT +La I-TREATMENT +anestesia I-TREATMENT +intrarraquídea I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +con I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +sedestación. I-TREATMENT +Antes B-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inducción I-EXPLORATION +anestésica I-EXPLORATION +se I-EXPLORATION +monitorizo I-EXPLORATION +un I-EXPLORATION +electrocardiograma I-EXPLORATION +continuo I-EXPLORATION +(ECG), I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +(PA) I-EXPLORATION +no I-EXPLORATION +invasiva I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +SpO2. I-EXPLORATION +La B-TREATMENT +intervención I-TREATMENT +tuvo I-TREATMENT +duración I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +minutos I-TREATMENT +y I-TREATMENT +transcurrio I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +3, I-TREATMENT +5 I-TREATMENT +litros I-TREATMENT +de I-TREATMENT +agua I-TREATMENT +estéril I-TREATMENT +(hipotónica) I-TREATMENT +como I-TREATMENT +liquido I-TREATMENT +de I-TREATMENT +irrigación, I-TREATMENT +contabilizandose I-TREATMENT +un I-TREATMENT +balance I-TREATMENT +negativo I-TREATMENT +de I-TREATMENT +1500ml. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +sala I-EVOLUTION +de I-EVOLUTION +despertar I-EVOLUTION +presento I-EVOLUTION +vómitos I-EVOLUTION +e I-EVOLUTION +hipotensión I-EVOLUTION +(100/60mmHg). I-EVOLUTION +No B-TREATMENT +se I-TREATMENT +objetivaron I-TREATMENT +alteraciones I-TREATMENT +neurológicas, I-TREATMENT +ni I-TREATMENT +cardiovasculares, I-TREATMENT +ni I-TREATMENT +edema I-TREATMENT +pulmonar. I-TREATMENT +ECG I-TREATMENT +y I-TREATMENT +Rx I-TREATMENT +torax I-TREATMENT +sin I-TREATMENT +alteraciones. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +bioquímica I-TREATMENT +sanguínea I-TREATMENT +destacaba: I-TREATMENT +sodio I-TREATMENT +: I-TREATMENT +122 I-TREATMENT +mEq/L, I-TREATMENT +potasio I-TREATMENT +: I-TREATMENT +5, I-TREATMENT +9 I-TREATMENT +mmol/L, I-TREATMENT +osmolaridad I-TREATMENT +: I-TREATMENT +256 I-TREATMENT +mOsmol/kg, I-TREATMENT +urea I-TREATMENT +: I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +g/L, I-TREATMENT +creatinina I-TREATMENT +(cr.s) I-TREATMENT +: I-TREATMENT +38 I-TREATMENT +mg/L, I-TREATMENT +calcio I-TREATMENT +: I-TREATMENT +80 I-TREATMENT +mg/L, I-TREATMENT +proteínas I-TREATMENT +totales I-TREATMENT +: I-TREATMENT +51 I-TREATMENT +g/L, I-TREATMENT +albúmina I-TREATMENT +: I-TREATMENT +28 I-TREATMENT +g/L, I-TREATMENT +CPK I-TREATMENT +: I-TREATMENT +225 I-TREATMENT +U/L, I-TREATMENT +LDH I-TREATMENT +: I-TREATMENT +416 I-TREATMENT +U/L, I-TREATMENT +GOT I-TREATMENT +: I-TREATMENT +48 I-TREATMENT +U/L, I-TREATMENT +GPT I-TREATMENT +: I-TREATMENT +97 I-TREATMENT +U/L, I-TREATMENT +haptoglobina I-TREATMENT +: I-TREATMENT +43.8 I-TREATMENT +mg/dL I-TREATMENT +(rango I-TREATMENT +normal I-TREATMENT +50-220 I-TREATMENT +mg/dL), I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +de I-TREATMENT +coagulación I-TREATMENT +salieron I-TREATMENT +normales, I-TREATMENT +Hb I-TREATMENT +: I-TREATMENT +10 I-TREATMENT +g/dl, I-TREATMENT +HCT I-TREATMENT +: I-TREATMENT +28.8 I-TREATMENT +%, I-TREATMENT +leucocitos I-TREATMENT +: I-TREATMENT +6400/mm3, I-TREATMENT +plaquetas I-TREATMENT +: I-TREATMENT +220.000/mm3. I-TREATMENT +Gasometría: I-TREATMENT +pH I-TREATMENT +: I-TREATMENT +7, I-TREATMENT +30; I-TREATMENT +PCO2 I-TREATMENT +: I-TREATMENT +36 I-TREATMENT +mmHg; I-TREATMENT +PO2 I-TREATMENT +: I-TREATMENT +72 I-TREATMENT +mmHg. I-TREATMENT +Se B-EVOLUTION +procede I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +Reanimación. I-EVOLUTION + I-EVOLUTION +Tras B-TREATMENT +la I-TREATMENT +estabilización I-TREATMENT +clínica I-TREATMENT +con I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tensión I-TREATMENT +arterial, I-TREATMENT +se I-TREATMENT +pudo I-TREATMENT +prescindir I-TREATMENT +de I-TREATMENT +las I-TREATMENT +drogas I-TREATMENT +vasopresoras, I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +Furosemida I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +suero I-TREATMENT +salino I-TREATMENT +hipertónico I-TREATMENT +al I-TREATMENT +3% I-TREATMENT +para I-TREATMENT +minimizar I-TREATMENT +la I-TREATMENT +sobrecarga I-TREATMENT +de I-TREATMENT +volumen. I-TREATMENT +A I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +aplicadas I-TREATMENT +persistia I-TREATMENT +con I-TREATMENT +insuficiencia I-TREATMENT +renal I-TREATMENT +aguda I-TREATMENT +oligúrica I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días, I-TREATMENT +llegando I-TREATMENT +a I-TREATMENT +cifras I-TREATMENT +máximas I-TREATMENT +de I-TREATMENT +urea I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +70 I-TREATMENT +g/L I-TREATMENT +y I-TREATMENT +de I-TREATMENT +creatinina I-TREATMENT +de I-TREATMENT +72 I-TREATMENT +mg/L, I-TREATMENT +precisando I-TREATMENT +de I-TREATMENT +04 I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +hemodiálisis. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +3 I-TREATMENT +semanas, I-TREATMENT +reinició I-TREATMENT +la I-TREATMENT +diuresis I-TREATMENT +entrando I-TREATMENT +en I-TREATMENT +fase I-TREATMENT +poliúrica, I-TREATMENT +recuperandose I-TREATMENT +así I-TREATMENT +progresivamente I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal, I-TREATMENT +siendo I-TREATMENT +la I-TREATMENT +Cr.s. I-TREATMENT +al I-TREATMENT +alta I-TREATMENT +de I-TREATMENT +14 I-TREATMENT +mg/L. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +normotenso, I-EVOLUTION +con I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +Cr.s. I-EVOLUTION +10 I-EVOLUTION +mg/L I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +Ccr. I-EVOLUTION +76 I-EVOLUTION +ml/minuto. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +conocida I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +enero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2003, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +acudir I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +sólida I-PRESENT_ILLNESS +dependiente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mesorriñón I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +cm I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tamaño, I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +adenomegalias I-PRESENT_ILLNESS +retrocavas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +nódulo I-PRESENT_ILLNESS +hepático I-PRESENT_ILLNESS +sospechoso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +metástasis, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +nódulos I-PRESENT_ILLNESS +pulmonares I-PRESENT_ILLNESS +bilaterales I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +campos I-PRESENT_ILLNESS +basales. I-PRESENT_ILLNESS +Para B-EXPLORATION +filiar I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +percutánea I-EXPLORATION +renal I-EXPLORATION +que I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +nefroblastoma. I-EXPLORATION +Se B-TREATMENT +estadió I-TREATMENT +como I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +conforme I-TREATMENT +a I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +según I-TREATMENT +protocolo I-TREATMENT +SIOP, I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +poliquimioterapia I-TREATMENT +sistémica I-TREATMENT +con I-TREATMENT +actinomicina I-TREATMENT +D, I-TREATMENT +vincristina I-TREATMENT +y I-TREATMENT +doxorrubicina I-TREATMENT +separados I-TREATMENT +3 I-TREATMENT +semanas. I-TREATMENT +Al B-EVOLUTION +cabo I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +período I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +la I-EVOLUTION +reducción I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +masa I-EVOLUTION +renal I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +evidente I-EVOLUTION +cambio I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +densidad I-EVOLUTION +del I-EVOLUTION +nódulo I-EVOLUTION +hepático, I-EVOLUTION +no I-EVOLUTION +habiendo I-EVOLUTION +variado I-EVOLUTION +ni I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +ni I-EVOLUTION +la I-EVOLUTION +densidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +ganglios I-EVOLUTION +regionales. I-EVOLUTION +Se B-TREATMENT +sometió I-TREATMENT +a I-TREATMENT +nefrectomía I-TREATMENT +radical I-TREATMENT +dcha, I-TREATMENT +linfadenectomía I-TREATMENT +regional I-TREATMENT +y I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +nódulo I-TREATMENT +hepático. I-TREATMENT +En I-TREATMENT +riñón I-TREATMENT +se I-TREATMENT +reconfirmó I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +nefroblastoma I-TREATMENT +con I-TREATMENT +componente I-TREATMENT +mixto, I-TREATMENT +un I-TREATMENT +tercio I-TREATMENT +de I-TREATMENT +blastema, I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +tercios I-TREATMENT +epiteliales, I-TREATMENT +acompañados I-TREATMENT +de I-TREATMENT +un I-TREATMENT +60% I-TREATMENT +de I-TREATMENT +necrosis. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +nefrectomía I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +actinomicina I-TREATMENT +D I-TREATMENT +y I-TREATMENT +vincristina, I-TREATMENT +hasta I-TREATMENT +que I-TREATMENT +en I-TREATMENT +estudio I-TREATMENT +control I-TREATMENT +aparece I-TREATMENT +un I-TREATMENT +nódulo I-TREATMENT +pulmonar I-TREATMENT +basal I-TREATMENT +izdo, I-TREATMENT +estudiado I-TREATMENT +mediante I-TREATMENT +PET, I-TREATMENT +ofreciendo I-TREATMENT +resultado I-TREATMENT +positivo, I-TREATMENT +y I-TREATMENT +procediéndose I-TREATMENT +a I-TREATMENT +resección I-TREATMENT +quirúrgica I-TREATMENT +poniendo I-TREATMENT +de I-TREATMENT +manifiesto I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +componente I-TREATMENT +nefroblastomatoso I-TREATMENT +sin I-TREATMENT +poder I-TREATMENT +reconocer I-TREATMENT +un I-TREATMENT +claro I-TREATMENT +patrón I-TREATMENT +de I-TREATMENT +crecimiento. I-TREATMENT +Posteriormente I-TREATMENT +y I-TREATMENT +siguiendo I-TREATMENT +las I-TREATMENT +indicaciones I-TREATMENT +de I-TREATMENT +la I-TREATMENT +SIOP I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +la I-TREATMENT +poliquimioterapia I-TREATMENT +sistémica I-TREATMENT +asociando I-TREATMENT +carboplatino I-TREATMENT +y I-TREATMENT +etopósido, I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +26 I-TREATMENT +semanas. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +46 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +inicial I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +H.T.A. I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +coágulos I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +urológicos I-PRESENT_ILLNESS +destacables I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +es I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +ecográfico I-EXPLORATION +no I-EXPLORATION +detecta I-EXPLORATION +anomalías I-EXPLORATION +de I-EXPLORATION +interés, I-EXPLORATION +con I-EXPLORATION +riñones I-EXPLORATION +y I-EXPLORATION +vías I-EXPLORATION +excretoras I-EXPLORATION +normales, I-EXPLORATION +próstata I-EXPLORATION +discretamente I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +vejiga I-EXPLORATION +sin I-EXPLORATION +hallazgos. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cistoscopia I-EXPLORATION +practicada I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +papilar I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +izquierda I-EXPLORATION +retromeatal I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +hasta I-EXPLORATION +vertiente I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +vesical. I-EXPLORATION +Se B-TREATMENT +practica I-TREATMENT +resección I-TREATMENT +transuretral. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +adenoma I-EXPLORATION +de I-EXPLORATION +Brunner I-EXPLORATION +(papiloma I-EXPLORATION +invertido) I-EXPLORATION +sobre I-EXPLORATION +varios I-EXPLORATION +fragmentos I-EXPLORATION +resecados I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +conjunto I-EXPLORATION +miden I-EXPLORATION +10x15x5 I-EXPLORATION +mm.. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +asintomático I-EVOLUTION +tras I-EVOLUTION +24 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +histerectomía I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +doble I-PAST_MEDICAL_HISTORY +anexectomía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +miomas I-PAST_MEDICAL_HISTORY +uterinos I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1997, I-PAST_MEDICAL_HISTORY +hernia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hiato, I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +médico. I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +asimismo I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +nódulo I-PAST_MEDICAL_HISTORY +tiroideo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diámetro, I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +coloide I-PAST_MEDICAL_HISTORY +nodular I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +PAAF I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1995. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +intervenida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2001, I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +nefrectomía I-PAST_MEDICAL_HISTORY +radical I-PAST_MEDICAL_HISTORY +derecha, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +heterogéneo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diámetro I-PAST_MEDICAL_HISTORY +localizado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tercio I-PAST_MEDICAL_HISTORY +medio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riñón I-PAST_MEDICAL_HISTORY +derecho, I-PAST_MEDICAL_HISTORY +correspondiendo I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +anatomopatológico I-PAST_MEDICAL_HISTORY +posterior, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alto I-PAST_MEDICAL_HISTORY +grado, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +infiltración I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vena I-PAST_MEDICAL_HISTORY +renal, I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +pT3bNoMo. I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +coadyuvante I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +interleukina- I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +subcutánea I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +informe I-PAST_MEDICAL_HISTORY +anatomopatológico I-PAST_MEDICAL_HISTORY +macroscópico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pieza I-PAST_MEDICAL_HISTORY +describía I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +nódulo I-PAST_MEDICAL_HISTORY +tumoral I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +infiltraba I-PAST_MEDICAL_HISTORY +pelvis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vena I-PAST_MEDICAL_HISTORY +renal, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +diámetro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +x I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +x I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +cm, I-PAST_MEDICAL_HISTORY +combinando I-PAST_MEDICAL_HISTORY +áreas I-PAST_MEDICAL_HISTORY +grisáceas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +pardoamarillentas. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +microscópico I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +tumoración I-PAST_MEDICAL_HISTORY +pseudocapsular I-PAST_MEDICAL_HISTORY +correspondiente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alto I-PAST_MEDICAL_HISTORY +grado, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +alguna I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +anaplásica. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +invadía I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +sistema I-PAST_MEDICAL_HISTORY +pielocalicial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +evidencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +invasión I-PAST_MEDICAL_HISTORY +vascular I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +vena I-PAST_MEDICAL_HISTORY +renal. I-PAST_MEDICAL_HISTORY +Los I-PAST_MEDICAL_HISTORY +márgenes I-PAST_MEDICAL_HISTORY +quirúrgicos I-PAST_MEDICAL_HISTORY +estaban I-PAST_MEDICAL_HISTORY +libres. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2004 I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +control, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +detectó I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +TAC, I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +marcado I-PAST_MEDICAL_HISTORY +crecimiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lóbulo I-PAST_MEDICAL_HISTORY +tiroideo I-PAST_MEDICAL_HISTORY +izquierdo, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +nódulo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +heterogéneo, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nódulo I-PAST_MEDICAL_HISTORY +coloide I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +conocido. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2005, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +nuevo I-PAST_MEDICAL_HISTORY +TAC, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +lóbulo I-PAST_MEDICAL_HISTORY +tiroideo I-PAST_MEDICAL_HISTORY +izquierdo, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +crecimiento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +nódulo I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +5, I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +desplazando I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +tráquea. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +gammagrafía I-EXPLORATION +tiroidea I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +'nódulo I-EXPLORATION +frío' I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +hormonas I-EXPLORATION +tiroideas. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +el I-TREATMENT +crecimiento I-TREATMENT +progresivo I-TREATMENT +del I-TREATMENT +nódulo I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +hemitiroidectomía I-TREATMENT +izquierda. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +describía I-EXPLORATION +un I-EXPLORATION +hemitiroides I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +zonas I-EXPLORATION +amarillentas I-EXPLORATION +en I-EXPLORATION +superficie, I-EXPLORATION +alternando I-EXPLORATION +con I-EXPLORATION +otras I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +más I-EXPLORATION +carnoso. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +microscópico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +con I-EXPLORATION +citoplasma I-EXPLORATION +claro, I-EXPLORATION +las I-EXPLORATION +cuales I-EXPLORATION +presentaban I-EXPLORATION +una I-EXPLORATION +acusada I-EXPLORATION +atipia, I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +incluso I-EXPLORATION +anaplásicas I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +figuras I-EXPLORATION +de I-EXPLORATION +mitosis. I-EXPLORATION +Presentaban I-EXPLORATION +un I-EXPLORATION +crecimiento I-EXPLORATION +difuso I-EXPLORATION +constituyendo I-EXPLORATION +nódulos I-EXPLORATION +con I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +esclerosis I-EXPLORATION +y I-EXPLORATION +extensas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +rodeada I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +tiroideo I-EXPLORATION +respetado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetivaban I-EXPLORATION +folículos I-EXPLORATION +linfoides. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +técnicas I-EXPLORATION +de I-EXPLORATION +inmunohistoquímica I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +cuales I-EXPLORATION +dichas I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +presentaron I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +tiroglobulina I-EXPLORATION +y I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +CK8, I-EXPLORATION +CK18, I-EXPLORATION +EMA, I-EXPLORATION +y I-EXPLORATION +Vimentina. I-EXPLORATION + I-EXPLORATION +Dadas I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +histológicas I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +perfil I-EXPLORATION +inmunohistoquímico, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +historia I-EXPLORATION +clínica I-EXPLORATION +del I-EXPLORATION +paciente, I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +renal I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +claras. I-EXPLORATION + I-EXPLORATION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Puertas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +escrotal I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemiescroto I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +traumático I-PAST_MEDICAL_HISTORY +conocido. I-PAST_MEDICAL_HISTORY +No B-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +enrojecimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +escrotal, I-EXPLORATION +más I-EXPLORATION +acusado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemiescroto I-EXPLORATION +izquierdo I-EXPLORATION +ligeramente I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +palpación. I-EXPLORATION +Cordón I-EXPLORATION +y I-EXPLORATION +testículos I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +normales I-EXPLORATION +no I-EXPLORATION +dolorosos. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +aparece I-EXPLORATION +hidrocele I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +transluminación I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +maniobra I-EXPLORATION +de I-EXPLORATION +Prehn I-EXPLORATION +es I-EXPLORATION +negativa. I-EXPLORATION +Reflejos I-EXPLORATION +cremastéricos I-EXPLORATION +conservados. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +estudio I-EXPLORATION +ultrasonográfico I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +de: I-EXPLORATION +testículo I-EXPLORATION +y I-EXPLORATION +epidídimos I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +normales I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +inflamación I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +el I-EXPLORATION +flujo I-EXPLORATION +al I-EXPLORATION +Eco-Doppler. I-EXPLORATION +Cubiertas I-EXPLORATION +testiculares I-EXPLORATION +y I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +de I-EXPLORATION +hemiescroto I-EXPLORATION +izquierdo I-EXPLORATION +engrosados I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +flujo I-EXPLORATION +Doppler. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +diagnosticó I-TREATMENT +de I-TREATMENT +edema I-TREATMENT +de I-TREATMENT +escroto I-TREATMENT +agudo I-TREATMENT +idiopático, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +recetaron I-TREATMENT +AINES I-TREATMENT +y B-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +cito I-EVOLUTION +para I-EVOLUTION +revisión I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +días, I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +observar I-EVOLUTION +que I-EVOLUTION +el I-EVOLUTION +edema, I-EVOLUTION +el I-EVOLUTION +eritema I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +habían I-EVOLUTION +desaparecido I-EVOLUTION +casi I-EVOLUTION +por I-EVOLUTION +completo. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +Colombiana B-PAST_MEDICAL_HISTORY +de B-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +episódico I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +punzada I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hematuria, I-PRESENT_ILLNESS +nauseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +Con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +patológico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +quirúrgico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +histerectomía. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +sus I-EXPLORATION +signos I-EXPLORATION +vitales, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +20kg/Mts2, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +único I-EXPLORATION +signo I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +era I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +flanco I-EXPLORATION +izquierdo. I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +manejo I-TREATMENT +médico I-TREATMENT +considerando I-TREATMENT +pielonefritis, I-TREATMENT +sin B-EVOLUTION +resolución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología, I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +toma I-EXPLORATION +Tomografía I-EXPLORATION +Axial I-EXPLORATION +Computarizada, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +informa I-EXPLORATION +masa I-EXPLORATION +dependiente I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +10 I-EXPLORATION +cms, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +nefrectomía. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +muestra I-EXPLORATION +quirúrgica I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +renal I-EXPLORATION +fue I-EXPLORATION +fijada I-EXPLORATION +luego I-EXPLORATION +de I-EXPLORATION +extraerse I-EXPLORATION +con I-EXPLORATION +formaldehído I-EXPLORATION +al I-EXPLORATION +10% I-EXPLORATION +y I-EXPLORATION +embebido I-EXPLORATION +en I-EXPLORATION +parafina I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +preparación I-EXPLORATION +y I-EXPLORATION +análisis I-EXPLORATION +microscópico, I-EXPLORATION +la I-EXPLORATION +coloración I-EXPLORATION +empleada I-EXPLORATION +fue I-EXPLORATION +Hematoxilina I-EXPLORATION +y I-EXPLORATION +Eosina. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +referir I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +testicular I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +acompañado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +termometrada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40ºC, I-PRESENT_ILLNESS +junto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +escalofríos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional I-PRESENT_ILLNESS +acompañante I-PRESENT_ILLNESS +(disuria, I-PRESENT_ILLNESS +polaquiuria, I-PRESENT_ILLNESS +tenesmo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +miccional), I-PRESENT_ILLNESS +ausencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Durante B-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +anamnesis I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +revela I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +profesión, I-PAST_MEDICAL_HISTORY +veterinario, I-PAST_MEDICAL_HISTORY +profesión I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +ciertas I-PAST_MEDICAL_HISTORY +patologías I-PAST_MEDICAL_HISTORY +infecciosas I-PAST_MEDICAL_HISTORY +(brucelosis, I-PAST_MEDICAL_HISTORY +triquinosis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +algunas I-PAST_MEDICAL_HISTORY +parasitosis). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +un I-EXPLORATION +teste I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +normales, I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +teste I-EXPLORATION +izquierdo, I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +al I-EXPLORATION +tacto I-EXPLORATION +sin I-EXPLORATION +fluctuación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +afecta I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +movilización I-EXPLORATION +testicular. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +resulta I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +abdominal I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +percusión I-EXPLORATION +renal I-EXPLORATION +también I-EXPLORATION +descartó I-EXPLORATION +afecciones I-EXPLORATION +acompañantes I-EXPLORATION +al I-EXPLORATION +ser I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Analíticamente I-EXPLORATION +destaca I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +22.240 I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(neutrófilos I-EXPLORATION +90%). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Ecografía I-EXPLORATION +testicular I-EXPLORATION +realizada I-EXPLORATION +previa I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +muestra I-EXPLORATION +aumentos I-EXPLORATION +homogéneos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecogenicidad I-EXPLORATION +del I-EXPLORATION +testículo I-EXPLORATION +afecto, I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +epidídimo. I-EXPLORATION +Engrosamiento I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +absceso I-EXPLORATION +testicular. I-EXPLORATION +Imágenes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +orquitis I-EXPLORATION +sin I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +epidídimo. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +orquitis I-TREATMENT +infecciosa, I-TREATMENT +procediéndose I-TREATMENT +a I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +con I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +que I-TREATMENT +comprendió I-TREATMENT +Doxiciclina, I-TREATMENT +Imipenem I-TREATMENT +y I-TREATMENT +Teicoplanina, I-TREATMENT +asociando I-TREATMENT +Corticoides I-TREATMENT +y I-TREATMENT +terapia I-TREATMENT +analgésica. I-TREATMENT + I-TREATMENT +Dos B-EXPLORATION +días I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +ingresse I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +ecografía, I-EXPLORATION +objetivándose I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecogenicidad I-EXPLORATION +homogénea I-EXPLORATION +similar I-EXPLORATION +al I-EXPLORATION +contralateral, I-EXPLORATION +afectación I-EXPLORATION +epididimaria. I-EXPLORATION +Engrosamiento I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +absceso I-EXPLORATION +testicular. I-EXPLORATION +Se I-EXPLORATION +termina I-EXPLORATION +de I-EXPLORATION +filiar I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +sindrómico: I-EXPLORATION +Orquiepididimitis I-EXPLORATION +infecciosa. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +averiguar I-EXPLORATION +la I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +patología I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +hace I-EXPLORATION +necesaria I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +que I-EXPLORATION +permitan I-EXPLORATION +conocer I-EXPLORATION +el I-EXPLORATION +germen I-EXPLORATION +causante. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +urocultivo I-EXPLORATION +resulta I-EXPLORATION +ser I-EXPLORATION +negativo, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +aglutinación I-EXPLORATION +específica I-EXPLORATION +de I-EXPLORATION +Brucella. I-EXPLORATION +Sin I-EXPLORATION +embargo I-EXPLORATION +la I-EXPLORATION +seroaglutinación I-EXPLORATION +de I-EXPLORATION +Rosa I-EXPLORATION +de I-EXPLORATION +Bengala I-EXPLORATION +resulta I-EXPLORATION +positiva, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +hemocultivos, I-EXPLORATION +que I-EXPLORATION +son I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +Brucella I-EXPLORATION +spp. I-EXPLORATION +(los I-EXPLORATION +tres). I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +confirmación I-TREATMENT +del I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +orquiepididimitis I-TREATMENT +brucelar I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +mantener I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Doxiciclina I-TREATMENT +y I-TREATMENT +ciprofloxacino. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +favorablemente I-EVOLUTION +con I-EVOLUTION +remisión I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +litiasis I-PRESENT_ILLNESS +piélica I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +nicturia I-PRESENT_ILLNESS +3-4, I-PRESENT_ILLNESS +polaquiuria, I-PRESENT_ILLNESS +escozor I-PRESENT_ILLNESS +miccional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +aislados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematuria. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +el I-EXPLORATION +sistemático I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +están I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +aparato I-EXPLORATION +urinario, I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +radiopaca I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +izquierdo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +anecóica I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +derecho, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +hidronefrosis I-EXPLORATION +e I-EXPLORATION +importante I-EXPLORATION +atrofia I-EXPLORATION +cortical. I-EXPLORATION +En I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +hidronefrosis I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +imágenes I-EXPLORATION +ecogénicas I-EXPLORATION +en I-EXPLORATION +pelvis, I-EXPLORATION +cálices I-EXPLORATION +medios I-EXPLORATION +e I-EXPLORATION +inferiores I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +cálculos. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +urografía I-EXPLORATION +intravenosa, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +distinguen I-EXPLORATION +un I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +no I-EXPLORATION +funcionante I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +bifidez I-EXPLORATION +pieloureteral, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +litiasis I-EXPLORATION +coraliforme I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pielón I-EXPLORATION +inferior I-EXPLORATION +izquierdo. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +TAC I-EXPLORATION +abdomino-pélvico, I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +aparece I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +cavidad I-EXPLORATION +quística, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +cortical I-EXPLORATION +funcionante. I-EXPLORATION +El I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +presenta I-EXPLORATION +hipertrofia I-EXPLORATION +compensadora, I-EXPLORATION +con I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +quísticas I-EXPLORATION +corticales I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +cálculos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +inferior. I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +practicar I-EXPLORATION +punción I-EXPLORATION +percutánea I-EXPLORATION +bilateral, I-EXPLORATION +observando I-EXPLORATION +gran I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +paso I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +al I-EXPLORATION +uréter I-EXPLORATION +y I-EXPLORATION +bifidez I-EXPLORATION +pieloureteral I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +litiasis I-EXPLORATION +coraliforme I-EXPLORATION +en I-EXPLORATION +pielón I-EXPLORATION +inferior. I-EXPLORATION +Se B-TREATMENT +deja I-TREATMENT +colocada I-TREATMENT +una I-TREATMENT +sonda I-TREATMENT +de I-TREATMENT +nefrostomía I-TREATMENT +en I-TREATMENT +el I-TREATMENT +lado I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +instaura I-TREATMENT +tratamiento I-TREATMENT +antibiótico, I-TREATMENT +al I-TREATMENT +extraer I-TREATMENT +orina I-TREATMENT +purulenta I-TREATMENT +en I-TREATMENT +la I-TREATMENT +descarga I-TREATMENT +del I-TREATMENT +pielón I-TREATMENT +inferior. I-TREATMENT +La B-EXPLORATION +gammagrafía I-EXPLORATION +renal I-EXPLORATION +confirma I-EXPLORATION +la I-EXPLORATION +escasa I-EXPLORATION +función I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +(11%). I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cistoscopia I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +objetivan I-EXPLORATION +neorformaciones I-EXPLORATION +vesicales. I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +estudios I-TREATMENT +preoperatorios I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +normalidad I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +intervenido I-TREATMENT +quirúrgicamente I-TREATMENT +realizándose I-TREATMENT +nefrolitotomía I-TREATMENT +percutánea I-TREATMENT +izquierda, I-TREATMENT +con I-TREATMENT +fragmentación I-TREATMENT +de I-TREATMENT +litiasis I-TREATMENT +con I-TREATMENT +lithoclast I-TREATMENT +y I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +fragmentos. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +quince I-TREATMENT +días I-TREATMENT +se I-TREATMENT +lleva I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +nefrolitotomía I-TREATMENT +con I-TREATMENT +el I-TREATMENT +fin I-TREATMENT +de I-TREATMENT +eliminar I-TREATMENT +todos I-TREATMENT +los I-TREATMENT +restos I-TREATMENT +litiásicos. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +eliminando I-EVOLUTION +orina I-EVOLUTION +purulenta I-EVOLUTION +por I-EVOLUTION +sonda I-EVOLUTION +de I-EVOLUTION +nefrostomía I-EVOLUTION +percutánea. I-EVOLUTION +La B-EXPLORATION +angiografía I-EXPLORATION +por I-EXPLORATION +sustracción I-EXPLORATION +digital' I-EXPLORATION +(DIVAS) I-EXPLORATION +demuestra I-EXPLORATION +una I-EXPLORATION +escasa I-EXPLORATION +vascularización I-EXPLORATION +del I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +izquierdo. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +heminefrectomía I-TREATMENT +polar I-TREATMENT +inferior I-TREATMENT +izquierda. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +postoperatorio I-TREATMENT +inmediato I-TREATMENT +se I-TREATMENT +produce I-TREATMENT +un I-TREATMENT +empeoramiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal, I-TREATMENT +con I-TREATMENT +fiebre I-TREATMENT +y I-TREATMENT +leucocitosis, I-TREATMENT +proceso I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +sepsis I-TREATMENT +de I-TREATMENT +origen I-TREATMENT +urinario I-TREATMENT +que I-TREATMENT +mejora I-TREATMENT +con I-TREATMENT +sueroterapia I-TREATMENT +y I-TREATMENT +antibioterapia I-TREATMENT +parenteral. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +pieza I-EXPLORATION +extirpada I-EXPLORATION +corresponde I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +452 I-EXPLORATION +gramos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +acompaña I-EXPLORATION +de I-EXPLORATION +abundante I-EXPLORATION +grasa I-EXPLORATION +intimamente I-EXPLORATION +pegada I-EXPLORATION +al I-EXPLORATION +parenquima I-EXPLORATION +renal. I-EXPLORATION +Al I-EXPLORATION +corte I-EXPLORATION +el I-EXPLORATION +parenquima I-EXPLORATION +está I-EXPLORATION +sustituido I-EXPLORATION +por I-EXPLORATION +grandes I-EXPLORATION +cavidades I-EXPLORATION +quísticas I-EXPLORATION +ocupadas I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +material I-EXPLORATION +blanquecino I-EXPLORATION +y I-EXPLORATION +blando. I-EXPLORATION +Histológicamente I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +grandes I-EXPLORATION +masas I-EXPLORATION +sólidas, I-EXPLORATION +nidos I-EXPLORATION +y I-EXPLORATION +regueros I-EXPLORATION +infiltrantes I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +hábito I-EXPLORATION +escamoso I-EXPLORATION +que I-EXPLORATION +presentan I-EXPLORATION +grandes I-EXPLORATION +núcleos I-EXPLORATION +vesiculosos I-EXPLORATION +e I-EXPLORATION +irregulares I-EXPLORATION +con I-EXPLORATION +nucleolo I-EXPLORATION +prominente, I-EXPLORATION +citoplasma I-EXPLORATION +amplio, I-EXPLORATION +bien I-EXPLORATION +definido, I-EXPLORATION +eosinófilo I-EXPLORATION +claro, I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +queratinización I-EXPLORATION +individual I-EXPLORATION +y I-EXPLORATION +formación I-EXPLORATION +de I-EXPLORATION +perlas I-EXPLORATION +corneas. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +urografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +posterior I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +función I-EXPLORATION +normal I-EXPLORATION +del I-EXPLORATION +hemirriñón I-EXPLORATION +superior I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +uropatía I-EXPLORATION +obstructiva. I-EXPLORATION + I-EXPLORATION +Un B-EVOLUTION +año I-EVOLUTION +y I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +ingresa I-EVOLUTION +desde I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +hematuria I-EVOLUTION +macroscópica. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +urografía I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +defecto I-EXPLORATION +de I-EXPLORATION +replección I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +derecha, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +corroborado I-EXPLORATION +mediante I-EXPLORATION +cistoscopia. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +resección I-TREATMENT +transuretral I-TREATMENT +de I-TREATMENT +tumoración I-TREATMENT +sólida I-TREATMENT +en I-TREATMENT +cara I-TREATMENT +lateral I-TREATMENT +derecha I-TREATMENT +de I-TREATMENT +vejiga, I-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +anatomo-patológico I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +vesical I-TREATMENT +con I-TREATMENT +áreas I-TREATMENT +de I-TREATMENT +diferenciación I-TREATMENT +escamosa I-TREATMENT +que I-TREATMENT +infiltra I-TREATMENT +la I-TREATMENT +muscular, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +cistoprostatectomía I-TREATMENT +radical I-TREATMENT +con I-TREATMENT +derivación I-TREATMENT +urinaria I-TREATMENT +de I-TREATMENT +uréter I-TREATMENT +izquierdo I-TREATMENT +a I-TREATMENT +sigma I-TREATMENT +(Mainz I-TREATMENT +II). I-TREATMENT +En I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +una I-TREATMENT +nefroureterectomía I-TREATMENT +derecha, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +observa I-TREATMENT +un I-TREATMENT +riñón I-TREATMENT +hidronefrótico, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +la I-TREATMENT +unión I-TREATMENT +pieloureteral I-TREATMENT +por I-TREATMENT +un I-TREATMENT +vaso I-TREATMENT +polar. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +escamosas, I-EXPLORATION +estadio I-EXPLORATION +pT3a, I-EXPLORATION +pNx, I-EXPLORATION +pMx. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fallece I-EVOLUTION +cuatro I-EVOLUTION +meses I-EVOLUTION +más I-EVOLUTION +tarde, I-EVOLUTION +con I-EVOLUTION +metástasis I-EVOLUTION +pulmonares I-EVOLUTION +y I-EVOLUTION +hepáticas. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +litiasis I-PRESENT_ILLNESS +piélica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +riñón I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +diámetro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS +Se B-TREATMENT +le I-TREATMENT +propone I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +NLPC. I-TREATMENT +Bajo I-TREATMENT +anestesia I-TREATMENT +general I-TREATMENT +y I-TREATMENT +en I-TREATMENT +posición I-TREATMENT +de I-TREATMENT +decúbito I-TREATMENT +prono I-TREATMENT +se I-TREATMENT +accede I-TREATMENT +al I-TREATMENT +riñón I-TREATMENT +por I-TREATMENT +grupo I-TREATMENT +calicial I-TREATMENT +inferior, I-TREATMENT +bajo I-TREATMENT +control I-TREATMENT +de I-TREATMENT +escopia. I-TREATMENT +Se I-TREATMENT +dilata I-TREATMENT +el I-TREATMENT +trayecto I-TREATMENT +de I-TREATMENT +acceso I-TREATMENT +percutáneo I-TREATMENT +con I-TREATMENT +dilatadores I-TREATMENT +metálicos I-TREATMENT +coaxiales I-TREATMENT +de I-TREATMENT +Alken. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +fragmentación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +litiasis I-TREATMENT +con I-TREATMENT +el I-TREATMENT +litotriptor I-TREATMENT +intracorpóreo I-TREATMENT +StoneBreakerTM I-TREATMENT +(LMA I-TREATMENT +Urology, I-TREATMENT +Gland, I-TREATMENT +Switzerland). I-TREATMENT +El I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +fragmentación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +litiasis I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +30 I-TREATMENT +minutos I-TREATMENT +utilizando I-TREATMENT +tres I-TREATMENT +cartuchos I-TREATMENT +de I-TREATMENT +dióxido I-TREATMENT +de I-TREATMENT +carbono I-TREATMENT +comprimido. I-TREATMENT +No B-EVOLUTION +existieron I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +procedimiento I-EVOLUTION +con B-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +doble I-TREATMENT +J I-TREATMENT +por I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +restos I-TREATMENT +litiásicos I-TREATMENT +menores I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +mm. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +al B-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ecografía I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +solicitada I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +prostático, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +diagnosticó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +RH I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +sólida I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +asienta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +istmo I-PRESENT_ILLNESS +renal. I-PRESENT_ILLNESS +El B-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +cm. I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +istmo I-EXPLORATION +renal I-EXPLORATION +sin I-EXPLORATION +evidenciar I-EXPLORATION +adenopatías, I-EXPLORATION +metástasis I-EXPLORATION +locoregionales I-EXPLORATION +ni I-EXPLORATION +lesiones I-EXPLORATION +a I-EXPLORATION +distancia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +vascular I-EXPLORATION +preoperatorio I-EXPLORATION +mediante I-EXPLORATION +arteriografía, I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +dos I-EXPLORATION +arterias I-EXPLORATION +renales I-EXPLORATION +con I-EXPLORATION +nacimiento I-EXPLORATION +ortotópico. I-EXPLORATION +Las I-EXPLORATION +imágenes I-EXPLORATION +selectivas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +renal I-EXPLORATION +derecha, I-EXPLORATION +evidenciaron I-EXPLORATION +vasos I-EXPLORATION +neoformados I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +rama I-EXPLORATION +medial I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +bifurcación I-EXPLORATION +con I-EXPLORATION +normalidad I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +venoso I-EXPLORATION +intra I-EXPLORATION +y I-EXPLORATION +extrarrenal. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +presunción I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +carcinoma I-TREATMENT +renal, I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +istmectomía I-TREATMENT +y I-TREATMENT +nefrectomía I-TREATMENT +izquierda I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +laparotomía I-TREATMENT +media. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +acto I-TREATMENT +operatorio I-TREATMENT +se I-TREATMENT +apreció I-TREATMENT +que I-TREATMENT +la I-TREATMENT +pelvis I-TREATMENT +renal I-TREATMENT +y I-TREATMENT +el I-TREATMENT +uréter I-TREATMENT +izquierdos I-TREATMENT +se I-TREATMENT +hallaban I-TREATMENT +infiltrados I-TREATMENT +por I-TREATMENT +el I-TREATMENT +tumor. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +renal I-EXPLORATION +neoformada I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm. I-EXPLORATION +afectando I-EXPLORATION +cápsula, I-EXPLORATION +grasa I-EXPLORATION +perirrenal, I-EXPLORATION +así I-EXPLORATION +como, I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +urinaria I-EXPLORATION +izquierda. I-EXPLORATION +La I-EXPLORATION +histología I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +neuroendocrino I-EXPLORATION +de I-EXPLORATION +célula I-EXPLORATION +no I-EXPLORATION +pequeña. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmuno-histoquímico I-EXPLORATION +resultó I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +CD-56 I-EXPLORATION +y I-EXPLORATION +sinaptofisina. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +4 I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención, I-EXPLORATION +el I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +apreció I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +sólido I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm. I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +derecho, I-EXPLORATION +así I-EXPLORATION +como, I-EXPLORATION +adenopatías I-EXPLORATION +para-aórticas I-EXPLORATION +izquierdas I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +nódulos I-EXPLORATION +retrocrurales I-EXPLORATION +subcentimétricos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +PET-TC I-EXPLORATION +mostró I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +descritas I-EXPLORATION +eran I-EXPLORATION +sugestivas I-EXPLORATION +de I-EXPLORATION +metástasis. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +radioterapia I-TREATMENT +externa I-TREATMENT +(RT) I-TREATMENT +y I-TREATMENT +quimioterapia I-TREATMENT +(QT) I-TREATMENT +(carboplatino I-TREATMENT +y I-TREATMENT +VP-16) I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +tolerancia I-TREATMENT +y I-TREATMENT +respuesta I-TREATMENT +parcial. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +permaneció I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +efectos I-EVOLUTION +secundarios I-EVOLUTION +tardíos I-EVOLUTION +de I-EVOLUTION +RT I-EVOLUTION +ni I-EVOLUTION +QT. I-EVOLUTION +Dos I-EVOLUTION +años I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +el I-EVOLUTION +TAC I-EVOLUTION +abdominal I-EVOLUTION +muestra I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +pequeños I-EVOLUTION +ganglios I-EVOLUTION +retroperitoneales, I-EVOLUTION +sin I-EVOLUTION +otros I-EVOLUTION +hallazgos I-EVOLUTION +destacables. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +realizado I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hemorragia I-PRESENT_ILLNESS +bilateral. I-PRESENT_ILLNESS +Resto B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +bulto I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +pene, I-PRESENT_ILLNESS +doloroso I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +erección. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +cordón I-EXPLORATION +longitudinal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +del I-EXPLORATION +pene I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +tres I-EXPLORATION +centímetros, I-EXPLORATION +móvil I-EXPLORATION +y I-EXPLORATION +doloroso. I-EXPLORATION +Afebril. I-EXPLORATION +No I-EXPLORATION +adenopatías I-EXPLORATION +inguinales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +eco-doppler I-EXPLORATION +peneano I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +clara I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +dorsal I-EXPLORATION +superficial I-EXPLORATION +del I-EXPLORATION +pene I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +colapsaba I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +del I-EXPLORATION +transductor. I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Juicio I-EXPLORATION +Diagnóstico: I-EXPLORATION +Enfermedad I-EXPLORATION +de I-EXPLORATION +Mondor. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +y I-TREATMENT +antiinflamatorios. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +67 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +18/9/07 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +sufre I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +calle, I-PRESENT_ILLNESS +golpeándose I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +lumbar. I-PRESENT_ILLNESS +Acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +MAP I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +aumenta I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +flexo-extensión I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +piernas; I-PRESENT_ILLNESS +se B-TREATMENT +pauta I-TREATMENT +tratamiento I-TREATMENT +analgésico I-TREATMENT +y I-TREATMENT +observación I-TREATMENT +domiciliaria. I-TREATMENT +Dos B-EVOLUTION +horas I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +avisan I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +domicilio I-EVOLUTION +por I-EVOLUTION +hematuria I-EVOLUTION +franca I-EVOLUTION +e I-EVOLUTION +intenso I-EVOLUTION +dolor I-EVOLUTION +abdominal; I-EVOLUTION +presenta B-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal, I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +110/70 I-EXPLORATION +y I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas; I-EXPLORATION +se B-DERIVED_FROM/TO +decide I-DERIVED_FROM/TO +traslado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Universitario I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Salamanca I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +valoración. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +su I-EXPLORATION +llegada I-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +urgencias I-EXPLORATION +(en I-EXPLORATION +torno I-EXPLORATION +las I-EXPLORATION +23 I-EXPLORATION +horas) I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +marcada I-EXPLORATION +defensa I-EXPLORATION +abdominal, I-EXPLORATION +con I-EXPLORATION +tensiones I-EXPLORATION +de I-EXPLORATION +135/85, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +94 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +y I-EXPLORATION +pulsos I-EXPLORATION +conservados; I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +sin I-EXPLORATION +datos I-EXPLORATION +de I-EXPLORATION +interés. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +ECG I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +fibrilación I-EXPLORATION +auricular I-EXPLORATION +no I-EXPLORATION +conocida I-EXPLORATION +previamente. I-EXPLORATION +Presenta I-EXPLORATION +una I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +12.8 I-EXPLORATION +g/dl I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +y I-EXPLORATION +69 I-EXPLORATION +% I-EXPLORATION +de I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +como I-EXPLORATION +datos I-EXPLORATION +más I-EXPLORATION +destacables. I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +urgente I-EXPLORATION +con I-EXPLORATION +contraste, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +informa I-EXPLORATION +como I-EXPLORATION +riñón I-EXPLORATION +en I-EXPLORATION +herradura I-EXPLORATION +con I-EXPLORATION +rotura I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +medial I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +gran I-EXPLORATION +hematoma I-EXPLORATION +retroperitoneal, I-EXPLORATION +con I-EXPLORATION +extravasación I-EXPLORATION +activa I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +próxima I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +fractura I-EXPLORATION +renal; I-EXPLORATION +no I-EXPLORATION +existe I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +estructuras. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +situación I-EXPLORATION +clínica I-EXPLORATION +del I-EXPLORATION +enfermo I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +laparotomía I-EXPLORATION +media I-EXPLORATION +exploradora, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +gran I-EXPLORATION +hemorretroperitoneo I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +raíz I-EXPLORATION +de I-EXPLORATION +mesenterio, I-EXPLORATION +consecuencia I-EXPLORATION +de I-EXPLORATION +rotura I-EXPLORATION +múltiple I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hemi-riñón I-EXPLORATION +izquierdo, I-EXPLORATION +llegando I-EXPLORATION +a I-EXPLORATION +comprometer I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +intrarrenal I-EXPLORATION +(grado I-EXPLORATION +IV I-EXPLORATION +según I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +orgánica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +American I-EXPLORATION +Association I-EXPLORATION +for I-EXPLORATION +the I-EXPLORATION +Surgery I-EXPLORATION +of I-EXPLORATION +Trauma) I-EXPLORATION +(5); I-EXPLORATION +se B-TREATMENT +realiza I-TREATMENT +evacuación I-TREATMENT +del I-TREATMENT +hematoma I-TREATMENT +retroperitoneal I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +nefrectomía I-TREATMENT +del I-TREATMENT +hemi-riñón I-TREATMENT +izquierdo. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +permanece I-TREATMENT +estable, I-TREATMENT +precisando I-TREATMENT +la I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +estable I-EVOLUTION +hemodinámicamente, I-EVOLUTION +con I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +hemoglobina I-EVOLUTION +en I-EVOLUTION +torno I-EVOLUTION +a I-EVOLUTION +10 I-EVOLUTION +g/dl, I-EVOLUTION +ligera I-EVOLUTION +febrícula, I-EVOLUTION +continúa I-EVOLUTION +con I-EVOLUTION +cierta I-EVOLUTION +distensión I-EVOLUTION +abdominal I-EVOLUTION +y I-EVOLUTION +escaso I-EVOLUTION +peristaltismo. I-EVOLUTION +En B-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +realizado I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION +23/9/07 I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +optando I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +vigilancia I-EXPLORATION +activa. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +trasplantado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +1986 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +glomerulonefritis I-PRESENT_ILLNESS +mesangiocapilar I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +II, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disfunción I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +injerto I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mismo, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +obliga I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +reanudar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hemodiálisis I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +1996. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +realizado I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +descenso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +inmunosupresión I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +CsA I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +adición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Azathioprina, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +resultados. I-PRESENT_ILLNESS +Presenta I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +iniciar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hemodiálisis I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +injerto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +inestabilidad I-PRESENT_ILLNESS +hemodinámica I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +refractaria I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +médico. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +urgente I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +hematoma I-EXPLORATION +subcapsular I-EXPLORATION +e I-EXPLORATION +intraparenquimatoso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +injerto, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +mediante I-EXPLORATION +TC, I-EXPLORATION +realizándose B-TREATMENT +trasplantectomía I-TREATMENT +pocas I-TREATMENT +horas I-TREATMENT +después. I-TREATMENT +Durante B-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +lesión I-EXPLORATION +sólida I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +superior I-EXPLORATION +del I-EXPLORATION +injerto, I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +con I-EXPLORATION +evidentes I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +ruptura I-EXPLORATION +espontánea I-EXPLORATION +y I-EXPLORATION +sangrado. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +advierten I-EXPLORATION +otras I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +sólidas I-EXPLORATION +y I-EXPLORATION +quísticas I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +del I-EXPLORATION +injerto. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +anatomopatológico I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +CCR I-EXPLORATION +multicéntrico, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +quística I-EXPLORATION +renal I-EXPLORATION +adquirida I-EXPLORATION +del I-EXPLORATION +injerto. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +reanudó I-EVOLUTION +la I-EVOLUTION +hemodiálisis I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +y I-EVOLUTION +asintomático I-EVOLUTION +tras I-EVOLUTION +12 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +litiásica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +centro I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ambos I-PAST_MEDICAL_HISTORY +riñones. I-PAST_MEDICAL_HISTORY +Según I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +informaba I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +realizado, I-PAST_MEDICAL_HISTORY +pielolitotomía I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +practica I-PAST_MEDICAL_HISTORY +pielolitotomía I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +atendida I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +(año I-PAST_MEDICAL_HISTORY +2005) I-PAST_MEDICAL_HISTORY +nueva I-PAST_MEDICAL_HISTORY +nefrolitotomía I-PAST_MEDICAL_HISTORY +sobre I-PAST_MEDICAL_HISTORY +riñón I-PAST_MEDICAL_HISTORY +izquierdo, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +litiasis I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +compleja. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +infección I-PRESENT_ILLNESS +urinaria I-PRESENT_ILLNESS +complicada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +pionefrosis I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +septicemia, I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +coloca I-PRESENT_ILLNESS +cateter I-PRESENT_ILLNESS +doble I-PRESENT_ILLNESS +J I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +queda I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +posicionado, I-PRESENT_ILLNESS +subpiélico, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +resuelve I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +séptico, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +preciso I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +nefrostomia I-PRESENT_ILLNESS +percutánea I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +drenaje I-PRESENT_ILLNESS +renal, I-PRESENT_ILLNESS +situación, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +remitida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +urografía I-EXPLORATION +intravenosa I-EXPLORATION +que I-EXPLORATION +aporta I-EXPLORATION +la I-EXPLORATION +enferma, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +litiasis I-EXPLORATION +radiodensa I-EXPLORATION +infecciosa, I-EXPLORATION +pielolocalicial I-EXPLORATION +múltiple I-EXPLORATION +compleja, I-EXPLORATION +sobre I-EXPLORATION +riñón I-EXPLORATION +con I-EXPLORATION +hidronefrosis I-EXPLORATION +grado I-EXPLORATION +III-IV I-EXPLORATION +por I-EXPLORATION +importante I-EXPLORATION +esclerosis I-EXPLORATION +piélica I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +cirugías I-EXPLORATION +previas I-EXPLORATION +sobre I-EXPLORATION +dicha I-EXPLORATION +unidad I-EXPLORATION +renal. I-EXPLORATION +Presenta I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +relativamente I-EXPLORATION +conservada. I-EXPLORATION +Observamos I-EXPLORATION +asimismo, I-EXPLORATION +cambios I-EXPLORATION +postquirúrgicos I-EXPLORATION +con I-EXPLORATION +moderada I-EXPLORATION +atrofia I-EXPLORATION +parenquimatosa I-EXPLORATION +de I-EXPLORATION +unidad I-EXPLORATION +renal I-EXPLORATION +derecha. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +reflejaba I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +urea I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +los I-TREATMENT +hallazgos I-TREATMENT +urográficos, I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +situación I-TREATMENT +del I-TREATMENT +riñón I-TREATMENT +contralateral I-TREATMENT +y I-TREATMENT +la I-TREATMENT +edad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +lumbotomía I-TREATMENT +exploradora I-TREATMENT +para I-TREATMENT +intentar I-TREATMENT +cirugía I-TREATMENT +conservadora, I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +nefrectomía I-TREATMENT +polar I-TREATMENT +inferior I-TREATMENT +con I-TREATMENT +nefrolitotomía I-TREATMENT +y I-TREATMENT +reconstrucción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +urinaria I-TREATMENT +superior I-TREATMENT +mediante I-TREATMENT +uréterocalicostomía. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +requiere I-EVOLUTION +la I-EVOLUTION +trasfusión I-EVOLUTION +de I-EVOLUTION +dos I-EVOLUTION +concentrados I-EVOLUTION +de I-EVOLUTION +hematíes I-EVOLUTION +por I-EVOLUTION +anemia I-EVOLUTION +persistente. I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +mayores I-EVOLUTION +complicaciones I-EVOLUTION +dándose I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +séptimo I-EVOLUTION +día. I-EVOLUTION +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +cambios I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +pielonefritis I-EXPLORATION +crónica I-EXPLORATION +postlitiásica I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +del I-EXPLORATION +cálculo I-EXPLORATION +reveló I-EXPLORATION +su I-EXPLORATION +composición I-EXPLORATION +de I-EXPLORATION +fosfato I-EXPLORATION +amónico I-EXPLORATION +magnésico. I-EXPLORATION + I-EXPLORATION +Dos B-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +únicamente I-EVOLUTION +molestias I-EVOLUTION +leves I-EVOLUTION +en I-EVOLUTION +flanco I-EVOLUTION +izquierdo. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +urografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +refleja I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +litiasis I-EXPLORATION +con I-EXPLORATION +cierto I-EXPLORATION +retraso I-EXPLORATION +nefrográfico I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +vía I-EXPLORATION +excretora I-EXPLORATION +derecha I-EXPLORATION +sin I-EXPLORATION +cambios I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +previos. I-EXPLORATION +El I-EXPLORATION +renograma I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +del I-EXPLORATION +30%, I-EXPLORATION +con I-EXPLORATION +riñón I-EXPLORATION +derecho I-EXPLORATION +compensador, I-EXPLORATION +70%. I-EXPLORATION +Continúa B-EVOLUTION +con I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad, I-EVOLUTION +y I-EVOLUTION +solo I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +un I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +ITU I-EVOLUTION +que I-EVOLUTION +ha I-EVOLUTION +cedido I-EVOLUTION +con I-EVOLUTION +ciprofloxacino. I-EVOLUTION +Presencia B-EXPLORATION +de I-EXPLORATION +pequeños I-EXPLORATION +restos I-EXPLORATION +litiásicos I-EXPLORATION +bilaterales I-EXPLORATION +subclínicos I-EXPLORATION +según I-EXPLORATION +técnicas I-EXPLORATION +de I-EXPLORATION +imagen. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +Hospital, I-PRESENT_ILLNESS +porque I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +introducción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +objeto I-PRESENT_ILLNESS +metálico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +área I-PRESENT_ILLNESS +genital I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +contexto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prácticas I-PRESENT_ILLNESS +erótico-sexuales. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Clínicamente B-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +asintomática, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +genital I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +material I-EXPLORATION +alguno I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vagina. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +un I-EXPLORATION +objeto I-EXPLORATION +metálico I-EXPLORATION +que I-EXPLORATION +sobresalía I-EXPLORATION +del I-EXPLORATION +contorno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vejiga I-EXPLORATION +urinaria. I-EXPLORATION +Se I-EXPLORATION +practica I-EXPLORATION +finalmente I-EXPLORATION +ecografia, I-EXPLORATION +seguida I-EXPLORATION +de I-EXPLORATION +TAC I-EXPLORATION +abdominal, I-EXPLORATION +en I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +un I-EXPLORATION +objeto I-EXPLORATION +metálico I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +alojado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +interior I-EXPLORATION +del I-EXPLORATION +uréter I-EXPLORATION +pelviano I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +procede I-TREATMENT +a I-TREATMENT +intervenir I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +cistoscopia I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +objetivándose I-TREATMENT +cilindro I-TREATMENT +metálico I-TREATMENT +que I-TREATMENT +sobresale I-TREATMENT +del I-TREATMENT +interior I-TREATMENT +del I-TREATMENT +orificio I-TREATMENT +ureteral I-TREATMENT +derecho. I-TREATMENT + I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +imposibilidad I-TREATMENT +de I-TREATMENT +extraer I-TREATMENT +dicho I-TREATMENT +objeto I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endoscópica, I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +infraumbilical, I-TREATMENT +con I-TREATMENT +apertura I-TREATMENT +de I-TREATMENT +vejiga I-TREATMENT +y I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +cilindro I-TREATMENT +metálico I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +cm. I-TREATMENT +de I-TREATMENT +longitud, I-TREATMENT +que I-TREATMENT +correspondía I-TREATMENT +a I-TREATMENT +perfilador I-TREATMENT +de I-TREATMENT +ojos. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +anexo I-PAST_MEDICAL_HISTORY +histerectomía I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +miomatosis I-PAST_MEDICAL_HISTORY +uterina, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +gastritis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +severo I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Debuta B-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +macrohematuria I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +efectúa I-PRESENT_ILLNESS +diagnostico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +exofítica I-PRESENT_ILLNESS +vesical. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +sometida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +primera I-PRESENT_ILLNESS +resección I-PRESENT_ILLNESS +endoscópica I-PRESENT_ILLNESS +(RTUV). I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +corto I-PRESENT_ILLNESS +plazo I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +recidiva I-PRESENT_ILLNESS +tumoral I-PRESENT_ILLNESS +requiriendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +RTUV. I-PRESENT_ILLNESS +Tras I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +resección I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +material I-PRESENT_ILLNESS +remitido I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +informa I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +trabecular I-PRESENT_ILLNESS +anaplásico. I-PRESENT_ILLNESS +Concurre B-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +segunda I-DERIVED_FROM/TO +opinión I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +ser I-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +oncólogo I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +urólogo I-DERIVED_FROM/TO +tratante. I-DERIVED_FROM/TO +En B-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +sólida I-EXPLORATION +con I-EXPLORATION +vascularización I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +periférica I-EXPLORATION +de I-EXPLORATION +35 I-EXPLORATION +x I-EXPLORATION +28 I-EXPLORATION +x I-EXPLORATION +33 I-EXPLORATION +mm I-EXPLORATION +con I-EXPLORATION +otra I-EXPLORATION +imagen I-EXPLORATION +polipoidea I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +postero I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +x I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +9 I-EXPLORATION +mm. I-EXPLORATION +En I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +severa I-EXPLORATION +atrofia I-EXPLORATION +renal I-EXPLORATION +derecha. I-EXPLORATION +Ausencia I-EXPLORATION +de I-EXPLORATION +adenomegalias. I-EXPLORATION +Vejiga I-EXPLORATION +con I-EXPLORATION +pólipo I-EXPLORATION +de I-EXPLORATION +38 I-EXPLORATION +x I-EXPLORATION +35 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +derecha I-EXPLORATION +sólido I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +superficie I-EXPLORATION +irregular. I-EXPLORATION +Otra I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +posterolateral I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +mm. I-EXPLORATION +El I-EXPLORATION +centellograma I-EXPLORATION +óseo I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +indica I-TREATMENT +cistectomía I-TREATMENT +radical I-TREATMENT +con I-TREATMENT +linfadenectomía I-TREATMENT +pelviana I-TREATMENT +bilateral I-TREATMENT +laparoscópica I-TREATMENT +y I-TREATMENT +ureterostomía I-TREATMENT +cutánea I-TREATMENT +izquierda. I-TREATMENT +La I-TREATMENT +técnica I-TREATMENT +empleada I-TREATMENT +fue I-TREATMENT +la I-TREATMENT +desarrollada I-TREATMENT +por I-TREATMENT +Castillo I-TREATMENT +et I-TREATMENT +al. I-TREATMENT +(4). I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +prepucial I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +peneano I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +niega I-PRESENT_ILLNESS +relaciones I-PRESENT_ILLNESS +sexuales I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +riesgo, I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +miccional, I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pene I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cordón I-PRESENT_ILLNESS +indurado I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +palpable I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dicha I-PRESENT_ILLNESS +región, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acentúa I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +erección. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +cigarrillos/ I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +ninguna I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +base I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +habitual; I-PAST_MEDICAL_HISTORY +en B-FAMILY_HISTORY +su I-FAMILY_HISTORY +historia I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +tampoco I-FAMILY_HISTORY +se I-FAMILY_HISTORY +encontraron I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Durante B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +inflamación I-EXPLORATION +prepucial I-EXPLORATION +intensa I-EXPLORATION +con I-EXPLORATION +erosiones I-EXPLORATION +blanquecinas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +candidiasis. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +dorso I-EXPLORATION +peneano I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +un I-EXPLORATION +cordón I-EXPLORATION +duro I-EXPLORATION +y I-EXPLORATION +doloroso I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +surco I-EXPLORATION +balanoprepucial, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +inflamación I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +adyacente. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Mondor I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +doppler I-EXPLORATION +peneana I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +instaurado I-TREATMENT +fue I-TREATMENT +Fluconazol I-TREATMENT +tópico I-TREATMENT +1 I-TREATMENT +aplicación I-TREATMENT +/12h, I-TREATMENT +Amoxicilina- I-TREATMENT +Clavulanico I-TREATMENT +875 I-TREATMENT +mg/8h I-TREATMENT +e I-TREATMENT +Ibuprofeno I-TREATMENT +600 I-TREATMENT +mg/8h I-TREATMENT +durante I-TREATMENT +10 I-TREATMENT +días, I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +reposo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +actividad I-TREATMENT +sexual I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +del I-TREATMENT +cuadro. I-TREATMENT + I-TREATMENT +Durante B-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +semana, I-EVOLUTION +se I-EVOLUTION +objetiva I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +progresiva I-EVOLUTION +del I-EVOLUTION +cordón I-EVOLUTION +dorsal I-EVOLUTION +en I-EVOLUTION +sentido I-EVOLUTION +distal I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +dolor. I-EVOLUTION +Las I-EVOLUTION +lesiones I-EVOLUTION +relacionadas I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +candidiasis I-EVOLUTION +han I-EVOLUTION +desaparecido. I-EVOLUTION +En B-EXPLORATION +este I-EXPLORATION +momento I-EXPLORATION +se I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +una I-EXPLORATION +fimosis I-EXPLORATION +puntiforme I-EXPLORATION +que I-EXPLORATION +impide I-EXPLORATION +la I-EXPLORATION +retracción I-EXPLORATION +prepucial, I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +precisará I-EXPLORATION +ser I-EXPLORATION +circuncidado. I-EXPLORATION +A I-EXPLORATION +las I-EXPLORATION +6 I-EXPLORATION +semanas I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +ecografía I-EXPLORATION +doppler I-EXPLORATION +peneana I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +la I-EXPLORATION +repermeabilización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +dorsal I-EXPLORATION +superficial I-EXPLORATION +del I-EXPLORATION +pene I-EXPLORATION +en I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +trombo I-EXPLORATION +venoso, I-EXPLORATION +dando I-EXPLORATION +por I-EXPLORATION +resuelto I-EXPLORATION +el I-EXPLORATION +cuadro. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +revisaron I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +historias I-PRESENT_ILLNESS +clínicas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +todos I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +pacientes I-PRESENT_ILLNESS +intervenidos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +les I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +RTU I-PRESENT_ILLNESS +vesical I-PRESENT_ILLNESS +entre I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +1990-2009 I-PRESENT_ILLNESS +descartando I-PRESENT_ILLNESS +aquellos I-PRESENT_ILLNESS +tumores I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cumplían I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +criterios I-PRESENT_ILLNESS +histológicos, I-PRESENT_ILLNESS +excluyendo I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +adenocarcinomas I-PRESENT_ILLNESS +metastáticos I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +infiltración I-PRESENT_ILLNESS +local I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vejiga. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Encontramos B-EXPLORATION +nueve I-EXPLORATION +casos I-EXPLORATION +con I-EXPLORATION +carcinoma I-EXPLORATION +vesical I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +en I-EXPLORATION +anillo I-EXPLORATION +de I-EXPLORATION +sello I-EXPLORATION +diagnosticados I-EXPLORATION +y I-EXPLORATION +tratados I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +servicio I-EXPLORATION +entre I-EXPLORATION +Enero I-EXPLORATION +de I-EXPLORATION +1992 I-EXPLORATION +y I-EXPLORATION +Enero I-EXPLORATION +de I-EXPLORATION +2009; I-EXPLORATION +ocho I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +eran I-EXPLORATION +varones I-EXPLORATION +y I-EXPLORATION +sólo I-EXPLORATION +había I-EXPLORATION +una I-EXPLORATION +mujer, I-EXPLORATION +con I-EXPLORATION +de I-EXPLORATION +edades I-EXPLORATION +comprendidas I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +39 I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +82 I-EXPLORATION +años, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +69 I-EXPLORATION +años. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +debut I-EXPLORATION +clínico I-EXPLORATION +fue I-EXPLORATION +la I-EXPLORATION +hematuria I-EXPLORATION +en I-EXPLORATION +seis I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +y I-EXPLORATION +clínica I-EXPLORATION +irritativa I-EXPLORATION +con I-EXPLORATION +polaquiuria I-EXPLORATION +y I-EXPLORATION +disuria I-EXPLORATION +importante I-EXPLORATION +en I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +ellos. I-EXPLORATION +Uno I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +pacientes I-EXPLORATION +presentaba I-EXPLORATION +importante I-EXPLORATION +síndrome I-EXPLORATION +general I-EXPLORATION +con I-EXPLORATION +caquexia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +diagnóstico. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +citológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +orina I-EXPLORATION +mostró I-EXPLORATION +células I-EXPLORATION +malignas I-EXPLORATION +en I-EXPLORATION +tres I-EXPLORATION +pacientes, I-EXPLORATION +atipias I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +y I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +restantes. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +mostró I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +vesical I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +casos, I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +del I-EXPLORATION +pericistio I-EXPLORATION +y I-EXPLORATION +adenopatías I-EXPLORATION +múltiples I-EXPLORATION +retroperitoneales I-EXPLORATION +en I-EXPLORATION +cuatro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +y I-EXPLORATION +uropatía I-EXPLORATION +obstructiva I-EXPLORATION +uni I-EXPLORATION +o I-EXPLORATION +bilateral I-EXPLORATION +en I-EXPLORATION +cuatro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +casos. I-EXPLORATION + I-EXPLORATION +Dos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +presentaron I-EXPLORATION +alteración I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +gastroduodenal I-EXPLORATION +siendo I-EXPLORATION +completado I-EXPLORATION +con I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +y I-EXPLORATION +baja I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +hallazgo I-EXPLORATION +de I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +antral I-EXPLORATION +con I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +metaplasia I-EXPLORATION +intestinal I-EXPLORATION +en I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +sujetos I-EXPLORATION +y I-EXPLORATION +pólipo I-EXPLORATION +adenomatoso I-EXPLORATION +de I-EXPLORATION +sigma I-EXPLORATION +en I-EXPLORATION +otro. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +estudios I-EXPLORATION +histológicos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +masas I-EXPLORATION +resecadas I-EXPLORATION +con I-EXPLORATION +inclusión I-EXPLORATION +en I-EXPLORATION +parafina, I-EXPLORATION +colorante I-EXPLORATION +Hematoxilina/Eosina I-EXPLORATION +y I-EXPLORATION +tinción I-EXPLORATION +PAS. I-EXPLORATION +En I-EXPLORATION +algunos I-EXPLORATION +casos I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +estudios I-EXPLORATION +inmunohistoquimicos I-EXPLORATION +(PSA, I-EXPLORATION +E-caderina, I-EXPLORATION +citoqueratina I-EXPLORATION +20, I-EXPLORATION +S100) I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +origen I-EXPLORATION +extravesical I-EXPLORATION +(1). I-EXPLORATION + I-EXPLORATION +Tras I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +encontramos I-EXPLORATION +cuatro I-EXPLORATION +casos I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +vesical I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +en I-EXPLORATION +anillo I-EXPLORATION +de I-EXPLORATION +sello I-EXPLORATION +primario I-EXPLORATION +puros I-EXPLORATION +y I-EXPLORATION +cinco I-EXPLORATION +mixtos I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +en I-EXPLORATION +anillo I-EXPLORATION +de I-EXPLORATION +sello I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +de I-EXPLORATION +carcinomas I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +transicionales. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +tumores I-EXPLORATION +mostró I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +citoplasma I-EXPLORATION +amplio I-EXPLORATION +eosinófilo I-EXPLORATION +con I-EXPLORATION +vacuola I-EXPLORATION +central I-EXPLORATION +PAS I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +desplazamiento I-EXPLORATION +del I-EXPLORATION +núcleo I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +periferia I-EXPLORATION +(morfología I-EXPLORATION +típica I-EXPLORATION +en I-EXPLORATION +anillo I-EXPLORATION +de I-EXPLORATION +sello). I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +definitivo I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +cistectomía I-TREATMENT +radical I-TREATMENT +con I-TREATMENT +derivación I-TREATMENT +tipo I-TREATMENT +Bricker I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +de I-TREATMENT +los I-TREATMENT +pacientes, I-TREATMENT +cistectomía I-TREATMENT +con I-TREATMENT +derivación I-TREATMENT +Mainz I-TREATMENT +II I-TREATMENT +en I-TREATMENT +otro I-TREATMENT +de I-TREATMENT +ellos I-TREATMENT +y I-TREATMENT +paliativo I-TREATMENT +en I-TREATMENT +los I-TREATMENT +cuatro I-TREATMENT +restantes I-TREATMENT +con I-TREATMENT +RTU I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +casos I-TREATMENT +y I-TREATMENT +NPC I-TREATMENT +paliativas I-TREATMENT +en I-TREATMENT +otro. I-TREATMENT + I-TREATMENT +Recibieron I-TREATMENT +quimioterapia I-TREATMENT +adyuvante I-TREATMENT +tres I-TREATMENT +pacientes I-TREATMENT +consistentes I-TREATMENT +en I-TREATMENT +MVAC. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +supervivencia I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +570, I-EVOLUTION +480, I-EVOLUTION +250 I-EVOLUTION +y I-EVOLUTION +8 I-EVOLUTION +días I-EVOLUTION +para I-EVOLUTION +los I-EVOLUTION +tumores I-EVOLUTION +puros I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +512, I-EVOLUTION +410, I-EVOLUTION +280, I-EVOLUTION +270 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +mayor I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +años I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +caso, I-EVOLUTION +para I-EVOLUTION +los I-EVOLUTION +tumores I-EVOLUTION +mixtos. I-EVOLUTION +Todos I-EVOLUTION +los I-EVOLUTION +pacientes, I-EVOLUTION +excepto I-EVOLUTION +dos I-EVOLUTION +habían I-EVOLUTION +fallecido I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +realizarse I-EVOLUTION +este I-EVOLUTION +estudio. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +literatura I-EVOLUTION +revisada I-EVOLUTION +la I-EVOLUTION +supervivencia I-EVOLUTION +global I-EVOLUTION +no I-EVOLUTION +supera I-EVOLUTION +el I-EVOLUTION +11% I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +(2,3). I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +cervical. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +bocio I-EXPLORATION +difuso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +y I-EXPLORATION +sus I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +revelaron I-EXPLORATION +hormonas I-EXPLORATION +tiroideas I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +anti-tiroglobulina I-EXPLORATION +(AAT) I-EXPLORATION +positivos. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +tiroidea I-EXPLORATION +reveló I-EXPLORATION +tres I-EXPLORATION +nódulos I-EXPLORATION +tiroideos, I-EXPLORATION +el I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mm I-EXPLORATION +con I-EXPLORATION +microcalcificaciones I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +punción-biopsia I-EXPLORATION +bajo I-EXPLORATION +ecografía, I-EXPLORATION +demostrándose I-EXPLORATION +cáncer I-EXPLORATION +papilar I-EXPLORATION +del I-EXPLORATION +tiroides. I-EXPLORATION +Se B-TREATMENT +sometió I-TREATMENT +a I-TREATMENT +tiroidectomía I-TREATMENT +total, I-TREATMENT +resultando I-TREATMENT +un I-TREATMENT +foco I-TREATMENT +de I-TREATMENT +cáncer I-TREATMENT +papilar I-TREATMENT +de I-TREATMENT +6x5x5 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +metástasis I-TREATMENT +paratraqueales I-TREATMENT +bilaterales. I-TREATMENT +Recibió I-TREATMENT +200 I-TREATMENT +mCi I-TREATMENT +de I-TREATMENT +radioyodo I-TREATMENT +con I-TREATMENT +rastreo I-TREATMENT +sistémico I-TREATMENT +post-dosis I-TREATMENT +terapéutica I-TREATMENT +negativo. I-TREATMENT +Se I-TREATMENT +mantuvo I-TREATMENT +con I-TREATMENT +dosis I-TREATMENT +supresiva I-TREATMENT +de I-TREATMENT +levotiroxina I-TREATMENT +(Eutirox®). I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +rastreo I-EVOLUTION +sistémico I-EVOLUTION +con I-EVOLUTION +dosis I-EVOLUTION +trazadora I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +mCi, I-EVOLUTION +resultando I-EVOLUTION +negativo, I-EVOLUTION +la I-EVOLUTION +tiroglobulina I-EVOLUTION +no I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +utilidad I-EVOLUTION +dado I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +anticuerpos I-EVOLUTION +AAT: I-EVOLUTION +164 I-EVOLUTION +ng/mL. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +por I-EVOLUTION +ecografía I-EVOLUTION +cervical, I-EVOLUTION +se I-EVOLUTION +detectó I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +nódulo I-EVOLUTION +de I-EVOLUTION +9, I-EVOLUTION +6 I-EVOLUTION +mm, I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +no I-EVOLUTION +fue I-EVOLUTION +técnicamente I-EVOLUTION +posible I-EVOLUTION +de I-EVOLUTION +puncionar, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +asoció I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +aumento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +títulos I-EVOLUTION +de I-EVOLUTION +AAT I-EVOLUTION +174 I-EVOLUTION +ng/mL. I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +dar I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +dosis I-TREATMENT +terapéutica I-TREATMENT +de I-TREATMENT +200 I-TREATMENT +mCi I-TREATMENT +con I-TREATMENT +rastreo I-TREATMENT +que I-TREATMENT +mostró I-TREATMENT +captación I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +cervical. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +al I-EXPLORATION +año I-EXPLORATION +post I-EXPLORATION +segunda I-EXPLORATION +dosis I-EXPLORATION +de I-EXPLORATION +radioyodo, I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +supraesternal I-EXPLORATION +central I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +ganglios I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +cada I-EXPLORATION +uno, I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +cervical I-EXPLORATION +izquierda, I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +neoplasia, I-EXPLORATION +contralaterales I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +primaria, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +ascenso I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +AAT I-EXPLORATION +a I-EXPLORATION +217 I-EXPLORATION +ng/mL. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +exploración I-TREATMENT +quirúrgica, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +disección I-TREATMENT +selectiva I-TREATMENT +de I-TREATMENT +cuello I-TREATMENT +bilateral I-TREATMENT +de I-TREATMENT +los I-TREATMENT +niveles I-TREATMENT +II, I-TREATMENT +III, I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +Vb I-TREATMENT +y I-TREATMENT +una I-TREATMENT +disección I-TREATMENT +del I-TREATMENT +nivel I-TREATMENT +VI I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +pretraqueal. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +compromiso I-EXPLORATION +neoplásico I-EXPLORATION +ganglionar I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +IV I-EXPLORATION +y I-EXPLORATION +Vb I-EXPLORATION +derechos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +IIb, I-EXPLORATION +III, I-EXPLORATION +IV, I-EXPLORATION +Vb I-EXPLORATION +y I-EXPLORATION +VI I-EXPLORATION +izquierdo. I-EXPLORATION +Recibió B-TREATMENT +300 I-TREATMENT +mCi I-TREATMENT +de I-TREATMENT +radioyodo I-TREATMENT +con I-TREATMENT +rastreo I-TREATMENT +post-dosis I-TREATMENT +negativo I-TREATMENT +y I-TREATMENT +los I-TREATMENT +AAT I-TREATMENT +se I-TREATMENT +hicieron I-TREATMENT +negativos I-TREATMENT +con I-TREATMENT +una I-TREATMENT +tiroglobulina I-TREATMENT +(TG) I-TREATMENT +menor I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +ng/mL, I-TREATMENT +con I-TREATMENT +85% I-TREATMENT +de I-TREATMENT +recuperación. I-TREATMENT + I-TREATMENT +A B-FAMILY_HISTORY +solicitud I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia, I-FAMILY_HISTORY +se I-FAMILY_HISTORY +realizó I-FAMILY_HISTORY +estudio I-FAMILY_HISTORY +tiroideo I-FAMILY_HISTORY +a I-FAMILY_HISTORY +padres I-FAMILY_HISTORY +y I-FAMILY_HISTORY +dos I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +quienes I-FAMILY_HISTORY +no I-FAMILY_HISTORY +presentaban I-FAMILY_HISTORY +evidencia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +enfermedad. I-FAMILY_HISTORY +La I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +ecografía I-FAMILY_HISTORY +tiroidea I-FAMILY_HISTORY +un I-FAMILY_HISTORY +nódulo I-FAMILY_HISTORY +de I-FAMILY_HISTORY +7 I-FAMILY_HISTORY +mm, I-FAMILY_HISTORY +el I-FAMILY_HISTORY +cual I-FAMILY_HISTORY +resultó I-FAMILY_HISTORY +ser I-FAMILY_HISTORY +cáncer I-FAMILY_HISTORY +papilar, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +compromiso I-FAMILY_HISTORY +capsular I-FAMILY_HISTORY +ni I-FAMILY_HISTORY +ganglionar. I-FAMILY_HISTORY +El I-FAMILY_HISTORY +hermano I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +2 I-FAMILY_HISTORY +nódulos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +8 I-FAMILY_HISTORY +y I-FAMILY_HISTORY +5 I-FAMILY_HISTORY +mm I-FAMILY_HISTORY +cuyo I-FAMILY_HISTORY +estudio I-FAMILY_HISTORY +con I-FAMILY_HISTORY +biopsia I-FAMILY_HISTORY +fue I-FAMILY_HISTORY +negativo I-FAMILY_HISTORY +para I-FAMILY_HISTORY +células I-FAMILY_HISTORY +neoplásicas I-FAMILY_HISTORY +y I-FAMILY_HISTORY +la I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +signos I-FAMILY_HISTORY +ecográficos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +tiroiditis I-FAMILY_HISTORY +crónica I-FAMILY_HISTORY +con I-FAMILY_HISTORY +AAT I-FAMILY_HISTORY +positivos. I-FAMILY_HISTORY + I-FAMILY_HISTORY + +Paciente B-PRESENT_ILLNESS +diestro, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +iniciar I-PRESENT_ILLNESS +disartria I-PRESENT_ILLNESS +severa, I-PRESENT_ILLNESS +desviación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mirada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +hemiplejia I-PRESENT_ILLNESS +facio-braquio-crural, I-PRESENT_ILLNESS +hemianestesia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hemianopsia I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +El B-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +examen I-EXPLORATION +no I-EXPLORATION +evidenciaba I-EXPLORATION +otras I-EXPLORATION +alteraciones. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +precoces I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +IMACM I-EXPLORATION +derecho. I-EXPLORATION +Se B-TREATMENT +discutió I-TREATMENT +con I-TREATMENT +la I-TREATMENT +familia I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +una I-TREATMENT +progresión I-TREATMENT +a I-TREATMENT +un I-TREATMENT +IMACM I-TREATMENT +y I-TREATMENT +la I-TREATMENT +eventual I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +una I-TREATMENT +HD. I-TREATMENT +La I-TREATMENT +familia I-TREATMENT +comprendió I-TREATMENT +y I-TREATMENT +aceptó I-TREATMENT +la I-TREATMENT +intervención. I-TREATMENT + I-TREATMENT +Su B-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION +A I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +h, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +en I-EXPLORATION +sopor I-EXPLORATION +superficial I-EXPLORATION +sin I-EXPLORATION +midriasis I-EXPLORATION +ni I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +Babinski I-EXPLORATION +a I-EXPLORATION +derecha. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TC. I-EXPLORATION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +progresión I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +clínico I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +TC, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +HD, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +recuperó I-EVOLUTION +conciencia I-EVOLUTION +antes I-EVOLUTION +de I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +extubado I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h. I-EVOLUTION +No I-EVOLUTION +presentó I-EVOLUTION +complicaciones. I-EVOLUTION +Recuperó I-EVOLUTION +la I-EVOLUTION +movilidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +pierna I-EVOLUTION +izquierda, I-EVOLUTION +logró I-EVOLUTION +deglución I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +22 I-EVOLUTION +días. I-EVOLUTION +Desde B-TREATMENT +el I-TREATMENT +séptimo I-TREATMENT +día I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +aspirina I-TREATMENT +(325 I-TREATMENT +mg/día). I-TREATMENT +Se I-TREATMENT +mantuvo I-TREATMENT +en I-TREATMENT +neurorrehabilitación I-TREATMENT +en I-TREATMENT +su I-TREATMENT +domicilio, I-TREATMENT +logrando B-EVOLUTION +marcha I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION +Al B-TREATMENT +cuarto I-TREATMENT +mes I-TREATMENT +se I-TREATMENT +instaló I-TREATMENT +la I-TREATMENT +plaqueta I-TREATMENT +ósea, I-TREATMENT +siendo B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +quinto I-EVOLUTION +día. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +crisis I-EVOLUTION +convulsiva, I-EVOLUTION +se B-TREATMENT +inició I-TREATMENT +fenitoína I-TREATMENT +(300 I-TREATMENT +mg/día). I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +realiza I-EVOLUTION +una I-EVOLUTION +vida I-EVOLUTION +independiente I-EVOLUTION +pero I-EVOLUTION +limitada I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +casa: I-EVOLUTION +camina I-EVOLUTION +ayudado I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +bastón, I-EVOLUTION +come I-EVOLUTION +solo, I-EVOLUTION +se I-EVOLUTION +viste I-EVOLUTION +y I-EVOLUTION +va I-EVOLUTION +al I-EVOLUTION +baño I-EVOLUTION +ayudado I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +señora I-EVOLUTION +(escala I-EVOLUTION +modificada I-EVOLUTION +de I-EVOLUTION +Rankin= I-EVOLUTION +3). I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +preguntarle I-EVOLUTION +a I-EVOLUTION +ambos I-EVOLUTION +pacientes I-EVOLUTION +y I-EVOLUTION +sus I-EVOLUTION +familias, I-EVOLUTION +individualmente, I-EVOLUTION +si I-EVOLUTION +volverían I-EVOLUTION +a I-EVOLUTION +realizar I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +sufrido I-EVOLUTION +la I-EVOLUTION +experiencia, I-EVOLUTION +respondieron I-EVOLUTION +afirmativamente. I-EVOLUTION + I-EVOLUTION + +Hombre, B-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +cardiovasculares. I-PAST_MEDICAL_HISTORY +Mientras B-PRESENT_ILLNESS +jugaba I-PRESENT_ILLNESS +fútbol, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +palpitaciones I-PRESENT_ILLNESS +rápidas, I-PRESENT_ILLNESS +regulares, I-PRESENT_ILLNESS +asociadas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +retroesternal I-PRESENT_ILLNESS +opresivo, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cedieron I-PRESENT_ILLNESS +espontáneamente I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +min. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +ciudad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +hospitalizado I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +monitorización. I-PRESENT_ILLNESS +Su B-EXPLORATION +ECG I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +mostró I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +preexcitación I-EXPLORATION +ventricular, I-EXPLORATION +con I-EXPLORATION +intervalo I-EXPLORATION +PR I-EXPLORATION +corto, I-EXPLORATION +onda I-EXPLORATION +delta I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +derivaciones I-EXPLORATION +precordiales I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +inferior, I-EXPLORATION +con I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +repolarización I-EXPLORATION +ventricular, I-EXPLORATION +caracterizadas I-EXPLORATION +por I-EXPLORATION +supradesnivel I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +V2 I-EXPLORATION +y I-EXPLORATION +V3. I-EXPLORATION +Se I-EXPLORATION +controlaron I-EXPLORATION +enzimas I-EXPLORATION +cardíacas I-EXPLORATION +seriadas. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +éstas, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +coronariografía I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Fue B-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +EEF I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +mostró I-DERIVED_FROM/TO +HPE I-DERIVED_FROM/TO +lateral I-DERIVED_FROM/TO +izquierdo, I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +cual I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +exitosamente I-DERIVED_FROM/TO +fulgurado. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Mujer, B-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tetralogía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Fallot, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +correctora I-PAST_MEDICAL_HISTORY +definitiva I-PAST_MEDICAL_HISTORY +consistente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cierre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +comunicación I-PAST_MEDICAL_HISTORY +interventricular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ampliación I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +TSVD I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +anillo I-PAST_MEDICAL_HISTORY +valvular I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +parche I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pericardio, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +TVS I-PAST_MEDICAL_HISTORY +recurrentes, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +pesar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +farmacológico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +amiodarona, I-PAST_MEDICAL_HISTORY +requiriendo I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +hospitalizaciones I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antiarrítmicos I-PAST_MEDICAL_HISTORY +intravenosos I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +cardioversión I-PAST_MEDICAL_HISTORY +eléctrica. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +ecocardiográfico I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +moderado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +función I-PAST_MEDICAL_HISTORY +sistólica I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ventrículo I-PAST_MEDICAL_HISTORY +derecho, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +libre I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dilatación I-PAST_MEDICAL_HISTORY +progresiva I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +TSVD, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +llegó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +constituir I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +verdadero I-PAST_MEDICAL_HISTORY +aneurisma, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +sometida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nueva I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +implantó I-PAST_MEDICAL_HISTORY +homoinjerto I-PAST_MEDICAL_HISTORY +valvulado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +arteria I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +resecó I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +aneurisma I-PAST_MEDICAL_HISTORY +ventricular. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +esta I-PAST_MEDICAL_HISTORY +última I-PAST_MEDICAL_HISTORY +intervención I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +mantuvo I-PAST_MEDICAL_HISTORY +asintomática, I-PAST_MEDICAL_HISTORY +libre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +arritmias, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +capacidad I-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY +I. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +mantuvo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +amiodarona I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +suspendió I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +23 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +embarazo. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +palpitaciones I-PRESENT_ILLNESS +rápidas, I-PRESENT_ILLNESS +sostenidas. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +documentó I-PRESENT_ILLNESS +taquicardia I-PRESENT_ILLNESS +ventricular I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +frecuencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +150 I-PRESENT_ILLNESS +latidos I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +minuto I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +imagen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bloqueo I-PRESENT_ILLNESS +completo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +rama I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +eje I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +hemodinámico. I-PRESENT_ILLNESS +Se B-TREATMENT +hospitalizó I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amiodarona I-TREATMENT +intravenosa, I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +permaneció I-TREATMENT +con I-TREATMENT +taquicardia, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +después I-TREATMENT +de I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +cardioversión I-TREATMENT +eléctrica. I-TREATMENT +Su B-EXPLORATION +electrocardiograma I-EXPLORATION +en I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +mostró I-EXPLORATION +conducción I-EXPLORATION +aurículo-ventricular I-EXPLORATION +con I-EXPLORATION +PR I-EXPLORATION +de I-EXPLORATION +200 I-EXPLORATION +ms I-EXPLORATION +y I-EXPLORATION +complejos I-EXPLORATION +QRS I-EXPLORATION +ancho I-EXPLORATION +con I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +bloqueo I-EXPLORATION +completo I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +240 I-EXPLORATION +ms I-EXPLORATION +de I-EXPLORATION +duración. I-EXPLORATION +Estando B-TREATMENT +hospitalizada I-TREATMENT +presentó I-TREATMENT +recurrencia I-TREATMENT +de I-TREATMENT +TVS, I-TREATMENT +apareciendo I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +morfología, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +intentar I-TREATMENT +tratamiento I-TREATMENT +mediante I-TREATMENT +fulguración I-TREATMENT +con I-TREATMENT +radiofrecuencia. I-TREATMENT +Bajo B-EXPLORATION +sedación I-EXPLORATION +con I-EXPLORATION +midazolam I-EXPLORATION +y I-EXPLORATION +fentanyl, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +electrofisiológico. I-EXPLORATION +Por I-EXPLORATION +vía I-EXPLORATION +venosa I-EXPLORATION +femoral I-EXPLORATION +derecha I-EXPLORATION +se I-EXPLORATION +avanzaron I-EXPLORATION +tres I-EXPLORATION +catéteres I-EXPLORATION +cuadripolares I-EXPLORATION +(Daig®, I-EXPLORATION +St. I-EXPLORATION +Jude I-EXPLORATION +Medical I-EXPLORATION +Inc) I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +ubicaron I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +alta I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +His I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ápex I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +derecho, I-EXPLORATION +para I-EXPLORATION +registrar I-EXPLORATION +potenciales I-EXPLORATION +endocavitarios I-EXPLORATION +y I-EXPLORATION +realizar I-EXPLORATION +estimulación. I-EXPLORATION +Con I-EXPLORATION +estimulación I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +ápex I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +ciclo I-EXPLORATION +basal I-EXPLORATION +de I-EXPLORATION +550 I-EXPLORATION +ms I-EXPLORATION +e I-EXPLORATION +introduciendo I-EXPLORATION +dos I-EXPLORATION +extraestímulos I-EXPLORATION +se I-EXPLORATION +indujo I-EXPLORATION +fácilmente I-EXPLORATION +las I-EXPLORATION +dos I-EXPLORATION +morfologías I-EXPLORATION +de I-EXPLORATION +taquicardia. I-EXPLORATION +Mediante I-EXPLORATION +mapeo I-EXPLORATION +durante I-EXPLORATION +estimulación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +TSVD, I-EXPLORATION +con I-EXPLORATION +catéter I-EXPLORATION +de I-EXPLORATION +fulguración I-EXPLORATION +EPT I-EXPLORATION +curva I-EXPLORATION +estándar I-EXPLORATION +y I-EXPLORATION +punta I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +mm I-EXPLORATION +(Boston I-EXPLORATION +Scientific® I-EXPLORATION +Corporation) I-EXPLORATION +se I-EXPLORATION +reprodujo I-EXPLORATION +la I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +taquicardias, I-EXPLORATION +con I-EXPLORATION +concordancia I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +12 I-EXPLORATION +derivaciones I-EXPLORATION +del I-EXPLORATION +electrocardiograma. I-EXPLORATION +Además B-TREATMENT +se I-TREATMENT +aplicó I-TREATMENT +radiofrecuencia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +región I-TREATMENT +del I-TREATMENT +infundíbulo, I-TREATMENT +identificando I-TREATMENT +zonas I-TREATMENT +de I-TREATMENT +electrogramas I-TREATMENT +fragmentados I-TREATMENT +y I-TREATMENT +potenciales I-TREATMENT +mediodiastólicos I-TREATMENT +durante I-TREATMENT +taquicardia. I-TREATMENT +Se I-TREATMENT +completó I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +46 I-TREATMENT +pulsos I-TREATMENT +de I-TREATMENT +radiofrecuencia. I-TREATMENT +Post-radiofrecuencia I-TREATMENT +se I-TREATMENT +repitió I-TREATMENT +la I-TREATMENT +estimulación I-TREATMENT +ventricular, I-TREATMENT +introduciendo I-TREATMENT +hasta I-TREATMENT +tres I-TREATMENT +extraestímulos, I-TREATMENT +sin I-TREATMENT +lograr I-TREATMENT +reinducir I-TREATMENT +TVS I-TREATMENT +aun I-TREATMENT +bajo I-TREATMENT +efecto I-TREATMENT +de I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +isoproterenol I-TREATMENT +endovenoso. I-TREATMENT + I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +dada I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +h I-TREATMENT +con I-TREATMENT +amiodarona I-TREATMENT +100 I-TREATMENT +mg/día. I-TREATMENT +Después B-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +suspendió I-EVOLUTION +el I-EVOLUTION +antiarrítmico I-EVOLUTION +por I-EVOLUTION +nuevo I-EVOLUTION +embarazo. I-EVOLUTION +A I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +su I-EVOLUTION +monitorización I-EVOLUTION +con I-EVOLUTION +electrocardiograma I-EVOLUTION +de I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +muestra I-EVOLUTION +sólo I-EVOLUTION +extrasistolia I-EVOLUTION +ventricular I-EVOLUTION +aislada I-EVOLUTION +ocasional I-EVOLUTION +de I-EVOLUTION +morfología I-EVOLUTION +diferente I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +taquicardias I-EVOLUTION +ventriculares I-EVOLUTION +tratadas. I-EVOLUTION + I-EVOLUTION + +Historia B-PRESENT_ILLNESS +actual: I-PRESENT_ILLNESS +mujer, I-PRESENT_ILLNESS +84 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mantenía I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +buenas I-PRESENT_ILLNESS +condiciones I-PRESENT_ILLNESS +generales, I-PRESENT_ILLNESS +autovalente I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +sus I-PRESENT_ILLNESS +actividades I-PRESENT_ILLNESS +habituales. I-PRESENT_ILLNESS +Ingresó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +31/12/04 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +través I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +decaimiento I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +inespecífico. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +semilíquidas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +cólico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +leve. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +observada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hijo I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio I-PRESENT_ILLNESS +quien I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +encontró I-PRESENT_ILLNESS +comprometida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +falta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +reactividad I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +órdenes I-PRESENT_ILLNESS +verbales, I-PRESENT_ILLNESS +mirada I-PRESENT_ILLNESS +fija, I-PRESENT_ILLNESS +midriasis I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipoventilación I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +evoluciona I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +apnea, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +sometida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +reanimación I-PRESENT_ILLNESS +básica, I-PRESENT_ILLNESS +recuperando I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ventilación I-PRESENT_ILLNESS +espontánea. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +mórbidos: I-PAST_MEDICAL_HISTORY +angina I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pecho I-PAST_MEDICAL_HISTORY +estable I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +cerebrovascular I-PAST_MEDICAL_HISTORY +cerebeloso I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +secuelas, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes. I-PAST_MEDICAL_HISTORY +Linfoma I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +recidiva I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +(HTA) I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +difícil I-PAST_MEDICAL_HISTORY +manejo I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +mitral I-PAST_MEDICAL_HISTORY +severa, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +disnea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +medianos I-PAST_MEDICAL_HISTORY +esfuerzos. I-PAST_MEDICAL_HISTORY +Terapia I-PAST_MEDICAL_HISTORY +habitual: I-PAST_MEDICAL_HISTORY +carvedilol I-PAST_MEDICAL_HISTORY +6, I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +losartan I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +espironolactona I-PAST_MEDICAL_HISTORY +25 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +hidroclorotiazida I-PAST_MEDICAL_HISTORY +12, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg/día, I-PAST_MEDICAL_HISTORY +amlodipino I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg/día. I-PAST_MEDICAL_HISTORY +Mantenía I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +laboratorio I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +periódica. I-PAST_MEDICAL_HISTORY +De I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +exámenes I-PAST_MEDICAL_HISTORY +previos, I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +basal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +mg/dl, I-PAST_MEDICAL_HISTORY +clearence I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +35-40 I-PAST_MEDICAL_HISTORY +ml/min I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +electrocardiograma I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ritmo I-PAST_MEDICAL_HISTORY +sinusal. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Examen B-EXPLORATION +físico: I-EXPLORATION +soporosa, I-EXPLORATION +sin I-EXPLORATION +déficit I-EXPLORATION +neurológico I-EXPLORATION +focal, I-EXPLORATION +presión I-EXPLORATION +arterial: I-EXPLORATION +146/76 I-EXPLORATION +mmHg, I-EXPLORATION +pulso I-EXPLORATION +30 I-EXPLORATION +a I-EXPLORATION +40 I-EXPLORATION +por I-EXPLORATION +min, I-EXPLORATION +Sa02 I-EXPLORATION +>95%. I-EXPLORATION +Pulso I-EXPLORATION +venoso I-EXPLORATION +yugular I-EXPLORATION +normal. I-EXPLORATION +Examen I-EXPLORATION +cardíaco: I-EXPLORATION +ruidos I-EXPLORATION +regulares, I-EXPLORATION +soplo I-EXPLORATION +holosistólico I-EXPLORATION +intensidad I-EXPLORATION +III/VI I-EXPLORATION +en I-EXPLORATION +foco I-EXPLORATION +mitral. I-EXPLORATION +Sin I-EXPLORATION +signos I-EXPLORATION +congestivos I-EXPLORATION +pulmonares, I-EXPLORATION +sin I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +extremidades. I-EXPLORATION +Abdomen I-EXPLORATION +depresible I-EXPLORATION +e I-EXPLORATION +indoloro. I-EXPLORATION + I-EXPLORATION +Laboratorio I-EXPLORATION +al I-EXPLORATION +ingreso: I-EXPLORATION +electrocardiograma: I-EXPLORATION +ritmo I-EXPLORATION +idioventricular I-EXPLORATION +50/min, I-EXPLORATION +trastorno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +conducción I-EXPLORATION +intraventricular I-EXPLORATION +mal I-EXPLORATION +definido I-EXPLORATION +con I-EXPLORATION +QRS I-EXPLORATION +0, I-EXPLORATION +12 I-EXPLORATION +s I-EXPLORATION +y I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +aumentadas I-EXPLORATION +de I-EXPLORATION +voltaje. I-EXPLORATION +Electrólitos I-EXPLORATION +plasmáticos: I-EXPLORATION +K: I-EXPLORATION +8, I-EXPLORATION +4 I-EXPLORATION +mEq/l, I-EXPLORATION +Cl: I-EXPLORATION +109 I-EXPLORATION +mEq/l, I-EXPLORATION +Na: I-EXPLORATION +132 I-EXPLORATION +mEq/, I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +24, I-EXPLORATION +PCO2: I-EXPLORATION +27, I-EXPLORATION +HCO3 I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +mEq/, I-EXPLORATION +anion I-EXPLORATION +gap I-EXPLORATION +10. I-EXPLORATION +BE: I-EXPLORATION +-14, I-EXPLORATION +4. I-EXPLORATION +Nitrógeno I-EXPLORATION +ureico I-EXPLORATION +61 I-EXPLORATION +mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +2, I-EXPLORATION +63 I-EXPLORATION +mg/dl, I-EXPLORATION +hematocrito I-EXPLORATION +33%, I-EXPLORATION +hemoglobina I-EXPLORATION +0, I-EXPLORATION +7 I-EXPLORATION +mg/dl, I-EXPLORATION +glóbulos I-EXPLORATION +blancos I-EXPLORATION +8.660, I-EXPLORATION +glicemia I-EXPLORATION +137 I-EXPLORATION +mg/dl, I-EXPLORATION +troponinas I-EXPLORATION +T I-EXPLORATION +<0, I-EXPLORATION +01, I-EXPLORATION +orina I-EXPLORATION +completa I-EXPLORATION +normal. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +sin I-EXPLORATION +congestión I-EXPLORATION +pulmonar. I-EXPLORATION +Ecocardiograma: I-EXPLORATION +mixomatosis I-EXPLORATION +mitral I-EXPLORATION +y I-EXPLORATION +tricuspídea, I-EXPLORATION +con I-EXPLORATION +prolapso I-EXPLORATION +mitral I-EXPLORATION +e I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +y I-EXPLORATION +tricuspídea I-EXPLORATION +severas, I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +izquierda I-EXPLORATION +concéntrica I-EXPLORATION +leve I-EXPLORATION +con I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +normal, I-EXPLORATION +dilatación I-EXPLORATION +biauricular I-EXPLORATION +moderada. I-EXPLORATION + I-EXPLORATION +Evolución: B-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +diarrea I-EVOLUTION +durante I-EVOLUTION +la I-EVOLUTION +hospitalización. I-EVOLUTION +No B-TREATMENT +hubo I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +médicas I-TREATMENT +habituales I-TREATMENT +para I-TREATMENT +controlar I-TREATMENT +la I-TREATMENT +hiperkalemia, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +hemodiálisis I-TREATMENT +de I-TREATMENT +emergencia I-TREATMENT +después I-TREATMENT +de I-TREATMENT +su I-TREATMENT +ingreso. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +recuperó I-TREATMENT +ritmo I-TREATMENT +sinusal I-TREATMENT +102 I-TREATMENT +por I-TREATMENT +min, I-TREATMENT +inicialmente I-TREATMENT +hipertensa I-TREATMENT +sistólica I-TREATMENT +hasta I-TREATMENT +208/63 I-TREATMENT +mmHg I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +con I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +propanolol I-TREATMENT +mantuvo I-TREATMENT +presiones I-TREATMENT +normales, I-TREATMENT +en B-EXPLORATION +estas I-EXPLORATION +circunstancias I-EXPLORATION +presentó I-EXPLORATION +angina I-EXPLORATION +de I-EXPLORATION +pecho I-EXPLORATION +con I-EXPLORATION +infradesnivel I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ECG I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +de I-EXPLORATION +daño I-EXPLORATION +miocárdico: I-EXPLORATION +CPK I-EXPLORATION +fracción I-EXPLORATION +MB I-EXPLORATION +hasta I-EXPLORATION +8, I-EXPLORATION +3 I-EXPLORATION +mg/dl, I-EXPLORATION +TT I-EXPLORATION +hasta I-EXPLORATION +0, I-EXPLORATION +072 I-EXPLORATION +y I-EXPLORATION +mioglobina I-EXPLORATION +hasta I-EXPLORATION +384 I-EXPLORATION +mg/dl, I-EXPLORATION +el I-EXPLORATION +K I-EXPLORATION +había I-EXPLORATION +descendido I-EXPLORATION +a I-EXPLORATION +4, I-EXPLORATION +7 I-EXPLORATION +mEq/L. I-EXPLORATION +Fracción I-EXPLORATION +excretada I-EXPLORATION +de I-EXPLORATION +Na I-EXPLORATION +13%, I-EXPLORATION +fracción I-EXPLORATION +excretada I-EXPLORATION +de I-EXPLORATION +nitrógeno I-EXPLORATION +ureico: I-EXPLORATION +16%. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +normalizó I-EVOLUTION +antes I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +su I-EVOLUTION +potasio I-EVOLUTION +y B-EXPLORATION +diuresis, I-EXPLORATION +mantuvo I-EXPLORATION +cifras I-EXPLORATION +tensionales I-EXPLORATION +normales, I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +creatinina I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +3 I-EXPLORATION +m/dl, I-EXPLORATION +nitrógeno I-EXPLORATION +ureico I-EXPLORATION +24 I-EXPLORATION +mg/dl I-EXPLORATION +y B-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +quinto I-EVOLUTION +día I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +ni B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +traumatismo I-PRESENT_ILLNESS +local, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mejilla I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +malar I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +previo I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta, I-PRESENT_ILLNESS +tratada I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +absceso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +dental. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme, I-EXPLORATION +fijo I-EXPLORATION +y I-EXPLORATION +levemente I-EXPLORATION +doloroso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +maxilar I-EXPLORATION +superior I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +ocupación I-EXPLORATION +del I-EXPLORATION +vestíbulo I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +extensión I-EXPLORATION +al I-EXPLORATION +paladar I-EXPLORATION +duro I-EXPLORATION +y I-EXPLORATION +blando I-EXPLORATION +derechos. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +sólido-quística I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +netos, I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +musculares I-EXPLORATION +faciales I-EXPLORATION +profundos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +malar I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +rellenaba I-EXPLORATION +seno I-EXPLORATION +maxilar. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +paranasales, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +proceso I-EXPLORATION +expansivo, I-EXPLORATION +sólido I-EXPLORATION +quístico, I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +quinta I-EXPLORATION +pieza I-EXPLORATION +dental I-EXPLORATION +superior I-EXPLORATION +derecha, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho, I-EXPLORATION +expandía I-EXPLORATION +y I-EXPLORATION +adelgazaba I-EXPLORATION +sus I-EXPLORATION +paredes, I-EXPLORATION +especialmente I-EXPLORATION +hacia I-EXPLORATION +fosa I-EXPLORATION +maxilar I-EXPLORATION +y I-EXPLORATION +pterigomaxilar, I-EXPLORATION +destruyendo I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +ventral I-EXPLORATION +de I-EXPLORATION +cornetes I-EXPLORATION +nasales I-EXPLORATION +y I-EXPLORATION +ascendiendo I-EXPLORATION +el I-EXPLORATION +piso I-EXPLORATION +orbitario I-EXPLORATION +con I-EXPLORATION +abombamiento I-EXPLORATION +del I-EXPLORATION +paladar I-EXPLORATION +óseo I-EXPLORATION +hacia I-EXPLORATION +cavidad I-EXPLORATION +oral. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +incisional, I-EXPLORATION +cuyo I-EXPLORATION +diagnóstico I-EXPLORATION +fue: I-EXPLORATION +quiste I-EXPLORATION +óseo I-EXPLORATION +aneurismático. I-EXPLORATION +A B-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses I-TREATMENT +fue I-TREATMENT +reintervenida I-TREATMENT +extirpándose I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +tumoral I-TREATMENT +que I-TREATMENT +ocupaba I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +seno I-TREATMENT +maxilar I-TREATMENT +derecho, I-TREATMENT +con I-TREATMENT +destrucción I-TREATMENT +de I-TREATMENT +su I-TREATMENT +pared I-TREATMENT +anterior I-TREATMENT +y I-TREATMENT +medial, I-TREATMENT +paladar I-TREATMENT +óseo I-TREATMENT +y I-TREATMENT +reborde I-TREATMENT +alveolar I-TREATMENT +superior. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +extracción I-TREATMENT +amplia I-TREATMENT +mediante I-TREATMENT +maxilectomía I-TREATMENT +de I-TREATMENT +infraestructura, I-TREATMENT +que I-TREATMENT +consiste I-TREATMENT +en I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +de I-TREATMENT +las I-TREATMENT +estructuras I-TREATMENT +antes I-TREATMENT +mencionadas, I-TREATMENT +conservando I-TREATMENT +el I-TREATMENT +piso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +órbita. I-TREATMENT +La B-EXPLORATION +pieza I-EXPLORATION +quirúrgica, I-EXPLORATION +macroscópicamente, I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +expansiva, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +compuesta I-EXPLORATION +por I-EXPLORATION +múltiples I-EXPLORATION +cavidades, I-EXPLORATION +separadas I-EXPLORATION +por I-EXPLORATION +tabiques I-EXPLORATION +pardo I-EXPLORATION +rojizos, I-EXPLORATION +rellenos I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +hemático. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +microscópico I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +numerosos I-EXPLORATION +tabiques I-EXPLORATION +que I-EXPLORATION +separaban I-EXPLORATION +cavidades, I-EXPLORATION +sin I-EXPLORATION +revestimiento I-EXPLORATION +endotelial, I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +irregular I-EXPLORATION +y I-EXPLORATION +contenido I-EXPLORATION +hemático. I-EXPLORATION +Los I-EXPLORATION +tabiques I-EXPLORATION +tenían I-EXPLORATION +estroma I-EXPLORATION +fibroso, I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +multinucleadas, I-EXPLORATION +fibroblastos, I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +antigua I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +con I-EXPLORATION +tejido I-EXPLORATION +osteoide, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +anaplasia. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +actividad I-EXPLORATION +mitótica. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +coexistencia I-EXPLORATION +con I-EXPLORATION +otras I-EXPLORATION +lesiones. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +permanentes, I-EVOLUTION +evolucionando I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +soldado. B-PAST_MEDICAL_HISTORY +Al B-PRESENT_ILLNESS +reiniciar I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +entrenamiento I-PRESENT_ILLNESS +físico I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +intención I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +participar I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +triatlón, I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +actividad I-PRESENT_ILLNESS +física I-PRESENT_ILLNESS +intensa, I-PRESENT_ILLNESS +recorrió I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +kilómetros I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +bicicleta I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +ascendió I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cima I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cerro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1.828 I-PRESENT_ILLNESS +metros, I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +calor I-PRESENT_ILLNESS +ambiental I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +ingiriendo I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +escaso I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +líquidos. I-PRESENT_ILLNESS +Al I-PRESENT_ILLNESS +bajar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +montaña I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +mareos, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +diarrea, I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +muscular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +calambres I-PRESENT_ILLNESS +musculares I-PRESENT_ILLNESS +intensos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +extremidades. I-PRESENT_ILLNESS +En B-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +se I-TREATMENT +lo I-TREATMENT +hidrató, I-TREATMENT +enviándolo I-TREATMENT +posteriormente I-TREATMENT +a I-TREATMENT +su I-TREATMENT +domicilio. I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +subsiguiente I-EVOLUTION +acudió I-EVOLUTION +al I-EVOLUTION +hospital I-EVOLUTION +por I-EVOLUTION +debilidad I-EVOLUTION +muscular, I-EVOLUTION +mialgias I-EVOLUTION +difusas, I-EVOLUTION +calambres I-EVOLUTION +y I-EVOLUTION +malestar I-EVOLUTION +general. I-EVOLUTION +Había I-EVOLUTION +orinado I-EVOLUTION +escasamente I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +anterior. I-EVOLUTION +Existía B-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +fuerzas I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +muscular. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +mostraron I-EXPLORATION +azotemia I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +enzimas I-EXPLORATION +musculares. I-EXPLORATION +La I-EXPLORATION +orina I-EXPLORATION +era I-EXPLORATION +rosada I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +sedimento I-EXPLORATION +mostró I-EXPLORATION +1 I-EXPLORATION +a I-EXPLORATION +2 I-EXPLORATION +eritrocitos I-EXPLORATION +por I-EXPLORATION +campo. I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +una I-EXPLORATION +insuficiencia I-EXPLORATION +renal I-EXPLORATION +aguda I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +RML I-EXPLORATION +de I-EXPLORATION +esfuerzo I-EXPLORATION +y B-EVOLUTION +se I-EVOLUTION +trasladó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidados I-EVOLUTION +intensivos. I-EVOLUTION +Allí B-TREATMENT +recibió I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +isotónica, I-TREATMENT +bicarbonato I-TREATMENT +y I-TREATMENT +furosemide, I-TREATMENT +recuperando B-EVOLUTION +rápidamente I-EVOLUTION +la I-EVOLUTION +diuresis. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +9 I-EVOLUTION +días I-EVOLUTION +siguientes I-EVOLUTION +se I-EVOLUTION +obtuvo I-EVOLUTION +una I-EVOLUTION +recuperación I-EVOLUTION +paulatina I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal, I-EVOLUTION +sin I-EVOLUTION +emplearse I-EVOLUTION +diálisis, I-EVOLUTION +persistiendo I-EVOLUTION +las I-EVOLUTION +mialgias, I-EVOLUTION +los I-EVOLUTION +calambres I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +elevación I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +enzimas I-EVOLUTION +musculares. I-EVOLUTION +Fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +décimoprimer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +con I-EVOLUTION +azotemia I-EVOLUTION +leve I-EVOLUTION +(creatinina I-EVOLUTION +1, I-EVOLUTION +43 I-EVOLUTION +mg/dl, I-EVOLUTION +uremia I-EVOLUTION +51 I-EVOLUTION +mg/dl) I-EVOLUTION +y I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +creatinquinasa I-EVOLUTION +(CK) I-EVOLUTION +-total I-EVOLUTION +elevada. I-EVOLUTION +Un I-EVOLUTION +mes I-EVOLUTION +después, I-EVOLUTION +estando I-EVOLUTION +con I-EVOLUTION +actividad I-EVOLUTION +física I-EVOLUTION +liviana, I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +concentración I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +enzimas I-EVOLUTION +musculares I-EVOLUTION +fue I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +44 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +obeso, I-PRESENT_ILLNESS +marino I-PRESENT_ILLNESS +mercante, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +estilo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +sedentario. I-PRESENT_ILLNESS +Estando I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vacaciones, I-PRESENT_ILLNESS +observó I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +ahogaba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mar. I-PRESENT_ILLNESS +Intentó I-PRESENT_ILLNESS +rescatarla I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mucho I-PRESENT_ILLNESS +esfuerzo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desesperación, I-PRESENT_ILLNESS +aspirando I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tragando I-PRESENT_ILLNESS +mucha I-PRESENT_ILLNESS +agua, I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +casi I-PRESENT_ILLNESS +ahogarse. I-PRESENT_ILLNESS +Durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +siguientes I-PRESENT_ILLNESS +tuvo I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +incapacidad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +alimentarse, I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +intensas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +débito I-PRESENT_ILLNESS +urinario. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia. I-PRESENT_ILLNESS +Estaba B-EXPLORATION +hipertenso I-EXPLORATION +(170/110 I-EXPLORATION +mmHg) I-EXPLORATION +y I-EXPLORATION +tenía I-EXPLORATION +aliento I-EXPLORATION +urémico. I-EXPLORATION +Era I-EXPLORATION +llamativa I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +petequias I-EXPLORATION +conjuntivales I-EXPLORATION +(signo I-EXPLORATION +de I-EXPLORATION +asfixia) I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal. I-EXPLORATION +La I-EXPLORATION +ecotomografía I-EXPLORATION +mostró I-EXPLORATION +riñones I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacó I-EXPLORATION +azotemia I-EXPLORATION +marcada I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +enzimas I-EXPLORATION +musculares. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +sedimento I-EXPLORATION +mostró I-EXPLORATION +sólo I-EXPLORATION +2 I-EXPLORATION +a I-EXPLORATION +3 I-EXPLORATION +eritrocitos I-EXPLORATION +por I-EXPLORATION +campo. I-EXPLORATION +Se B-TREATMENT +manejó I-TREATMENT +con I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +volumen I-TREATMENT +y I-TREATMENT +bicarbonato I-TREATMENT +parenteral. I-TREATMENT +Al I-TREATMENT +día I-TREATMENT +siguiente I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +urémicos I-TREATMENT +se I-TREATMENT +intensificaron I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +hemodializó I-TREATMENT +por I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +consecutivos. I-TREATMENT +Al B-EVOLUTION +cuarto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +inició I-EVOLUTION +una I-EVOLUTION +poliuria I-EVOLUTION +con I-EVOLUTION +recuperación I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +función I-EVOLUTION +renal, I-EVOLUTION +hasta I-EVOLUTION +alcanzar I-EVOLUTION +una I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +1, I-EVOLUTION +1 I-EVOLUTION +mg/dl I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +episodio I-EVOLUTION +inicial I-EVOLUTION +referido. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipertenso, B-PAST_MEDICAL_HISTORY +tabáquico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dislipidémico. I-PAST_MEDICAL_HISTORY +Comenzó B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +retroesternal I-PRESENT_ILLNESS +bajo, I-PRESENT_ILLNESS +opresivo, I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +hipocondrios I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +espalda, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +decidió I-PRESENT_ILLNESS +consultar I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +estaba I-EXPLORATION +vígil, I-EXPLORATION +orientado, I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +140/90, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +80 I-EXPLORATION +lat/min, I-EXPLORATION +con I-EXPLORATION +pulsos I-EXPLORATION +distales I-EXPLORATION +simétricos I-EXPLORATION +y I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +relevantes. I-EXPLORATION + I-EXPLORATION +Un I-EXPLORATION +electrocardiograma I-EXPLORATION +practicado I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +sólo I-EXPLORATION +demostró I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +izquierda. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +hallazgos I-EXPLORATION +relevantes. I-EXPLORATION + I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +del I-EXPLORATION +fuerte I-EXPLORATION +dolor I-EXPLORATION +torácico I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +disección I-EXPLORATION +aórtica, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +angiografía I-EXPLORATION +por I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +(Angio-Tac), I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +flap I-EXPLORATION +de I-EXPLORATION +disección I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +agudo, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +descendente I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hilios I-EXPLORATION +renales, I-EXPLORATION +con I-EXPLORATION +permeabilidad I-EXPLORATION +del I-EXPLORATION +falso I-EXPLORATION +lumen I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +hemotórax I-EXPLORATION +menor I-EXPLORATION +y I-EXPLORATION +hemopericardio. I-EXPLORATION +Se I-EXPLORATION +diagnosticó I-EXPLORATION +entonces I-EXPLORATION +disección I-EXPLORATION +aórtica I-EXPLORATION +aguda I-EXPLORATION +tipo I-EXPLORATION +B, I-EXPLORATION +complicada I-EXPLORATION +por I-EXPLORATION +rotura. I-EXPLORATION + I-EXPLORATION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +complicación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +disección, I-TREATMENT +anatomía I-TREATMENT +favorable I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +y I-TREATMENT +de I-TREATMENT +los I-TREATMENT +accesos I-TREATMENT +vasculares, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +prótesis I-TREATMENT +endovascular. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +general, I-TREATMENT +con I-TREATMENT +acceso I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +arterias I-TREATMENT +femorales I-TREATMENT +e I-TREATMENT +hipotensión I-TREATMENT +controlada, I-TREATMENT +instalándose I-TREATMENT +prótesis I-TREATMENT +endovascular I-TREATMENT +(Talent®) I-TREATMENT +de I-TREATMENT +34 I-TREATMENT +mm I-TREATMENT +de I-TREATMENT +diámetro I-TREATMENT +y I-TREATMENT +130 I-TREATMENT +mm I-TREATMENT +de I-TREATMENT +longitud I-TREATMENT +en I-TREATMENT +la I-TREATMENT +aorta I-TREATMENT +torácica I-TREATMENT +con I-TREATMENT +resultado I-TREATMENT +técnico I-TREATMENT +adecuado, I-TREATMENT +cobertura I-TREATMENT +de I-TREATMENT +sitio I-TREATMENT +de I-TREATMENT +fractura I-TREATMENT +proximal I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +inmediatas. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +adecuada I-EXPLORATION +posición I-EXPLORATION +de I-EXPLORATION +endoprótesis I-EXPLORATION +con I-EXPLORATION +exclusión I-EXPLORATION +del I-EXPLORATION +falso I-EXPLORATION +lumen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +torácica, I-EXPLORATION +sólo I-EXPLORATION +con I-EXPLORATION +permeabilidad I-EXPLORATION +de I-EXPLORATION +éste I-EXPLORATION +distal I-EXPLORATION +a I-EXPLORATION +origen I-EXPLORATION +de I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +inferior, I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +aumentado I-EXPLORATION +con I-EXPLORATION +respecto I-EXPLORATION +a I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +ingreso. I-EXPLORATION +Los I-EXPLORATION +accesos I-EXPLORATION +vasculares I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +complicaciones. I-EXPLORATION +Se B-EVOLUTION +decidió I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +cinco I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +procedimiento, I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +control I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +procedimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +con I-EVOLUTION +Angio-Tac I-EVOLUTION +que I-EVOLUTION +no I-EVOLUTION +demostró I-EVOLUTION +complicaciones I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +endoprótesis, I-EVOLUTION +con I-EVOLUTION +exclusión I-EVOLUTION +total I-EVOLUTION +del I-EVOLUTION +falso I-EVOLUTION +lumen I-EVOLUTION +torácico I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +variaciones I-EVOLUTION +con I-EVOLUTION +respecto I-EVOLUTION +a I-EVOLUTION +examen I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +segundo I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enseñanza I-PAST_MEDICAL_HISTORY +media I-PAST_MEDICAL_HISTORY +completa, I-PAST_MEDICAL_HISTORY +casada, I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hija I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Asistió B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +consultorio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +atención I-PRESENT_ILLNESS +primaria I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +angustiosos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +depresivos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ocho I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +iniciados I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +nacimiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hija I-PRESENT_ILLNESS +mayor. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +exacerbado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +año, I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +nacimiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +segundo I-PRESENT_ILLNESS +hijo. I-PRESENT_ILLNESS +Junto I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +anterior, I-PRESENT_ILLNESS +golpeaba I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hija, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +marido I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +sugirió I-PRESENT_ILLNESS +consultar. I-PRESENT_ILLNESS +Fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Psiquiatría I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +pesquisa I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +hizo I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +médico I-DERIVED_FROM/TO +general I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +antecedente I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +abuso I-DERIVED_FROM/TO +sexual I-DERIVED_FROM/TO +infantil, I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +hasta I-DERIVED_FROM/TO +esa I-DERIVED_FROM/TO +fecha I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +había I-DERIVED_FROM/TO +silenciado. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Antecedentes. B-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +golpeada I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +padre I-PAST_MEDICAL_HISTORY +alcohólico, I-PAST_MEDICAL_HISTORY +quién I-PAST_MEDICAL_HISTORY +abusó I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ella I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +caricias I-PAST_MEDICAL_HISTORY +sexuales I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +penetración, I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +15, I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +abandonó I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +colegio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +trasladó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +ciudad I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +trabajar I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +asesora I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +hogar. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +primera I-PAST_MEDICAL_HISTORY +casa I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +trabajó I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +violada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +patrona. I-PAST_MEDICAL_HISTORY +Esta I-PAST_MEDICAL_HISTORY +experiencia I-PAST_MEDICAL_HISTORY +traumática I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +silenció I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +susto, I-PAST_MEDICAL_HISTORY +vergüenza I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +culpa. I-PAST_MEDICAL_HISTORY +Posteriormente I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +angustia, I-PAST_MEDICAL_HISTORY +pesadillas I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +imágenes I-PAST_MEDICAL_HISTORY +intrusivas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +violación I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +cedieron I-PAST_MEDICAL_HISTORY +espontáneamente I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +mes, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +abandono I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +lugar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trabajo. I-PAST_MEDICAL_HISTORY +Estos I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +reactivaron I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +después, I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +divisó I-PAST_MEDICAL_HISTORY +casualmente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +calle I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +victimario I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +nuevamente I-PAST_MEDICAL_HISTORY +cedieron I-PAST_MEDICAL_HISTORY +espontáneamente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +regreso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +lugar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +casó I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +sexual. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +angustia I-PAST_MEDICAL_HISTORY +relacionada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +idea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tener I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hija, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +podría I-PAST_MEDICAL_HISTORY +suceder I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ella, I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +decir I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +violada. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +angustia I-PAST_MEDICAL_HISTORY +aumentó I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +nació I-PAST_MEDICAL_HISTORY +ésta, I-PAST_MEDICAL_HISTORY +agregándose I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +puerperio I-PAST_MEDICAL_HISTORY +anhedonia, I-PAST_MEDICAL_HISTORY +intolerancia, I-PAST_MEDICAL_HISTORY +irritabilidad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +labilidad I-PAST_MEDICAL_HISTORY +emocional, I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +consultó. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +reiniciar I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +sexual, I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +parto, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +oportunidad I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +marido I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +efecto I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +alcohol, I-PAST_MEDICAL_HISTORY +reaparecieron I-PAST_MEDICAL_HISTORY +imágenes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +percepciones I-PAST_MEDICAL_HISTORY +olfativas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +padre I-PAST_MEDICAL_HISTORY +abusaba I-PAST_MEDICAL_HISTORY +sexualmente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ella. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +volvió I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +«sentir I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +olor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +padre» I-PAST_MEDICAL_HISTORY +cerca I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ella. I-PAST_MEDICAL_HISTORY +Antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +recuerdos I-PAST_MEDICAL_HISTORY +borrosos I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +abuso I-PAST_MEDICAL_HISTORY +sufrido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +niñez. I-PAST_MEDICAL_HISTORY +Después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +incidente, I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +imágenes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +abuso I-PAST_MEDICAL_HISTORY +infantil I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +presentaron I-PAST_MEDICAL_HISTORY +egodistónicamente I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +vez I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sexuales. I-PAST_MEDICAL_HISTORY +Además, I-PAST_MEDICAL_HISTORY +aparecieron I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipervigilancia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +conductas I-PAST_MEDICAL_HISTORY +evitativas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +sexual, I-PAST_MEDICAL_HISTORY +originándose I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +frigidez I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +serios I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pareja. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +violación I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +disfunción I-PAST_MEDICAL_HISTORY +sexual I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +habían I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +develadas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente. I-PAST_MEDICAL_HISTORY +Un I-PAST_MEDICAL_HISTORY +ejemplo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +constata I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +ficha I-PAST_MEDICAL_HISTORY +clínica, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +ginecología I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +matrimonio I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +fibroadenoma I-PAST_MEDICAL_HISTORY +mamario, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +médico I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +atendió I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +esa I-PAST_MEDICAL_HISTORY +oportunidad I-PAST_MEDICAL_HISTORY +consignó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes: I-PAST_MEDICAL_HISTORY +nulípara I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +relaciones I-PAST_MEDICAL_HISTORY +sexuales, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +referencia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +traumáticos I-PAST_MEDICAL_HISTORY +sexuales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Evolución B-EVOLUTION +y I-EVOLUTION +tratamiento. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +experimentó I-EVOLUTION +un I-EVOLUTION +gran I-EVOLUTION +alivio I-EVOLUTION +cuando I-EVOLUTION +el I-EVOLUTION +médico I-EVOLUTION +general I-EVOLUTION +le I-EVOLUTION +preguntó I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +antecedente I-EVOLUTION +de I-EVOLUTION +abuso I-EVOLUTION +sexual. I-EVOLUTION +Uno I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +aspectos I-EVOLUTION +que I-EVOLUTION +más I-EVOLUTION +la I-EVOLUTION +habían I-EVOLUTION +angustiado I-EVOLUTION +durante I-EVOLUTION +su I-EVOLUTION +vida I-EVOLUTION +era I-EVOLUTION +el I-EVOLUTION +miedo I-EVOLUTION +de I-EVOLUTION +que I-EVOLUTION +otras I-EVOLUTION +personas, I-EVOLUTION +incluyendo I-EVOLUTION +su I-EVOLUTION +marido, I-EVOLUTION +supiesen I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +historia I-EVOLUTION +traumática I-EVOLUTION +sexual, I-EVOLUTION +pues I-EVOLUTION +se I-EVOLUTION +imaginaba I-EVOLUTION +que I-EVOLUTION +sería I-EVOLUTION +rechazada I-EVOLUTION +y I-EVOLUTION +enjuiciada, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +para I-EVOLUTION +su I-EVOLUTION +alivio I-EVOLUTION +no I-EVOLUTION +ocurrió. I-EVOLUTION + I-EVOLUTION +Con I-EVOLUTION +el I-EVOLUTION +equipo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +especialidad I-EVOLUTION +habló I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +otros I-EVOLUTION +antecedentes I-EVOLUTION +traumáticos. I-EVOLUTION +Posteriormente I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +tercera I-EVOLUTION +intervención, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +refirió I-EVOLUTION +sus I-EVOLUTION +traumas I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +marido, I-EVOLUTION +quien I-EVOLUTION +no I-EVOLUTION +sólo I-EVOLUTION +la I-EVOLUTION +comprendió I-EVOLUTION +sino I-EVOLUTION +que I-EVOLUTION +también I-EVOLUTION +le I-EVOLUTION +brindó I-EVOLUTION +apoyo. I-EVOLUTION +Después I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +acontecimiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +mejoró I-EVOLUTION +sustancialmente, I-EVOLUTION +remitieron I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +depresivos, I-EVOLUTION +la I-EVOLUTION +disfunción I-EVOLUTION +sexual I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +maltrato I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +hija. I-EVOLUTION + I-EVOLUTION +Asistió I-EVOLUTION +en I-EVOLUTION +total I-EVOLUTION +a I-EVOLUTION +cinco I-EVOLUTION +controles I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +Psiquiatría I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +su I-EVOLUTION +mejoría. I-EVOLUTION +Durante B-TREATMENT +ese I-TREATMENT +tiempo I-TREATMENT +se I-TREATMENT +la I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +fluoxetina I-TREATMENT +20 I-TREATMENT +mg/día I-TREATMENT +y I-TREATMENT +meleril I-TREATMENT +25 I-TREATMENT +mg/día. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +el I-EVOLUTION +equipo I-EVOLUTION +de I-EVOLUTION +salud I-EVOLUTION +mental I-EVOLUTION +se I-EVOLUTION +enteró I-EVOLUTION +que I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +asintomática, I-EVOLUTION +trabajando I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +conflictos I-EVOLUTION +de I-EVOLUTION +pareja. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +intenso, I-PAST_MEDICAL_HISTORY +bronquítico I-PAST_MEDICAL_HISTORY +crónico, I-PAST_MEDICAL_HISTORY +portador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +(HTA) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +prostático I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución. I-PAST_MEDICAL_HISTORY +Enfermedad B-PRESENT_ILLNESS +actual: I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +4/6/04 I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +precordial I-PRESENT_ILLNESS +opresivo. I-PRESENT_ILLNESS +Se B-TREATMENT +diagnosticó I-TREATMENT +infarto I-TREATMENT +agudo I-TREATMENT +de I-TREATMENT +miocardio I-TREATMENT +y I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +fibrinolítico I-TREATMENT +sistémico I-TREATMENT +con I-TREATMENT +estreptoquinasa. I-TREATMENT +Reapareció B-EXPLORATION +angor, I-EXPLORATION +realizándose I-EXPLORATION +cineangiocoronariografía I-EXPLORATION +(CACG) I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +arterias I-EXPLORATION +coronarias I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +significativas. I-EXPLORATION +En B-EVOLUTION +forma I-EVOLUTION +inmediata I-EVOLUTION +al I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +procedimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +frialdad I-EVOLUTION +intensa I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +ambos I-EVOLUTION +miembros I-EVOLUTION +inferiores I-EVOLUTION +de I-EVOLUTION +predominio I-EVOLUTION +distal, I-EVOLUTION +con I-EVOLUTION +cianosis I-EVOLUTION +de I-EVOLUTION +dedos I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +pies. I-EVOLUTION +Concomitantemente I-EVOLUTION +apareció I-EVOLUTION +epigastralgia, I-EVOLUTION +náuseas I-EVOLUTION +y I-EVOLUTION +vómitos. I-EVOLUTION + I-EVOLUTION +Al B-EXPLORATION +examen I-EXPLORATION +destacaba I-EXPLORATION +cianosis I-EXPLORATION +de I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +pies, I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +seca I-EXPLORATION +en I-EXPLORATION +3º, I-EXPLORATION +4º I-EXPLORATION +y I-EXPLORATION +5º I-EXPLORATION +dedos I-EXPLORATION +derechos I-EXPLORATION +y I-EXPLORATION +3º I-EXPLORATION +y I-EXPLORATION +5º I-EXPLORATION +dedos I-EXPLORATION +izquierdos. I-EXPLORATION + I-EXPLORATION +Examen I-EXPLORATION +cardiovascular: I-EXPLORATION +ritmo I-EXPLORATION +irregular I-EXPLORATION +110 I-EXPLORATION +lpm, I-EXPLORATION +pulsos I-EXPLORATION +distales I-EXPLORATION +conservados, I-EXPLORATION +simétricos I-EXPLORATION +en I-EXPLORATION +4 I-EXPLORATION +miembros. I-EXPLORATION + I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio. I-EXPLORATION +Azoemia: I-EXPLORATION +140 I-EXPLORATION +mg/dL. I-EXPLORATION +Creatininemia: I-EXPLORATION +5, I-EXPLORATION +8 I-EXPLORATION +mg/dL I-EXPLORATION +(función I-EXPLORATION +renal I-EXPLORATION +3 I-EXPLORATION +meses I-EXPLORATION +previos I-EXPLORATION +normal). I-EXPLORATION +Depuración I-EXPLORATION +de I-EXPLORATION +creatinina: I-EXPLORATION +11 I-EXPLORATION +ml/min. I-EXPLORATION +Hemograma, I-EXPLORATION +ionograma I-EXPLORATION +sanguíneo I-EXPLORATION +y I-EXPLORATION +glicemia: I-EXPLORATION +normales. I-EXPLORATION +Examen I-EXPLORATION +de I-EXPLORATION +orina: I-EXPLORATION +densidad I-EXPLORATION +1015; I-EXPLORATION +proteínas I-EXPLORATION +2, I-EXPLORATION +09 I-EXPLORATION +g/L; I-EXPLORATION +hematíes+++; I-EXPLORATION +leucocitos++. I-EXPLORATION +Antígeno I-EXPLORATION +prostático I-EXPLORATION +específico: I-EXPLORATION +2, I-EXPLORATION +4 I-EXPLORATION +ng/mL. I-EXPLORATION +Ecografía I-EXPLORATION +aparato I-EXPLORATION +urinario: I-EXPLORATION +tamaño I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +espesor I-EXPLORATION +parenquimatoso I-EXPLORATION +conservados, I-EXPLORATION +leve I-EXPLORATION +dilatación I-EXPLORATION +pielocalicial I-EXPLORATION +izquierda, I-EXPLORATION +hipertrofia I-EXPLORATION +prostática I-EXPLORATION +grado I-EXPLORATION +III. I-EXPLORATION +ECG: I-EXPLORATION +fibrilación I-EXPLORATION +auricular I-EXPLORATION +con I-EXPLORATION +frecuencia I-EXPLORATION +promedio I-EXPLORATION +de I-EXPLORATION +90 I-EXPLORATION +lpm. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +normal. I-EXPLORATION +Ecocardiograma: I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +izquierda, I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +aurícula I-EXPLORATION +izquierda, I-EXPLORATION +fracción I-EXPLORATION +de I-EXPLORATION +eyección I-EXPLORATION +ventricular I-EXPLORATION +izquierda: I-EXPLORATION +57%. I-EXPLORATION +Doppler I-EXPLORATION +arterial I-EXPLORATION +miembros I-EXPLORATION +inferiores: I-EXPLORATION +lesiones I-EXPLORATION +hemodinámicamente I-EXPLORATION +significativas I-EXPLORATION +en I-EXPLORATION +sector I-EXPLORATION +ilíaco I-EXPLORATION +y I-EXPLORATION +femoral I-EXPLORATION +común, I-EXPLORATION +bilaterales; I-EXPLORATION +arterias I-EXPLORATION +distales I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +significativas. I-EXPLORATION +Colonoscopia: I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +lesiones I-EXPLORATION +ulceradas I-EXPLORATION +superficiales I-EXPLORATION +cubiertas I-EXPLORATION +por I-EXPLORATION +fibrina, I-EXPLORATION +desde I-EXPLORATION +recto I-EXPLORATION +bajo I-EXPLORATION +hasta I-EXPLORATION +sigmoides I-EXPLORATION +proximal, I-EXPLORATION +donde I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +eran I-EXPLORATION +más I-EXPLORATION +extensas I-EXPLORATION +e I-EXPLORATION +impidieron I-EXPLORATION +proseguir I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +(aspecto I-EXPLORATION +de I-EXPLORATION +colitis I-EXPLORATION +isquémica). I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +sigmoides: I-EXPLORATION +sin I-EXPLORATION +elementos I-EXPLORATION +de I-EXPLORATION +especificidad. I-EXPLORATION +Gastroscopia: I-EXPLORATION +lesiones I-EXPLORATION +ulceradas I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +duodeno. I-EXPLORATION +Fondo I-EXPLORATION +de I-EXPLORATION +ojo: I-EXPLORATION +embolias I-EXPLORATION +colesterínicas I-EXPLORATION +en I-EXPLORATION +retina I-EXPLORATION +izquierda. I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +piel: I-EXPLORATION +cristales I-EXPLORATION +de I-EXPLORATION +colesterol I-EXPLORATION +ocluyendo I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +mediano I-EXPLORATION +calibre; I-EXPLORATION +trombosis I-EXPLORATION +vascular I-EXPLORATION +en I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +calibre. I-EXPLORATION + I-EXPLORATION +Evolución B-EVOLUTION +y I-EVOLUTION +tratamiento. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +evolución, I-EVOLUTION +destacó I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +masiva I-EVOLUTION +(reiterado I-EVOLUTION +en I-EVOLUTION +dos I-EVOLUTION +oportunidades) I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +tranfusiones; I-TREATMENT +posteriormente, B-EVOLUTION +diarrea I-EVOLUTION +mantenida. I-EVOLUTION +Esto I-EVOLUTION +impidió I-EVOLUTION +su I-EVOLUTION +traslado I-EVOLUTION +para I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +angiorresonancia I-EVOLUTION +magnética I-EVOLUTION +para I-EVOLUTION +evaluación I-EVOLUTION +de I-EVOLUTION +aorta I-EVOLUTION +torácica I-EVOLUTION +y I-EVOLUTION +abdominal. I-EVOLUTION +A I-EVOLUTION +nivel I-EVOLUTION +ocular, I-EVOLUTION +presentó I-EVOLUTION +gran I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +agudeza I-EVOLUTION +visual. I-EVOLUTION +Hubo I-EVOLUTION +franco I-EVOLUTION +empeoramiento I-EVOLUTION +del I-EVOLUTION +dolor I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +miembros I-EVOLUTION +inferiores, I-EVOLUTION +llegando B-TREATMENT +a I-TREATMENT +requerir I-TREATMENT +opiáceos, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +simpaticectomía I-TREATMENT +lumbar I-TREATMENT +unilateral, I-TREATMENT +con I-TREATMENT +criterio I-TREATMENT +analgésico, I-TREATMENT +con I-TREATMENT +resultado I-TREATMENT +favorable. I-TREATMENT + I-TREATMENT +Bajo B-EVOLUTION +tratamiento I-EVOLUTION +médico, I-EVOLUTION +se I-EVOLUTION +logró I-EVOLUTION +estabilización I-EVOLUTION +de I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +creatinina, I-EVOLUTION +destacando I-EVOLUTION +el I-EVOLUTION +difícil I-EVOLUTION +manejo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +HTA, I-EVOLUTION +que I-EVOLUTION +requirió I-EVOLUTION +de I-EVOLUTION +múltiples I-EVOLUTION +fármacos. I-EVOLUTION + I-EVOLUTION +Como B-TREATMENT +tratamiento I-TREATMENT +tentativo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +de I-TREATMENT +base, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +anticoagulante I-TREATMENT +(enoxaparina I-TREATMENT +1 I-TREATMENT +mg/kg I-TREATMENT +peso I-TREATMENT +corporal I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h) I-TREATMENT +y I-TREATMENT +corticoides I-TREATMENT +(prednisona I-TREATMENT +0, I-TREATMENT +5 I-TREATMENT +mg/kg I-TREATMENT +peso I-TREATMENT +corporal), I-TREATMENT +debiendo I-TREATMENT +ser I-TREATMENT +suspendida I-TREATMENT +por I-TREATMENT +la I-TREATMENT +hemorragia I-TREATMENT +digestiva I-TREATMENT +relatada. I-TREATMENT + I-TREATMENT +Evolución B-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +control: I-EVOLUTION +hubo I-EVOLUTION +caída I-EVOLUTION +espontánea I-EVOLUTION +de I-EVOLUTION +falanges I-EVOLUTION +distales I-EVOLUTION +del I-EVOLUTION +tercer I-EVOLUTION +dedo I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +pies I-EVOLUTION +y I-EVOLUTION +quinto I-EVOLUTION +dedo I-EVOLUTION +de I-EVOLUTION +pie I-EVOLUTION +izquierdo, I-EVOLUTION +estabilización I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +renal. I-EVOLUTION +Azoemia: I-EVOLUTION +80 I-EVOLUTION +mg/dL. I-EVOLUTION +Creatininemia: I-EVOLUTION +2, I-EVOLUTION +5 I-EVOLUTION +mg/dL. I-EVOLUTION +Continúa I-EVOLUTION +actualmente I-EVOLUTION +bajo I-EVOLUTION +tratamiento I-EVOLUTION +médico I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +repetido I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +agudeza I-EVOLUTION +visual I-EVOLUTION +ni I-EVOLUTION +de I-EVOLUTION +sangrado I-EVOLUTION +digestivo. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipotiroidea. B-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +2000 I-PRESENT_ILLNESS +debutó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +falla I-PRESENT_ILLNESS +renal, I-PRESENT_ILLNESS +ingresando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hemodiálisis I-PRESENT_ILLNESS +crónica. I-PRESENT_ILLNESS +En B-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +siguientes I-EVOLUTION +tuvo I-EVOLUTION +múltiples I-EVOLUTION +oclusiones I-EVOLUTION +de I-EVOLUTION +sus I-EVOLUTION +accesos I-EVOLUTION +vasculares, I-EVOLUTION +practicándose B-TREATMENT +fístulas I-TREATMENT +arteriovenosas I-TREATMENT +radiocefálicas I-TREATMENT +y I-TREATMENT +braquiales I-TREATMENT +bilaterales, I-TREATMENT +instalación I-TREATMENT +de I-TREATMENT +prótesis I-TREATMENT +axilohumerales I-TREATMENT +bilaterales I-TREATMENT +de I-TREATMENT +politetrafluoretileno I-TREATMENT +(PTFE) I-TREATMENT +y I-TREATMENT +numerosos I-TREATMENT +catéteres I-TREATMENT +transitorios I-TREATMENT +y I-TREATMENT +tunelizados I-TREATMENT +en I-TREATMENT +posiciones I-TREATMENT +yugular, I-TREATMENT +subclavia I-TREATMENT +y I-TREATMENT +femoral. I-TREATMENT +En B-EXPLORATION +2003 I-EXPLORATION +se I-EXPLORATION +determinó I-EXPLORATION +el I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina, I-EXPLORATION +TTPK, I-EXPLORATION +anticoagulante I-EXPLORATION +lúpico, I-EXPLORATION +VDRL, I-EXPLORATION +antitrombina I-EXPLORATION +III I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +anticardiolipina I-EXPLORATION +IgG I-EXPLORATION +e I-EXPLORATION +IgM, I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +o I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +2004 I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +una I-EXPLORATION +diabetes I-EXPLORATION +mellitus I-EXPLORATION +2. I-EXPLORATION + I-EXPLORATION +En B-TREATMENT +marzo I-TREATMENT +de I-TREATMENT +2005 I-TREATMENT +recibió I-TREATMENT +un I-TREATMENT +riñón I-TREATMENT +de I-TREATMENT +donante I-TREATMENT +cadáver, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +que I-TREATMENT +compartía I-TREATMENT +2 I-TREATMENT +antígenos I-TREATMENT +DR I-TREATMENT +y I-TREATMENT +presentaba I-TREATMENT +incompatibilidades I-TREATMENT +en I-TREATMENT +los I-TREATMENT +2 I-TREATMENT +antígenos I-TREATMENT +A I-TREATMENT +y I-TREATMENT +B. I-TREATMENT +Su B-EXPLORATION +reactividad I-EXPLORATION +histórica I-EXPLORATION +y I-EXPLORATION +previa I-EXPLORATION +al I-EXPLORATION +trasplante I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +linfocitos I-EXPLORATION +de I-EXPLORATION +panel I-EXPLORATION +era I-EXPLORATION +0%. I-EXPLORATION +Hubo B-TREATMENT +un I-TREATMENT +sangrado I-TREATMENT +intraoperatorio I-TREATMENT +abundante, I-TREATMENT +usaba I-TREATMENT +clopidogrel I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +la I-TREATMENT +oclusión I-TREATMENT +de I-TREATMENT +los I-TREATMENT +catéteres. I-TREATMENT +Recibió I-TREATMENT +glóbulos I-TREATMENT +rojos, I-TREATMENT +plaquetas, I-TREATMENT +plasma I-TREATMENT +fresco I-TREATMENT +congelado I-TREATMENT +e I-TREATMENT +inmunosupresión I-TREATMENT +con I-TREATMENT +ciclosporina I-TREATMENT +(CsA), I-TREATMENT +micofenolato I-TREATMENT +(MMF) I-TREATMENT +y I-TREATMENT +esteroides. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +necrosis I-EVOLUTION +tubular I-EVOLUTION +aguda, I-EVOLUTION +hemodializándose I-EVOLUTION +en I-EVOLUTION +6 I-EVOLUTION +ocasiones I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +primeros I-EVOLUTION +14 I-EVOLUTION +días. I-EVOLUTION +Recibió B-TREATMENT +insulina, I-TREATMENT +y I-TREATMENT +por I-TREATMENT +no I-TREATMENT +tener I-TREATMENT +anticuerpos I-TREATMENT +de I-TREATMENT +tipo I-TREATMENT +IgG I-TREATMENT +anti I-TREATMENT +CMV I-TREATMENT +utilizó I-TREATMENT +ganciclovir I-TREATMENT +endovenoso I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +valganciclovir I-TREATMENT +(VGC) I-TREATMENT +oral. I-TREATMENT +Como I-TREATMENT +complicaciones I-TREATMENT +tuvo I-TREATMENT +una I-TREATMENT +infección I-TREATMENT +urinaria I-TREATMENT +y I-TREATMENT +un I-TREATMENT +urinoma, I-TREATMENT +que I-TREATMENT +requirió I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +quirúrgico. I-TREATMENT +Egresó B-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +34 I-EVOLUTION +días, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +1, I-EVOLUTION +6 I-EVOLUTION +mg/dl. I-EVOLUTION +Una I-EVOLUTION +semana I-EVOLUTION +después, I-EVOLUTION +notó I-EVOLUTION +edema I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +superior I-EVOLUTION +derecha, I-EVOLUTION +tos I-EVOLUTION +y I-EVOLUTION +disnea I-EVOLUTION +de I-EVOLUTION +esfuerzos. I-EVOLUTION +Una B-EXPLORATION +ecotomografía I-EXPLORATION +doppler I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +axilar I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cintigrama I-EXPLORATION +pulmonar I-EXPLORATION +mostró I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +embolia I-EXPLORATION +pulmonar. I-EXPLORATION +Inició B-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +acenocumarol. I-TREATMENT +Egresó B-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +1, I-EVOLUTION +6 I-EVOLUTION +mg/dl I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +clearence I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +35 I-EVOLUTION +ml/min. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +cuatro I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +trasplante I-EVOLUTION +renal I-EVOLUTION +(TxR) I-EVOLUTION +y I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +reducir I-EVOLUTION +la I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +MMF I-EVOLUTION +desde I-EVOLUTION +1.500 I-EVOLUTION +a I-EVOLUTION +500 I-EVOLUTION +mg/día I-EVOLUTION +por I-EVOLUTION +leucopenia, I-EVOLUTION +utilizando I-EVOLUTION +prednisona I-EVOLUTION +10 I-EVOLUTION +mg I-EVOLUTION +y I-EVOLUTION +CsA I-EVOLUTION +80 I-EVOLUTION +mg I-EVOLUTION +(obteniendo I-EVOLUTION +una I-EVOLUTION +concentración I-EVOLUTION +sanguínea I-EVOLUTION +de I-EVOLUTION +504 I-EVOLUTION +ng/ml I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +2 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +ingerida) I-EVOLUTION +la I-EVOLUTION +creatinina I-EVOLUTION +se I-EVOLUTION +elevó I-EVOLUTION +a I-EVOLUTION +4, I-EVOLUTION +9 I-EVOLUTION +mg/dl, I-EVOLUTION +el I-EVOLUTION +clearence I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +cayó I-EVOLUTION +a I-EVOLUTION +8, I-EVOLUTION +7 I-EVOLUTION +ml/min I-EVOLUTION +y I-EVOLUTION +apareció I-EVOLUTION +proteinuria I-EVOLUTION +de I-EVOLUTION +14, I-EVOLUTION +9 I-EVOLUTION +g/día. I-EVOLUTION +Se I-EVOLUTION +diagnosticó I-EVOLUTION +un I-EVOLUTION +rechazo I-EVOLUTION +agudo. I-EVOLUTION +No B-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +por I-EXPLORATION +estar I-EXPLORATION +bajo I-EXPLORATION +terapia I-EXPLORATION +anticoagulante. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +metilprednisolona I-TREATMENT +por I-TREATMENT +3 I-TREATMENT +días, I-TREATMENT +descendiendo I-TREATMENT +la I-TREATMENT +creatinina I-TREATMENT +a I-TREATMENT +1, I-TREATMENT +7 I-TREATMENT +mg/dl I-TREATMENT +y I-TREATMENT +la I-TREATMENT +proteinuria I-TREATMENT +a I-TREATMENT +780 I-TREATMENT +mg/día, I-TREATMENT +elevándose I-TREATMENT +el I-TREATMENT +clearence I-TREATMENT +de I-TREATMENT +creatinina I-TREATMENT +a I-TREATMENT +40 I-TREATMENT +ml/min. I-TREATMENT +La B-EXPLORATION +antigenemia I-EXPLORATION +para I-EXPLORATION +CMV I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +Egresó B-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +mismo I-EVOLUTION +esquema I-EVOLUTION +inmunosupresor. I-EVOLUTION + I-EVOLUTION +Once I-EVOLUTION +semanas I-EVOLUTION +después, I-EVOLUTION +recibiendo I-EVOLUTION +MMF I-EVOLUTION +1.000 I-EVOLUTION +mg, I-EVOLUTION +CsA I-EVOLUTION +70 I-EVOLUTION +mg I-EVOLUTION +(obteniendo I-EVOLUTION +un I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +457 I-EVOLUTION +ng/ml I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +hora I-EVOLUTION +de I-EVOLUTION +ingerida) I-EVOLUTION +y I-EVOLUTION +prednisona I-EVOLUTION +10 I-EVOLUTION +mg, I-EVOLUTION +hizo I-EVOLUTION +un I-EVOLUTION +nuevo I-EVOLUTION +rechazo I-EVOLUTION +agudo, I-EVOLUTION +tratándose I-EVOLUTION +con I-EVOLUTION +pulsos I-EVOLUTION +de I-EVOLUTION +metilprednisolona, I-EVOLUTION +descendiendo I-EVOLUTION +la I-EVOLUTION +creatinina I-EVOLUTION +desde I-EVOLUTION +2, I-EVOLUTION +9 I-EVOLUTION +a I-EVOLUTION +1, I-EVOLUTION +6 I-EVOLUTION +mg/dl. I-EVOLUTION +Posterior B-TREATMENT +a I-TREATMENT +ello I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +la I-TREATMENT +CsA I-TREATMENT +por I-TREATMENT +tacrolimus I-TREATMENT +(TCR) I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +c/12 I-TREATMENT +h I-TREATMENT +(obteniendo I-TREATMENT +un I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +ng/ml) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +reinició I-TREATMENT +el I-TREATMENT +VGC I-TREATMENT +por I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +febrículas I-TREATMENT +asociadas I-TREATMENT +a I-TREATMENT +una I-TREATMENT +antigenemia I-TREATMENT +(+). I-TREATMENT +A I-TREATMENT +los I-TREATMENT +7 I-TREATMENT +meses I-TREATMENT +del I-TREATMENT +TxR I-TREATMENT +y I-TREATMENT +a I-TREATMENT +los I-TREATMENT +6 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +iniciada I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +anticoagulante, I-TREATMENT +ésta I-TREATMENT +se I-TREATMENT +suspendió, I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +programado I-TREATMENT +a I-TREATMENT +su I-TREATMENT +inicio. I-TREATMENT +Egresó B-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +1, I-EVOLUTION +6 I-EVOLUTION +mg/dl. I-EVOLUTION +Dos I-EVOLUTION +días I-EVOLUTION +más I-EVOLUTION +tarde, I-EVOLUTION +12 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +del I-EVOLUTION +anticoagulante, I-EVOLUTION +cayó I-EVOLUTION +bruscamente I-EVOLUTION +en I-EVOLUTION +anuria. I-EVOLUTION +Una B-EXPLORATION +ecotomografía I-EXPLORATION +doppler I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +flujo I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +cintigrama I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +perfusión I-EXPLORATION +renal. I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +una I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +renal. I-EXPLORATION +Se B-TREATMENT +instalaron I-TREATMENT +nuevos I-TREATMENT +catéteres I-TREATMENT +tunelizados I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +femoral I-TREATMENT +derecha I-TREATMENT +e I-TREATMENT +inició I-TREATMENT +hemodiálisis. I-TREATMENT +Tres B-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +se I-EXPLORATION +efectuó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +infarto I-EXPLORATION +renal I-EXPLORATION +y B-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +una I-TREATMENT +nefrectomía. I-TREATMENT +Se B-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +renal I-EXPLORATION +con I-EXPLORATION +infarto I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +injerto, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +intersticial I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +rechazo I-EXPLORATION +leve. I-EXPLORATION +Frente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +trombofilia I-EXPLORATION +como I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +trombosis I-EXPLORATION +arterial, I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +confirmar I-EXPLORATION +dicha I-EXPLORATION +hipótesis. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +antitrombina I-EXPLORATION +III, I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +activada, I-EXPLORATION +factor I-EXPLORATION +V I-EXPLORATION +Leiden, I-EXPLORATION +mutación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +G20210A I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +protrombina, I-EXPLORATION +proteína I-EXPLORATION +S, I-EXPLORATION +anticoagulante I-EXPLORATION +lúpico, I-EXPLORATION +anticuerpos I-EXPLORATION +anticardiolipinas I-EXPLORATION +IgG I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +o I-EXPLORATION +negativos. I-EXPLORATION +La I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +PrC I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +sólo I-EXPLORATION +39, I-EXPLORATION +1% I-EXPLORATION +(VN: I-EXPLORATION +72-106%) I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +homocisteína I-EXPLORATION +total I-EXPLORATION +estuvieron I-EXPLORATION +levemente I-EXPLORATION +elevados I-EXPLORATION +16, I-EXPLORATION +6 I-EXPLORATION +umol/L I-EXPLORATION +(VN: I-EXPLORATION +4, I-EXPLORATION +5-11). I-EXPLORATION + I-EXPLORATION +Días B-EVOLUTION +después I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +trombosis I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +vena I-EVOLUTION +femoral I-EVOLUTION +común I-EVOLUTION +y I-EVOLUTION +profunda I-EVOLUTION +derechas. I-EVOLUTION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +acenocumarol I-TREATMENT +permanente. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Puerto I-PAST_MEDICAL_HISTORY +Aisén, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +realizada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +causa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +difuso I-PAST_MEDICAL_HISTORY +hipertiroideo. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +consecuencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cirugía, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +desarrolló I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hipoparatiroidismo I-PAST_MEDICAL_HISTORY +definitivo. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +indicó I-PAST_MEDICAL_HISTORY +suplemento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vitamina I-PAST_MEDICAL_HISTORY +D, I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +cumplió I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +irregular I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +laboratorio. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Quince I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +tarde, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1999, I-PAST_MEDICAL_HISTORY +consultó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +hospital I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +calambres, I-PAST_MEDICAL_HISTORY +parestesias I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +espasmos I-PAST_MEDICAL_HISTORY +faciales, I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +signos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Chvostek I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Trousseau I-PAST_MEDICAL_HISTORY +manifiestos. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +reinició I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vitamina I-PAST_MEDICAL_HISTORY +D I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +solicitó I-PAST_MEDICAL_HISTORY +exámenes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcemia, I-PAST_MEDICAL_HISTORY +T4 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +TSH. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +regresó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +control. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Reapareció I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +noviembre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2003, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento. I-PAST_MEDICAL_HISTORY +Presentaba I-PAST_MEDICAL_HISTORY +marcado I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +general, I-PAST_MEDICAL_HISTORY +astenia, I-PAST_MEDICAL_HISTORY +debilidad I-PAST_MEDICAL_HISTORY +muscular, I-PAST_MEDICAL_HISTORY +calambres, I-PAST_MEDICAL_HISTORY +parestesias I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cefalea. I-PAST_MEDICAL_HISTORY +Sus I-PAST_MEDICAL_HISTORY +menstruaciones I-PAST_MEDICAL_HISTORY +eran I-PAST_MEDICAL_HISTORY +abundantes. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +examen I-PAST_MEDICAL_HISTORY +físico I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +facies I-PAST_MEDICAL_HISTORY +hipotiroidea, I-PAST_MEDICAL_HISTORY +cicatriz I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +tiroidectomía, I-PAST_MEDICAL_HISTORY +pulso I-PAST_MEDICAL_HISTORY +regular I-PAST_MEDICAL_HISTORY +70x', I-PAST_MEDICAL_HISTORY +presión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +110/70 I-PAST_MEDICAL_HISTORY +mmHg, I-PAST_MEDICAL_HISTORY +palidez I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +signos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Chvostek I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Trousseau; I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +examen I-PAST_MEDICAL_HISTORY +cardiopulmonar I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +eran I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Sus I-PAST_MEDICAL_HISTORY +exámenes I-PAST_MEDICAL_HISTORY +revelaron: I-PAST_MEDICAL_HISTORY +calcemia I-PAST_MEDICAL_HISTORY +7, I-PAST_MEDICAL_HISTORY +98 I-PAST_MEDICAL_HISTORY +mg/dL I-PAST_MEDICAL_HISTORY +(probable I-PAST_MEDICAL_HISTORY +error I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +laboratorio, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +discordancia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +calcemias I-PAST_MEDICAL_HISTORY +posteriores), I-PAST_MEDICAL_HISTORY +fosfemia I-PAST_MEDICAL_HISTORY +6, I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +mg/dL, I-PAST_MEDICAL_HISTORY +BUN I-PAST_MEDICAL_HISTORY +14 I-PAST_MEDICAL_HISTORY +mg/dL, I-PAST_MEDICAL_HISTORY +proteína I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +6, I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +g/dL, I-PAST_MEDICAL_HISTORY +albuminemia I-PAST_MEDICAL_HISTORY +3, I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +g/dL, I-PAST_MEDICAL_HISTORY +hematocrito I-PAST_MEDICAL_HISTORY +27%, I-PAST_MEDICAL_HISTORY +hemoglobina I-PAST_MEDICAL_HISTORY +6, I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +g/dL, I-PAST_MEDICAL_HISTORY +microcitosis I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipocromía, I-PAST_MEDICAL_HISTORY +TSH I-PAST_MEDICAL_HISTORY +9, I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +µU/ml I-PAST_MEDICAL_HISTORY +(vn: I-PAST_MEDICAL_HISTORY +0, I-PAST_MEDICAL_HISTORY +4-4, I-PAST_MEDICAL_HISTORY +8). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipoparatiroidismo I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +postiroidectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +ferropriva, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +indicó I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Elcal I-PAST_MEDICAL_HISTORY +D I-PAST_MEDICAL_HISTORY +Forte® I-PAST_MEDICAL_HISTORY +(carbonato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +1.125 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY ++ I-PAST_MEDICAL_HISTORY +vitamina I-PAST_MEDICAL_HISTORY +D I-PAST_MEDICAL_HISTORY +175 I-PAST_MEDICAL_HISTORY +UI) I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +Elcal® I-PAST_MEDICAL_HISTORY +(carbonato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +800 I-PAST_MEDICAL_HISTORY +mg) I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +levotiroxina I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +µg I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sulfato I-PAST_MEDICAL_HISTORY +ferroso I-PAST_MEDICAL_HISTORY +400 I-PAST_MEDICAL_HISTORY +mg/día. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Dos B-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +mínimos I-PRESENT_ILLNESS +esfuerzos, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +epigástrico, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rápida I-PRESENT_ILLNESS +progresión. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +afebril, I-EXPLORATION +con I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca I-EXPLORATION +70x' I-EXPLORATION +regular, I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +100/70 I-EXPLORATION +mmHg, I-EXPLORATION +ortopnea, I-EXPLORATION +edema I-EXPLORATION +generalizado, I-EXPLORATION +ingurgitación I-EXPLORATION +yugular, I-EXPLORATION +estertores I-EXPLORATION +pulmonares, I-EXPLORATION +ruidos I-EXPLORATION +cardíacos I-EXPLORATION +apagados, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +auscultaron I-EXPLORATION +soplos, I-EXPLORATION +hepatomegalia I-EXPLORATION +sensible I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +bajo I-EXPLORATION +el I-EXPLORATION +reborde I-EXPLORATION +costal. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +profunda. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +indicó I-EXPLORATION +hospitalización. I-EXPLORATION +En I-EXPLORATION +sus I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +destacaba: I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +cardiomegalia I-EXPLORATION +y I-EXPLORATION +congestión I-EXPLORATION +pulmonar. I-EXPLORATION +ECG: I-EXPLORATION +ritmo I-EXPLORATION +sinusal, I-EXPLORATION +83x', I-EXPLORATION +bajo I-EXPLORATION +voltaje I-EXPLORATION +generalizado, I-EXPLORATION +intervalo I-EXPLORATION +QT I-EXPLORATION +prolongado I-EXPLORATION +y I-EXPLORATION +alteraciones I-EXPLORATION +inespecíficas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +repolarización I-EXPLORATION +ventricular. I-EXPLORATION +Ecocardiograma: I-EXPLORATION +marcada I-EXPLORATION +dilatación, I-EXPLORATION +disfunción I-EXPLORATION +sistólica I-EXPLORATION +y I-EXPLORATION +disfunción I-EXPLORATION +diastólica I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +restrictivo I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo, I-EXPLORATION +severa I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +y I-EXPLORATION +tricuspídea, I-EXPLORATION +hipertensión I-EXPLORATION +pulmonar I-EXPLORATION +sistólica I-EXPLORATION +moderada, I-EXPLORATION +derrame I-EXPLORATION +pericárdico I-EXPLORATION +moderado I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +aurícula I-EXPLORATION +izquierda. I-EXPLORATION +Ecotomografía I-EXPLORATION +abdominal: I-EXPLORATION +hepatomegalia I-EXPLORATION +congestiva. I-EXPLORATION +Endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta: I-EXPLORATION +gastritis I-EXPLORATION +hiperémica. I-EXPLORATION +Calcemia I-EXPLORATION +2, I-EXPLORATION +9 I-EXPLORATION +mg/dL, I-EXPLORATION +parathormona I-EXPLORATION +5, I-EXPLORATION +9 I-EXPLORATION +ng/l I-EXPLORATION +(vn: I-EXPLORATION +10-73), I-EXPLORATION +magnesio I-EXPLORATION +1, I-EXPLORATION +08 I-EXPLORATION +mEq/l I-EXPLORATION +(vn: I-EXPLORATION +1, I-EXPLORATION +4-2, I-EXPLORATION +1), I-EXPLORATION +albúmina I-EXPLORATION +3, I-EXPLORATION +3 I-EXPLORATION +g/dL, I-EXPLORATION +sodio I-EXPLORATION +140 I-EXPLORATION +mEq/l, I-EXPLORATION +potasio I-EXPLORATION +2, I-EXPLORATION +3 I-EXPLORATION +mEq/l, I-EXPLORATION +hematocrito I-EXPLORATION +26%, I-EXPLORATION +hemoglobina I-EXPLORATION +7, I-EXPLORATION +4 I-EXPLORATION +g/dL, I-EXPLORATION +proteinuria I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +h: I-EXPLORATION +negativa, I-EXPLORATION +bilirrubinemia I-EXPLORATION +total I-EXPLORATION +1, I-EXPLORATION +3 I-EXPLORATION +mg/dL, I-EXPLORATION +transaminasas I-EXPLORATION +glutámico I-EXPLORATION +oxalacéticas I-EXPLORATION +63 I-EXPLORATION +U/l I-EXPLORATION +(vn: I-EXPLORATION +<35), I-EXPLORATION +creatinfosfokinasa I-EXPLORATION +total I-EXPLORATION +1.260 I-EXPLORATION +U/l I-EXPLORATION +(vn: I-EXPLORATION +<70) I-EXPLORATION +(fracción I-EXPLORATION +miocárdica I-EXPLORATION +3%), I-EXPLORATION +TSH I-EXPLORATION +18, I-EXPLORATION +1 I-EXPLORATION +µU/ml. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +insuficiencia I-EXPLORATION +cardíaca I-EXPLORATION +congestiva I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +hipocalcemia I-EXPLORATION +severa, I-EXPLORATION +descompensada I-EXPLORATION +por I-EXPLORATION +sustitución I-EXPLORATION +con I-EXPLORATION +hormona I-EXPLORATION +tiroidea I-EXPLORATION +y I-EXPLORATION +agravada I-EXPLORATION +por I-EXPLORATION +anemia I-EXPLORATION +ferropriva. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +gluconato I-TREATMENT +de I-TREATMENT +calcio I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +iv I-TREATMENT +c/12 I-TREATMENT +h, I-TREATMENT +carbonato I-TREATMENT +de I-TREATMENT +calcio I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +vo, I-TREATMENT +vitamina I-TREATMENT +D I-TREATMENT +175 I-TREATMENT +µ/día, I-TREATMENT +vitamina I-TREATMENT +D I-TREATMENT +300.000 I-TREATMENT +UI I-TREATMENT +por I-TREATMENT +una I-TREATMENT +vez, I-TREATMENT +l-tiroxina I-TREATMENT +100 I-TREATMENT +µg, I-TREATMENT +sulfato I-TREATMENT +ferroso I-TREATMENT +400 I-TREATMENT +mg, I-TREATMENT +furosemida I-TREATMENT +40 I-TREATMENT +mg, I-TREATMENT +cloruro I-TREATMENT +de I-TREATMENT +potasio I-TREATMENT +1, I-TREATMENT +8 I-TREATMENT +g, I-TREATMENT +captopril I-TREATMENT +12, I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +digoxina I-TREATMENT +0, I-TREATMENT +125 I-TREATMENT +mg/día. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +con I-EVOLUTION +diuresis I-EVOLUTION +intensa I-EVOLUTION +y I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +manifestaciones I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +cardíaca, I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +edema I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +hepatomegalia. I-EVOLUTION +Diez B-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +tenía I-EXPLORATION +calcemia I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mg/dL, I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +37% I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +ecocardiograma I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +reducción I-EXPLORATION +del I-EXPLORATION +grado I-EXPLORATION +del I-EXPLORATION +reflujo I-EXPLORATION +mitral I-EXPLORATION +y I-EXPLORATION +tricuspídeo, I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +sistólica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +a I-EXPLORATION +33 I-EXPLORATION +mmHg I-EXPLORATION +(vn: I-EXPLORATION +15-30) I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +derrame I-EXPLORATION +pericárdico. I-EXPLORATION +En B-EVOLUTION +controles I-EVOLUTION +posteriores, I-EVOLUTION +hasta I-EVOLUTION +los I-EVOLUTION +18 I-EVOLUTION +meses, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +cumplía I-EVOLUTION +rigurosamente I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +sólo I-EVOLUTION +presentaba I-EVOLUTION +disnea I-EVOLUTION +a I-EVOLUTION +esfuerzos I-EVOLUTION +medianos I-EVOLUTION +a I-EVOLUTION +mayores, I-EVOLUTION +su B-EXPLORATION +calcemia I-EXPLORATION +se I-EXPLORATION +mantenía I-EXPLORATION +entre I-EXPLORATION +8 I-EXPLORATION +y I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +seguimiento I-EXPLORATION +ecocardiográfico, I-EXPLORATION +se I-EXPLORATION +observó, I-EXPLORATION +además, I-EXPLORATION +una I-EXPLORATION +recuperación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +marcada I-EXPLORATION +disfunción I-EXPLORATION +diastólica I-EXPLORATION +inicial I-EXPLORATION +-evaluada I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +índice I-EXPLORATION +E/A: I-EXPLORATION +relación I-EXPLORATION +entre I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +llene I-EXPLORATION +ventricular I-EXPLORATION +rápido I-EXPLORATION +(E) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +llene I-EXPLORATION +relacionada I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +contracción I-EXPLORATION +auricular I-EXPLORATION +(A) I-EXPLORATION +-, I-EXPLORATION +normalización I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +desaparición I-EXPLORATION +del I-EXPLORATION +derrame I-EXPLORATION +pericárdico, I-EXPLORATION +persistiendo I-EXPLORATION +la I-EXPLORATION +dilatación I-EXPLORATION +y I-EXPLORATION +disfunción I-EXPLORATION +sistólica I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo, I-EXPLORATION +en I-EXPLORATION +grado I-EXPLORATION +similar I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +observada I-EXPLORATION +en I-EXPLORATION +exámenes I-EXPLORATION +iniciales. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +CPT. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +biopsia I-EXPLORATION +quirúrgica I-EXPLORATION +informó I-EXPLORATION +un I-EXPLORATION +CPT I-EXPLORATION +bifocal, I-EXPLORATION +variedad I-EXPLORATION +usual, I-EXPLORATION +con I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +15 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +permea-ción I-EXPLORATION +vascular, I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +cápsula I-EXPLORATION +ni I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +borde I-EXPLORATION +quirúrgico. I-EXPLORATION +Recibió B-TREATMENT +150 I-TREATMENT +mCi I-TREATMENT +I131 I-TREATMENT +y B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +sistémica I-EXPLORATION +posdosis I-EXPLORATION +mostró I-EXPLORATION +remanente I-EXPLORATION +tiroideo I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +ganglionar I-EXPLORATION +derecho. I-EXPLORATION +Inició B-TREATMENT +terapia I-TREATMENT +supresiva I-TREATMENT +con I-TREATMENT +levotiroxina I-TREATMENT +y B-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +presentó I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +Tg I-EVOLUTION +indetectables I-EVOLUTION +(<0, I-EVOLUTION +2 I-EVOLUTION +ng/ml) I-EVOLUTION +en I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +AcTg I-EVOLUTION +y B-EXPLORATION +las I-EXPLORATION +ecografías I-EXPLORATION +cervicales I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +recidiva I-EXPLORATION +tumoral. I-EXPLORATION +En I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +18 I-EXPLORATION +meses I-EXPLORATION +poscirugía I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +mostró I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +cervical I-EXPLORATION +derecha, I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +linfonodo. I-EXPLORATION +En I-EXPLORATION +forma I-EXPLORATION +simultánea, I-EXPLORATION +la I-EXPLORATION +Tg-s I-EXPLORATION +estimulada I-EXPLORATION +(TSH I-EXPLORATION +=105 I-EXPLORATION +uUI/mL) I-EXPLORATION +fue I-EXPLORATION +<0, I-EXPLORATION +2 I-EXPLORATION +ng/ml, I-EXPLORATION +en I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +AcTg. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +sistémica I-EXPLORATION +mostró I-EXPLORATION +captación I-EXPLORATION +aumentada I-EXPLORATION +en I-EXPLORATION +compartimento I-EXPLORATION +central I-EXPLORATION +a I-EXPLORATION +ambos I-EXPLORATION +lados I-EXPLORATION +de I-EXPLORATION +línea I-EXPLORATION +media, I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +derecha. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +punción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +CPT. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +disección I-TREATMENT +cervical, I-TREATMENT +cuya B-EXPLORATION +biopsia I-EXPLORATION +confirmó I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +CPT I-EXPLORATION +en I-EXPLORATION +ganglio I-EXPLORATION +del I-EXPLORATION +grupo I-EXPLORATION +VI, I-EXPLORATION +intrano-dal, I-EXPLORATION +sin I-EXPLORATION +extensión I-EXPLORATION +al I-EXPLORATION +tejido I-EXPLORATION +adiposo. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +para I-EXPLORATION +Tg I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +difusa I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +coloide I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +citoplasma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +tumorales. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +Dental I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Referencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Salud I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Peñalolén, I-PRESENT_ILLNESS +Cordillera I-PRESENT_ILLNESS +Oriente, I-PRESENT_ILLNESS +Santiago, I-PRESENT_ILLNESS +Chile. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +labio I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +izquierdo. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +señaló I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +crecido I-PRESENT_ILLNESS +lentamente I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ella I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +detectó. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +inspección I-EXPLORATION +clínica I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +el I-EXPLORATION +labio I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +nodular, I-EXPLORATION +irregular, I-EXPLORATION +globuloso I-EXPLORATION +(como I-EXPLORATION +racimo), I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +indoloro, I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +más I-EXPLORATION +o I-EXPLORATION +menos I-EXPLORATION +difusos I-EXPLORATION +y I-EXPLORATION +recubierto I-EXPLORATION +por I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +anamnesis I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +pesquisaron I-EXPLORATION +otros I-EXPLORATION +procesos I-EXPLORATION +ni I-EXPLORATION +antecedentes I-EXPLORATION +mórbidos I-EXPLORATION +relevantes. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +hipótesis I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +adenoma I-TREATMENT +pleomorfo, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +la I-TREATMENT +biopsia I-TREATMENT +excisional I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +local. I-TREATMENT +Se I-TREATMENT +logró I-TREATMENT +extraer I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +tumoración I-TREATMENT +además I-TREATMENT +de I-TREATMENT +tejido I-TREATMENT +adyacente, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +si I-TREATMENT +bien I-TREATMENT +se I-TREATMENT +observaba I-TREATMENT +algo I-TREATMENT +de I-TREATMENT +fibrosis I-TREATMENT +periférica, I-TREATMENT +ésta I-TREATMENT +se I-TREATMENT +entremezclaba I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tejido I-TREATMENT +conjuntivo I-TREATMENT +y I-TREATMENT +capa I-TREATMENT +muscular I-TREATMENT +de I-TREATMENT +los I-TREATMENT +labios. I-TREATMENT +La B-EXPLORATION +muestra I-EXPLORATION +fue I-EXPLORATION +enviada I-EXPLORATION +a I-EXPLORATION +análisis I-EXPLORATION +histopatológico. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +histopatológico I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +pero I-EXPLORATION +no I-EXPLORATION +capsulada, I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +vasos I-EXPLORATION +sanguíneos I-EXPLORATION +de I-EXPLORATION +paredes I-EXPLORATION +engrosadas, I-EXPLORATION +entremezclados I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +linfocitario I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +disponía I-EXPLORATION +a I-EXPLORATION +manera I-EXPLORATION +de I-EXPLORATION + I-EXPLORATION +folículos I-EXPLORATION +con I-EXPLORATION +centros I-EXPLORATION +germinativos, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +presencia I-EXPLORATION +destacada I-EXPLORATION +de I-EXPLORATION +eosinófilos. I-EXPLORATION +El I-EXPLORATION +tejido I-EXPLORATION +presentaba I-EXPLORATION +múltiples I-EXPLORATION +tabicaciones I-EXPLORATION +por I-EXPLORATION +haces I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +colágenas. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +histopatológico I-EXPLORATION +correspondió I-EXPLORATION +a I-EXPLORATION +hiperplasia I-EXPLORATION +angiolinfoidea I-EXPLORATION +con I-EXPLORATION +eosinofilia. I-EXPLORATION +Los I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +distintos I-EXPLORATION +parámetros I-EXPLORATION +del I-EXPLORATION +hemograma I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +controlada I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +procedió I-EVOLUTION +al I-EVOLUTION +retiro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sutura. I-EVOLUTION +Luego I-EVOLUTION +se I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +controlar I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +y I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +realizada I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +sin I-EVOLUTION +observarse I-EVOLUTION +recidiva. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +relevancia, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +junio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2005, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +epigástrico, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carácter I-PRESENT_ILLNESS +sordo, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +moderada I-PRESENT_ILLNESS +intensidad, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cedió I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antiespasmó-dicos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +bloqueadores I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +bomba I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +protones, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +dada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio. I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +reconsultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +siguiente I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +persistencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +epigastralgia, I-PRESENT_ILLNESS +realizándose B-EXPLORATION +una I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +quística I-EXPLORATION +retroperitoneal. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +(TAC), I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +quística I-EXPLORATION +multitabicada I-EXPLORATION +de I-EXPLORATION +44 I-EXPLORATION +x I-EXPLORATION +26 I-EXPLORATION +mm, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +que I-EXPLORATION +contactaba I-EXPLORATION +caudalmente I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +cuerpo I-EXPLORATION +del I-EXPLORATION +páncreas. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometida I-TREATMENT +a I-TREATMENT +una I-TREATMENT +laparotomía I-TREATMENT +exploradora I-TREATMENT +subcostal I-TREATMENT +bilateral, I-TREATMENT +encontrándose I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +descrita I-TREATMENT +en I-TREATMENT +la I-TREATMENT +TAC, I-TREATMENT +íntimamente I-TREATMENT +adherida I-TREATMENT +al I-TREATMENT +páncreas, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +debió I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +pancreatectomía I-TREATMENT +distal I-TREATMENT +junto I-TREATMENT +a I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +quiste, I-TREATMENT +enviándose I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +a I-TREATMENT +anatomía I-TREATMENT +patológica. I-TREATMENT + I-TREATMENT +Hallazgos I-TREATMENT +patológicos I-TREATMENT + I-TREATMENT +El I-TREATMENT +páncreas I-TREATMENT +mostraba I-TREATMENT +acinos I-TREATMENT +e I-TREATMENT +islotes I-TREATMENT +pancreáticos I-TREATMENT +de I-TREATMENT +arquitectura I-TREATMENT +normal. I-TREATMENT +Se I-TREATMENT +identificaban I-TREATMENT +además I-TREATMENT +dos I-TREATMENT +ganglios I-TREATMENT +linfáticos I-TREATMENT +peripancreáticos I-TREATMENT +sin I-TREATMENT +alteraciones. I-TREATMENT + I-TREATMENT +El I-TREATMENT +diagnóstico I-TREATMENT +histológico I-TREATMENT +fue I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +un I-TREATMENT +quiste I-TREATMENT +broncogénico I-TREATMENT +retroperitoneal. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +posopera-torio, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +décimo I-EVOLUTION +día I-EVOLUTION +posoperatorio. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcoholismo I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Emergencia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Complejo I-PRESENT_ILLNESS +Asistencial I-PRESENT_ILLNESS +Barros I-PRESENT_ILLNESS +Luco I-PRESENT_ILLNESS +(CABL) I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cadera I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +intensidad. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +asoció I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cuadrante I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +ipsilateral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lipotimia. I-PRESENT_ILLNESS +No B-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +asociadas. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +80/54 I-EXPLORATION +mmHg, I-EXPLORATION +pulso I-EXPLORATION +78 I-EXPLORATION +x', I-EXPLORATION +coloración I-EXPLORATION +lívida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +infraumbilical I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +inferiores. I-EXPLORATION +Se I-EXPLORATION +aportaron I-EXPLORATION +entonces I-EXPLORATION +1.000 I-EXPLORATION +ce I-EXPLORATION +de I-EXPLORATION +solución I-EXPLORATION +cristaloide I-EXPLORATION +intravenosa I-EXPLORATION +que I-EXPLORATION +permitieron I-EXPLORATION +normalizar I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +arterial. I-EXPLORATION +El I-EXPLORATION +abdomen I-EXPLORATION +aparecía I-EXPLORATION +distendido, I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +intenso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +profunda I-EXPLORATION +en I-EXPLORATION +hipocondrio, I-EXPLORATION +flanco I-EXPLORATION +y I-EXPLORATION +fosa I-EXPLORATION +ilíaca I-EXPLORATION +derecha. I-EXPLORATION +Presentaba, I-EXPLORATION +además, I-EXPLORATION +dolor I-EXPLORATION +de I-EXPLORATION +rebote I-EXPLORATION +difuso, I-EXPLORATION +resistencia I-EXPLORATION +muscular I-EXPLORATION +difusa I-EXPLORATION +y I-EXPLORATION +puño I-EXPLORATION +percusión I-EXPLORATION +derecha I-EXPLORATION +positiva. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +obtuvo: I-EXPLORATION +glicemla I-EXPLORATION +de I-EXPLORATION +250 I-EXPLORATION +mg/dl, I-EXPLORATION +nitrógeno I-EXPLORATION +ureico I-EXPLORATION +de I-EXPLORATION +17 I-EXPLORATION +mg/dl, I-EXPLORATION +creatininemia I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +17 I-EXPLORATION +mg/dl, I-EXPLORATION +amilasa I-EXPLORATION +86 I-EXPLORATION +U/1, I-EXPLORATION +lipasa I-EXPLORATION +40 I-EXPLORATION +U/1, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +2 I-EXPLORATION +mg/1, I-EXPLORATION +protrombine-mia I-EXPLORATION +83, I-EXPLORATION +5%; I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +tromboplastina I-EXPLORATION +parcial I-EXPLORATION +activado: I-EXPLORATION +28, I-EXPLORATION +1 I-EXPLORATION +s, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +de I-EXPLORATION +18.200/fxl, I-EXPLORATION +hemoglobinemia I-EXPLORATION +de I-EXPLORATION +12, I-EXPLORATION +7 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +39%. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +con I-EXPLORATION +contraste, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +espontáneamente I-EXPLORATION +hiperdensa I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hipocondrio I-EXPLORATION +y I-EXPLORATION +flanco I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +por I-EXPLORATION +12 I-EXPLORATION +por I-EXPLORATION +9 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +desplazaba I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +derecho I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +periferia, I-EXPLORATION +manteniendo I-EXPLORATION +un I-EXPLORATION +plano I-EXPLORATION +de I-EXPLORATION +clivaje I-EXPLORATION +con I-EXPLORATION +él. I-EXPLORATION +Se I-EXPLORATION +sugería I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +extenso I-EXPLORATION +hematoma I-EXPLORATION +mesentérico, I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +descartar I-EXPLORATION +también I-EXPLORATION +neoplasia I-EXPLORATION +subyacente. I-EXPLORATION +Al B-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +hemodinámicamente I-EVOLUTION +estable, I-EVOLUTION +afebril I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +menos I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +espontáneo, I-EVOLUTION +sin I-EVOLUTION +embargo, I-EVOLUTION +el I-EVOLUTION +hematocrito I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +descendió I-EVOLUTION +a I-EVOLUTION +21%, I-EVOLUTION +decidiéndose B-TREATMENT +entonces I-TREATMENT +transfundir I-TREATMENT +2 I-TREATMENT +U I-TREATMENT +de I-TREATMENT +glóbulos I-TREATMENT +rojos I-TREATMENT +e I-TREATMENT +intervenir I-TREATMENT +quirúrgicamente I-TREATMENT +al I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +efectuó I-TREATMENT +laparotomía I-TREATMENT +exploradora, I-TREATMENT +encontrándose I-TREATMENT +un I-TREATMENT +gran I-TREATMENT +hematoma I-TREATMENT +encapsulado I-TREATMENT +retrope-ritoneal I-TREATMENT +derecho, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +extendía I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +mesocolon I-TREATMENT +transverso I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +pelvis, I-TREATMENT +sin I-TREATMENT +observar I-TREATMENT +lesión I-TREATMENT +con I-TREATMENT +sangrado I-TREATMENT +activo. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +vaciamiento, I-TREATMENT +aseo, I-TREATMENT +instalación I-TREATMENT +de I-TREATMENT +drenajes I-TREATMENT +en I-TREATMENT +el I-TREATMENT +retroperito-neo I-TREATMENT +y I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +muestras I-TREATMENT +para I-TREATMENT +biopsia, I-TREATMENT +la I-TREATMENT +que, I-TREATMENT +posteriormente, I-TREATMENT +se I-TREATMENT +informó I-TREATMENT +como I-TREATMENT +hematoma I-TREATMENT +de I-TREATMENT +mesenterio I-TREATMENT +sin I-TREATMENT +evidencias I-TREATMENT +de I-TREATMENT +neoplasia. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +satisfactoriamente I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +del I-EVOLUTION +posoperatorio, I-EVOLUTION +cuando I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +salida I-EVOLUTION +de I-EVOLUTION +líquido I-EVOLUTION +fecal I-EVOLUTION +por I-EVOLUTION +los I-EVOLUTION +drenajes, I-EVOLUTION +realizándose I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +fístula I-EVOLUTION +estercorácea. I-EVOLUTION +Se B-TREATMENT +decidió, I-TREATMENT +entonces, I-TREATMENT +conectar I-TREATMENT +los I-TREATMENT +tubulares I-TREATMENT +a I-TREATMENT +aspiración I-TREATMENT +e I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +metronidazol I-TREATMENT +más I-TREATMENT +ciprofloxacina, I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +consiguió I-TREATMENT +buen I-TREATMENT +control I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fístula, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +evolucionó I-TREATMENT +al I-TREATMENT +cierre I-TREATMENT +definitivo I-TREATMENT +al I-TREATMENT +vigésimo I-TREATMENT +día I-TREATMENT +desde I-TREATMENT +la I-TREATMENT +operación, I-TREATMENT +dándose I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +en I-TREATMENT +óptimas I-TREATMENT +condiciones I-TREATMENT +generales I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +herida. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +en I-EVOLUTION +control I-EVOLUTION +ambulatorio I-EVOLUTION +en I-EVOLUTION +policlínico I-EVOLUTION +de I-EVOLUTION +cirugía, I-EVOLUTION +permaneciendo I-EVOLUTION +asintomático I-EVOLUTION +a I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +egreso. I-EVOLUTION + I-EVOLUTION + +Familia B-PRESENT_ILLNESS +afectada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +madre. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Estudio I-PRESENT_ILLNESS +molecular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hormonal. I-PRESENT_ILLNESS +El B-FAMILY_HISTORY +estudio I-FAMILY_HISTORY +hormonal I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +tía I-FAMILY_HISTORY +y I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +del I-FAMILY_HISTORY +probando I-FAMILY_HISTORY +(sujetos I-FAMILY_HISTORY +II. I-FAMILY_HISTORY +2 I-FAMILY_HISTORY +y I-FAMILY_HISTORY +II. I-FAMILY_HISTORY +3) I-FAMILY_HISTORY +incluyó I-FAMILY_HISTORY +una I-FAMILY_HISTORY +prueba I-FAMILY_HISTORY +de I-FAMILY_HISTORY +ACTH, I-FAMILY_HISTORY +cuyos I-FAMILY_HISTORY +valores I-FAMILY_HISTORY +de I-FAMILY_HISTORY +170H I-FAMILY_HISTORY +Progesterona I-FAMILY_HISTORY +basal I-FAMILY_HISTORY +y I-FAMILY_HISTORY +estimulado I-FAMILY_HISTORY +fueron I-FAMILY_HISTORY +normales, I-FAMILY_HISTORY +no I-FAMILY_HISTORY +permitiendo I-FAMILY_HISTORY +aclarar I-FAMILY_HISTORY +si I-FAMILY_HISTORY +estos I-FAMILY_HISTORY +sujetos I-FAMILY_HISTORY +eran I-FAMILY_HISTORY +heterocigotos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +una I-FAMILY_HISTORY +mutación I-FAMILY_HISTORY +del I-FAMILY_HISTORY +CYP21A2. I-FAMILY_HISTORY + I-FAMILY_HISTORY +El B-EXPLORATION +estudio I-EXPLORATION +molecular I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +en I-EXPLORATION +ADN I-EXPLORATION +genómi-co I-EXPLORATION +extraído I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +siete I-EXPLORATION +mutaciones I-EXPLORATION +más I-EXPLORATION +frecuentes I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +CYP21A2 I-EXPLORATION +fueron I-EXPLORATION +estudiadas I-EXPLORATION +con I-EXPLORATION +PCR I-EXPLORATION +alelo I-EXPLORATION +específica I-EXPLORATION +(Fardella, I-EXPLORATION +1998). I-EXPLORATION +Este B-FAMILY_HISTORY +estudio I-FAMILY_HISTORY +demostró I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia I-FAMILY_HISTORY +paterna I-FAMILY_HISTORY +(sujetos I-FAMILY_HISTORY +II.2, I-FAMILY_HISTORY +II.4, I-FAMILY_HISTORY +II.6) I-FAMILY_HISTORY +la I-FAMILY_HISTORY +mutación I-FAMILY_HISTORY +Q318X I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +exón I-FAMILY_HISTORY +8, I-FAMILY_HISTORY +que I-FAMILY_HISTORY +consiste I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +cambio I-FAMILY_HISTORY +de I-FAMILY_HISTORY +una I-FAMILY_HISTORY +glutamina I-FAMILY_HISTORY +por I-FAMILY_HISTORY +un I-FAMILY_HISTORY +codón I-FAMILY_HISTORY +de I-FAMILY_HISTORY +stop. I-FAMILY_HISTORY +Este I-FAMILY_HISTORY +resultado I-FAMILY_HISTORY +no I-FAMILY_HISTORY +permitió I-FAMILY_HISTORY +clasificar I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia I-FAMILY_HISTORY +materna I-FAMILY_HISTORY +y I-FAMILY_HISTORY +por I-FAMILY_HISTORY +ende I-FAMILY_HISTORY +decidir I-FAMILY_HISTORY +sobre I-FAMILY_HISTORY +la I-FAMILY_HISTORY +necesidad I-FAMILY_HISTORY +del I-FAMILY_HISTORY +tratamiento I-FAMILY_HISTORY +prenatal I-FAMILY_HISTORY +en I-FAMILY_HISTORY +estas I-FAMILY_HISTORY +parejas. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Posteriormente, B-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +CYP21A2fue I-EXPLORATION +secuenciado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Sao I-EXPLORATION +Paulo I-EXPLORATION +según I-EXPLORATION +las I-EXPLORATION +técnicas I-EXPLORATION +clásicas I-EXPLORATION +(Wedell, I-EXPLORATION +1993). I-EXPLORATION +Usando B-FAMILY_HISTORY +esta I-FAMILY_HISTORY +metodología, I-FAMILY_HISTORY +se I-FAMILY_HISTORY +encontró I-FAMILY_HISTORY +en I-FAMILY_HISTORY +uno I-FAMILY_HISTORY +de I-FAMILY_HISTORY +los I-FAMILY_HISTORY +alelos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia I-FAMILY_HISTORY +paterna I-FAMILY_HISTORY +(sujetos I-FAMILY_HISTORY +II.2, I-FAMILY_HISTORY +II.4, I-FAMILY_HISTORY +II.6) I-FAMILY_HISTORY +la I-FAMILY_HISTORY +mutación I-FAMILY_HISTORY +Q318X I-FAMILY_HISTORY +junto I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +mutación I-FAMILY_HISTORY +R483W, I-FAMILY_HISTORY +la I-FAMILY_HISTORY +que I-FAMILY_HISTORY +consiste I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +sustitución I-FAMILY_HISTORY +de I-FAMILY_HISTORY +una I-FAMILY_HISTORY +arginina I-FAMILY_HISTORY +por I-FAMILY_HISTORY +triptofano I-FAMILY_HISTORY +(CGG>TGG). I-FAMILY_HISTORY +En I-FAMILY_HISTORY +la I-FAMILY_HISTORY +familia I-FAMILY_HISTORY +materna I-FAMILY_HISTORY +(sujetos I-FAMILY_HISTORY +II. I-FAMILY_HISTORY +1, I-FAMILY_HISTORY +II.3, I-FAMILY_HISTORY +II.5) I-FAMILY_HISTORY +se I-FAMILY_HISTORY +encontró I-FAMILY_HISTORY +un I-FAMILY_HISTORY +alelo I-FAMILY_HISTORY +con I-FAMILY_HISTORY +la I-FAMILY_HISTORY +mutación I-FAMILY_HISTORY +R483->frameshift, I-FAMILY_HISTORY +también I-FAMILY_HISTORY +conocida I-FAMILY_HISTORY +como I-FAMILY_HISTORY +R483delGGinsC, I-FAMILY_HISTORY +la I-FAMILY_HISTORY +cuál I-FAMILY_HISTORY +consiste I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +cambio I-FAMILY_HISTORY +de I-FAMILY_HISTORY +los I-FAMILY_HISTORY +nucleótidos I-FAMILY_HISTORY +GG I-FAMILY_HISTORY +por I-FAMILY_HISTORY +C, I-FAMILY_HISTORY +alterando I-FAMILY_HISTORY +la I-FAMILY_HISTORY +lectura I-FAMILY_HISTORY +del I-FAMILY_HISTORY +codón. I-FAMILY_HISTORY +De I-FAMILY_HISTORY +este I-FAMILY_HISTORY +modo I-FAMILY_HISTORY +se I-FAMILY_HISTORY +certificó I-FAMILY_HISTORY +que I-FAMILY_HISTORY +los I-FAMILY_HISTORY +seis I-FAMILY_HISTORY +cónyuges I-FAMILY_HISTORY +poseen I-FAMILY_HISTORY +mutaciones I-FAMILY_HISTORY +para I-FAMILY_HISTORY +HSC I-FAMILY_HISTORY +perdedora I-FAMILY_HISTORY +de I-FAMILY_HISTORY +sal, I-FAMILY_HISTORY +y I-FAMILY_HISTORY +por I-FAMILY_HISTORY +lo I-FAMILY_HISTORY +tanto, I-FAMILY_HISTORY +se I-FAMILY_HISTORY +encuentran I-FAMILY_HISTORY +en I-FAMILY_HISTORY +riesgo I-FAMILY_HISTORY +de I-FAMILY_HISTORY +tener I-FAMILY_HISTORY +hijas I-FAMILY_HISTORY +con I-FAMILY_HISTORY +ambigüedad I-FAMILY_HISTORY +genital. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Consejo B-TREATMENT +genético I-TREATMENT +y I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +los I-TREATMENT +embarazos. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +dar I-TREATMENT +consejo I-TREATMENT +genético I-TREATMENT +a I-TREATMENT +los I-TREATMENT +tres I-TREATMENT +matrimonios I-TREATMENT +afectados. I-TREATMENT +La B-EVOLUTION +tía I-EVOLUTION +paterna I-EVOLUTION +(sujeto I-EVOLUTION +II.2), I-EVOLUTION +mujer I-EVOLUTION +sana I-EVOLUTION +de I-EVOLUTION +34 I-EVOLUTION +años, I-EVOLUTION +suspende I-EVOLUTION +el I-EVOLUTION +método I-EVOLUTION +anticonceptivo I-EVOLUTION +por I-EVOLUTION +deseos I-EVOLUTION +de I-EVOLUTION +fertilidad I-EVOLUTION +y I-EVOLUTION +logra I-EVOLUTION +concepción I-EVOLUTION +espontánea I-EVOLUTION +en I-EVOLUTION +marzo I-EVOLUTION +2005. I-EVOLUTION +Se B-TREATMENT +explican I-TREATMENT +los I-TREATMENT +beneficios I-TREATMENT +y I-TREATMENT +riesgos I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +prenatal I-TREATMENT +con I-TREATMENT +corti-coides, I-TREATMENT +los I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +entiende I-TREATMENT +y I-TREATMENT +acepta, I-TREATMENT +firmando I-TREATMENT +un I-TREATMENT +consentimiento I-TREATMENT +en I-TREATMENT +que I-TREATMENT +opta I-TREATMENT +por I-TREATMENT +realizar I-TREATMENT +esta I-TREATMENT +terapia. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +comenzó I-TREATMENT +a I-TREATMENT +las I-TREATMENT +6 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +edad I-TREATMENT +gestacional I-TREATMENT +(EG) I-TREATMENT +con I-TREATMENT +dexametasona I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +µg/kg/día. I-TREATMENT + I-TREATMENT +A B-EXPLORATION +las I-EXPLORATION +13 I-EXPLORATION +semanas I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +sexo I-EXPLORATION +fetal I-EXPLORATION +masculino I-EXPLORATION +por I-EXPLORATION +ultrasonografía I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resolución I-EXPLORATION +(Voluson I-EXPLORATION +730, I-EXPLORATION +General I-EXPLORATION +Electric, I-EXPLORATION +Austria, I-EXPLORATION +transductor I-EXPLORATION +transabdominal I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5-5 I-EXPLORATION +MHz), I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +es I-EXPLORATION +capaz I-EXPLORATION +de I-EXPLORATION +predecir I-EXPLORATION +conectamente I-EXPLORATION +el I-EXPLORATION +sexo I-EXPLORATION +fetal I-EXPLORATION +con I-EXPLORATION +99% I-EXPLORATION +de I-EXPLORATION +certeza I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +12+6 I-EXPLORATION +semanas I-EXPLORATION +EG I-EXPLORATION +(Efrat, I-EXPLORATION +2006); I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +no I-EXPLORATION +aceptó I-EXPLORATION +técnicas I-EXPLORATION +invasivas I-EXPLORATION +de I-EXPLORATION +diagnóstico I-EXPLORATION +prenatal. I-EXPLORATION +Se B-TREATMENT +disminuyó I-TREATMENT +progresivamente I-TREATMENT +las I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +esteroides, I-TREATMENT +suspendiéndolo I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +completa I-TREATMENT +a I-TREATMENT +las I-TREATMENT +22 I-TREATMENT +semanas. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +período I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +edema I-EVOLUTION +e I-EVOLUTION +hipertensión I-EVOLUTION +arterial I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ametildo-pa. I-TREATMENT +Los B-EVOLUTION +síntomas I-EVOLUTION +revirtieron I-EVOLUTION +parcialmente I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +de I-EVOLUTION +terapia I-EVOLUTION +corticoidal, I-EVOLUTION +y I-EVOLUTION +totalmente I-EVOLUTION +posparto. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +39 I-EVOLUTION +semanas I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +cesárea I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +obtuvo I-EVOLUTION +recién I-EVOLUTION +nacido I-EVOLUTION +de I-EVOLUTION +sexo I-EVOLUTION +masculino, I-EVOLUTION +con I-EVOLUTION +peso I-EVOLUTION +adecuado I-EVOLUTION +y I-EVOLUTION +examen I-EVOLUTION +físico I-EVOLUTION +normal. I-EVOLUTION +Los I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +170HP I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +se I-EVOLUTION +muestran I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Figura I-EVOLUTION +IB. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +tía I-EVOLUTION +materna I-EVOLUTION +(sujeto I-EVOLUTION +II.5) I-EVOLUTION +de I-EVOLUTION +37 I-EVOLUTION +años I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +embarazo I-EVOLUTION +inicial I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +EG. I-EVOLUTION +Se B-TREATMENT +ofrece I-TREATMENT +nuevamente I-TREATMENT +tratamiento I-TREATMENT +prenatal I-TREATMENT +de I-TREATMENT +HSC, I-TREATMENT +y I-TREATMENT +también I-TREATMENT +se I-TREATMENT +solicitó I-TREATMENT +firma I-TREATMENT +de I-TREATMENT +consentimiento I-TREATMENT +informado. I-TREATMENT +La I-TREATMENT +familia I-TREATMENT +optó I-TREATMENT +nuevamente I-TREATMENT +por I-TREATMENT +seguir I-TREATMENT +este I-TREATMENT +tratamiento. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +6 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +EG I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +dexametasona I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +Lig/kg/día. I-TREATMENT +La B-EXPLORATION +madre I-EXPLORATION +no I-EXPLORATION +aceptó I-EXPLORATION +las I-EXPLORATION +técnicas I-EXPLORATION +invasivas I-EXPLORATION +de I-EXPLORATION +diagnóstico I-EXPLORATION +prenatal I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +sexo I-EXPLORATION +fetal I-EXPLORATION +mediante I-EXPLORATION +ecografía I-EXPLORATION +precoz. I-EXPLORATION +En B-TREATMENT +caso I-TREATMENT +de I-TREATMENT +que I-TREATMENT +se I-TREATMENT +tratara I-TREATMENT +de I-TREATMENT +un I-TREATMENT +feto I-TREATMENT +femenino I-TREATMENT +continuarían I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +término I-TREATMENT +del I-TREATMENT +embarazo. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +12 I-TREATMENT +semanas I-TREATMENT +se I-TREATMENT +diagnosticó I-TREATMENT +sexo I-TREATMENT +fetal I-TREATMENT +masculino I-TREATMENT +y I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +suspensión I-TREATMENT +de I-TREATMENT +esteroides. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +efectos I-EVOLUTION +adversos I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +dexametasona. I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +40 I-EVOLUTION +semanas I-EVOLUTION +nació I-EVOLUTION +niño I-EVOLUTION +sano, I-EVOLUTION +no I-EVOLUTION +afectado. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad. I-PRESENT_ILLNESS +Después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +varicela, I-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +deglutir I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +evidencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipo I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +hipertiroidismo. I-PRESENT_ILLNESS +Su I-PRESENT_ILLNESS +velocidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +pondoestatural I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +normal I-PRESENT_ILLNESS +(5 I-PRESENT_ILLNESS +cm/año) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +ósea I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +previos. I-PAST_MEDICAL_HISTORY +Recién I-PAST_MEDICAL_HISTORY +nacido I-PAST_MEDICAL_HISTORY +pretérmino I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +33 I-PAST_MEDICAL_HISTORY +semanas; I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +periodo I-PAST_MEDICAL_HISTORY +neonatal I-PAST_MEDICAL_HISTORY +cursó I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +distress I-PAST_MEDICAL_HISTORY +respiratorio; I-PAST_MEDICAL_HISTORY +requirió I-PAST_MEDICAL_HISTORY +ventilación I-PAST_MEDICAL_HISTORY +mecánica I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +días. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +relevantes. I-PAST_MEDICAL_HISTORY +Actualmente I-PAST_MEDICAL_HISTORY +cursa I-PAST_MEDICAL_HISTORY +sexto I-PAST_MEDICAL_HISTORY +básico I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buen I-PAST_MEDICAL_HISTORY +rendimiento I-PAST_MEDICAL_HISTORY +escolar. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Historia B-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +Hijo I-FAMILY_HISTORY +de I-FAMILY_HISTORY +padres I-FAMILY_HISTORY +sanos, I-FAMILY_HISTORY +con I-FAMILY_HISTORY +antecedente I-FAMILY_HISTORY +de I-FAMILY_HISTORY +tiroiditis I-FAMILY_HISTORY +de I-FAMILY_HISTORY +Hashimoto I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +abuelo I-FAMILY_HISTORY +y I-FAMILY_HISTORY +tía I-FAMILY_HISTORY +materna. I-FAMILY_HISTORY +Su I-FAMILY_HISTORY +talla I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +es I-FAMILY_HISTORY +de I-FAMILY_HISTORY +l69±5 I-FAMILY_HISTORY +cm I-FAMILY_HISTORY +(percentil I-FAMILY_HISTORY +13, I-FAMILY_HISTORY +7). I-FAMILY_HISTORY + I-FAMILY_HISTORY +Examen B-EXPLORATION +físico. I-EXPLORATION +Talla: I-EXPLORATION +146, I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +(percentil I-EXPLORATION +54), I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +Masa I-EXPLORATION +Corporal: I-EXPLORATION +18, I-EXPLORATION +2 I-EXPLORATION +kg/m2 I-EXPLORATION +(percentil I-EXPLORATION +62, I-EXPLORATION +5); I-EXPLORATION +sin I-EXPLORATION +desarrollo I-EXPLORATION +puberal I-EXPLORATION +(vello I-EXPLORATION +púbico I-EXPLORATION +Tanner I-EXPLORATION +I, I-EXPLORATION +testículos I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +ce, I-EXPLORATION +simétricos). I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +faringe, I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +rojiza I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +2x2 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua, I-EXPLORATION +con I-EXPLORATION +vasos I-EXPLORATION +venosos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +superficie, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +o I-EXPLORATION +ulceración. I-EXPLORATION +Sin I-EXPLORATION +estridor I-EXPLORATION +u I-EXPLORATION +odinofagia. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +cuello I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +palpó I-EXPLORATION +tiroides I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +posición I-EXPLORATION +pre I-EXPLORATION +traqueal. I-EXPLORATION + I-EXPLORATION +Laboratorio. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +tiroidea I-EXPLORATION +revelaron I-EXPLORATION +TSH I-EXPLORATION +elevada I-EXPLORATION +10, I-EXPLORATION +79 I-EXPLORATION +UI/mL I-EXPLORATION +(rango I-EXPLORATION +normal I-EXPLORATION +=0, I-EXPLORATION +7-5, I-EXPLORATION +7 I-EXPLORATION +UI/mL), I-EXPLORATION +con I-EXPLORATION +tiroxina I-EXPLORATION +normal, I-EXPLORATION +pero I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +cuartil I-EXPLORATION +más I-EXPLORATION +bajo, I-EXPLORATION +6, I-EXPLORATION +0 I-EXPLORATION +Lig/dl I-EXPLORATION +(rango I-EXPLORATION +normal I-EXPLORATION +TT I-EXPLORATION +=5, I-EXPLORATION +5-11, I-EXPLORATION +7 I-EXPLORATION +Hg/dl) I-EXPLORATION +y I-EXPLORATION +triyodotironina I-EXPLORATION +baja I-EXPLORATION +57, I-EXPLORATION +8 I-EXPLORATION +ng/dL I-EXPLORATION +(rango I-EXPLORATION +normal I-EXPLORATION +=84, I-EXPLORATION +4-214, I-EXPLORATION +3 I-EXPLORATION +ng/dL) I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antiperoxidasa I-EXPLORATION +y I-EXPLORATION +antiroglobulina I-EXPLORATION +ausentes. I-EXPLORATION + I-EXPLORATION +Estudio I-EXPLORATION +de I-EXPLORATION +imágenes. I-EXPLORATION +La I-EXPLORATION +nasofibrolaringoscopia I-EXPLORATION +óptica I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +rojiza, I-EXPLORATION +tensa, I-EXPLORATION +redondeada, I-EXPLORATION +con I-EXPLORATION +vasos I-EXPLORATION +sanguíneos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +cuello I-EXPLORATION +confirmó I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +bien I-EXPLORATION +circunscrita I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua, I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +0 I-EXPLORATION +x I-EXPLORATION +1, I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +1, I-EXPLORATION +8 I-EXPLORATION +cm, I-EXPLORATION +hiperdensa I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +cortes I-EXPLORATION +sin I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +endovenoso, I-EXPLORATION +sin I-EXPLORATION +nodulos I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +cinügrafía I-EXPLORATION +con I-EXPLORATION +Tc-99 I-EXPLORATION +mostró I-EXPLORATION +captación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +tiroides I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +localización I-EXPLORATION +normal, I-EXPLORATION +concordante I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +ectopia I-EXPLORATION +lingual I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +tiroides. I-EXPLORATION + I-EXPLORATION +Seguimiento. B-TREATMENT +Después I-TREATMENT +que I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +fue I-TREATMENT +realizado, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +L-Tiroxina I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +75 I-TREATMENT +\ig/día. I-TREATMENT +Al B-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +la I-EVOLUTION +TSH I-EVOLUTION +estaba I-EVOLUTION +suprimida I-EVOLUTION +(0, I-EVOLUTION +11 I-EVOLUTION +UI/mL) I-EVOLUTION +con I-EVOLUTION +tiroxina I-EVOLUTION +libre I-EVOLUTION +normal I-EVOLUTION +alta I-EVOLUTION +1, I-EVOLUTION +93 I-EVOLUTION +ng/dL I-EVOLUTION +(0,8-2,0). I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +gradual I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tiroides I-EXPLORATION +lingual I-EXPLORATION +y I-EXPLORATION +desaparición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +disfagia. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +47 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +DM I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +9 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +actual I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +esquema I-PAST_MEDICAL_HISTORY +insulínico I-PAST_MEDICAL_HISTORY +intensivo I-PAST_MEDICAL_HISTORY +(una I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +nocturna I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insulina I-PAST_MEDICAL_HISTORY +glargina I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insulina I-PAST_MEDICAL_HISTORY +lispro I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +comidas). I-PAST_MEDICAL_HISTORY +Entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +gran I-PAST_MEDICAL_HISTORY +tabaquismo, I-PAST_MEDICAL_HISTORY +dislipidemia I-PAST_MEDICAL_HISTORY +mixta I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +irregular I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ciprofibrato I-PAST_MEDICAL_HISTORY +100 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +microalbuminuria I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg/12 I-PAST_MEDICAL_HISTORY +h, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +mg/día. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +salud I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuantificada, I-PRESENT_ILLNESS +calofríos, I-PRESENT_ILLNESS +odinofagia, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +alimentarios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Se B-EXPLORATION +constató I-EXPLORATION +deshidratación I-EXPLORATION +moderada, I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +8°C I-EXPLORATION +y I-EXPLORATION +glicemia I-EXPLORATION +capilar I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +400 I-EXPLORATION +mg/dl. I-EXPLORATION +Fue B-TREATMENT +internado, I-TREATMENT +recibiendo I-TREATMENT +solución I-TREATMENT +fisiológica I-TREATMENT +e I-TREATMENT +insulina I-TREATMENT +cristalina I-TREATMENT +en I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +minidosis. I-TREATMENT +Entre B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +obtenidos I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +destacaban I-EXPLORATION +glicemia I-EXPLORATION +549 I-EXPLORATION +mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +1, I-EXPLORATION +67 I-EXPLORATION +mg/dl, I-EXPLORATION +pH I-EXPLORATION +6, I-EXPLORATION +91, I-EXPLORATION +BE I-EXPLORATION +-27, I-EXPLORATION +HC03 I-EXPLORATION +4, I-EXPLORATION +6 I-EXPLORATION +(en I-EXPLORATION +sangre I-EXPLORATION +arterial), I-EXPLORATION +cetonemia I-EXPLORATION ++++, I-EXPLORATION +natremia I-EXPLORATION +141, I-EXPLORATION +7 I-EXPLORATION +mEq/L, I-EXPLORATION +kalemia I-EXPLORATION +5, I-EXPLORATION +92 I-EXPLORATION +mEq/L, I-EXPLORATION +cloremia I-EXPLORATION +98 I-EXPLORATION +mEq/L, I-EXPLORATION +amilasemia I-EXPLORATION +48 I-EXPLORATION +U/L, I-EXPLORATION +hematocrito I-EXPLORATION +40, I-EXPLORATION +5%, I-EXPLORATION +leucocitos I-EXPLORATION +9-100 I-EXPLORATION +mm3, I-EXPLORATION +VHS I-EXPLORATION +38 I-EXPLORATION +mm/h I-EXPLORATION +y I-EXPLORATION +urocultivo I-EXPLORATION +negativo. I-EXPLORATION +Fue B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +cetoacidosis I-EVOLUTION +diabética, I-EVOLUTION +se B-TREATMENT +le I-TREATMENT +indicó I-TREATMENT +mantener I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +insulínico I-TREATMENT +intensificado I-TREATMENT +y I-TREATMENT +asistir I-TREATMENT +a I-TREATMENT +control I-TREATMENT +ambulatorio. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +trasladó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +ciudad I-EVOLUTION +de I-EVOLUTION +Temuco, I-EVOLUTION +consultando I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +por I-EVOLUTION +sensación I-EVOLUTION +febril I-EVOLUTION +no I-EVOLUTION +cuantificada, I-EVOLUTION +sudoración I-EVOLUTION +nocturna, I-EVOLUTION +odinofagia I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +al I-EVOLUTION +movilizar I-EVOLUTION +el I-EVOLUTION +cuello. I-EVOLUTION +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +cuello, I-EXPLORATION +sensible, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios I-EXPLORATION +ni I-EXPLORATION +crepitación, I-EXPLORATION +fetor I-EXPLORATION +pútrido I-EXPLORATION +y I-EXPLORATION +faringe I-EXPLORATION +congestiva I-EXPLORATION +con I-EXPLORATION +escaso I-EXPLORATION +exudado I-EXPLORATION +purulento. I-EXPLORATION +Se B-EVOLUTION +indicó I-EVOLUTION +hospitalización I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +DM I-EVOLUTION +descompensada, I-EVOLUTION +faringo-amigdalitis I-EVOLUTION +pultácea I-EVOLUTION +y I-EVOLUTION +masa I-EVOLUTION +cervical I-EVOLUTION +en I-EVOLUTION +estudio. I-EVOLUTION +Entre B-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +destacaban I-EXPLORATION +glicemia I-EXPLORATION +270 I-EXPLORATION +mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +mg/ I-EXPLORATION +di, I-EXPLORATION +hematocrito I-EXPLORATION +35, I-EXPLORATION +7%, I-EXPLORATION +leucocitos I-EXPLORATION +18.800 I-EXPLORATION +por I-EXPLORATION +mm3, I-EXPLORATION +VHS I-EXPLORATION +91 I-EXPLORATION +mm/hora, I-EXPLORATION +PCR I-EXPLORATION +309 I-EXPLORATION +mg/L. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +hidratación I-TREATMENT +con I-TREATMENT +solución I-TREATMENT +fisiológica I-TREATMENT +e I-TREATMENT +infusión I-TREATMENT +endovenosa I-TREATMENT +continua I-TREATMENT +de I-TREATMENT +insulina, I-TREATMENT +fue B-EXPLORATION +evaluado I-EXPLORATION +por I-EXPLORATION +otorrinolaringólogo I-EXPLORATION +con I-EXPLORATION +nasofaringoscopia, I-EXPLORATION +pesquisándose I-EXPLORATION +flegmón I-EXPLORATION +faríngeo. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +sódica I-TREATMENT +EV I-TREATMENT +20 I-TREATMENT +millones I-TREATMENT +U/día, I-TREATMENT +cloxacilina I-TREATMENT +12 I-TREATMENT +g I-TREATMENT +EV/ I-TREATMENT +día I-TREATMENT +y I-TREATMENT +ceftriaxona I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +EV/día. I-TREATMENT +El B-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +cervical I-EXPLORATION +fue I-EXPLORATION +estudiado I-EXPLORATION +con I-EXPLORATION +ecotomografía I-EXPLORATION +cervical, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +compartimiento I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +y I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +multicorte I-EXPLORATION +de I-EXPLORATION +cuello I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +retrofa-ríngeo I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +compartimientos I-EXPLORATION +posteriores I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +flegmonoso. I-EXPLORATION + I-EXPLORATION +Evaluado B-TREATMENT +en I-TREATMENT +conjunto I-TREATMENT +con I-TREATMENT +otorrinolaringólogo I-TREATMENT +y I-TREATMENT +cirujano I-TREATMENT +de I-TREATMENT +cabeza I-TREATMENT +y I-TREATMENT +cuello, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +practicar I-TREATMENT +drenaje I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colección. I-TREATMENT +Al I-TREATMENT +segundo I-TREATMENT +día I-TREATMENT +de I-TREATMENT +hospitalización I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +2 I-TREATMENT +incisiones I-TREATMENT +en I-TREATMENT +la I-TREATMENT +región I-TREATMENT +posterior I-TREATMENT +del I-TREATMENT +cuello, I-TREATMENT +drenando I-TREATMENT +líquido I-TREATMENT +purulento. I-TREATMENT +No B-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +o I-EXPLORATION +gas. I-EXPLORATION +Se I-EXPLORATION +obtuvo I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +secreción, I-EXPLORATION +aislándose I-EXPLORATION +Streptococcus I-EXPLORATION +grupo I-EXPLORATION +B, I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Luego B-TREATMENT +de I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +EV, I-TREATMENT +los I-TREATMENT +drenajes I-TREATMENT +Penrose I-TREATMENT +dejaron I-TREATMENT +de I-TREATMENT +entregar I-TREATMENT +secreción I-TREATMENT +y I-TREATMENT +fueron I-TREATMENT +retirados. I-TREATMENT +La B-EVOLUTION +exploración I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +incisiones I-EVOLUTION +fue I-EVOLUTION +satisfactoria. I-EVOLUTION +Se B-TREATMENT +dio I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +con I-TREATMENT +antibiótico I-TREATMENT +oral I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +otra I-TREATMENT +semana I-TREATMENT +(Ampicilina/Sulbactam). I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +(20 I-PAST_MEDICAL_HISTORY +cig/día) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +urolitiasis I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +27 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +flanco I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +súbito, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +irradiación, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómito I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +ocasión I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cede I-PRESENT_ILLNESS +espontáneamente. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +repitió I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +después, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +similares I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +anterior. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +No B-EXPLORATION +presentó I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +140/82 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +ilíaca I-EXPLORATION +derecha I-EXPLORATION +(FID). I-EXPLORATION + I-EXPLORATION +Dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +orina I-EXPLORATION +completa I-EXPLORATION +sin I-EXPLORATION +hematuria, I-EXPLORATION +hemogra-ma I-EXPLORATION +con I-EXPLORATION +leucocitosis I-EXPLORATION +(17.200 I-EXPLORATION +x I-EXPLORATION +mm3), I-EXPLORATION +creatininemia I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +de I-EXPLORATION +1.457 I-EXPLORATION +UI/1. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +pieloTC I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +ser I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +urolitiasis, I-EXPLORATION +prosiguiéndose I-EXPLORATION +con I-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +extensa I-EXPLORATION +área I-EXPLORATION +hipodensa I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +cuneiforme I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +renal I-EXPLORATION +derecho, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +infarto I-EXPLORATION +parcial I-EXPLORATION +renal I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Se B-EVOLUTION +hospitalizó I-EVOLUTION +al I-EVOLUTION +paciente. I-EVOLUTION +Se B-EXPLORATION +tomaron I-EXPLORATION +exámenes I-EXPLORATION +para I-EXPLORATION +trombofilia, I-EXPLORATION +cuyos I-EXPLORATION +resultados I-EXPLORATION +fueron I-EXPLORATION +normales, I-EXPLORATION +previo I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +anticoagulación I-EXPLORATION +(Fragmin I-EXPLORATION +y I-EXPLORATION +Neosintrón I-EXPLORATION +). I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecocardiografía I-EXPLORATION +transesofágica I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +angioTC I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +arteria I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +dominante I-EXPLORATION +(AD) I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +polar I-EXPLORATION +de I-EXPLORATION +menor I-EXPLORATION +calibre I-EXPLORATION +con I-EXPLORATION +trayecto I-EXPLORATION +normal, I-EXPLORATION +e I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +arterial I-EXPLORATION +con I-EXPLORATION +infarto I-EXPLORATION +renal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +prosiguió I-EXPLORATION +con I-EXPLORATION +estudio I-EXPLORATION +angiográfico, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +aortografía I-EXPLORATION +normal, I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +perfusión I-EXPLORATION +del I-EXPLORATION +polo I-EXPLORATION +superior, I-EXPLORATION +cara I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +riñon I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +perfusión I-EXPLORATION +del I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +dado I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +polar I-EXPLORATION +secundaria. I-EXPLORATION +La I-EXPLORATION +arteria I-EXPLORATION +renal I-EXPLORATION +dominante I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +irregular, I-EXPLORATION +dilatada I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +que I-EXPLORATION +además I-EXPLORATION +presentó I-EXPLORATION +un I-EXPLORATION +flap I-EXPLORATION +de I-EXPLORATION +disección I-EXPLORATION +que I-EXPLORATION +comprometió I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +ramas I-EXPLORATION +interlobares, I-EXPLORATION +limitando I-EXPLORATION +así I-EXPLORATION +el I-EXPLORATION +flujo I-EXPLORATION +distal. I-EXPLORATION +El I-EXPLORATION +flap I-EXPLORATION +de I-EXPLORATION +disección I-EXPLORATION +fue I-EXPLORATION +descrito I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +complejidad I-EXPLORATION +sin I-EXPLORATION +posibilidades I-EXPLORATION +de I-EXPLORATION +maniobras I-EXPLORATION +endovasculares. I-EXPLORATION + I-EXPLORATION +Dos B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +presentó I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +flanco I-EVOLUTION +derecho. I-EVOLUTION +Nuevo B-EXPLORATION +angioTC I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +clara I-EXPLORATION +progresión I-EXPLORATION +del I-EXPLORATION +infarto I-EXPLORATION +renal I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +2/3 I-EXPLORATION +superiores I-EXPLORATION +del I-EXPLORATION +riñon I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +presiones I-EVOLUTION +arteriales I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +rango I-EVOLUTION +de I-EVOLUTION +160/100 I-EVOLUTION +mmHg I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +deterioro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +(creatininemia I-EVOLUTION +1, I-EVOLUTION +2 I-EVOLUTION +mg/dl). I-EVOLUTION +Fue B-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +con I-TREATMENT +terapia I-TREATMENT +antihipertensiva I-TREATMENT +(Blox I-TREATMENT +4 I-TREATMENT +mg/día) I-TREATMENT +en I-TREATMENT +buenas I-TREATMENT +condiciones I-TREATMENT +generales I-TREATMENT +para I-TREATMENT +su I-TREATMENT +manejo I-TREATMENT +ambulatorio. I-TREATMENT +En B-EVOLUTION +control I-EVOLUTION +ambulatorio I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +y I-EVOLUTION +diecisiete I-EVOLUTION +días I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +se I-EVOLUTION +encontró I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +asintomático, I-EVOLUTION +normotenso I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +resto I-EVOLUTION +del I-EVOLUTION +examen I-EVOLUTION +físico I-EVOLUTION +sin I-EVOLUTION +hallazgos I-EVOLUTION +patológicos. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +76 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +quien B-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +urgencia I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1974 I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +lesión I-PAST_MEDICAL_HISTORY +ulcerada I-PAST_MEDICAL_HISTORY +gástrica I-PAST_MEDICAL_HISTORY +sangrante. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +practicó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +gastrectomía I-PAST_MEDICAL_HISTORY +subtotal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +reconstrucción I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +Billroth I-PAST_MEDICAL_HISTORY +II. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +postoperatoria I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +normal. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +pieza I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gastrectomía I-PAST_MEDICAL_HISTORY +subtotal I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontró I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +ulcerado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cara I-PAST_MEDICAL_HISTORY +anterior, I-PAST_MEDICAL_HISTORY +distante I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +mm I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +sección I-PAST_MEDICAL_HISTORY +gástrica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +píloro. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +tumor I-PAST_MEDICAL_HISTORY +medía I-PAST_MEDICAL_HISTORY +3, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +eje I-PAST_MEDICAL_HISTORY +longitudinal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +transversal, I-PAST_MEDICAL_HISTORY +comprometiendo I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +curvatura I-PAST_MEDICAL_HISTORY +menor I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +extendiéndose I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cara I-PAST_MEDICAL_HISTORY +posterior. I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +corte, I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +constituido I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +tejido I-PAST_MEDICAL_HISTORY +rosado I-PAST_MEDICAL_HISTORY +pálido I-PAST_MEDICAL_HISTORY +lobulado, I-PAST_MEDICAL_HISTORY +liso I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +brillante, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +reemplazaba I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +túnicas I-PAST_MEDICAL_HISTORY +submucosa, I-PAST_MEDICAL_HISTORY +muscular I-PAST_MEDICAL_HISTORY +propia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +subserosa, I-PAST_MEDICAL_HISTORY +abombando I-PAST_MEDICAL_HISTORY +levemente I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +serosa. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +examen I-PAST_MEDICAL_HISTORY +histopatológico I-PAST_MEDICAL_HISTORY +demostró I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +linfoma I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +Hodgkin I-PAST_MEDICAL_HISTORY +mixto I-PAST_MEDICAL_HISTORY +linfo-histiocítico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clasificación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Rappaport I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1966, I-PAST_MEDICAL_HISTORY +vigente I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +formularon I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +clasificaciones I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Kiel I-PAST_MEDICAL_HISTORY +(1974) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Lukes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +Collins I-PAST_MEDICAL_HISTORY +(1974). I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontró I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +ganglios I-PAST_MEDICAL_HISTORY +linfáticos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +linfoma. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +enfermo I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +radioterapia I-PAST_MEDICAL_HISTORY +adyuvante I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +seguido I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +endoscopias I-PAST_MEDICAL_HISTORY +anuales I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +23 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observaron I-PAST_MEDICAL_HISTORY +nuevas I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +gástricas I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +demostró I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Helicobacter I-PAST_MEDICAL_HISTORY +pylori. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +período, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +desarrolló I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +tumores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Warthin I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ambas I-PAST_MEDICAL_HISTORY +glándulas I-PAST_MEDICAL_HISTORY +parótidas, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +resecó I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +piel I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +epidermoide I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +extremidad I-PAST_MEDICAL_HISTORY +inferior I-PAST_MEDICAL_HISTORY +derecha. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +septiembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2006, I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +operación I-PRESENT_ILLNESS +gástrica, I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +anemia. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +palidez, I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +abdominales. I-EXPLORATION +El I-EXPLORATION +hematocrito I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +34, I-EXPLORATION +5% I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +proliferativa I-EXPLORATION +y I-EXPLORATION +ulcerada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +muñón I-EXPLORATION +gástrico I-EXPLORATION +que I-EXPLORATION +obstruía I-EXPLORATION +parcialmente I-EXPLORATION +la I-EXPLORATION +anastomosis I-EXPLORATION +gastroyeyunal. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +mostró I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +gástrica I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +infiltrada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +tubular I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +Helicobacter I-EXPLORATION +pylori. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +operado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +gastrectomía I-TREATMENT +total I-TREATMENT +con I-TREATMENT +disección I-TREATMENT +ganglionar. I-TREATMENT +La B-EVOLUTION +recuperación I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +normal. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +tumoral I-EXPLORATION +ulcerada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +muñón I-EXPLORATION +gástrico I-EXPLORATION +con I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anastomosis I-EXPLORATION +gastroyeyunal. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +microscópico I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +tubular I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +subserosa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +gástrica, I-EXPLORATION +metástasis I-EXPLORATION +en I-EXPLORATION +10 I-EXPLORATION +linfonodos I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +resecados I-EXPLORATION +y I-EXPLORATION +permeaciones I-EXPLORATION +vasculares I-EXPLORATION +linfáticas I-EXPLORATION +(T2bN2M0, I-EXPLORATION +Etapa I-EXPLORATION +IIIB). I-EXPLORATION + I-EXPLORATION + +En B-PRESENT_ILLNESS +septiembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2006 I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +Dento-Máxilo-Facial I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Universidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Chile, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +estudiante, B-PAST_MEDICAL_HISTORY +derivada B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Hematología I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +blanquecinas I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +mucosa I-DERIVED_FROM/TO +bucal. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +anemia I-PAST_MEDICAL_HISTORY +aplásica I-PAST_MEDICAL_HISTORY +severa I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2005, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +atribuyó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +derivado I-PAST_MEDICAL_HISTORY +fenotiacínico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +sometida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +médula I-PAST_MEDICAL_HISTORY +ósea I-PAST_MEDICAL_HISTORY +(TMO) I-PAST_MEDICAL_HISTORY +alogénico. I-PAST_MEDICAL_HISTORY +Presentó B-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +primeras I-PRESENT_ILLNESS +manifestaciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +EICH I-PRESENT_ILLNESS +agudo, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +predominante I-PRESENT_ILLNESS +cutáneo I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS ++42, I-PRESENT_ILLNESS +manifestado B-EXPLORATION +como I-EXPLORATION +lesión I-EXPLORATION +máculo-pápulo I-EXPLORATION +eritematosa I-EXPLORATION +de I-EXPLORATION +tronco I-EXPLORATION +y I-EXPLORATION +extremidades I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +EICH I-EXPLORATION +agudo, I-EXPLORATION +momento B-TREATMENT +en I-TREATMENT +que I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +asociación I-TREATMENT +de I-TREATMENT +corticoides I-TREATMENT +(prednisona I-TREATMENT +20 I-TREATMENT +mg/dia) I-TREATMENT +con I-TREATMENT +ciclosporina, I-TREATMENT +reemplazándose I-TREATMENT +luego I-TREATMENT +la I-TREATMENT +ciclosporina I-TREATMENT +por I-TREATMENT +tacrolimus, I-TREATMENT +3 I-TREATMENT +mg/dia I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +toxicidad I-TREATMENT +neurológica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +primera. I-TREATMENT +Las B-EVOLUTION +lesiones I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mucosa I-EVOLUTION +oral I-EVOLUTION +aparecieron I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +más I-EVOLUTION +tardía I-EVOLUTION +y I-EVOLUTION +su I-EVOLUTION +primera I-EVOLUTION +descripción I-EVOLUTION +aparece I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +día I-EVOLUTION ++310. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +clínico, I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +bucales I-EXPLORATION +comprometían I-EXPLORATION +casi I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +manifestaban I-EXPLORATION +mayormente I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +labios, I-EXPLORATION +cara I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +mejilla I-EXPLORATION +y I-EXPLORATION +cara I-EXPLORATION +ventral I-EXPLORATION +de I-EXPLORATION +lengua. I-EXPLORATION +Las I-EXPLORATION +lesiones I-EXPLORATION +eran I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +blanquecino, I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +reticular I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +desprendían I-EXPLORATION +al I-EXPLORATION +raspado. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +refería I-EXPLORATION +síntomas I-EXPLORATION +asociados. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +hipótesis I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +oral I-EXPLORATION +por I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +injerto I-EXPLORATION +contra I-EXPLORATION +huésped I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +realizar I-EXPLORATION +biopsia I-EXPLORATION +incisional I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +cara I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +labio I-EXPLORATION +inferior, I-EXPLORATION +lugar I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +eran I-EXPLORATION +manifiestas. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +histopatológico I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +EIVH. I-EXPLORATION +Se I-EXPLORATION +describió I-EXPLORATION +un I-EXPLORATION +epitelio I-EXPLORATION +de I-EXPLORATION +revestimiento I-EXPLORATION +plano I-EXPLORATION +pluriestratificado I-EXPLORATION +hiperparaqueratinizado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +hiperplasia I-EXPLORATION +agujiforme. I-EXPLORATION +Un I-EXPLORATION +estrato I-EXPLORATION +basal I-EXPLORATION +con I-EXPLORATION +desorganización I-EXPLORATION +celular I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +corion I-EXPLORATION +inmediatamente I-EXPLORATION +subyacente I-EXPLORATION +infiltración I-EXPLORATION +linfocitaria I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +neoformación I-EXPLORATION +y I-EXPLORATION +proliferación I-EXPLORATION +fibroblástica. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +describió I-EXPLORATION +leve I-EXPLORATION +infiltrado I-EXPLORATION +linfocitario I-EXPLORATION +periductal I-EXPLORATION +en I-EXPLORATION +glándula I-EXPLORATION +salival I-EXPLORATION +menor I-EXPLORATION +vecina. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +indicaron I-TREATMENT +medidas I-TREATMENT +locales I-TREATMENT +para I-TREATMENT +disminuir I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +infecciones I-TREATMENT +y I-TREATMENT +mantener I-TREATMENT +adecuada I-TREATMENT +humectación I-TREATMENT +del I-TREATMENT +medio I-TREATMENT +bucal; I-TREATMENT +clorhexidina I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +12% I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +sustituto I-TREATMENT +de I-TREATMENT +saliva I-TREATMENT +de I-TREATMENT +uso I-TREATMENT +diario, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +instrucción I-TREATMENT +de I-TREATMENT +higiene I-TREATMENT +oral. I-TREATMENT + I-TREATMENT +Seis B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +controlada I-EVOLUTION +manifestando I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +algunas I-EVOLUTION +zonas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mucosa I-EVOLUTION +bucal, I-EVOLUTION +evidenciándose I-EVOLUTION +lesiones I-EVOLUTION +erosivas I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +examen I-EVOLUTION +clínico. I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +incorporar I-TREATMENT +en I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +local, I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +betametasona I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +1% I-TREATMENT +en I-TREATMENT +plastibase, I-TREATMENT +reforzando I-TREATMENT +las I-TREATMENT +medidas I-TREATMENT +de I-TREATMENT +higiene I-TREATMENT +bucal. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +permanecieron I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +aumentó, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +por I-TREATMENT +tacrolimus I-TREATMENT +0, I-TREATMENT +1% I-TREATMENT +en I-TREATMENT +aplicación I-TREATMENT +tópica I-TREATMENT +3 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +agregándose I-TREATMENT +además I-TREATMENT +miconazol I-TREATMENT +2% I-TREATMENT +(Daktarin I-TREATMENT +Gel) I-TREATMENT +de I-TREATMENT +aplicación I-TREATMENT +tópica, I-TREATMENT +3 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +sustituyó I-TREATMENT +la I-TREATMENT +clorhexidina I-TREATMENT +al I-TREATMENT +0, I-TREATMENT +12% I-TREATMENT +por I-TREATMENT +una I-TREATMENT +concentración I-TREATMENT +más I-TREATMENT +baja, I-TREATMENT +0, I-TREATMENT +05%, I-TREATMENT +dado I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +le I-TREATMENT +costaba I-TREATMENT +tolerar I-TREATMENT +la I-TREATMENT +primera I-TREATMENT +por I-TREATMENT +provocarle I-TREATMENT +ardor I-TREATMENT +al I-TREATMENT +momento I-TREATMENT +de I-TREATMENT +usarla. I-TREATMENT +Después B-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +remitieron I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentaba I-EVOLUTION +dolor I-EVOLUTION +ni I-EVOLUTION +dificultades I-EVOLUTION +para I-EVOLUTION +alimentarse. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabaquista I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +paquetes/año, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +LNH I-PAST_MEDICAL_HISTORY +sistémico I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +características I-PAST_MEDICAL_HISTORY +clínicas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +SAA, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +variante I-PAST_MEDICAL_HISTORY +disección I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aorta I-PAST_MEDICAL_HISTORY +descendente. I-PAST_MEDICAL_HISTORY +Se B-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +emergencias I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +agudo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea. I-PRESENT_ILLNESS +La B-EXPLORATION +TAC I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +blando, I-EXPLORATION +periaórtico, I-EXPLORATION +tóraco-abdominal I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +adenopatías. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN). I-EXPLORATION +Se I-EXPLORATION +internó I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Unidad I-EXPLORATION +de I-EXPLORATION +Cuidados I-EXPLORATION +Intensivos, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +transesofágico I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +disección I-EXPLORATION +aórtica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +toracocentesis, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aspiraron I-EXPLORATION +cerca I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +litros I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +hemorrágico, I-EXPLORATION +cuya I-EXPLORATION +citología I-EXPLORATION +reveló I-EXPLORATION +células I-EXPLORATION +malignas I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +LNH. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +mostró I-EXPLORATION +linfoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +pequeñas, I-EXPLORATION +fenotipo I-EXPLORATION +B. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +por I-EXPLORATION +laparotomía I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +periaórtica I-EXPLORATION +mostró I-EXPLORATION +LNH I-EXPLORATION +folicular I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +con I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +arribó I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +LP. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +CHOP-R I-TREATMENT +fue I-TREATMENT +efectiva, I-TREATMENT +con I-TREATMENT +resolución I-TREATMENT +inicial I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +objetivado I-TREATMENT +por I-TREATMENT +TAC, I-TREATMENT +pero B-EVOLUTION +desarrolló I-EVOLUTION +luego I-EVOLUTION +quilotórax, I-EVOLUTION +malnutrición I-EVOLUTION +y I-EVOLUTION +falleció. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +o B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +importancia. I-FAMILY_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +septiembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2007 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hipocondrio I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +afebril, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tránsito I-PRESENT_ILLNESS +intestinal. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +concluyente I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +e I-EXPLORATION +imágenes. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +análisis I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +2 I-EXPLORATION +mg/dL, I-EXPLORATION +leucocitos I-EXPLORATION +8.080/mm3 I-EXPLORATION +con I-EXPLORATION +67, I-EXPLORATION +8% I-EXPLORATION +de I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +amilasemia I-EXPLORATION +normal. I-EXPLORATION +Una I-EXPLORATION +ecotomografía I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +sólido-quística I-EXPLORATION +compleja I-EXPLORATION +de I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo I-EXPLORATION +del I-EXPLORATION +hígado. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +probable I-EXPLORATION +colecistitis I-EXPLORATION +aguda I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +focal I-EXPLORATION +hepática I-EXPLORATION +sospechosa I-EXPLORATION +de I-EXPLORATION +absceso. I-EXPLORATION +Se B-TREATMENT +efectuó I-TREATMENT +colecistectomía I-TREATMENT +y I-TREATMENT +biopsia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +hepática. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +identifican I-TREATMENT +otras I-TREATMENT +lesiones I-TREATMENT +abdominales I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +exploración I-TREATMENT +quirúrgica. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +demuestra I-EXPLORATION +una I-EXPLORATION +metástasis I-EXPLORATION +hepática I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +neuroendocrino I-EXPLORATION +con I-EXPLORATION +inmunohistoquímica I-EXPLORATION +concordante. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +PET/CT I-EXPLORATION +con I-EXPLORATION +18FDG I-EXPLORATION +de I-EXPLORATION +cuerpo I-EXPLORATION +entero I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +sólo I-EXPLORATION +captación I-EXPLORATION +fisiológica I-EXPLORATION +en I-EXPLORATION +diversos I-EXPLORATION +órganos I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +un I-EXPLORATION +incremento I-EXPLORATION +significativo I-EXPLORATION +del I-EXPLORATION +metabolismo I-EXPLORATION +glucídico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +metástasis I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +izquierdo I-EXPLORATION +del I-EXPLORATION +hígado I-EXPLORATION +en I-EXPLORATION +comparación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +hepático. I-EXPLORATION +Una I-EXPLORATION +colonoscopia I-EXPLORATION +en I-EXPLORATION +búsqueda I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +fue I-EXPLORATION +catalogada I-EXPLORATION +como I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Tres I-EXPLORATION +meses I-EXPLORATION +más I-EXPLORATION +tarde I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +examen I-EXPLORATION +PET/CT I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +nuevo I-EXPLORATION +radiofármaco I-EXPLORATION +68Ga-DOTATATE I-EXPLORATION +(CGM I-EXPLORATION +Nuclear, I-EXPLORATION +Santiago-Chile) I-EXPLORATION +recientemente I-EXPLORATION +incorporado I-EXPLORATION +a I-EXPLORATION +nuestro I-EXPLORATION +centro. I-EXPLORATION +El I-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +calidad I-EXPLORATION +del I-EXPLORATION +producto I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +pureza I-EXPLORATION +radioquímica I-EXPLORATION +superior I-EXPLORATION +al I-EXPLORATION +99%. I-EXPLORATION +Se I-EXPLORATION +inyectaron I-EXPLORATION +por I-EXPLORATION +vía I-EXPLORATION +e.v. I-EXPLORATION +111 I-EXPLORATION +MBq I-EXPLORATION +(3 I-EXPLORATION +mCi) I-EXPLORATION +del I-EXPLORATION +radiotrazador. I-EXPLORATION +Cincuenta I-EXPLORATION +minutos I-EXPLORATION +más I-EXPLORATION +tarde I-EXPLORATION +se I-EXPLORATION +registraron I-EXPLORATION +imágenes I-EXPLORATION +PET/ I-EXPLORATION +CT I-EXPLORATION +3D I-EXPLORATION +de I-EXPLORATION +cuerpo I-EXPLORATION +entero I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +aparato I-EXPLORATION +Biograph I-EXPLORATION +6 I-EXPLORATION +HiRez I-EXPLORATION +P3D I-EXPLORATION +(Siemens I-EXPLORATION +Medical I-EXPLORATION +Systems, I-EXPLORATION +USA). I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +mostró, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intensa I-EXPLORATION +captación I-EXPLORATION +del I-EXPLORATION +radiofármaco I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +metástasis I-EXPLORATION +del I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +segundo I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +sobreexpresión I-EXPLORATION +de I-EXPLORATION +receptores I-EXPLORATION +de I-EXPLORATION +SST I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +asa I-EXPLORATION +de I-EXPLORATION +íleon I-EXPLORATION +distal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +ileocecal I-EXPLORATION +altamente I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +corresponder I-EXPLORATION +al I-EXPLORATION +tumor I-EXPLORATION +primario. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +otros I-EXPLORATION +focos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +cirugía I-TREATMENT +mediante I-TREATMENT +laparotomía I-TREATMENT +subcostal I-TREATMENT +identificándose I-TREATMENT +un I-TREATMENT +nodulo I-TREATMENT +de I-TREATMENT +16 I-TREATMENT +mm I-TREATMENT +en I-TREATMENT +el I-TREATMENT +íleon I-TREATMENT +terminal, I-TREATMENT +vecino I-TREATMENT +a I-TREATMENT +la I-TREATMENT +válvula I-TREATMENT +ileocecal, I-TREATMENT +sin I-TREATMENT +extensión I-TREATMENT +regional I-TREATMENT +macroscópica. I-TREATMENT +Se I-TREATMENT +efectúa I-TREATMENT +resección I-TREATMENT +del I-TREATMENT +íleon I-TREATMENT +terminal, I-TREATMENT +ciego I-TREATMENT +y I-TREATMENT +apéndice I-TREATMENT +cecal I-TREATMENT +mediante I-TREATMENT +laparotomía I-TREATMENT +subcostal I-TREATMENT +ampliada. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +mismo I-TREATMENT +acto I-TREATMENT +se I-TREATMENT +extirpa I-TREATMENT +la I-TREATMENT +metástasis I-TREATMENT +hepática I-TREATMENT +mediante I-TREATMENT +hepatectomía I-TREATMENT +izquierda. I-TREATMENT +Como I-TREATMENT +hallazgos I-TREATMENT +intraoperatorio I-TREATMENT +se I-TREATMENT +identifica I-TREATMENT +una I-TREATMENT +segunda I-TREATMENT +metástasis I-TREATMENT +de I-TREATMENT +8 I-TREATMENT +mm I-TREATMENT +del I-TREATMENT +segmento I-TREATMENT +VII I-TREATMENT +del I-TREATMENT +hígado I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +reseca I-TREATMENT +en I-TREATMENT +cuña. I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +confirmó I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +neuroendocrino I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado I-EXPLORATION +del I-EXPLORATION +íleon I-EXPLORATION +terminal I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +mm I-EXPLORATION +que I-EXPLORATION +infiltraba I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +penetración I-EXPLORATION +linfovascular, I-EXPLORATION +6 I-EXPLORATION +linfonodos I-EXPLORATION +regionales I-EXPLORATION +sin I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +2 I-EXPLORATION +metástasis I-EXPLORATION +hepáticas I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +neuroendocrino I-EXPLORATION +de I-EXPLORATION +también I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +grado, I-EXPLORATION +la I-EXPLORATION +ya I-EXPLORATION +conocida I-EXPLORATION +de I-EXPLORATION +4, I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +cm. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sana, I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +previas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +ictericia, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +adinamia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +progresivo. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +hubo I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +transaminasas, I-EXPLORATION +gamaglutamiltranspeptidasas, I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +INR I-EXPLORATION +y I-EXPLORATION +disfunción I-EXPLORATION +renal. I-EXPLORATION +No B-PAST_MEDICAL_HISTORY +hubo I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fármacos I-PAST_MEDICAL_HISTORY +y B-EXPLORATION +los I-EXPLORATION +marcadores I-EXPLORATION +virales I-EXPLORATION +e I-EXPLORATION +inmunológicos I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +exceptuando, I-EXPLORATION +un I-EXPLORATION +título I-EXPLORATION +de I-EXPLORATION +intensidad I-EXPLORATION +menor I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +A. I-EXPLORATION +Evolucionó B-TREATMENT +rápidamente I-TREATMENT +a I-TREATMENT +sopor I-TREATMENT +profundo, I-TREATMENT +requirió I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +invasiva I-TREATMENT +y B-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +de I-EXPLORATION +encéfalo I-EXPLORATION +(TC) I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +edema I-EXPLORATION +encefálico I-EXPLORATION +con I-EXPLORATION +elementos I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +HIC. I-EXPLORATION +La I-EXPLORATION +monitorización I-EXPLORATION +electroencefalográfica I-EXPLORATION +mostró I-EXPLORATION +ritmos I-EXPLORATION +lentos I-EXPLORATION +y I-EXPLORATION +simétricos I-EXPLORATION +bilaterales. I-EXPLORATION +El I-EXPLORATION +INR I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +0 I-EXPLORATION +se I-EXPLORATION +corrigió I-EXPLORATION +a I-EXPLORATION +1, I-EXPLORATION +6 I-EXPLORATION +con I-EXPLORATION +40 I-EXPLORATION +ug/kg I-EXPLORATION +de I-EXPLORATION +Factor I-EXPLORATION +VII I-EXPLORATION +activado I-EXPLORATION +recombinante I-EXPLORATION +(rFVIIa) I-EXPLORATION +previo I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +instalación I-EXPLORATION +de I-EXPLORATION +catéter I-EXPLORATION +intraparenquimatoso I-EXPLORATION +Raudemic® I-EXPLORATION +para I-EXPLORATION +medición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +presión I-EXPLORATION +intracraneana I-EXPLORATION +(PIC) I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +encefálica. I-EXPLORATION +Los I-EXPLORATION +valores I-EXPLORATION +iniciales I-EXPLORATION +de I-EXPLORATION +PIC I-EXPLORATION +fluctuaron I-EXPLORATION +entre I-EXPLORATION +20 I-EXPLORATION +y I-EXPLORATION +25 I-EXPLORATION +mmHg, I-EXPLORATION +con I-EXPLORATION +temperatura I-EXPLORATION +cerebral I-EXPLORATION +de I-EXPLORATION +37°C. I-EXPLORATION +El I-EXPLORATION +Doppler I-EXPLORATION +transcraneano I-EXPLORATION +determinó I-EXPLORATION +velocidad I-EXPLORATION +sistólica I-EXPLORATION +e I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +pulsatibilidad I-EXPLORATION +normales; I-EXPLORATION +siendo I-EXPLORATION +enlistada I-EXPLORATION +para I-EXPLORATION +trasplante I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +del I-EXPLORATION +King's I-EXPLORATION +College8. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +HIC I-TREATMENT +se I-TREATMENT +tornó I-TREATMENT +refractaria I-TREATMENT +a I-TREATMENT +medidas I-TREATMENT +de I-TREATMENT +primera I-TREATMENT +línea, I-TREATMENT +iniciándose I-TREATMENT +hipotermia I-TREATMENT +intravascular I-TREATMENT +mediante I-TREATMENT +catéter I-TREATMENT +tipo I-TREATMENT +ICY® I-TREATMENT +vía I-TREATMENT +femoral I-TREATMENT +con I-TREATMENT +máquina I-TREATMENT +Alsius I-TREATMENT +CoolGard®, I-TREATMENT +disminuyendo I-TREATMENT +la I-TREATMENT +temperatura I-TREATMENT +encefálica I-TREATMENT +a I-TREATMENT +33oC. I-TREATMENT +Recibió I-TREATMENT +sedación I-TREATMENT +con I-TREATMENT +opiáceos I-TREATMENT +(Fentanyl) I-TREATMENT +e I-TREATMENT +infusión I-TREATMENT +continua I-TREATMENT +de I-TREATMENT +relajante I-TREATMENT +muscular I-TREATMENT +(vecuronium) I-TREATMENT +para I-TREATMENT +prevenir I-TREATMENT +escalofríos; I-TREATMENT +en B-EVOLUTION +3, I-EVOLUTION +5 I-EVOLUTION +h I-EVOLUTION +se I-EVOLUTION +logró I-EVOLUTION +la I-EVOLUTION +meta I-EVOLUTION +de I-EVOLUTION +33oC. I-EVOLUTION +A B-TREATMENT +las I-TREATMENT +72 I-TREATMENT +h, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +ofreció I-TREATMENT +un I-TREATMENT +injerto I-TREATMENT +hepático I-TREATMENT +de I-TREATMENT +donante I-TREATMENT +cadavérico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +trasplante I-TREATMENT +ortotópico I-TREATMENT +bajo I-TREATMENT +hipotermia I-TREATMENT +intravascular I-TREATMENT +activa. I-TREATMENT +Posteriormente B-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidados I-EVOLUTION +intensivos, I-EVOLUTION +y I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +comprobar I-EVOLUTION +la I-EVOLUTION +perfusión I-EVOLUTION +del I-EVOLUTION +injerto, I-EVOLUTION +se I-EVOLUTION +reinició I-EVOLUTION +recalentamiento I-EVOLUTION +lento I-EVOLUTION +controlado I-EVOLUTION +alcanzando I-EVOLUTION +la I-EVOLUTION +normotermia I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +76 I-EVOLUTION +h I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +continua I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +hepática, I-EVOLUTION +completando I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +manera I-EVOLUTION +122 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +hipotermia I-EVOLUTION +a I-EVOLUTION +33oC. I-EVOLUTION +Desarrolló I-EVOLUTION +mioneuropatía I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +crítico I-EVOLUTION +y I-EVOLUTION +permaneció I-EVOLUTION +en I-EVOLUTION +ventilación I-EVOLUTION +mecánica I-EVOLUTION +durante I-EVOLUTION +15 I-EVOLUTION +días, I-EVOLUTION +requiriendo B-TREATMENT +de I-TREATMENT +traqueostomía I-TREATMENT +percutánea I-TREATMENT +para I-TREATMENT +facilitar I-TREATMENT +el I-TREATMENT +destete I-TREATMENT +del I-TREATMENT +ventilador I-TREATMENT +mecánico. I-TREATMENT + I-TREATMENT +Luego I-TREATMENT +de I-TREATMENT +un I-TREATMENT +despertar I-TREATMENT +lento, I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +la I-TREATMENT +cánula I-TREATMENT +de I-TREATMENT +traqueostomía I-TREATMENT +al I-TREATMENT +día I-TREATMENT +37. I-TREATMENT +Recibió B-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +69 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +nutritivas, I-EVOLUTION +neurológicas I-EVOLUTION +y I-EVOLUTION +ligada I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +programa I-EVOLUTION +de I-EVOLUTION +rehabilitación I-EVOLUTION +física. I-EVOLUTION +Actualmente I-EVOLUTION +asiste I-EVOLUTION +a I-EVOLUTION +sus I-EVOLUTION +estudios I-EVOLUTION +secundarios I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +en I-EVOLUTION +control I-EVOLUTION +ambulatorio. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +obesa B-PAST_MEDICAL_HISTORY +mórbida I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertensa, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +agosto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2007 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +intermitente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +asoció I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rápido I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ortopnea. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +mostró I-EXPLORATION +bocio I-EXPLORATION +con I-EXPLORATION +nodulo I-EXPLORATION +sólido I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +tamaño I-EXPLORATION +(4, I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +5, I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +4, I-EXPLORATION +5 I-EXPLORATION +cm), I-EXPLORATION +hipoecogénico, I-EXPLORATION +escasamente I-EXPLORATION +vascularizado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +adenopatías I-EXPLORATION +cervicales I-EXPLORATION +bilaterales I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +reactivo. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +destacó I-EXPLORATION +TSH I-EXPLORATION +elevada I-EXPLORATION +y I-EXPLORATION +T4 I-EXPLORATION +disminuida. I-EXPLORATION +Se B-TREATMENT +sospechó I-TREATMENT +cáncer I-TREATMENT +de I-TREATMENT +tiroides, I-TREATMENT +inició I-TREATMENT +levotiroxina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +resección I-TREATMENT +quirúrgica. I-TREATMENT + I-TREATMENT +En I-TREATMENT +la I-TREATMENT +cirugía, I-TREATMENT +se I-TREATMENT +seccionaron I-TREATMENT +los I-TREATMENT +músculos I-TREATMENT +pretiroideos I-TREATMENT +izquierdos I-TREATMENT +para I-TREATMENT +facilitar I-TREATMENT +la I-TREATMENT +exploración, I-TREATMENT +los I-TREATMENT +que I-TREATMENT +estaban I-TREATMENT +adheridos I-TREATMENT +a I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT +El I-TREATMENT +gran I-TREATMENT +nodulo I-TREATMENT +blanquecino I-TREATMENT +se I-TREATMENT +proyectaba I-TREATMENT +hacia I-TREATMENT +esófago I-TREATMENT +cervical. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +tiroidectomía I-TREATMENT +total. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +rápida I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +informó I-EXPLORATION +proliferación I-EXPLORATION +linfoide I-EXPLORATION +atípica I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +linfoma. I-EXPLORATION + I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +hipocalcemia I-EVOLUTION +sintomática I-EVOLUTION +de I-EVOLUTION +7, I-EVOLUTION +6 I-EVOLUTION +mg/dl I-EVOLUTION +que I-EVOLUTION +cedió I-EVOLUTION +con I-EVOLUTION +calcio I-EVOLUTION +oral. I-EVOLUTION +Fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +biopsia I-EXPLORATION +definitiva I-EXPLORATION +concluyó I-EXPLORATION +"infiltrado I-EXPLORATION +linfoide I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes, I-EXPLORATION +con I-EXPLORATION +metaplasia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Hürtle, I-EXPLORATION +que I-EXPLORATION +comprometió I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +tiroidea I-EXPLORATION +y I-EXPLORATION +focalmente I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +muscular I-EXPLORATION +peritiroideo. I-EXPLORATION +Inmunohistoquímica: I-EXPLORATION +CD20 I-EXPLORATION +(+) I-EXPLORATION +difuso, I-EXPLORATION +CD3 I-EXPLORATION +(+) I-EXPLORATION +focal I-EXPLORATION +en I-EXPLORATION +linfocitos I-EXPLORATION +pequeños, I-EXPLORATION +CD10 I-EXPLORATION +(+) I-EXPLORATION +difuso, I-EXPLORATION +BCL2 I-EXPLORATION +(-) I-EXPLORATION +". I-EXPLORATION +Compatible I-EXPLORATION +con I-EXPLORATION +LNH I-EXPLORATION +tiroideo I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes I-EXPLORATION +estirpe I-EXPLORATION +B, I-EXPLORATION +tiroiditis I-EXPLORATION +de I-EXPLORATION +Hashimoto I-EXPLORATION +y I-EXPLORATION +metaplasia I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Hürtle. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +quimioterapia I-TREATMENT +pero I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +rechazó I-TREATMENT +por I-TREATMENT +motivos I-TREATMENT +religiosos. I-TREATMENT + I-TREATMENT +Seis B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +consultó I-EVOLUTION +en I-EVOLUTION +cirugía I-EVOLUTION +por I-EVOLUTION +recidiva I-EVOLUTION +local I-EVOLUTION +con I-EVOLUTION +sintomatología I-EVOLUTION +obstructiva I-EVOLUTION +de I-EVOLUTION +vía I-EVOLUTION +aérea. I-EVOLUTION +Fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +hematología I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +pierde I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +control. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +morbilidad I-PAST_MEDICAL_HISTORY +previa, I-PAST_MEDICAL_HISTORY +proveniente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Puerto I-PAST_MEDICAL_HISTORY +Varas. I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +sometida I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +colecistec-tomía I-PAST_MEDICAL_HISTORY +laparoscópica I-PAST_MEDICAL_HISTORY +electiva I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +julio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2003 I-PAST_MEDICAL_HISTORY +recibiendo I-PAST_MEDICAL_HISTORY +anestesia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +halotano. I-PAST_MEDICAL_HISTORY +Evolucionó I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +complicaciones I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +dada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alta. I-PAST_MEDICAL_HISTORY +Al B-PRESENT_ILLNESS +quinto I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +postoperatorio I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +alteración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +encefalopatía I-PRESENT_ILLNESS +hepática, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +hospitalizó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hepatitis I-PRESENT_ILLNESS +fulminante. I-PRESENT_ILLNESS +El B-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +viral, I-EXPLORATION +metabólico, I-EXPLORATION +autoinmune I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +drogas I-EXPLORATION +resultó I-EXPLORATION +negativo. I-EXPLORATION +Fue B-DERIVED_FROM/TO +trasladada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Paciente I-DERIVED_FROM/TO +Crítico I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Clínico I-DERIVED_FROM/TO +San I-DERIVED_FROM/TO +Borja I-DERIVED_FROM/TO +Arriarán I-DERIVED_FROM/TO +(HCSBA) I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +5 I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +agosto I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2003 I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hepatitis I-DERIVED_FROM/TO +aguda I-DERIVED_FROM/TO +fulminante I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +halotano I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +activó I-DERIVED_FROM/TO +como I-DERIVED_FROM/TO +urgencia I-DERIVED_FROM/TO +nacional I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +trasplante I-DERIVED_FROM/TO +hepático. I-DERIVED_FROM/TO +Dada B-TREATMENT +la I-TREATMENT +emergencia I-TREATMENT +vital I-TREATMENT +se I-TREATMENT +efectuó I-TREATMENT +un I-TREATMENT +trasplante I-TREATMENT +hepático I-TREATMENT +de I-TREATMENT +donante I-TREATMENT +cadáver I-TREATMENT +ABO I-TREATMENT +incompatible I-TREATMENT +(donante I-TREATMENT +grupo I-TREATMENT +A, I-TREATMENT +receptor I-TREATMENT +grupo I-TREATMENT +O) I-TREATMENT +el I-TREATMENT +8 I-TREATMENT +de I-TREATMENT +agosto I-TREATMENT +de I-TREATMENT +2003, I-TREATMENT +en I-TREATMENT +Clínica I-TREATMENT +Las I-TREATMENT +Condes. I-TREATMENT +El I-TREATMENT +protocolo I-TREATMENT +terapéutico I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +plasmaféresis I-TREATMENT +intra I-TREATMENT +y I-TREATMENT +postrasplante, I-TREATMENT +esplenectomía I-TREATMENT +e I-TREATMENT +inmunosupresión I-TREATMENT +cuádruple, I-TREATMENT +con I-TREATMENT +metilprednisolona, I-TREATMENT +ciclofosfamida, I-TREATMENT +timoglobulina I-TREATMENT +y I-TREATMENT +ciclosporina. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +del I-EXPLORATION +explante I-EXPLORATION +concluyó I-EXPLORATION +necrosis I-EXPLORATION +submasiva. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +5 I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +plasmaféresis, I-TREATMENT +que I-TREATMENT +disminuyó I-TREATMENT +significativamente I-TREATMENT +el I-TREATMENT +título I-TREATMENT +de I-TREATMENT +isohemoglutininas I-TREATMENT +anti I-TREATMENT +A. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +su I-TREATMENT +incremento I-TREATMENT +posterior I-TREATMENT +no I-TREATMENT +se I-TREATMENT +tradujo I-TREATMENT +en I-TREATMENT +una I-TREATMENT +injuria I-TREATMENT +significativa I-TREATMENT +al I-TREATMENT +injerto. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +temprano I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +hemoperitoneo I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +cirugía, I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +una I-TREATMENT +neumopatía I-TREATMENT +aguda. I-TREATMENT +Los B-EXPLORATION +estudios I-EXPLORATION +imagenológicos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +El B-EVOLUTION +egreso I-EVOLUTION +médico I-EVOLUTION +fue I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +54 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +trasplante, I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +y B-TREATMENT +con I-TREATMENT +terapia I-TREATMENT +inmunosupre-sora I-TREATMENT +en I-TREATMENT +base I-TREATMENT +a I-TREATMENT +ciclosporina, I-TREATMENT +ciclofosfamida I-TREATMENT +y I-TREATMENT +prednisona. I-TREATMENT +En B-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +intrahospitalaria I-EVOLUTION +presentó I-EVOLUTION +infección I-EVOLUTION +por I-EVOLUTION +citomegalovirus I-EVOLUTION +en I-EVOLUTION +dos I-EVOLUTION +oportunidades I-EVOLUTION +tratadas I-EVOLUTION +satisfactoriamente, I-EVOLUTION +un I-EVOLUTION +rechazo I-EVOLUTION +agudo I-EVOLUTION +moderado I-EVOLUTION +corticoide-sensible I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +bilioma I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +drenaje I-TREATMENT +bajo I-TREATMENT +tomografía I-TREATMENT +computarizada. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +asiste I-EVOLUTION +a I-EVOLUTION +controles I-EVOLUTION +médicos I-EVOLUTION +periódicos I-EVOLUTION +y I-EVOLUTION +cumplió I-EVOLUTION +cinco I-EVOLUTION +años I-EVOLUTION +postrasplante. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +desarrollando I-EVOLUTION +una I-EVOLUTION +vida I-EVOLUTION +laboralmente I-EVOLUTION +activa, I-EVOLUTION +con I-EVOLUTION +pruebas I-EVOLUTION +hepáticas I-EVOLUTION +normales, I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +inmunosupresión I-EVOLUTION +a I-EVOLUTION +dosis I-EVOLUTION +bajas I-EVOLUTION +(ciclosporina I-EVOLUTION +200 I-EVOLUTION +mg/día, I-EVOLUTION +azatioprina I-EVOLUTION +100 I-EVOLUTION +mg/día) I-EVOLUTION +y I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +conservada. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +NF1 I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +manifestó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +abundantes I-PAST_MEDICAL_HISTORY +efélides I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +todo I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cuerpo, I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +axilar I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +inguinal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +neurofibro-mas I-PAST_MEDICAL_HISTORY +discretos. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Emergencia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +La I-PRESENT_ILLNESS +Serena I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +inicialmente I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +posteriormente I-PRESENT_ILLNESS +difuso. I-PRESENT_ILLNESS +Ingresó B-EXPLORATION +en I-EXPLORATION +shock I-EXPLORATION +séptico I-EXPLORATION +y I-EXPLORATION +mala I-EXPLORATION +condición I-EXPLORATION +general. I-EXPLORATION +Después B-TREATMENT +de I-TREATMENT +estabilización I-TREATMENT +hemodi-námica I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +su I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +abdomen I-TREATMENT +agudo I-TREATMENT +de I-TREATMENT +origen I-TREATMENT +no I-TREATMENT +precisado I-TREATMENT +y I-TREATMENT +peritonitis I-TREATMENT +secundaria. I-TREATMENT +No B-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ningún I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +nuestro I-EXPLORATION +hospital I-EXPLORATION +no I-EXPLORATION +cuenta I-EXPLORATION +con I-EXPLORATION +radiólogo I-EXPLORATION +de I-EXPLORATION +turno I-EXPLORATION +y I-EXPLORATION +tampoco I-EXPLORATION +ecografía I-EXPLORATION +o I-EXPLORATION +tomografía I-EXPLORATION +de I-EXPLORATION +urgencia. I-EXPLORATION +El B-TREATMENT +abordaje I-TREATMENT +del I-TREATMENT +abdomen I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +laparotomía I-TREATMENT +mediana. I-TREATMENT +Se I-TREATMENT +aspiraron I-TREATMENT +3 I-TREATMENT +litros I-TREATMENT +de I-TREATMENT +exudado I-TREATMENT +purulento I-TREATMENT +y I-TREATMENT +en I-TREATMENT +la I-TREATMENT +exploración I-TREATMENT +se I-TREATMENT +evidenció I-TREATMENT +un I-TREATMENT +tumor I-TREATMENT +quístico I-TREATMENT +de I-TREATMENT +15 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +diámetro I-TREATMENT +que I-TREATMENT +se I-TREATMENT +originaba I-TREATMENT +en I-TREATMENT +la I-TREATMENT +A- I-TREATMENT +porción I-TREATMENT +del I-TREATMENT +duodeno, I-TREATMENT +perforado, I-TREATMENT +adherido I-TREATMENT +al I-TREATMENT +colon I-TREATMENT +sigmoides I-TREATMENT +y I-TREATMENT +cubierto I-TREATMENT +de I-TREATMENT +epiplón I-TREATMENT +mayor. I-TREATMENT +El I-TREATMENT +tumor I-TREATMENT +fue I-TREATMENT +resecado I-TREATMENT +en I-TREATMENT +bloque I-TREATMENT +con I-TREATMENT +el I-TREATMENT +epiplón I-TREATMENT +y I-TREATMENT +la I-TREATMENT +A- I-TREATMENT +porción I-TREATMENT +del I-TREATMENT +duodeno. I-TREATMENT +El I-TREATMENT +tránsito I-TREATMENT +intestinal I-TREATMENT +se I-TREATMENT +reconstituyó I-TREATMENT +mediante I-TREATMENT +anastomosis I-TREATMENT +término-terminal I-TREATMENT +entre I-TREATMENT +la I-TREATMENT +3a I-TREATMENT +porción I-TREATMENT +del I-TREATMENT +duodeno I-TREATMENT +y I-TREATMENT +el I-TREATMENT +yeyuno. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +tórpida, I-EVOLUTION +con I-EVOLUTION +complicaciones: I-EVOLUTION +infección I-EVOLUTION +del I-EVOLUTION +sitio I-EVOLUTION +quirúrgico I-EVOLUTION +superficial, I-EVOLUTION +íleo I-EVOLUTION +intestinal I-EVOLUTION +prolongado I-EVOLUTION +y I-EVOLUTION +neumonía I-EVOLUTION +nosocomial. I-EVOLUTION +Después I-EVOLUTION +de I-EVOLUTION +37 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +sólido-quísti-co, I-EXPLORATION +parcialmente I-EXPLORATION +necrótico I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +bajo I-EXPLORATION +índice I-EXPLORATION +mitótico I-EXPLORATION +(1 I-EXPLORATION +a I-EXPLORATION +2 I-EXPLORATION +mitosis I-EXPLORATION +por I-EXPLORATION +50 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +aumento I-EXPLORATION +mayor). I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +células I-EXPLORATION +epiteloides I-EXPLORATION +y I-EXPLORATION +fusiformes, I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +CD117, I-EXPLORATION +CD34 I-EXPLORATION +y I-EXPLORATION +desmina. I-EXPLORATION +La I-EXPLORATION +reacción I-EXPLORATION +inmunohistoquímica I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +S100, I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +acüna-a I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +liso. I-EXPLORATION +El I-EXPLORATION +tamaño I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico I-EXPLORATION +de I-EXPLORATION +presentación I-EXPLORATION +(necrosis I-EXPLORATION +y I-EXPLORATION +perforación), I-EXPLORATION +constituyen I-EXPLORATION +indicaciones I-EXPLORATION +para I-EXPLORATION +terapia I-EXPLORATION +con I-EXPLORATION +imatinib I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +derivada I-EXPLORATION +al I-EXPLORATION +Comité I-EXPLORATION +Oncológico I-EXPLORATION +Regional I-EXPLORATION +para I-EXPLORATION +iniciar I-EXPLORATION +tratamiento I-EXPLORATION +pertinente. I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +seguimiento I-EVOLUTION +hace I-EVOLUTION +11 I-EVOLUTION +meses. I-EVOLUTION +Figura I-EVOLUTION +2 I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +hospitalizada B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +peritonitis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +precisado. I-PRESENT_ILLNESS +Consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +La B-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +fue I-EXPLORATION +131/76, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +126 I-EXPLORATION +x' I-EXPLORATION +y I-EXPLORATION +38, I-EXPLORATION +9eC I-EXPLORATION +de I-EXPLORATION +temperatura I-EXPLORATION +rectal. I-EXPLORATION +El I-EXPLORATION +abdomen I-EXPLORATION +estaba I-EXPLORATION +distendido, I-EXPLORATION +mate I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +ruidos I-EXPLORATION +intestinales I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +auscultación. I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +ginecológica I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +reveló I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +intraperitoneal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +estructura I-EXPLORATION +quística I-EXPLORATION +adyacente I-EXPLORATION +al I-EXPLORATION +intestino I-EXPLORATION +delgado. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +abdominal I-EXPLORATION +(TAC), I-EXPLORATION +demostró I-EXPLORATION +algunas I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +rodeando I-EXPLORATION +una I-EXPLORATION +estructura I-EXPLORATION +tubular I-EXPLORATION +quística I-EXPLORATION +y I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +peritoneal. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +revelaron I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +25.700 I-EXPLORATION +x I-EXPLORATION +mm3 I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +356, I-EXPLORATION +06 I-EXPLORATION +mg/dl. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +quístico I-TREATMENT +intestinal I-TREATMENT +complicado I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +operada. I-TREATMENT +La B-EXPLORATION +cavidad I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +llena I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +seroso I-EXPLORATION +del I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +para I-EXPLORATION +citología I-EXPLORATION +y I-EXPLORATION +cultivo. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +reveló I-EXPLORATION +múltiples I-EXPLORATION +implantes I-EXPLORATION +tumorales I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +peritoneo I-EXPLORATION +parietal I-EXPLORATION +y I-EXPLORATION +visceral, I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +extensa I-EXPLORATION +del I-EXPLORATION +epiplón I-EXPLORATION +mayor, I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +implantes I-EXPLORATION +para I-EXPLORATION +biopsia. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +mesenterio I-EXPLORATION +del I-EXPLORATION +íleon I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +quístico I-EXPLORATION +tubular I-EXPLORATION +blanquecino I-EXPLORATION +rodeado I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +intestinales, I-EXPLORATION +que I-EXPLORATION +medía I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +por I-EXPLORATION +15 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud. I-EXPLORATION +Se B-TREATMENT +abrió I-TREATMENT +el I-TREATMENT +tumor I-TREATMENT +aspirándose I-TREATMENT +un I-TREATMENT +líquido I-TREATMENT +oscuro I-TREATMENT +y I-TREATMENT +espeso I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +enviado I-TREATMENT +a I-TREATMENT +citología. I-TREATMENT +Se I-TREATMENT +resecó I-TREATMENT +la I-TREATMENT +mayor I-TREATMENT +cantidad I-TREATMENT +posible I-TREATMENT +de I-TREATMENT +pared I-TREATMENT +tumoral I-TREATMENT +quedando I-TREATMENT +una I-TREATMENT +parte I-TREATMENT +adherida I-TREATMENT +al I-TREATMENT +mesenterio, I-TREATMENT +la I-TREATMENT +resección I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +tumor I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +posible I-TREATMENT +por I-TREATMENT +la I-TREATMENT +diseminación I-TREATMENT +peritoneal I-TREATMENT +y I-TREATMENT +su I-TREATMENT +localización I-TREATMENT +en I-TREATMENT +el I-TREATMENT +mesenterio I-TREATMENT +del I-TREATMENT +íleon. I-TREATMENT +La B-EVOLUTION +recuperación I-EVOLUTION +postoperatoria I-EVOLUTION +fue I-EVOLUTION +satisfactoria I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +treinta I-EVOLUTION +y I-EVOLUTION +cuatro I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +falleció. I-EVOLUTION +La B-EXPLORATION +muestras I-EXPLORATION +citológicas I-EXPLORATION +tomadas I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +contenido I-EXPLORATION +tumoral I-EXPLORATION +fueron I-EXPLORATION +positivas I-EXPLORATION +para I-EXPLORATION +células I-EXPLORATION +neoplásicas. I-EXPLORATION +La I-EXPLORATION +histopatología I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +arquitectura I-EXPLORATION +típica I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +intestinal, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +reconocían I-EXPLORATION +capas I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +liso I-EXPLORATION +circular I-EXPLORATION +y I-EXPLORATION +longitudinal I-EXPLORATION +bien I-EXPLORATION +organizadas, I-EXPLORATION +identificándose I-EXPLORATION +plexos I-EXPLORATION +nerviosos I-EXPLORATION +mientéricos I-EXPLORATION +entre I-EXPLORATION +ambas I-EXPLORATION +capas I-EXPLORATION +musculares. I-EXPLORATION +La I-EXPLORATION +superficie I-EXPLORATION +interna I-EXPLORATION +estaba I-EXPLORATION +revestida I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +adeno I-EXPLORATION +carcinoma I-EXPLORATION +mucosecretor I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado I-EXPLORATION +que I-EXPLORATION +infiltraba I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +en I-EXPLORATION +varias I-EXPLORATION +partes I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendió I-EXPLORATION +superficialmente I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +serosa. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +intraoperatorios I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +informe I-EXPLORATION +histopatológico I-EXPLORATION +confirmaron I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +adenocarcinoma I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +duplicación I-EXPLORATION +intestinal I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +paciente I-EXPLORATION +adulta. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +FQ I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +regulares I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +mayo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2000, I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +bilateral, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +2009. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +caracterizó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +descompensación I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +bronquiolitis I-PRESENT_ILLNESS +obliterante I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +hospitalizado I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +tratamiento. I-PRESENT_ILLNESS +Al B-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +refirió I-EVOLUTION +un I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +tipo I-EVOLUTION +cólico I-EVOLUTION +de I-EVOLUTION +intensidad I-EVOLUTION +progresiva, I-EVOLUTION +localizado I-EVOLUTION +mayormente I-EVOLUTION +en I-EVOLUTION +hemiabdomen I-EVOLUTION +inferior I-EVOLUTION +derecho, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +3 I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +vómitos I-EVOLUTION +alimentarios. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +distendido I-EXPLORATION +y I-EXPLORATION +sensible I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +bazuqueo. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +tomar I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +moderada I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +en I-EXPLORATION +hemiabdomen I-EXPLORATION +superior I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +abundante I-EXPLORATION +aire I-EXPLORATION +y I-EXPLORATION +contenido I-EXPLORATION +estercoráceo I-EXPLORATION +en I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +marco I-EXPLORATION +cólico. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +además I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +más I-EXPLORATION +alta I-EXPLORATION +del I-EXPLORATION +yeyuno I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +proximal I-EXPLORATION +del I-EXPLORATION +íleon I-EXPLORATION +que I-EXPLORATION +parecían I-EXPLORATION +ocupados I-EXPLORATION +y I-EXPLORATION +distendidos I-EXPLORATION +por I-EXPLORATION +material I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fecaloideo, I-EXPLORATION +concluyendo I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +SOID. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +Gastrografin® I-TREATMENT +(100 I-TREATMENT +mi I-TREATMENT +diluidos I-TREATMENT +en I-TREATMENT +400 I-TREATMENT +mi. I-TREATMENT +de I-TREATMENT +suero I-TREATMENT +fisiológico) I-TREATMENT +presentando I-TREATMENT +al I-TREATMENT +cabo I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +horas, I-TREATMENT +gran I-TREATMENT +cantidad I-TREATMENT +de I-TREATMENT +deposiciones I-TREATMENT +líquidas I-TREATMENT +e I-TREATMENT +importante I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas. I-TREATMENT +La B-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +distensión I-EXPLORATION +de I-EXPLORATION +algunas I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +en I-EXPLORATION +menor I-EXPLORATION +grado I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +anterior I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +intestino I-EXPLORATION +distal I-EXPLORATION +y I-EXPLORATION +marco I-EXPLORATION +colónico. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +suplemento I-EVOLUTION +de I-EVOLUTION +enzimas I-EVOLUTION +pancreáticas, I-EVOLUTION +encontrándose I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +tras I-EVOLUTION +10 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +hospitalización I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +nuevos I-EVOLUTION +cuadros I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +distensión I-EVOLUTION +o I-EVOLUTION +constipación. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +indio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +44 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipertenso B-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +fumador I-PAST_MEDICAL_HISTORY +ocasional, I-PAST_MEDICAL_HISTORY +quien B-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +levantó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mañana I-PRESENT_ILLNESS +previa I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hemicuerpo I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sensibilidad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hemicara I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +progresó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +siguientes I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +imposibilidad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +hubo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ingresar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +vez I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +llevado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +departamento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +emergencias, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +constató I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +presión I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +165/105 I-PRESENT_ILLNESS +mmHg, I-PRESENT_ILLNESS +pulso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +92 I-PRESENT_ILLNESS +latidos I-PRESENT_ILLNESS +x' I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +frecuencia I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +x'. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +hipoestesia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +rama I-EXPLORATION +maxilar I-EXPLORATION +del I-EXPLORATION +trigémino I-EXPLORATION +derecho I-EXPLORATION +como I-EXPLORATION +único I-EXPLORATION +trastorno I-EXPLORATION +objetivo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensibilidad. I-EXPLORATION +La I-EXPLORATION +fuerza I-EXPLORATION +muscular I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tono I-EXPLORATION +estaba I-EXPLORATION +conservados I-EXPLORATION +a I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +niveles, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +hiperreflexia I-EXPLORATION +osteotendinosa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemicuerpo I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +Babinski I-EXPLORATION +ipsilateral. I-EXPLORATION +Elementos I-EXPLORATION +de I-EXPLORATION +disfunción I-EXPLORATION +cerebelosa I-EXPLORATION +se I-EXPLORATION +evidenciaron I-EXPLORATION +al I-EXPLORATION +existir I-EXPLORATION +disdiadococinesia, I-EXPLORATION +dismetría I-EXPLORATION +y I-EXPLORATION +discronometría I-EXPLORATION +al I-EXPLORATION +movilizar I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +derechas. I-EXPLORATION +La I-EXPLORATION +marcha I-EXPLORATION +era I-EXPLORATION +imposible I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +caer I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +derecha I-EXPLORATION +al I-EXPLORATION +tratar I-EXPLORATION +de I-EXPLORATION +hacerla I-EXPLORATION +sin I-EXPLORATION +apoyo. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +sanguínea I-EXPLORATION +mostró I-EXPLORATION +hemoglobina, I-EXPLORATION +conteo I-EXPLORATION +diferencial I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +y I-EXPLORATION +electrolitos I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +constató I-EXPLORATION +una I-EXPLORATION +hiperlipidemia I-EXPLORATION +dada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +incremento I-EXPLORATION +del I-EXPLORATION +colesterol I-EXPLORATION +total I-EXPLORATION +(7, I-EXPLORATION +42 I-EXPLORATION +mm/1). I-EXPLORATION +El I-EXPLORATION +electrocardiograma I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ecocardiograma I-EXPLORATION +transtorácico I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RMN) I-EXPLORATION +identificó I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +infarto I-EXPLORATION +isquémico I-EXPLORATION +subagudo I-EXPLORATION +que I-EXPLORATION +comprendía I-EXPLORATION +el I-EXPLORATION +núcleo I-EXPLORATION +lenticular I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +interna I-EXPLORATION +izquierdos. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +anti-agregantes I-TREATMENT +plaquetarios, I-TREATMENT +estatinas I-TREATMENT +y I-TREATMENT +fisioterapia. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +egresado I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +con I-EVOLUTION +evidente I-EVOLUTION +mejoría. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inercia I-PAST_MEDICAL_HISTORY +colónica. I-PAST_MEDICAL_HISTORY +En B-TREATMENT +mayo I-TREATMENT +de I-TREATMENT +2003, I-TREATMENT +a I-TREATMENT +los I-TREATMENT +46 I-TREATMENT +años, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +colectomía I-TREATMENT +total I-TREATMENT +laparoscópica I-TREATMENT +con I-TREATMENT +anastomosis I-TREATMENT +ileorrectal I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +taquicardia, I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +e I-EVOLUTION +hipotensión. I-EVOLUTION +Se B-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +laparotomía I-EXPLORATION +exploradora I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +yeyuno I-EXPLORATION +distal I-EXPLORATION +e I-EXPLORATION +ileon, I-EXPLORATION +realizándose I-EXPLORATION +resección I-EXPLORATION +del I-EXPLORATION +intestino I-EXPLORATION +desde I-EXPLORATION +los I-EXPLORATION +120 I-EXPLORATION +cm I-EXPLORATION +distales I-EXPLORATION +al I-EXPLORATION +Treitz, I-EXPLORATION +además B-TREATMENT +de I-TREATMENT +una I-TREATMENT +yeyunostomía I-TREATMENT +terminal I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +del I-TREATMENT +muñón I-TREATMENT +rectal. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +informó I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +con I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +enteropatía I-EXPLORATION +isquémica I-EXPLORATION +aguda. I-EXPLORATION +Evolucionó B-EVOLUTION +con I-EVOLUTION +fujos I-EVOLUTION +de I-EVOLUTION +4.500 I-EVOLUTION +cc/día I-EVOLUTION +por I-EVOLUTION +yeyunostomía I-EVOLUTION +y I-EVOLUTION +desnutrición I-EVOLUTION +calórico-proteica. I-EVOLUTION +Manejada B-TREATMENT +inicialmente I-TREATMENT +con I-TREATMENT +NPTC, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +día I-TREATMENT +12 I-TREATMENT +post I-TREATMENT +operatorio I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +alimentación I-TREATMENT +por I-TREATMENT +sonda I-TREATMENT +nasoenteral I-TREATMENT +y I-TREATMENT +en I-TREATMENT +el I-TREATMENT +día I-TREATMENT +50 I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +alimentación I-TREATMENT +oral I-TREATMENT +exclusiva. I-TREATMENT +Al B-EVOLUTION +alta I-EVOLUTION +toleró I-EVOLUTION +bien I-EVOLUTION +régimen I-EVOLUTION +oral I-EVOLUTION +con I-EVOLUTION +suplementos I-EVOLUTION +nutricionales. I-EVOLUTION +Hasta I-EVOLUTION +junio I-EVOLUTION +2008 I-EVOLUTION +presentó I-EVOLUTION +17 I-EVOLUTION +hospitalizaciones, I-EVOLUTION +4 I-EVOLUTION +por I-EVOLUTION +cuadros I-EVOLUTION +de I-EVOLUTION +íleo I-EVOLUTION +mecánico, I-EVOLUTION +todos B-TREATMENT +resueltos I-TREATMENT +sin I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +cirugía, I-TREATMENT +y B-EVOLUTION +13 I-EVOLUTION +por I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +deshidratación I-EVOLUTION +moderada I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +altos I-EVOLUTION +débitos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ostomía, I-EVOLUTION +los I-EVOLUTION +que B-TREATMENT +se I-TREATMENT +manejaron I-TREATMENT +con I-TREATMENT +reposición I-TREATMENT +hidroelectrolítica I-TREATMENT +y I-TREATMENT +ajuste I-TREATMENT +de I-TREATMENT +fármacos I-TREATMENT +para I-TREATMENT +disminuir I-TREATMENT +fujo I-TREATMENT +por I-TREATMENT +yeyunostomía I-TREATMENT +logrando B-EVOLUTION +volumen I-EVOLUTION +de I-EVOLUTION +deposiciones I-EVOLUTION +de I-EVOLUTION +2.000-3.000 I-EVOLUTION +cc/día. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +26/06/08 I-EVOLUTION +ingresó I-EVOLUTION +nuevamente I-EVOLUTION +por I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +deshidratación I-EVOLUTION +grave. I-EVOLUTION +Se I-EVOLUTION +constató I-EVOLUTION +creatininemia I-EVOLUTION +de I-EVOLUTION +4, I-EVOLUTION +39 I-EVOLUTION +mg/dl, I-EVOLUTION +objetivándose I-EVOLUTION +clearence I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +de I-EVOLUTION +30 I-EVOLUTION +ml/min. I-EVOLUTION +Dado B-TREATMENT +el I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal I-TREATMENT +y I-TREATMENT +compromiso I-TREATMENT +nutricional I-TREATMENT +de I-TREATMENT +predominio I-TREATMENT +calórico I-TREATMENT +con I-TREATMENT +IMC I-TREATMENT +de I-TREATMENT +14, I-TREATMENT +2 I-TREATMENT +kg/m2 I-TREATMENT +y I-TREATMENT +albúmina I-TREATMENT +de I-TREATMENT +ingreso I-TREATMENT +de I-TREATMENT +3, I-TREATMENT +1 I-TREATMENT +gr/dl, I-TREATMENT +se I-TREATMENT +planteó I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +un I-TREATMENT +procedimiento I-TREATMENT +de I-TREATMENT +elongación I-TREATMENT +intestinal I-TREATMENT +y I-TREATMENT +reconstitución I-TREATMENT +del I-TREATMENT +tránsito I-TREATMENT +para I-TREATMENT +mejorar I-TREATMENT +la I-TREATMENT +condición I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +calidad I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +preoperatorio I-EXPLORATION +incluyó I-EXPLORATION +una I-EXPLORATION +rectoscopia I-EXPLORATION +rígida I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +muñón I-EXPLORATION +rectal I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +cm. I-EXPLORATION +El I-EXPLORATION +tránsito I-EXPLORATION +intestinal I-EXPLORATION +demostró I-EXPLORATION +140 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +sin I-EXPLORATION +estrecheces I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +asas. I-EXPLORATION +Por I-EXPLORATION +sospecha I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +superior I-EXPLORATION +(AMS), I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +Doppler I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +estenosis I-EXPLORATION +signifcativa I-EXPLORATION +(70%) I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +AMS, I-EXPLORATION +que B-TREATMENT +se I-TREATMENT +resolvió I-TREATMENT +mediante I-TREATMENT +angioplastía I-TREATMENT +y I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +endoprótesis. I-TREATMENT +Con I-TREATMENT +aporte I-TREATMENT +de I-TREATMENT +régimen I-TREATMENT +hipercalórico-hiperproteico I-TREATMENT +y I-TREATMENT +NPTC I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +optimización I-TREATMENT +de I-TREATMENT +parámetros I-TREATMENT +nutricionales I-TREATMENT +(albúmina: I-TREATMENT +3, I-TREATMENT +8 I-TREATMENT +mg/dl). I-TREATMENT + I-TREATMENT +Cinco I-TREATMENT +semanas I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +endoprótesis I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +operar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +intraoperatorio I-TREATMENT +se I-TREATMENT +midió I-TREATMENT +intestino I-TREATMENT +remanente I-TREATMENT +con-frmando I-TREATMENT +una I-TREATMENT +longitud I-TREATMENT +de I-TREATMENT +140 I-TREATMENT +cm. I-TREATMENT +Se I-TREATMENT +desmanteló I-TREATMENT +la I-TREATMENT +yeyunostomía I-TREATMENT +y I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +una I-TREATMENT +anastomosis I-TREATMENT +mecánica I-TREATMENT +término-terminal I-TREATMENT +yeyunorectal. I-TREATMENT +Luego I-TREATMENT +se I-TREATMENT +hicieron I-TREATMENT +15 I-TREATMENT +secciones I-TREATMENT +transversas I-TREATMENT +parciales I-TREATMENT +con I-TREATMENT +cargas I-TREATMENT +lineales I-TREATMENT +de I-TREATMENT +3, I-TREATMENT +5 I-TREATMENT +mm I-TREATMENT +para I-TREATMENT +seccionar I-TREATMENT +la I-TREATMENT +mitad I-TREATMENT +del I-TREATMENT +lumen I-TREATMENT +del I-TREATMENT +intestino I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +de I-TREATMENT +zig-zag I-TREATMENT +según I-TREATMENT +lo I-TREATMENT +descrito I-TREATMENT +por I-TREATMENT +Kim9. I-TREATMENT +La I-TREATMENT +longitud I-TREATMENT +fnal I-TREATMENT +del I-TREATMENT +intestino I-TREATMENT +delgado I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +180 I-TREATMENT +cm, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +sumado I-TREATMENT +al I-TREATMENT +muñón I-TREATMENT +rectal I-TREATMENT +da I-TREATMENT +una I-TREATMENT +longitud I-TREATMENT +de I-TREATMENT +190 I-TREATMENT +cm I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +ano. I-TREATMENT + I-TREATMENT +Dentro B-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +eventos I-EVOLUTION +del I-EVOLUTION +postoperatorio I-EVOLUTION +destacó I-EVOLUTION +la I-EVOLUTION +formación I-EVOLUTION +de I-EVOLUTION +colecciones I-EVOLUTION +hemáticas I-EVOLUTION +intraabdominales, I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +fltración. I-EVOLUTION +Por B-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +episodios I-EXPLORATION +febriles, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +eco-cardiograma I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +trombo I-EXPLORATION +séptico I-EXPLORATION +en I-EXPLORATION +aurícula I-EXPLORATION +derecha I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +endocarditis I-TREATMENT +bacteriana. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +progresivo I-EVOLUTION +del I-EVOLUTION +aporte I-EVOLUTION +por I-EVOLUTION +vía I-EVOLUTION +oral. I-EVOLUTION +El B-TREATMENT +día I-TREATMENT +34 I-TREATMENT +del I-TREATMENT +post I-TREATMENT +operatorio I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +NPTC, I-TREATMENT +logrando I-TREATMENT +balance I-TREATMENT +hidroelectrolitico I-TREATMENT +y I-TREATMENT +nutricional I-TREATMENT +adecuado I-TREATMENT +exclusivamente I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +tránsito I-EXPLORATION +intestinal I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +98 I-EXPLORATION +días I-EXPLORATION +post I-EXPLORATION +cirugía I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +enterotomías. I-EXPLORATION + I-EXPLORATION +Actualmente B-TREATMENT +en I-TREATMENT +control I-TREATMENT +ambulatorio, I-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +loperamida I-TREATMENT +y I-TREATMENT +suplementos I-TREATMENT +nutricionales, I-TREATMENT +logrando I-TREATMENT +adecuado I-TREATMENT +balance I-TREATMENT +hidroelectrolítico, I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +peso I-TREATMENT +y I-TREATMENT +con I-TREATMENT +una I-TREATMENT +frecuencia I-TREATMENT +de I-TREATMENT +deposiciones I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +veces I-TREATMENT +por I-TREATMENT +día I-TREATMENT +con I-TREATMENT +escurrimiento I-TREATMENT +escaso. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +IMC B-PAST_MEDICAL_HISTORY +21, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +legrado I-PAST_MEDICAL_HISTORY +uterino I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +aborto I-PAST_MEDICAL_HISTORY +provocado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +trimestre, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +17 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +marzo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2007 I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dismenorrea I-PRESENT_ILLNESS +invalidante, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pesar I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +uso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +anticonceptivos I-PRESENT_ILLNESS +orales, I-PRESENT_ILLNESS +polimenorrea I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipermenorrea I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +ciclos I-PRESENT_ILLNESS +menstruales, I-PRESENT_ILLNESS +refriendo I-PRESENT_ILLNESS +además I-PRESENT_ILLNESS +dispareunia. I-PRESENT_ILLNESS +Examen B-EXPLORATION +físico I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +ginecológico I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +primera I-EXPLORATION +consulta. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +ecotomografía I-EXPLORATION +transvaginal I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +endometrial I-EXPLORATION +ocupada I-EXPLORATION +por I-EXPLORATION +imagen I-EXPLORATION +hiperecogénica I-EXPLORATION +lineal I-EXPLORATION +con I-EXPLORATION +sombra I-EXPLORATION +acústica I-EXPLORATION +posterior, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +extensa I-EXPLORATION +metaplasia I-EXPLORATION +ósea. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +histeroscopía I-EXPLORATION +mostró I-EXPLORATION +cavidad I-EXPLORATION +uterina I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +poco I-EXPLORATION +distensible, I-EXPLORATION +revestida I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +totalidad I-EXPLORATION +por I-EXPLORATION +múltiples I-EXPLORATION +fragmentos I-EXPLORATION +espiculados I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +ósea. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +éstos I-TREATMENT +con I-TREATMENT +asa I-TREATMENT +de I-TREATMENT +resectoscopio I-TREATMENT +asistido I-TREATMENT +con I-TREATMENT +cucharilla I-TREATMENT +N° I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +pinza I-TREATMENT +Randall, I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT +Posteriormente B-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +cavidad I-EVOLUTION +endometrial I-EVOLUTION +sana I-EVOLUTION +y I-EVOLUTION +ostium I-EVOLUTION +tubarios I-EVOLUTION +permeables. I-EVOLUTION + I-EVOLUTION +Su B-EXPLORATION +laparoscopía I-EXPLORATION +exploradora I-EXPLORATION +mostró I-EXPLORATION +pelvis I-EXPLORATION +sana, I-EXPLORATION +útero I-EXPLORATION +y I-EXPLORATION +anexos I-EXPLORATION +normales, I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +relación I-EXPLORATION +tubo I-EXPLORATION +ovárica. I-EXPLORATION +Trompas I-EXPLORATION +permeables I-EXPLORATION +con I-EXPLORATION +índigo I-EXPLORATION +carmín. I-EXPLORATION + I-EXPLORATION +Biopsia I-EXPLORATION +operatoria I-EXPLORATION +estuvo I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +fragmentos I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +óseo I-EXPLORATION +maduro, I-EXPLORATION +reconociéndose I-EXPLORATION +además I-EXPLORATION +colonias I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +Actinomyces. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +neoplasia. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +metaplasia I-EXPLORATION +ósea I-EXPLORATION +del I-EXPLORATION +endometrio. I-EXPLORATION +Se B-TREATMENT +indicaron I-TREATMENT +anticonceptivos I-TREATMENT +orales I-TREATMENT +hasta I-TREATMENT +deseo I-TREATMENT +de I-TREATMENT +embarazo. I-TREATMENT + I-TREATMENT +Una B-EXPLORATION +histerosonografía I-EXPLORATION +tres I-EXPLORATION +meses I-EXPLORATION +post I-EXPLORATION +cirugía I-EXPLORATION +mostraba I-EXPLORATION +cavidad I-EXPLORATION +uterina I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +En B-TREATMENT +agosto I-TREATMENT +de I-TREATMENT +2008 I-TREATMENT +consultó I-TREATMENT +cursando I-TREATMENT +embarazo I-TREATMENT +espontáneo I-TREATMENT +único I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +gestación I-TREATMENT +confirmado I-TREATMENT +ecográficamente. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +39 I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +gestación, I-TREATMENT +se I-TREATMENT +obtuvo I-TREATMENT +un I-TREATMENT +recién I-TREATMENT +nacido I-TREATMENT +sano I-TREATMENT +de I-TREATMENT +3.380 I-TREATMENT +g I-TREATMENT +mediante I-TREATMENT +operación I-TREATMENT +cesárea I-TREATMENT +por I-TREATMENT +prueba I-TREATMENT +de I-TREATMENT +trabajo I-TREATMENT +de I-TREATMENT +parto I-TREATMENT +fracasada. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +misma, I-TREATMENT +se I-TREATMENT +produjo I-TREATMENT +inercia I-TREATMENT +uterina I-TREATMENT +que I-TREATMENT +logró I-TREATMENT +ser I-TREATMENT +revertida I-TREATMENT +con I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +retractores I-TREATMENT +en I-TREATMENT +altas I-TREATMENT +dosis. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +65 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +larga I-PAST_MEDICAL_HISTORY +data, I-PAST_MEDICAL_HISTORY +trasplante I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1999 I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +rechazó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +trisemanal I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2000 I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +secundaria. I-PAST_MEDICAL_HISTORY +Tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +eritropoyetina, I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +fólico, I-PAST_MEDICAL_HISTORY +atenolol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +losartan. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +pruriginosas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +manos, I-PRESENT_ILLNESS +antebrazos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +espalda. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaban I-EXPLORATION +hiperpigmentación I-EXPLORATION +difusa, I-EXPLORATION +erosiones, I-EXPLORATION +úlceras I-EXPLORATION +y I-EXPLORATION +pápulas I-EXPLORATION +costrosas, I-EXPLORATION +ubicadas I-EXPLORATION +preferentemente I-EXPLORATION +en I-EXPLORATION +dorso I-EXPLORATION +de I-EXPLORATION +manos, I-EXPLORATION +antebrazos, I-EXPLORATION +tórax I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +región I-EXPLORATION +interescapular. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +piel I-EXPLORATION +con I-EXPLORATION +úlcera I-EXPLORATION +y I-EXPLORATION +costra I-EXPLORATION +fibrinoleucocitaria. I-EXPLORATION +El I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +úlcera I-EXPLORATION +con I-EXPLORATION +haces I-EXPLORATION +de I-EXPLORATION +colágeno I-EXPLORATION +de I-EXPLORATION +disposición I-EXPLORATION +vertical, I-EXPLORATION +epidermis I-EXPLORATION +adyacente I-EXPLORATION +con I-EXPLORATION +hiperortoqueratosis, I-EXPLORATION +acantosis I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +espongiosis. I-EXPLORATION +La I-EXPLORATION +dermis I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +disperso I-EXPLORATION +y I-EXPLORATION +perivascular I-EXPLORATION +superfcial I-EXPLORATION +linfocitario, I-EXPLORATION +con I-EXPLORATION +algunos I-EXPLORATION +plasmocitos I-EXPLORATION +y I-EXPLORATION +neutróflos I-EXPLORATION +y I-EXPLORATION +foco I-EXPLORATION +hemorrágico. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +informados I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +colagenosis I-EXPLORATION +perforante I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +reactivo. I-EXPLORATION +Se B-TREATMENT +indicaron I-TREATMENT +antihistamínicos I-TREATMENT +orales I-TREATMENT +y I-TREATMENT +clobetasol I-TREATMENT +0, I-TREATMENT +05% I-TREATMENT ++ I-TREATMENT +cloranfenicol I-TREATMENT +2% I-TREATMENT +con B-EVOLUTION +respuesta I-EVOLUTION +parcial I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +residencia I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +IX I-PAST_MEDICAL_HISTORY +región, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +conocidos. I-PAST_MEDICAL_HISTORY +Ingresó B-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +luego I-EXPLORATION +de I-EXPLORATION +sufrir I-EXPLORATION +accidente I-EXPLORATION +de I-EXPLORATION +tránsito I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +energía I-EXPLORATION +sin I-EXPLORATION +presentar I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +consideración I-EXPLORATION +secundarias I-EXPLORATION +a I-EXPLORATION +el. I-EXPLORATION +Luego I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +semana, I-EXPLORATION +consultó I-EXPLORATION +por I-EXPLORATION +presentar I-EXPLORATION +debilidad I-EXPLORATION +progresiva I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +inferiores, I-EXPLORATION +dorsalgia I-EXPLORATION +de I-EXPLORATION +moderada I-EXPLORATION +intensidad I-EXPLORATION +y I-EXPLORATION +dificultad I-EXPLORATION +para I-EXPLORATION +orinar. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +se I-EXPLORATION +constata I-EXPLORATION +con I-EXPLORATION +hipoestesia I-EXPLORATION +bilateral I-EXPLORATION +desde I-EXPLORATION +nivel I-EXPLORATION +D5 I-EXPLORATION +hacia I-EXPLORATION +distal, I-EXPLORATION +paraparesia I-EXPLORATION +moderada, I-EXPLORATION +hiperrefexia I-EXPLORATION +osteotendínea I-EXPLORATION +patelar I-EXPLORATION +y I-EXPLORATION +aquiliana I-EXPLORATION +bilateral I-EXPLORATION +con I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Babinski I-EXPLORATION +positivo I-EXPLORATION +bilateral; I-EXPLORATION +se I-EXPLORATION +hospitalizó I-EXPLORATION +planteándose I-EXPLORATION +un I-EXPLORATION +trauma I-EXPLORATION +raquimedular I-EXPLORATION +complicado. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +con I-EXPLORATION +radiografía I-EXPLORATION +(Rx) I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorsal I-EXPLORATION +mostraba I-EXPLORATION +aplastamiento I-EXPLORATION +de I-EXPLORATION +cuerpo I-EXPLORATION +D3. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +y I-EXPLORATION +resonancia I-EXPLORATION +nuclear I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorsal I-EXPLORATION +demostraron I-EXPLORATION +múltiples I-EXPLORATION +quistes I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +variable I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +paravertebral I-EXPLORATION +derecha I-EXPLORATION +que I-EXPLORATION +compromete I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +y I-EXPLORATION +elementos I-EXPLORATION +posteriores I-EXPLORATION +de I-EXPLORATION +D2, I-EXPLORATION +D3 I-EXPLORATION +y I-EXPLORATION +D4 I-EXPLORATION +e I-EXPLORATION +invasión I-EXPLORATION +del I-EXPLORATION +canal I-EXPLORATION +raquídeo I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +aplastamiento I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +D3 I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +probable I-EXPLORATION +etiología I-EXPLORATION +hidatídica. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +anamnesis I-EXPLORATION +dirigida I-EXPLORATION +donde I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +señaló I-EXPLORATION +presentar I-EXPLORATION +dorsalgia I-EXPLORATION +de I-EXPLORATION +tres I-EXPLORATION +años I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +episodio I-EXPLORATION +de I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +fuerzas I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +que I-EXPLORATION +revirtió I-EXPLORATION +espontáneamente. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +(hemograma, I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +renal) I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Si B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +albendazol I-TREATMENT +y I-TREATMENT +realizó I-TREATMENT +hemilaminectomía I-TREATMENT +D3-D4 I-TREATMENT +con I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +quistes I-TREATMENT +confirmando I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +histopatológico I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +hidatidosis I-TREATMENT +ósea. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +recuperando I-EVOLUTION +movilidad I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +extremidades I-EVOLUTION +inferiores I-EVOLUTION +sin I-EVOLUTION +déficit I-EVOLUTION +esfinteriano. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +demostraron I-EXPLORATION +enfermedad I-EXPLORATION +hidatídica I-EXPLORATION +diseminada. I-EXPLORATION +Completa B-TREATMENT +cuatro I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +albendazol. I-TREATMENT + I-TREATMENT +Luego B-EVOLUTION +de I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +fue I-EVOLUTION +nuevamente I-EVOLUTION +intervenido I-EVOLUTION +quirúrgicamente I-EVOLUTION +por I-EVOLUTION +absceso I-EVOLUTION +dorsal I-EVOLUTION +hidatídico I-EVOLUTION +y I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +por I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +paraparesia I-EVOLUTION +progresiva I-EVOLUTION +con I-EVOLUTION +nivel I-EVOLUTION +sensitivo I-EVOLUTION +en I-EVOLUTION +D5 I-EVOLUTION +realizándose I-EVOLUTION +laminectomía I-EVOLUTION +D3-D4 I-EVOLUTION +con I-EVOLUTION +exéresis I-EVOLUTION +de I-EVOLUTION +quistes. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +positivo I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +decaimiento, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +conducta I-PRESENT_ILLNESS +frontalizada. I-PRESENT_ILLNESS +La B-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +resultó I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +VDRL, I-EXPLORATION +toxoplasma I-EXPLORATION +y I-EXPLORATION +VEB I-EXPLORATION +(por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +PCR). I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +hematológicos I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +leve I-EXPLORATION +con I-EXPLORATION +Hb I-EXPLORATION +de I-EXPLORATION +10, I-EXPLORATION +3 I-EXPLORATION +g/dL I-EXPLORATION +(ref. I-EXPLORATION +13, I-EXPLORATION +5-17, I-EXPLORATION +5 I-EXPLORATION +g/dL), I-EXPLORATION +Hto I-EXPLORATION +30% I-EXPLORATION +(ref. I-EXPLORATION +41-53%), I-EXPLORATION +leucopenia I-EXPLORATION +con I-EXPLORATION +3.100 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +(ref. I-EXPLORATION +4.500-11.000/mm3) I-EXPLORATION +y I-EXPLORATION +linfopenia I-EXPLORATION +con I-EXPLORATION +800/mm3 I-EXPLORATION +(ref. I-EXPLORATION +1.000-4.800/mm3). I-EXPLORATION +LDH I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales I-EXPLORATION +(133 I-EXPLORATION +U/L I-EXPLORATION +[ref. I-EXPLORATION +135-225 I-EXPLORATION +U/L] I-EXPLORATION +y I-EXPLORATION +0, I-EXPLORATION +1 I-EXPLORATION +mg/dL I-EXPLORATION +[ref. I-EXPLORATION +0-1 I-EXPLORATION +mg/dL], I-EXPLORATION +respectivamente). I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +además I-EXPLORATION +severo I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +inmunosupresión I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +CD4 I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +9/mm3. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +revelaron I-EXPLORATION +2 I-EXPLORATION +nódulos I-EXPLORATION +córtico-subcorticales I-EXPLORATION +en I-EXPLORATION +zonas I-EXPLORATION +frontal I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +inflamatorio. I-EXPLORATION +No I-EXPLORATION +había I-EXPLORATION +compromiso I-EXPLORATION +pulmonar I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +sitios I-EXPLORATION +anatómicos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +estereotáxica I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +tejido I-EXPLORATION +cerebral I-EXPLORATION +con I-EXPLORATION +gliosis I-EXPLORATION +reactiva I-EXPLORATION +y I-EXPLORATION +extenso I-EXPLORATION +infiltrado I-EXPLORATION +celular I-EXPLORATION +mixto, I-EXPLORATION +predominantemente I-EXPLORATION +perivascular I-EXPLORATION +y I-EXPLORATION +zonas I-EXPLORATION +con I-EXPLORATION +angiotropismo I-EXPLORATION +y I-EXPLORATION +angiodestruccción I-EXPLORATION +compuestas I-EXPLORATION +por I-EXPLORATION +linfocitos I-EXPLORATION +pequeños I-EXPLORATION +inmunorreactivos I-EXPLORATION +para I-EXPLORATION +CD3 I-EXPLORATION +(linfocitos I-EXPLORATION +T). I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +abundantes I-EXPLORATION +células I-EXPLORATION +linfoides I-EXPLORATION +atípicas I-EXPLORATION +medianas I-EXPLORATION +y I-EXPLORATION +grandes, I-EXPLORATION +de I-EXPLORATION +núcleos I-EXPLORATION +vesiculosos I-EXPLORATION +y I-EXPLORATION +pleomórficos I-EXPLORATION +inmunorreactivas I-EXPLORATION +para I-EXPLORATION +CD20 I-EXPLORATION +(linfocitos I-EXPLORATION +B). I-EXPLORATION +Los I-EXPLORATION +linfocitos I-EXPLORATION +mostraron I-EXPLORATION +reacción I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +pequeña I-EXPLORATION +de I-EXPLORATION +ARN I-EXPLORATION +asociado I-EXPLORATION +al I-EXPLORATION +VEB I-EXPLORATION +EBER-1 I-EXPLORATION +mediante I-EXPLORATION +hibridización I-EXPLORATION +in I-EXPLORATION +situ. I-EXPLORATION +Estas I-EXPLORATION +células I-EXPLORATION +mostraron I-EXPLORATION +reacción I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +CD30, I-EXPLORATION +CD68 I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +S-100. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +microorganismos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +con I-EXPLORATION +tinciones I-EXPLORATION +de I-EXPLORATION +Gram, I-EXPLORATION +PAS, I-EXPLORATION +Ziehl-Neelsen I-EXPLORATION +y I-EXPLORATION +Warthin-Starry. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +citometría I-EXPLORATION +de I-EXPLORATION +flujo I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +cerebral I-EXPLORATION +reveló I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +atípicas I-EXPLORATION +medianas I-EXPLORATION +de I-EXPLORATION +estirpe I-EXPLORATION +B I-EXPLORATION +con I-EXPLORATION +restricción I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +ligera I-EXPLORATION +Kappa, I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +linfoproliferativo. I-EXPLORATION +El I-EXPLORATION +mielograma I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +conjunto, I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +GL I-EXPLORATION +cerebral I-EXPLORATION +grado I-EXPLORATION +3 I-EXPLORATION +(linfoma I-EXPLORATION +B I-EXPLORATION +difuso I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes). I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +caso I-TREATMENT +comunicado I-TREATMENT +en I-TREATMENT +el I-TREATMENT +presente I-TREATMENT +artículo I-TREATMENT +fue I-TREATMENT +confirmado I-TREATMENT +como I-TREATMENT +síndrome I-TREATMENT +de I-TREATMENT +inmunodeficiencia I-TREATMENT +por I-TREATMENT +virus I-TREATMENT +VIH I-TREATMENT +etapa I-TREATMENT +C3 I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +terapia I-TREATMENT +antirretroviral. I-TREATMENT +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +solicitó I-DERIVED_FROM/TO +posteriormente I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +traslado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +continuar I-DERIVED_FROM/TO +manejo. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +respiratoria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diagnóstico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +neumonía. I-PRESENT_ILLNESS +Los B-EXPLORATION +cultivos I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +y I-EXPLORATION +CMV I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +serologías I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +pacientes I-EXPLORATION +previos. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +empírico. I-TREATMENT +A B-EXPLORATION +las I-EXPLORATION +dos I-EXPLORATION +semanas I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +presentó I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +empeoramiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +radiológicas I-EXPLORATION +basales I-EXPLORATION +derechas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +BAL I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +crecimiento I-EXPLORATION +bacteriano. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +desarrolló I-EXPLORATION +paulatinamente I-EXPLORATION +citopenias I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +series: I-EXPLORATION +Hb: I-EXPLORATION +7 I-EXPLORATION +g/l; I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos: I-EXPLORATION +1.600/ I-EXPLORATION +mm3; I-EXPLORATION +plaquetas: I-EXPLORATION +49.000 I-EXPLORATION +/mm3. I-EXPLORATION +La I-EXPLORATION +ferritina I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +4.000 I-EXPLORATION +µg/l, I-EXPLORATION +trigliceridos I-EXPLORATION +607 I-EXPLORATION +mg/dl, I-EXPLORATION +fibrinógeno I-EXPLORATION +111%. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +PAMO I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +macrófagos I-EXPLORATION +en I-EXPLORATION +10% I-EXPLORATION +con I-EXPLORATION +hemofa-gocitosis. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +solo I-EXPLORATION +presentó I-EXPLORATION +ligera I-EXPLORATION +hepato I-EXPLORATION +esplenomegalia. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +le I-TREATMENT +administró I-TREATMENT +metilprednisona I-TREATMENT +a I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +g/día I-TREATMENT +por I-TREATMENT +tres I-TREATMENT +días I-TREATMENT +y I-TREATMENT +gammaglobulina I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +400 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +5 I-TREATMENT +días. I-TREATMENT +Evolucionó B-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +persistente I-EVOLUTION +y B-TREATMENT +requerimiento I-TREATMENT +de I-TREATMENT +asistencia I-TREATMENT +respiratoria I-TREATMENT +mecánica. I-TREATMENT +Las B-EVOLUTION +citopenias I-EVOLUTION +no I-EVOLUTION +mejoraron. I-EVOLUTION +Se B-EXPLORATION +repitieron I-EXPLORATION +cultivos I-EXPLORATION +que I-EXPLORATION +siempre I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +a I-EXPLORATION +excepción I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +BAL I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +el I-EXPLORATION +crecimiento I-EXPLORATION +significativo I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +Acinetobacter I-EXPLORATION +baumannii I-EXPLORATION +multirresistente I-EXPLORATION +que B-TREATMENT +recibió I-TREATMENT +tratamiento. I-TREATMENT +Falleció B-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +44 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +con I-EVOLUTION +falla I-EVOLUTION +multiorgánica. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +candidato I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +trasplante I-PRESENT_ILLNESS +hepático. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +hepatorenal I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +motivó I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +aporte I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +furosemida, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +obtener I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +diurética. I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esto I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontró I-PRESENT_ILLNESS +donante. I-PRESENT_ILLNESS +En B-EXPLORATION +ese I-EXPLORATION +momento I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +soporoso, I-EXPLORATION +con I-EXPLORATION +escasa I-EXPLORATION +respuesta I-EXPLORATION +a I-EXPLORATION +estímulos I-EXPLORATION +verbales, I-EXPLORATION +PA I-EXPLORATION +110/60, I-EXPLORATION +FC I-EXPLORATION +115 I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +35x'. I-EXPLORATION +Un I-EXPLORATION +ecocardiograma I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +mostró I-EXPLORATION +buena I-EXPLORATION +función I-EXPLORATION +ventricular I-EXPLORATION +global, I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cuatro I-EXPLORATION +cavidades I-EXPLORATION +y I-EXPLORATION +presión I-EXPLORATION +sistólica I-EXPLORATION +de I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +(PSAP) I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +mmHg. I-EXPLORATION +En I-EXPLORATION +pabellón, I-EXPLORATION +se I-EXPLORATION +intubó I-EXPLORATION +e I-EXPLORATION +instaló I-EXPLORATION +sonda I-EXPLORATION +para I-EXPLORATION +ETE I-EXPLORATION +y I-EXPLORATION +CAP I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +PVC I-EXPLORATION +de I-EXPLORATION +25 I-EXPLORATION +mmHg, I-EXPLORATION +PCP I-EXPLORATION +26 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +RVSI I-EXPLORATION +de I-EXPLORATION +987 I-EXPLORATION +dinas*segundo/cm5/m2. I-EXPLORATION +El I-EXPLORATION +IC I-EXPLORATION +y I-EXPLORATION +PSAP I-EXPLORATION +medidas I-EXPLORATION +por I-EXPLORATION +CAP I-EXPLORATION +y I-EXPLORATION +ETE I-EXPLORATION +fueron I-EXPLORATION +respectivamente I-EXPLORATION +4, I-EXPLORATION +7 I-EXPLORATION +y I-EXPLORATION +5, I-EXPLORATION +3 I-EXPLORATION +1/ I-EXPLORATION +m2, I-EXPLORATION +y I-EXPLORATION +49/32 I-EXPLORATION +y I-EXPLORATION +48. I-EXPLORATION +El I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +fin I-EXPLORATION +de I-EXPLORATION +diástole I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +indexado I-EXPLORATION +(VFDVII) I-EXPLORATION +fue I-EXPLORATION +98 I-EXPLORATION +ml/m2 I-EXPLORATION +(valor I-EXPLORATION +normal: I-EXPLORATION +35-75 I-EXPLORATION +ml/m2). I-EXPLORATION +Se B-TREATMENT +aportaron I-TREATMENT +fluidos I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +muy I-TREATMENT +restringida, I-TREATMENT +observándose I-TREATMENT +durante I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +buena I-TREATMENT +concordancia I-TREATMENT +entre I-TREATMENT +los I-TREATMENT +valores I-TREATMENT +de I-TREATMENT +IC I-TREATMENT +y I-TREATMENT +PSAP I-TREATMENT +medidos I-TREATMENT +con I-TREATMENT +CAP I-TREATMENT +y I-TREATMENT +ETE. I-TREATMENT +Al B-EXPLORATION +término I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +la I-EXPLORATION +PVC I-EXPLORATION +era I-EXPLORATION +14 I-EXPLORATION +mmHg, I-EXPLORATION +PCP I-EXPLORATION +19 I-EXPLORATION +mmHg, I-EXPLORATION +PAP I-EXPLORATION +33/22 I-EXPLORATION +e I-EXPLORATION +IC I-EXPLORATION +5, I-EXPLORATION +1/ I-EXPLORATION +m2. I-EXPLORATION +El I-EXPLORATION +ETE I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +PSAP I-EXPLORATION +de I-EXPLORATION +32, I-EXPLORATION +IC I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +1/ I-EXPLORATION +m2, I-EXPLORATION +y I-EXPLORATION +VFDVI67ml/m2. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hipertenso B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabáquico, I-PAST_MEDICAL_HISTORY +programado B-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +tiroidectomía I-PRESENT_ILLNESS +total. I-PRESENT_ILLNESS +Inducción B-EXPLORATION +anestésica I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +hemodinámicas, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +modificación I-EXPLORATION +de I-EXPLORATION +onda I-EXPLORATION +T I-EXPLORATION +y I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +isquemia. I-EXPLORATION +La I-EXPLORATION +ETE I-EXPLORATION +no I-EXPLORATION +mostraba I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +ventricular. I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +suspender I-EXPLORATION +y I-EXPLORATION +realizar I-EXPLORATION +coronariografía I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +antecedentes I-PRESENT_ILLNESS +mórbidos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +importancia, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rápida I-PRESENT_ILLNESS +progresión, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +hemoptoica I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +AngioTAC I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +tumoral, I-EXPLORATION +intracavitaria I-EXPLORATION +en I-EXPLORATION +aurícula I-EXPLORATION +izquierda I-EXPLORATION +infiltrativa I-EXPLORATION +a I-EXPLORATION +venas I-EXPLORATION +pulmonares. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +complementó I-EXPLORATION +con I-EXPLORATION +ecocardiograma I-EXPLORATION +confirmando I-EXPLORATION +masa I-EXPLORATION +hiperdensa I-EXPLORATION +de I-EXPLORATION +43 I-EXPLORATION +x I-EXPLORATION +38 I-EXPLORATION +mm I-EXPLORATION +ocupando I-EXPLORATION +el I-EXPLORATION +75% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +izquierda. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +resecó I-EXPLORATION +quirúrgicamente I-EXPLORATION +cerca I-EXPLORATION +de I-EXPLORATION +95% I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +por I-EXPLORATION +infiltración I-EXPLORATION +a I-EXPLORATION +venas I-EXPLORATION +pulmonares. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +histológico I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +fusado I-EXPLORATION +con I-EXPLORATION +algunas I-EXPLORATION +células I-EXPLORATION +ovaladas, I-EXPLORATION +pericitos, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +disponían I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +sólido, I-EXPLORATION +interrumpido I-EXPLORATION +por I-EXPLORATION +espacios I-EXPLORATION +vasculares I-EXPLORATION +delgados, I-EXPLORATION +revestidos I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +endoteliales I-EXPLORATION +y I-EXPLORATION +aplanadas. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +inmuno-histoquímica I-EXPLORATION +demostró I-EXPLORATION +reactividad I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +vimentina I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +proliferantes, I-EXPLORATION +CD-34 I-EXPLORATION +positivo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +endotelio I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +y I-EXPLORATION +pericitos, I-EXPLORATION +factor I-EXPLORATION +VIII I-EXPLORATION +positivo I-EXPLORATION +sólo I-EXPLORATION +en I-EXPLORATION +endotelio, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +S-100 I-EXPLORATION +y I-EXPLORATION +CD-68. I-EXPLORATION +Estos I-EXPLORATION +hallazgos, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +claro I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +reticulina I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +técnicas I-EXPLORATION +argénticas, I-EXPLORATION +indicaron I-EXPLORATION +el I-EXPLORATION +carácter I-EXPLORATION +pericítico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +neoplasia I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +su I-EXPLORATION +carácter I-EXPLORATION +benigno I-EXPLORATION +histológico, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +mitótico I-EXPLORATION +inferior I-EXPLORATION +a I-EXPLORATION +tres I-EXPLORATION +mitosis I-EXPLORATION +por I-EXPLORATION +10 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +mayor I-EXPLORATION +aumento. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +satisfactoriamente I-EVOLUTION +post I-EVOLUTION +cirugía I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +el I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +mes I-EVOLUTION +siguiente, I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +consultar I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +dolor I-EVOLUTION +cervical I-EVOLUTION +intenso I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +odinofagia. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +diseminación I-EXPLORATION +con I-EXPLORATION +PET-CP I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +zonas I-EXPLORATION +hipermetabólicas I-EXPLORATION +en I-EXPLORATION +pulmón, I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +cráneo, I-EXPLORATION +hígado, I-EXPLORATION +amígdala I-EXPLORATION +izquierda, I-EXPLORATION +aurícula I-EXPLORATION +izquierda, I-EXPLORATION +suprarrenal I-EXPLORATION +izquierda, I-EXPLORATION +cola I-EXPLORATION +de I-EXPLORATION +páncreas I-EXPLORATION +y I-EXPLORATION +colon I-EXPLORATION +descendente. I-EXPLORATION +Esto I-EXPLORATION +se I-EXPLORATION +explicó I-EXPLORATION +por I-EXPLORATION +embolización I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +circulación I-EXPLORATION +sistémica. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +presentó I-TREATMENT +caso I-TREATMENT +a I-TREATMENT +comité I-TREATMENT +oncológico I-TREATMENT +que I-TREATMENT +decidió I-TREATMENT +manejo I-TREATMENT +paliativo I-TREATMENT +y I-TREATMENT +del I-TREATMENT +dolor. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +de I-EVOLUTION +falla I-EVOLUTION +multiorgánica. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +73 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +valsartán I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hidroclorotiazida I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +trombocitemia I-PAST_MEDICAL_HISTORY +esencial I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +inicialmente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hidroxiurea I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +anagrelide. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +mediados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diciembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2007 I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +porque I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +fatigabilidad, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +adinamia, I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna, I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esfuerzo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca I-PRESENT_ILLNESS +frecuente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +productiva. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +tenido I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +prurito. I-PRESENT_ILLNESS +El B-EXPLORATION +electrocardiograma I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fueron I-EXPLORATION +normales, I-EXPLORATION +salvo I-EXPLORATION +elongación I-EXPLORATION +aórtica I-EXPLORATION +moderada I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +ecocardiograma I-EXPLORATION +mostró I-EXPLORATION +insuficiencia I-EXPLORATION +aórtica I-EXPLORATION +leve, I-EXPLORATION +aurícula I-EXPLORATION +y I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +conservada. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +destacaba I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +29%, I-EXPLORATION +macrocitosis, I-EXPLORATION +rouleaux I-EXPLORATION +++, I-EXPLORATION +VHS I-EXPLORATION +49 I-EXPLORATION +mm/hora I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +de I-EXPLORATION +717.000 I-EXPLORATION +mm3. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +generales I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Una B-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +presentó I-EVOLUTION +esputo I-EVOLUTION +hemoptoico I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +hospitalizado I-EVOLUTION +por I-EVOLUTION +sospecha I-EVOLUTION +de I-EVOLUTION +embolia I-EVOLUTION +pulmonar. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +AngioTAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +trombos I-EXPLORATION +pero I-EXPLORATION +mostró I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +ascendente, I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +plano I-EXPLORATION +valvular I-EXPLORATION +aórtico, I-EXPLORATION +estaba I-EXPLORATION +cubierta I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +hipodenso, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +abdominal I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +inferior. I-EXPLORATION +También I-EXPLORATION +presentaban I-EXPLORATION +un I-EXPLORATION +halo I-EXPLORATION +similar I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +subclavia I-EXPLORATION +izquierda, I-EXPLORATION +renales I-EXPLORATION +y I-EXPLORATION +mesentérica I-EXPLORATION +superior I-EXPLORATION +(AMS). I-EXPLORATION +Las I-EXPLORATION +arterias I-EXPLORATION +renales I-EXPLORATION +y I-EXPLORATION +mesentéricas I-EXPLORATION +estaban I-EXPLORATION +estenosadas, I-EXPLORATION +el I-EXPLORATION +tronco I-EXPLORATION +celíaco I-EXPLORATION +presentaba I-EXPLORATION +dilatación I-EXPLORATION +post-estenótica I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +flujo I-EXPLORATION +sanguíneo I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +AMS I-EXPLORATION +era I-EXPLORATION +filiforme. I-EXPLORATION +Existía I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +derrame I-EXPLORATION +pericárdico, I-EXPLORATION +esplenomegalia I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +perinéfrico I-EXPLORATION +bilateral. I-EXPLORATION +El I-EXPLORATION +cintigrama I-EXPLORATION +renal I-EXPLORATION +mostró I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +perfusión I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +(RD I-EXPLORATION +62%, I-EXPLORATION +RI I-EXPLORATION +38%). I-EXPLORATION +Los I-EXPLORATION +vasos I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +eran I-EXPLORATION +normales I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +angioresonancia I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +periaórtico I-EXPLORATION +se I-EXPLORATION +reforzó I-EXPLORATION +con I-EXPLORATION +gadolinio I-EXPLORATION +concluyéndose I-EXPLORATION +que I-EXPLORATION +era I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +inflamatorio-fibroso. I-EXPLORATION +La I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +AMS I-EXPLORATION +era I-EXPLORATION +crítica; I-EXPLORATION +las I-EXPLORATION +dos I-EXPLORATION +arterias I-EXPLORATION +renales I-EXPLORATION +izquierdas I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tronco I-EXPLORATION +celíaco I-EXPLORATION +presentaban I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +70% I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +mesentérica I-EXPLORATION +inferior, I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +50%. I-EXPLORATION +Los I-EXPLORATION +senos I-EXPLORATION +renales I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +perinéfricas I-EXPLORATION +estaban I-EXPLORATION +ocupados I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +que I-EXPLORATION +envolvía I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +aorta. I-EXPLORATION +Se B-TREATMENT +instaló I-TREATMENT +stents I-TREATMENT +en I-TREATMENT +AMS I-TREATMENT +y I-TREATMENT +en I-TREATMENT +ambas I-TREATMENT +arterias I-TREATMENT +renales, I-TREATMENT +mejorando B-EVOLUTION +la I-EVOLUTION +perfusión. I-EVOLUTION +El B-EXPLORATION +radiólogo I-EXPLORATION +planteó I-EXPLORATION +ECD. I-EXPLORATION +El I-EXPLORATION +cintigrama I-EXPLORATION +óseo I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +dicho I-EXPLORATION +diagnóstico I-EXPLORATION +al I-EXPLORATION +mostrar I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +captación I-EXPLORATION +en I-EXPLORATION +fémures I-EXPLORATION +y I-EXPLORATION +tibias. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +60 I-TREATMENT +mg/día I-TREATMENT +y I-TREATMENT +metotrexato I-TREATMENT +10 I-TREATMENT +mg I-TREATMENT +semanales, I-TREATMENT +con B-EVOLUTION +mejoría I-EVOLUTION +sintomática I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +redujo I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +gradual I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +corticoides I-TREATMENT +hasta I-TREATMENT +10 I-TREATMENT +mg. I-TREATMENT +Tres B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +(marzo I-EVOLUTION +de I-EVOLUTION +2008) I-EVOLUTION +fue I-EVOLUTION +hospitalizado I-EVOLUTION +por I-EVOLUTION +neumonía I-EVOLUTION +y I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +antibiótico. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +(diciembre I-EVOLUTION +de I-EVOLUTION +2008) I-EVOLUTION +y I-EVOLUTION +estando I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +prácticamente I-EVOLUTION +asintomático, I-EVOLUTION +salvo I-EVOLUTION +edema I-EVOLUTION +de I-EVOLUTION +piernas I-EVOLUTION +atribuido I-EVOLUTION +al I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +anagrelide, I-EVOLUTION +persistía I-EVOLUTION +anémico I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +leucocitosis. I-EVOLUTION +Un B-EXPLORATION +scanner I-EXPLORATION +mostró I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +grosor I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +periaórtico I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +aorta I-EXPLORATION +ascendente I-EXPLORATION +como I-EXPLORATION +descendente I-EXPLORATION +y I-EXPLORATION +prolongación I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +arterias I-EXPLORATION +ilíacas I-EXPLORATION +primitivas. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +18 I-EXPLORATION +meses I-EXPLORATION +(julio I-EXPLORATION +de I-EXPLORATION +2009), I-EXPLORATION +por I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +rodillas I-EXPLORATION +se I-EXPLORATION +tomó I-EXPLORATION +radiografías I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +osteoesclerosis I-EXPLORATION +en I-EXPLORATION +fémures I-EXPLORATION +y I-EXPLORATION +tibias I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +localización I-EXPLORATION +que I-EXPLORATION +las I-EXPLORATION +alteraciones I-EXPLORATION +del I-EXPLORATION +cintigrama I-EXPLORATION +óseo I-EXPLORATION +y I-EXPLORATION +calcificaciones I-EXPLORATION +del I-EXPLORATION +cartílago I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +condrocalcinosis. I-EXPLORATION +Un I-EXPLORATION +nuevo I-EXPLORATION +scanner, I-EXPLORATION +mostró I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +previos I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +(70%) I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +inferior. I-EXPLORATION +A B-EVOLUTION +28 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +(abril I-EVOLUTION +de I-EVOLUTION +2010), I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +insuficiencia I-EVOLUTION +cardiaca I-EVOLUTION +congestiva. I-EVOLUTION +El B-EXPLORATION +scanner I-EXPLORATION +mostró I-EXPLORATION +acentuación I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +perirrenal, I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pleuras I-EXPLORATION +bibasales I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pericardio. I-EXPLORATION +El I-EXPLORATION +ecocardiograma I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +gran I-EXPLORATION +derrame I-EXPLORATION +pericárdico I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +iniciales I-EXPLORATION +de I-EXPLORATION +taponamiento I-EXPLORATION +y I-EXPLORATION +superficie I-EXPLORATION +pericárdica I-EXPLORATION +irregular I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +tumoral. I-EXPLORATION +El I-EXPLORATION +electrocardiograma I-EXPLORATION +mostró I-EXPLORATION +bajo I-EXPLORATION +voltaje. I-EXPLORATION +Fue B-TREATMENT +hospitalizado I-TREATMENT +efectuándose I-TREATMENT +una I-TREATMENT +ventana I-TREATMENT +pleuro-pericárdica. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +operación I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +el I-TREATMENT +pericardio I-TREATMENT +a I-TREATMENT +tensión I-TREATMENT +drenando I-TREATMENT +1.200 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +un I-TREATMENT +líquido I-TREATMENT +amarillo I-TREATMENT +pardusco. I-TREATMENT +El B-EXPLORATION +pericardio I-EXPLORATION +parietal I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +visceral I-EXPLORATION +estaba I-EXPLORATION +infiltrado I-EXPLORATION +difusamente I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +duro. I-EXPLORATION +El I-EXPLORATION +líquido I-EXPLORATION +pericárdico I-EXPLORATION +tenía I-EXPLORATION +abundantes I-EXPLORATION +histiocitos I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +pericárdico I-EXPLORATION +parietal I-EXPLORATION +resecado, I-EXPLORATION +que I-EXPLORATION +tenía I-EXPLORATION +infiltración I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +citoplasma I-EXPLORATION +granular I-EXPLORATION +y I-EXPLORATION +espumoso I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +inmunohistoquímico I-EXPLORATION +confirmó I-EXPLORATION +que I-EXPLORATION +dichas I-EXPLORATION +células I-EXPLORATION +correspondían I-EXPLORATION +a I-EXPLORATION +histiocitos, I-EXPLORATION +CD68 I-EXPLORATION +(+), I-EXPLORATION +CD1a I-EXPLORATION +(-) I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +S100 I-EXPLORATION +(-), I-EXPLORATION +confirmando I-EXPLORATION +la I-EXPLORATION +ECD. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +clara I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sintomatología I-EVOLUTION +posterior I-EVOLUTION +al I-EVOLUTION +procedimiento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PAST_MEDICAL_HISTORY +chileno, I-PAST_MEDICAL_HISTORY +masculino, B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +viaje I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +Cuzco, I-PRESENT_ILLNESS +Perú, I-PRESENT_ILLNESS +inicia I-PRESENT_ILLNESS +súbitamente I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +reposo I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agrega I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +epigástrico I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general. I-PRESENT_ILLNESS +Se B-TREATMENT +diagnostica I-TREATMENT +mal I-TREATMENT +de I-TREATMENT +altura I-TREATMENT +agudo, I-TREATMENT +recibiendo I-TREATMENT +furosemida, I-TREATMENT +acetazolamida, I-TREATMENT +dexametasona, I-TREATMENT +ranitidina I-TREATMENT +y I-TREATMENT +ceftriaxona. I-TREATMENT + B-EVOLUTION +En I-EVOLUTION +Chile, I-EVOLUTION +6 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +persistir I-EVOLUTION +con I-EVOLUTION +idéntica I-EVOLUTION +sintomatología I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +derivado I-EVOLUTION +al I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencia I-EVOLUTION +del I-EVOLUTION +Hospital I-EVOLUTION +Clínico I-EVOLUTION +Universidad I-EVOLUTION +de I-EVOLUTION +Chile I-EVOLUTION +por I-EVOLUTION +sospecha I-EVOLUTION +de I-EVOLUTION +tromboembolismo I-EVOLUTION +pulmonar. I-EVOLUTION +Ingresó B-EXPLORATION +afebril, I-EXPLORATION +disneico, I-EXPLORATION +con I-EXPLORATION +tope I-EXPLORATION +inspiratorio I-EXPLORATION +y I-EXPLORATION +distensión I-EXPLORATION +abdominal. I-EXPLORATION +Tenía B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +apnea-hipopnea I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +sueño, I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +bipolar I-PAST_MEDICAL_HISTORY +manejado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +valproico, I-PAST_MEDICAL_HISTORY +rinitis I-PAST_MEDICAL_HISTORY +alérgica, I-PAST_MEDICAL_HISTORY +várices I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +miembros I-PAST_MEDICAL_HISTORY +inferiores, I-PAST_MEDICAL_HISTORY +apendicectomizado, I-PAST_MEDICAL_HISTORY +tabáquico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +paquetes-año, I-PAST_MEDICAL_HISTORY +bebedor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +copas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vino I-PAST_MEDICAL_HISTORY +diarias I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Signos B-EXPLORATION +vitales: I-EXPLORATION +Pulso I-EXPLORATION +81, I-EXPLORATION +ventilación I-EXPLORATION +18 I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +102-67 I-EXPLORATION +mmHg, I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +36°C. I-EXPLORATION +Al I-EXPLORATION +examen: I-EXPLORATION +en I-EXPLORATION +decúbito I-EXPLORATION +dorsal, I-EXPLORATION +consciente, I-EXPLORATION +hidratado, I-EXPLORATION +bien I-EXPLORATION +perfundido, I-EXPLORATION +piel I-EXPLORATION +blanca, I-EXPLORATION +pálida. I-EXPLORATION +Destacaba I-EXPLORATION +abdomen I-EXPLORATION +doloroso I-EXPLORATION +en I-EXPLORATION +hipocondrio I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +bazo I-EXPLORATION +aumentado I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +várices I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +inferiores. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +hemograma I-EXPLORATION +con I-EXPLORATION +hematocrito I-EXPLORATION +27, I-EXPLORATION +1%, I-EXPLORATION +hemoglobina I-EXPLORATION +8, I-EXPLORATION +7 I-EXPLORATION +g/dl, I-EXPLORATION +VCM I-EXPLORATION +y I-EXPLORATION +CHCM I-EXPLORATION +normales, I-EXPLORATION +leucocitos I-EXPLORATION +10.100/uL, I-EXPLORATION +VHS I-EXPLORATION +28 I-EXPLORATION +mm/hr, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +y I-EXPLORATION +TTPK I-EXPLORATION +normales. I-EXPLORATION +Dímero I-EXPLORATION +D I-EXPLORATION +4.683 I-EXPLORATION +ng/ml I-EXPLORATION +(normal I-EXPLORATION +< I-EXPLORATION +500), I-EXPLORATION +LDH I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +1.247 I-EXPLORATION +(rango: I-EXPLORATION +313-618), I-EXPLORATION +proBNP, I-EXPLORATION +CK, I-EXPLORATION +CK-MB I-EXPLORATION +y I-EXPLORATION +troponinas I-EXPLORATION +normales. I-EXPLORATION +Angio-TAC I-EXPLORATION +pulmonar I-EXPLORATION +descartó I-EXPLORATION +tromboembolismo I-EXPLORATION +y I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +periesplénico, I-EXPLORATION +subcapsular I-EXPLORATION +de I-EXPLORATION +17 I-EXPLORATION +cm, I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +ingresado I-EVOLUTION +a I-EVOLUTION +cuidados I-EVOLUTION +intermedios I-EVOLUTION +con I-EVOLUTION +diagnóstico I-EVOLUTION +probable I-EVOLUTION +de I-EVOLUTION +infarto I-EVOLUTION +esplénico I-EVOLUTION +con I-EVOLUTION +transformación I-EVOLUTION +hemorrágica. I-EVOLUTION + I-EVOLUTION +Hemogramas B-EXPLORATION +seriados I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +cambios, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecocardiografía I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +crecimiento I-EXPLORATION +del I-EXPLORATION +hematoma I-EXPLORATION +esplénico I-EXPLORATION +a I-EXPLORATION +19 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +Ante B-EVOLUTION +estabilidad I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +trasladado I-EVOLUTION +a I-EVOLUTION +sala I-EVOLUTION +en I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +laboratorio I-EXPLORATION +no I-EXPLORATION +sugerían I-EXPLORATION +etiologías I-EXPLORATION +infecciosas I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +hematoma I-EXPLORATION +esplénico, I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +elementos I-EXPLORATION +sospechosos I-EXPLORATION +de I-EXPLORATION +síndromes I-EXPLORATION +mieloproliferativos, I-EXPLORATION +linfoproliferativos I-EXPLORATION +u I-EXPLORATION +otra I-EXPLORATION +neoplasia I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +tomografía I-EXPLORATION +y I-EXPLORATION +bioquímicos. I-EXPLORATION +Hemogramas I-EXPLORATION +previos I-EXPLORATION +a I-EXPLORATION +este I-EXPLORATION +evento I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +Ante I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +esplénico, I-EXPLORATION +pese I-EXPLORATION +a I-EXPLORATION +ser I-EXPLORATION +una I-EXPLORATION +causa I-EXPLORATION +rara, I-EXPLORATION +fue I-EXPLORATION +estudiado I-EXPLORATION +para I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +rasgo I-EXPLORATION +falciforme I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +inducción I-EXPLORATION +de I-EXPLORATION +drepanocitos I-EXPLORATION +con I-EXPLORATION +metabisulfito I-EXPLORATION +de I-EXPLORATION +sodio I-EXPLORATION +al I-EXPLORATION +2%, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positiva. I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +intrahospitalaria I-TREATMENT +favorable, I-TREATMENT +acompañado I-TREATMENT +de I-TREATMENT +laboratorio I-TREATMENT +general I-TREATMENT +y I-TREATMENT +estudios I-TREATMENT +radiológicos I-TREATMENT +sin I-TREATMENT +progresión, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +intervenir I-TREATMENT +quirúrgicamente I-TREATMENT +y B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +control I-EXPLORATION +ambulatorio I-EXPLORATION +por I-EXPLORATION +hematología I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +en I-EXPLORATION +medio I-EXPLORATION +alcalino I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +hemoglobina I-EXPLORATION +normal I-EXPLORATION +A I-EXPLORATION +54, I-EXPLORATION +8% I-EXPLORATION +y I-EXPLORATION +41, I-EXPLORATION +8% I-EXPLORATION +de I-EXPLORATION +fracción I-EXPLORATION +3, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +hemoglobina I-EXPLORATION +S I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +rasgo I-EXPLORATION +falciforme. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos, I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +consultó I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sufrir I-PAST_MEDICAL_HISTORY +trauma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +baja I-PAST_MEDICAL_HISTORY +intensidad I-PAST_MEDICAL_HISTORY +(pelotazo) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +genital. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +dolor I-EXPLORATION +que I-EXPLORATION +dificultaba I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +evidenciándose I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +asimétrico I-EXPLORATION +testicular I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +lesiones I-EXPLORATION +asociadas. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +ecotomografía I-EXPLORATION +testicular I-EXPLORATION +presentándose I-EXPLORATION +a I-EXPLORATION +control I-EXPLORATION +luego I-EXPLORATION +de I-EXPLORATION +transcurridos I-EXPLORATION +5 I-EXPLORATION +meses, I-EXPLORATION +constatándose I-EXPLORATION +clínicamente I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +indurada I-EXPLORATION +en I-EXPLORATION +testículo I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +no I-EXPLORATION +dolorosa I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +escrotal; I-EXPLORATION +testículo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +pene I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +La I-EXPLORATION +ultrasonografía I-EXPLORATION +demostró I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +testículo I-EXPLORATION +izquierdo I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +18 I-EXPLORATION +x I-EXPLORATION +19 I-EXPLORATION +x I-EXPLORATION +15 I-EXPLORATION +mm, I-EXPLORATION +bien I-EXPLORATION +delimitado, I-EXPLORATION +de I-EXPLORATION +paredes I-EXPLORATION +hiperecogénicas I-EXPLORATION +con I-EXPLORATION +sombra I-EXPLORATION +acústica I-EXPLORATION +posterior. I-EXPLORATION +El I-EXPLORATION +testículo I-EXPLORATION +derecho, I-EXPLORATION +epidídimos I-EXPLORATION +y I-EXPLORATION +cordones I-EXPLORATION +espermáticos I-EXPLORATION +no I-EXPLORATION +presentan I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +ecoestructura. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +serológico I-EXPLORATION +para I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +(α-feto I-EXPLORATION +proteína I-EXPLORATION +y I-EXPLORATION +hormona I-EXPLORATION +gonadotropina I-EXPLORATION +coriónica I-EXPLORATION +sub-unidad I-EXPLORATION +β) I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +complementó I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +pelvis, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +tórax I-EXPLORATION +las I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +demostraron I-EXPLORATION +lesiones I-EXPLORATION +secundarias. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +efectuó I-TREATMENT +enucleación I-TREATMENT +del I-TREATMENT +tumor I-TREATMENT +y I-TREATMENT +biopsia I-TREATMENT +intra-operatoria. I-TREATMENT +Se B-EXPLORATION +examinó I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +testicular I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +g I-EXPLORATION +de I-EXPLORATION +35 I-EXPLORATION +x I-EXPLORATION +17 I-EXPLORATION +x I-EXPLORATION +15 I-EXPLORATION +mm I-EXPLORATION +presentando I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +subcapsular I-EXPLORATION +redondeada, I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +amarillenta, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +firme I-EXPLORATION +de I-EXPLORATION +22 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +grumosas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +arenoso. I-EXPLORATION +El I-EXPLORATION +corte I-EXPLORATION +histológico I-EXPLORATION +por I-EXPLORATION +congelaci��n I-EXPLORATION +y I-EXPLORATION +diferido I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +que I-EXPLORATION +presentaba I-EXPLORATION +nidos I-EXPLORATION +y I-EXPLORATION +cordones I-EXPLORATION +conformados I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +ovales I-EXPLORATION +a I-EXPLORATION +poligonales I-EXPLORATION +de I-EXPLORATION +núcleos I-EXPLORATION +grandes, I-EXPLORATION +excéntricos I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +nucléolo I-EXPLORATION +prominente, I-EXPLORATION +el I-EXPLORATION +citoplasma I-EXPLORATION +es I-EXPLORATION +eosinófilo I-EXPLORATION +y I-EXPLORATION +abundante, I-EXPLORATION +apreciándose I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +polimorfonuclear I-EXPLORATION +neutrófilo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +central I-EXPLORATION +del I-EXPLORATION +tumor I-EXPLORATION +y I-EXPLORATION +linfocitos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +periferia I-EXPLORATION +en I-EXPLORATION +partes I-EXPLORATION +formando I-EXPLORATION +agregados I-EXPLORATION +linfoides. I-EXPLORATION +El I-EXPLORATION +estroma I-EXPLORATION +es I-EXPLORATION +en I-EXPLORATION +partes I-EXPLORATION +hialino I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +degeneración I-EXPLORATION +mixoide I-EXPLORATION +y I-EXPLORATION +abundantes I-EXPLORATION +calcificaciones I-EXPLORATION +dispuestas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +intersticial I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lumen I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +nidos I-EXPLORATION +tumorales, I-EXPLORATION +concluyéndose I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +contemporánea I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Sertoli I-EXPLORATION +calcificado. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +extensión I-EXPLORATION +tumoral I-EXPLORATION +intratubular, I-EXPLORATION +figuras I-EXPLORATION +mitóticas, I-EXPLORATION +necrosis, I-EXPLORATION +acentuada I-EXPLORATION +atipía I-EXPLORATION +citológica I-EXPLORATION +ni I-EXPLORATION +extensión I-EXPLORATION +tumoral I-EXPLORATION +extra-testicular. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +demostró I-EXPLORATION +intensa I-EXPLORATION +positividad I-EXPLORATION +para I-EXPLORATION +α-inhibina, I-EXPLORATION +S-100 I-EXPLORATION +y I-EXPLORATION +vimentina; I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +proliferación I-EXPLORATION +(Ki-67) I-EXPLORATION +bajo I-EXPLORATION +(< I-EXPLORATION +1%). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +completó I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +realizándose I-TREATMENT +orquiectomía I-TREATMENT +radical. I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +registraron I-EVOLUTION +complicaciones I-EVOLUTION +post-operatorias. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +meses I-EVOLUTION +post-cirugía, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +sano, I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +en I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +tórax-abdomen I-EVOLUTION +y I-EVOLUTION +pelvis; I-EVOLUTION +descartándose I-EVOLUTION +en I-EVOLUTION +este I-EVOLUTION +paciente I-EVOLUTION +la I-EVOLUTION +asociación I-EVOLUTION +con I-EVOLUTION +complejo I-EVOLUTION +de I-EVOLUTION +Carney I-EVOLUTION +y I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +Peutz-Jeghers. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +domiciliada B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Calama, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +causa I-PAST_MEDICAL_HISTORY +desconocida, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +programa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año. I-PAST_MEDICAL_HISTORY +Durante I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +período I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +agregó I-PAST_MEDICAL_HISTORY +baja I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +30 I-PAST_MEDICAL_HISTORY +kg, I-PAST_MEDICAL_HISTORY +cefalea, I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +polineuropático I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +guante I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +calcetín I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +poliartralgias. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +aparecido I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +blando, I-PRESENT_ILLNESS +indoloro, I-PRESENT_ILLNESS +progresivo, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +hombros, I-PRESENT_ILLNESS +antebrazo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +muslos, I-PRESENT_ILLNESS +inmovilidad I-PRESENT_ILLNESS +articular I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rodillas, I-PRESENT_ILLNESS +postración I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +últimas I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas. I-PRESENT_ILLNESS +Fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +posible I-DERIVED_FROM/TO +enfermedad I-DERIVED_FROM/TO +reumatológica. I-DERIVED_FROM/TO +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +paciente I-EXPLORATION +caquéctica, I-EXPLORATION +pálida, I-EXPLORATION +postrada. I-EXPLORATION +Destacó I-EXPLORATION +macroglosia I-EXPLORATION +con I-EXPLORATION +lengua I-EXPLORATION +geográfica, I-EXPLORATION +masas I-EXPLORATION +gomosas I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +hombros I-EXPLORATION +(periarticulares) I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm: I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +shoulder I-EXPLORATION +pad, I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +antebrazo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +muslos, I-EXPLORATION +manos I-EXPLORATION +contracturadas I-EXPLORATION +en I-EXPLORATION +flexión I-EXPLORATION +y I-EXPLORATION +rigidez I-EXPLORATION +de I-EXPLORATION +ambas I-EXPLORATION +rodillas. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron I-EXPLORATION +hemoglobina I-EXPLORATION +8, I-EXPLORATION +7 I-EXPLORATION +g/dL, I-EXPLORATION +creatinina I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +mg/dL, I-EXPLORATION +calcemia I-EXPLORATION +12 I-EXPLORATION +mg/dL, I-EXPLORATION +albúmina I-EXPLORATION +1, I-EXPLORATION +9 I-EXPLORATION +g/L, I-EXPLORATION +proteína I-EXPLORATION +total I-EXPLORATION +5, I-EXPLORATION +4 I-EXPLORATION +g/dL I-EXPLORATION +y I-EXPLORATION +triglicéridos I-EXPLORATION +450 I-EXPLORATION +mg/dL. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +fuerte I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +mieloma I-EXPLORATION +múltiple I-EXPLORATION +y I-EXPLORATION +amiloidosis I-EXPLORATION +asociada, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +mielograma I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +infiltrado I-EXPLORATION +de I-EXPLORATION +25% I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +plasmáticas. I-EXPLORATION +El I-EXPLORATION +inmunofenotipo I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +mostró I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +plasmáticas I-EXPLORATION +con I-EXPLORATION +restricción I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +liviana I-EXPLORATION +lambda I-EXPLORATION +y I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +mieloma. I-EXPLORATION +La I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +pequeño I-EXPLORATION +componente I-EXPLORATION +M I-EXPLORATION +en I-EXPLORATION +G1 I-EXPLORATION +y I-EXPLORATION +cuantificación I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +muy I-EXPLORATION +disminuidas, I-EXPLORATION +IgA I-EXPLORATION +27, I-EXPLORATION +7 I-EXPLORATION +mg/dL, I-EXPLORATION +IgG I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +8 I-EXPLORATION +mg/dL. I-EXPLORATION +No I-EXPLORATION +fue I-EXPLORATION +posible I-EXPLORATION +estudiar I-EXPLORATION +proteinuria I-EXPLORATION +ya I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +diuresis. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +muslo I-EXPLORATION +izquierdo, I-EXPLORATION +informó I-EXPLORATION +tejido I-EXPLORATION +fibroadiposo, I-EXPLORATION +escaso I-EXPLORATION +tejido I-EXPLORATION +muscular I-EXPLORATION +estriado I-EXPLORATION +y I-EXPLORATION +depósitos I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Rojo I-EXPLORATION +Congo, I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +amiloidosis. I-EXPLORATION +Las I-EXPLORATION +radiografías I-EXPLORATION +óseas I-EXPLORATION +mostraron I-EXPLORATION +lesiones I-EXPLORATION +líticas I-EXPLORATION +en I-EXPLORATION +cadera I-EXPLORATION +y I-EXPLORATION +fémur I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +en I-EXPLORATION +correspondencia I-EXPLORATION +a I-EXPLORATION +masas I-EXPLORATION +descritas I-EXPLORATION +anteriormente, I-EXPLORATION +sin I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +estructuras I-EXPLORATION +óseas. I-EXPLORATION +Una I-EXPLORATION +electromiografía I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +neuropatía I-EXPLORATION +por I-EXPLORATION +atrapamiento I-EXPLORATION +de I-EXPLORATION +nervio I-EXPLORATION +peroneo I-EXPLORATION +y I-EXPLORATION +nervio I-EXPLORATION +mediano I-EXPLORATION +derecho. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +depósitos I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +en I-EXPLORATION +hombros I-EXPLORATION +(periarticulares), I-EXPLORATION +pericardio, I-EXPLORATION +pared I-EXPLORATION +intestinal, I-EXPLORATION +hepatomegalia I-EXPLORATION +y I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +cabeza I-EXPLORATION +de I-EXPLORATION +páncreas. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecocardiograma. I-EXPLORATION +Se I-EXPLORATION +concluyó I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +mieloma I-EXPLORATION +múltiple, I-EXPLORATION +amiloidosis I-EXPLORATION +asociada I-EXPLORATION +e I-EXPLORATION +insuficiencia I-EXPLORATION +renal I-EXPLORATION +terminal. I-EXPLORATION +Recibió B-TREATMENT +bisfosfonatos, I-TREATMENT +con I-TREATMENT +reducción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hipercalcemia I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +melfalan I-TREATMENT +10 I-TREATMENT +mg/día I-TREATMENT +y I-TREATMENT +prednisona I-TREATMENT +40 I-TREATMENT +mg/día I-TREATMENT +por I-TREATMENT +4 I-TREATMENT +días. I-TREATMENT +Luego I-TREATMENT +se I-TREATMENT +agregó I-TREATMENT +talidomida I-TREATMENT +50 I-TREATMENT +mg/día. I-TREATMENT +Lamentablemente, B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +ingeniero, B-PAST_MEDICAL_HISTORY +previamente I-PAST_MEDICAL_HISTORY +sano, I-PAST_MEDICAL_HISTORY +presentó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +curso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas, I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +retención I-PRESENT_ILLNESS +urinaria, I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +déficits I-PRESENT_ILLNESS +sensoriales I-PRESENT_ILLNESS +irregulares I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tórax I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +abdomen. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +único I-PAST_MEDICAL_HISTORY +antecedente, I-PAST_MEDICAL_HISTORY +comunicó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +tos I-PAST_MEDICAL_HISTORY +leve I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +4-5 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +admisión I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clínica. I-PAST_MEDICAL_HISTORY +Una I-PAST_MEDICAL_HISTORY +evaluación I-PAST_MEDICAL_HISTORY +urológica I-PAST_MEDICAL_HISTORY +descartó I-PAST_MEDICAL_HISTORY +uropatía I-PAST_MEDICAL_HISTORY +obstructiva. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +estaba I-EXPLORATION +alerta, I-EXPLORATION +febril I-EXPLORATION +(38°C), I-EXPLORATION +sin I-EXPLORATION +déficits I-EXPLORATION +en I-EXPLORATION +nervios I-EXPLORATION +craneales. I-EXPLORATION +La I-EXPLORATION +fuerza I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +miembros I-EXPLORATION +superiores I-EXPLORATION +era I-EXPLORATION +normal, I-EXPLORATION +pero I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +debilidad I-EXPLORATION +moderada I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +con I-EXPLORATION +incapacidad I-EXPLORATION +para I-EXPLORATION +levantarse I-EXPLORATION +desde I-EXPLORATION +una I-EXPLORATION +posición I-EXPLORATION +sentada. I-EXPLORATION +Los I-EXPLORATION +reflejos I-EXPLORATION +plantares I-EXPLORATION +eran I-EXPLORATION +extensores, I-EXPLORATION +había I-EXPLORATION +déficit I-EXPLORATION +sensorial I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +parte I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +cuello I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +dermatoma I-EXPLORATION +D6. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +rutina: I-EXPLORATION +hemograma, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva, I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +urocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +del I-EXPLORATION +LCR I-EXPLORATION +mostró I-EXPLORATION +35 I-EXPLORATION +glóbulos I-EXPLORATION +blancos I-EXPLORATION +por I-EXPLORATION +mm3, I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +mononucleares. I-EXPLORATION +La I-EXPLORATION +proteínorraquia I-EXPLORATION +fue I-EXPLORATION +75 I-EXPLORATION +mg/dl. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectaron I-EXPLORATION +bandas I-EXPLORATION +oligoclonales. I-EXPLORATION +La I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +ARN I-EXPLORATION +viral I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +PCR-Microarray I-EXPLORATION +(Entherpex®, I-EXPLORATION +Genomica, I-EXPLORATION +España), I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +LCR I-EXPLORATION +sólo I-EXPLORATION +para I-EXPLORATION +VHH-7. I-EXPLORATION +Los I-EXPLORATION +herpes I-EXPLORATION +virus I-EXPLORATION +VHS-1, I-EXPLORATION +VHS-2, I-EXPLORATION +VHH-6, I-EXPLORATION +Epstein-Barr, I-EXPLORATION +VVZ, I-EXPLORATION +citomegalovirus I-EXPLORATION +y I-EXPLORATION +también I-EXPLORATION +anterovirus I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +test I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +y I-EXPLORATION +HTLV-1 I-EXPLORATION +fue I-EXPLORATION +negativo, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +pruebas I-EXPLORATION +inmunológicas I-EXPLORATION +para I-EXPLORATION +vasculitis I-EXPLORATION +y I-EXPLORATION +test I-EXPLORATION +serológico I-EXPLORATION +para I-EXPLORATION +Mycoplasma I-EXPLORATION +pneumoniae. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RNM) I-EXPLORATION +cerebral I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +RNM I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +evidenció I-EXPLORATION +lesiones I-EXPLORATION +inflamatorias, I-EXPLORATION +difusas, I-EXPLORATION +extensas I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +segmentos I-EXPLORATION +cervical, I-EXPLORATION +y I-EXPLORATION +dorsal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +médula I-EXPLORATION +(ver I-EXPLORATION +Figuras I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +2). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +metilprednisolona I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +3 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +ganciclovir I-TREATMENT +iv I-TREATMENT +300 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +h I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +recuperó I-TREATMENT +la I-TREATMENT +fuerza I-TREATMENT +en I-TREATMENT +extremidades I-TREATMENT +por I-TREATMENT +completo; I-TREATMENT +la B-EVOLUTION +retención I-EVOLUTION +urinaria I-EVOLUTION +persistió I-EVOLUTION +por I-EVOLUTION +1 I-EVOLUTION +mes I-EVOLUTION +para I-EVOLUTION +resolverse I-EVOLUTION +por I-EVOLUTION +completo I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +control I-EXPLORATION +de I-EXPLORATION +LCR I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +10 I-EXPLORATION +días I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +PCR I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +Herpesviridae. I-EXPLORATION +Se I-EXPLORATION +observaron I-EXPLORATION +15 I-EXPLORATION +células I-EXPLORATION +con I-EXPLORATION +proteinas I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +repetición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +PCR I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +LCR, I-EXPLORATION +tomada I-EXPLORATION +al I-EXPLORATION +ingreso, I-EXPLORATION +también I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +fue I-EXPLORATION +mielitis I-EXPLORATION +viral I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +HHV-7. I-EXPLORATION + I-EXPLORATION +Los B-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +evidenciaron I-EVOLUTION +un I-EVOLUTION +paciente I-EVOLUTION +sano, I-EVOLUTION +sin I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +desarrollado I-EVOLUTION +inmunodeficiencia. I-EVOLUTION + I-EVOLUTION + +Sexo B-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +VIH B-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2000, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +enfermedades I-PAST_MEDICAL_HISTORY +marcadoras I-PAST_MEDICAL_HISTORY +etapa I-PAST_MEDICAL_HISTORY +SIDA, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +antirretroviral I-PAST_MEDICAL_HISTORY +(TARV) I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +con: I-PAST_MEDICAL_HISTORY +zidovudina, I-PAST_MEDICAL_HISTORY +lamivudina, I-PAST_MEDICAL_HISTORY +indinavir/ritonavir, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +migraña. I-PAST_MEDICAL_HISTORY +Cuarenta B-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ocho I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +previas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta, I-PRESENT_ILLNESS +comenzó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +tensionales, I-PRESENT_ILLNESS +automedicándose I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ibuprofeno/ergotamina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +agregando I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas: I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +intenso, I-PRESENT_ILLNESS +parestesias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tercio I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba: I-EXPLORATION +palidez I-EXPLORATION +cutánea I-EXPLORATION +alternante I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +cianosis I-EXPLORATION +y I-EXPLORATION +frialdad I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +tobillos I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +tibial I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +pedio.. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +originario B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Tamaulipas, I-PAST_MEDICAL_HISTORY +México, I-PAST_MEDICAL_HISTORY +evaluado B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +xerosis I-PRESENT_ILLNESS +generalizada, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +incierto. I-PRESENT_ILLNESS +Producto B-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +segundo I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +pareja I-PAST_MEDICAL_HISTORY +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +aparentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +consanguineidad, I-FAMILY_HISTORY +se B-PAST_MEDICAL_HISTORY +caracteriza I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +intolerancia I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +calor I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ausencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +sudoración I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +nacimiento. I-PAST_MEDICAL_HISTORY +No B-FAMILY_HISTORY +refierían I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +heredofamiliares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +importancia. I-FAMILY_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +la I-EXPLORATION +frenteprominente, I-EXPLORATION +hipoplasia I-EXPLORATION +del I-EXPLORATION +puente I-EXPLORATION +nasal, I-EXPLORATION +dos I-EXPLORATION +incisivos I-EXPLORATION +únicos I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +cono, I-EXPLORATION +pigmentación I-EXPLORATION +periorbitaria, I-EXPLORATION +pelo I-EXPLORATION +escaso, I-EXPLORATION +fino, I-EXPLORATION +disperso I-EXPLORATION +y I-EXPLORATION +frágil I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +cejas I-EXPLORATION +y I-EXPLORATION +pestañas. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +dermatosis I-EXPLORATION +diseminada I-EXPLORATION +a I-EXPLORATION +cabeza, I-EXPLORATION +tronco I-EXPLORATION +y I-EXPLORATION +principalmente I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +pápulas I-EXPLORATION +puntiformes I-EXPLORATION +eritematosas, I-EXPLORATION +con I-EXPLORATION +eritema I-EXPLORATION +difuso I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +piel I-EXPLORATION +xerótica. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +palma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +izquierda I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +glándulas I-EXPLORATION +sudoríparas I-EXPLORATION +y I-EXPLORATION +sebáceas. I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +obtener I-EXPLORATION +el I-EXPLORATION +consentimiento I-EXPLORATION +informado, I-EXPLORATION +obtuvimos I-EXPLORATION +sangre I-EXPLORATION +periférica I-EXPLORATION +para I-EXPLORATION +realizar I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +cariotipo I-EXPLORATION +reportándose I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +vez, I-EXPLORATION +obtuvimos I-EXPLORATION +sangre I-EXPLORATION +no I-EXPLORATION +coagulada I-EXPLORATION +en I-EXPLORATION +tubos I-EXPLORATION +de I-EXPLORATION +EDTA I-EXPLORATION +(ácido I-EXPLORATION +etilendiaminotetraacético) I-EXPLORATION +de I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +miembros I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +siguiendo I-EXPLORATION +los I-EXPLORATION +Principios I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Declaración I-EXPLORATION +de I-EXPLORATION +Helsinki. I-EXPLORATION +Se I-EXPLORATION +extrajo I-EXPLORATION +ADN I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +sanguíneas I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +PUREGENER I-EXPLORATION +(Systema I-EXPLORATION +Gentra). I-EXPLORATION +Para I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mutaciones I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +exones I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +las I-EXPLORATION +secuencias I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +uniones I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +intrones-exones I-EXPLORATION +fueron I-EXPLORATION +amplificados I-EXPLORATION +por I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +(reacción I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +polimerasa) I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +EDA-A1 I-EXPLORATION +en I-EXPLORATION +condiciones I-EXPLORATION +reportadas I-EXPLORATION +previamente. I-EXPLORATION +Las I-EXPLORATION +condiciones I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +amplificación I-EXPLORATION +de I-EXPLORATION +cada I-EXPLORATION +PCR I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +94 I-EXPLORATION +°C I-EXPLORATION +por I-EXPLORATION +2 I-EXPLORATION +minutos, I-EXPLORATION +seguido I-EXPLORATION +por I-EXPLORATION +35 I-EXPLORATION +ciclos I-EXPLORATION +de I-EXPLORATION +94°C I-EXPLORATION +durante I-EXPLORATION +30 I-EXPLORATION +segundos, I-EXPLORATION +55°C I-EXPLORATION +por I-EXPLORATION +30 I-EXPLORATION +segundos I-EXPLORATION +y I-EXPLORATION +72°C I-EXPLORATION +por I-EXPLORATION +30 I-EXPLORATION +segundos I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +extensión I-EXPLORATION +final I-EXPLORATION +a I-EXPLORATION +72°C I-EXPLORATION +durante I-EXPLORATION +7 I-EXPLORATION +minutos. I-EXPLORATION +Los I-EXPLORATION +productos I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +fueron I-EXPLORATION +colocados I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +gel I-EXPLORATION +de I-EXPLORATION +agarosa I-EXPLORATION +al I-EXPLORATION +1% I-EXPLORATION +y I-EXPLORATION +posteriormente I-EXPLORATION +fueron I-EXPLORATION +analizados I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +Secuenciadora I-EXPLORATION +Automática I-EXPLORATION +Directa I-EXPLORATION +ABI I-EXPLORATION +Prism I-EXPLORATION +310, I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +equipo I-EXPLORATION +de I-EXPLORATION +Reacción I-EXPLORATION +"ABI I-EXPLORATION +PRISM® I-EXPLORATION +BigDye™ I-EXPLORATION +Terminator I-EXPLORATION +Cycle I-EXPLORATION +Sequencing' I-EXPLORATION +(PE I-EXPLORATION +Biosystem) I-EXPLORATION +8. I-EXPLORATION + I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +que I-EXPLORATION +comúnmente I-EXPLORATION +la I-EXPLORATION +displasia I-EXPLORATION +ectodérmica I-EXPLORATION +hipohidrótica I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +ligada I-EXPLORATION +a I-EXPLORATION +X, I-EXPLORATION +se I-EXPLORATION +decidió I-EXPLORATION +obtener I-EXPLORATION +ADN I-EXPLORATION +genómico, I-EXPLORATION +logrando I-EXPLORATION +identificar I-EXPLORATION +la I-EXPLORATION +mutación I-EXPLORATION +sinsentido I-EXPLORATION +Ala349Thr I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +EDA, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +la I-EXPLORATION +correlación I-EXPLORATION +clínico-patológica, I-EXPLORATION +concluyendo I-EXPLORATION +así I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +displasia I-EXPLORATION +ectodérmica I-EXPLORATION +hipohidrótica.. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +ictal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +cuantitativo I-PRESENT_ILLNESS +progresivo. I-PRESENT_ILLNESS +Consultó B-EXPLORATION +inicialmente I-EXPLORATION +en I-EXPLORATION +otro I-EXPLORATION +hospital I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +mediante I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +encéfalo I-EXPLORATION +un I-EXPLORATION +hematoma I-EXPLORATION +intraparenquimatoso I-EXPLORATION +parietal I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +42 I-EXPLORATION +ml, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +hidrocefalia I-EXPLORATION +aguda. I-EXPLORATION +En I-EXPLORATION +pabellón I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +urgente, I-EXPLORATION +se I-EXPLORATION +instaló I-EXPLORATION +un I-EXPLORATION +drenaje I-EXPLORATION +ventricular I-EXPLORATION +externo I-EXPLORATION +(DVE). I-EXPLORATION +Se I-EXPLORATION +registróuna I-EXPLORATION +presión I-EXPLORATION +intracraneana I-EXPLORATION +(PIC) I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +H2O. I-EXPLORATION +Se I-EXPLORATION +conectó I-EXPLORATION +a I-EXPLORATION +ventilación I-EXPLORATION +mecánica I-EXPLORATION +(VM) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +indicó I-EXPLORATION +sedación I-EXPLORATION +profunda. I-EXPLORATION +Inicialmente, B-EVOLUTION +la I-EVOLUTION +hipertensión I-EVOLUTION +intracraneana I-EVOLUTION +se I-EVOLUTION +trató I-EVOLUTION +con I-EVOLUTION +drenaje I-EVOLUTION +de I-EVOLUTION +líquido I-EVOLUTION +cefalorraquídeo I-EVOLUTION +y I-EVOLUTION +sodio I-EVOLUTION +hipertónico I-EVOLUTION +intravenoso I-EVOLUTION +en I-EVOLUTION +bolos, I-EVOLUTION +según I-EVOLUTION +necesidad. I-EVOLUTION +Se I-EVOLUTION +trasladó I-EVOLUTION +a I-EVOLUTION +nuestro I-EVOLUTION +servicio I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +más I-EVOLUTION +tarde. I-EVOLUTION + I-EVOLUTION +Ingresó I-EVOLUTION +intubado I-EVOLUTION +y I-EVOLUTION +conectado I-EVOLUTION +a I-EVOLUTION +VM, I-EVOLUTION +sedado I-EVOLUTION +con I-EVOLUTION +propofol I-EVOLUTION +0, I-EVOLUTION +71 I-EVOLUTION +mg/kg/h, I-EVOLUTION +y I-EVOLUTION +hemodinamia I-EVOLUTION +apoyada I-EVOLUTION +con I-EVOLUTION +noradrenalina I-EVOLUTION +a I-EVOLUTION +0, I-EVOLUTION +06 I-EVOLUTION +μg/kg/min, I-EVOLUTION +PIC I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +cm I-EVOLUTION +de I-EVOLUTION +H2O I-EVOLUTION +y I-EVOLUTION +presión I-EVOLUTION +de I-EVOLUTION +perfusión I-EVOLUTION +cerebral I-EVOLUTION +(PPC) I-EVOLUTION +de I-EVOLUTION +80 I-EVOLUTION +mmHg. I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +coma, I-EXPLORATION +con I-EXPLORATION +midriasis I-EXPLORATION +fija I-EXPLORATION +a I-EXPLORATION +derecha, I-EXPLORATION +reflejos I-EXPLORATION +corneales I-EXPLORATION +abolidos, I-EXPLORATION +reflejos I-EXPLORATION +oculocefálicos I-EXPLORATION +esbozados, I-EXPLORATION +tono I-EXPLORATION +y I-EXPLORATION +reflejos I-EXPLORATION +osteotendíneos I-EXPLORATION +disminuidos, I-EXPLORATION +reflejos I-EXPLORATION +plantares I-EXPLORATION +indiferentes I-EXPLORATION +bilaterales. I-EXPLORATION + I-EXPLORATION +Exámenes I-EXPLORATION +generales I-EXPLORATION +de I-EXPLORATION +ingreso: I-EXPLORATION +Na+ I-EXPLORATION +146 I-EXPLORATION +mEq/L, I-EXPLORATION +K+ I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +mEq/L, I-EXPLORATION +hematocrito I-EXPLORATION +31%, I-EXPLORATION +lactato I-EXPLORATION +1, I-EXPLORATION +4 I-EXPLORATION +mmol/L, I-EXPLORATION +leucocitos I-EXPLORATION +9.600 I-EXPLORATION +por I-EXPLORATION +mm3 I-EXPLORATION +y I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +11, I-EXPLORATION +4 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +angiografía I-EXPLORATION +cerebral I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +vasos I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +malformación I-EXPLORATION +arteriovenosa I-EXPLORATION +(MAV) I-EXPLORATION +parietal I-EXPLORATION +mesial I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +rotura I-EXPLORATION +reciente, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +tres I-EXPLORATION +aneurismas I-EXPLORATION +paranidales. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +embolización I-TREATMENT +con I-TREATMENT +N-butil-cianocrilato I-TREATMENT +(Histoacryl®, I-TREATMENT +Braun, I-TREATMENT +Alemania), I-TREATMENT +logrando I-TREATMENT +reducir I-TREATMENT +el I-TREATMENT +nido I-TREATMENT +de I-TREATMENT +la I-TREATMENT +MAV I-TREATMENT +y I-TREATMENT +excluir I-TREATMENT +sus I-TREATMENT +aneurismas. I-TREATMENT +Después I-TREATMENT +del I-TREATMENT +procedimiento, I-TREATMENT +la I-TREATMENT +TC I-TREATMENT +de I-TREATMENT +encéfalo I-TREATMENT +mostró I-TREATMENT +el I-TREATMENT +Histoacryl® I-TREATMENT +correctamente I-TREATMENT +situado. I-TREATMENT +Sin B-EVOLUTION +embargo, I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +un I-EVOLUTION +incremento I-EVOLUTION +del I-EVOLUTION +hematoma I-EVOLUTION +con I-EVOLUTION +acentuado I-EVOLUTION +efecto I-EVOLUTION +de I-EVOLUTION +masa I-EVOLUTION +y I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +edema I-EVOLUTION +cerebral I-EVOLUTION +difuso I-EVOLUTION +con I-EVOLUTION +obliteración I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +surcos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +convexidad, I-EVOLUTION +además I-EVOLUTION +de I-EVOLUTION +herniaciones I-EVOLUTION +subfalcina I-EVOLUTION +y I-EVOLUTION +uncal I-EVOLUTION +con I-EVOLUTION +desviación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +línea I-EVOLUTION +media I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +mm, I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +glándula I-EVOLUTION +pineal. I-EVOLUTION +Se B-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +evacuación I-TREATMENT +del I-TREATMENT +hematoma I-TREATMENT +y I-TREATMENT +una I-TREATMENT +craniectomía I-TREATMENT +descompresiva I-TREATMENT +frontoparietoccipital I-TREATMENT +derecha I-TREATMENT +extensa I-TREATMENT +de I-TREATMENT +10, I-TREATMENT +2 I-TREATMENT +x I-TREATMENT +9, I-TREATMENT +3 I-TREATMENT +cm. I-TREATMENT +La I-TREATMENT +TC I-TREATMENT +de I-TREATMENT +encéfalo I-TREATMENT +de I-TREATMENT +control I-TREATMENT +al I-TREATMENT +día I-TREATMENT +siguiente I-TREATMENT +mostró I-TREATMENT +una I-TREATMENT +reducción I-TREATMENT +del I-TREATMENT +hematoma I-TREATMENT +a I-TREATMENT +11 I-TREATMENT +ml, I-TREATMENT +pero I-TREATMENT +aún I-TREATMENT +se I-TREATMENT +mantenía I-TREATMENT +un I-TREATMENT +importante I-TREATMENT +efecto I-TREATMENT +de I-TREATMENT +masa, I-TREATMENT +con I-TREATMENT +desviación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +línea I-TREATMENT +media I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mm. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +craniectomía I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +PIC I-EVOLUTION +mayores I-EVOLUTION +a I-EVOLUTION +20 I-EVOLUTION +cm I-EVOLUTION +H2O I-EVOLUTION +(23 I-EVOLUTION +± I-EVOLUTION +5 I-EVOLUTION +cm I-EVOLUTION +H2O; I-EVOLUTION +media I-EVOLUTION +± I-EVOLUTION +DS). I-EVOLUTION +Se B-TREATMENT +instauró I-TREATMENT +un I-TREATMENT +manejo I-TREATMENT +médico I-TREATMENT +escalonado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +HEC, I-TREATMENT +con I-TREATMENT +sedación I-TREATMENT +profunda I-TREATMENT +(fentanilo I-TREATMENT +2, I-TREATMENT +86 I-TREATMENT +μg/kg/h, I-TREATMENT +midazolam I-TREATMENT +0, I-TREATMENT +11 I-TREATMENT +mg/kg/h I-TREATMENT +y I-TREATMENT +propofol I-TREATMENT +1, I-TREATMENT +43 I-TREATMENT +mg/kg/h), I-TREATMENT +bloqueo I-TREATMENT +neuromuscular I-TREATMENT +(vecuronio I-TREATMENT +0, I-TREATMENT +09 I-TREATMENT +mg/kg/h), I-TREATMENT +además I-TREATMENT +del I-TREATMENT +uso I-TREATMENT +frecuente I-TREATMENT +de I-TREATMENT +bolos I-TREATMENT +de I-TREATMENT +sodio I-TREATMENT +hipertónico I-TREATMENT +frente I-TREATMENT +a I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +PIC I-TREATMENT +> I-TREATMENT +30 I-TREATMENT +cm I-TREATMENT +H2O. I-TREATMENT +Se B-EVOLUTION +descartó I-EVOLUTION +actividad I-EVOLUTION +epiléptica I-EVOLUTION +no I-EVOLUTION +convulsiva I-EVOLUTION +mediante I-EVOLUTION +un I-EVOLUTION +electroencefalograma I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +TC I-EVOLUTION +de I-EVOLUTION +encéfalo I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +post I-EVOLUTION +craniectomía I-EVOLUTION +no I-EVOLUTION +mostró I-EVOLUTION +cambios I-EVOLUTION +significativos. I-EVOLUTION +Debido B-TREATMENT +a I-TREATMENT +la I-TREATMENT +persistencia I-TREATMENT +de I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +PIC I-TREATMENT +> I-TREATMENT +a I-TREATMENT +20 I-TREATMENT +cm I-TREATMENT +H2O, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +hipotermia I-TREATMENT +terapéutica. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +empleó I-TREATMENT +hipotermia I-TREATMENT +moderada, I-TREATMENT +con I-TREATMENT +temperatura I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +33°C, I-TREATMENT +mediante I-TREATMENT +técnica I-TREATMENT +intravascular I-TREATMENT +(Alsius, I-TREATMENT +Zoll, I-TREATMENT +Chelmsford, I-TREATMENT +Massachusetts, I-TREATMENT +EEUU). I-TREATMENT +Se I-TREATMENT +midió I-TREATMENT +la I-TREATMENT +temperatura I-TREATMENT +central I-TREATMENT +con I-TREATMENT +catéter I-TREATMENT +intravesical. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +conseguida I-TREATMENT +la I-TREATMENT +hipotermia I-TREATMENT +(~12 I-TREATMENT +h I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +HEC I-TREATMENT +refractaria), I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +un I-TREATMENT +rápido I-TREATMENT +control I-TREATMENT +de I-TREATMENT +la I-TREATMENT +PIC I-TREATMENT +con I-TREATMENT +cifras I-TREATMENT +entre I-TREATMENT +9 I-TREATMENT +a I-TREATMENT +12 I-TREATMENT +cm I-TREATMENT +H2O I-TREATMENT +(~3 I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +procedimiento). I-TREATMENT +El I-TREATMENT +bloqueo I-TREATMENT +neuromuscular I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +en I-TREATMENT +infusión I-TREATMENT +continua I-TREATMENT +los I-TREATMENT +primeros I-TREATMENT +dos I-TREATMENT +días I-TREATMENT +de I-TREATMENT +hipotermia, I-TREATMENT +para I-TREATMENT +evitar I-TREATMENT +los I-TREATMENT +calofríos. I-TREATMENT + I-TREATMENT +Luego I-TREATMENT +de I-TREATMENT +48 I-TREATMENT +h I-TREATMENT +en I-TREATMENT +hipotermia, I-TREATMENT +se I-TREATMENT +realizaron I-TREATMENT +intentos I-TREATMENT +programados I-TREATMENT +de I-TREATMENT +recalentamiento I-TREATMENT +a I-TREATMENT +una I-TREATMENT +tasa I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +5°C/h. I-TREATMENT +Sin I-TREATMENT +embargo, I-TREATMENT +todos I-TREATMENT +ellos I-TREATMENT +fueron I-TREATMENT +interrumpidos I-TREATMENT +por I-TREATMENT +rebote I-TREATMENT +de I-TREATMENT +la I-TREATMENT +PIC. I-TREATMENT +A B-EVOLUTION +partir I-EVOLUTION +del I-EVOLUTION +día I-EVOLUTION +20 I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +coincidiendo I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +del I-EVOLUTION +edema I-EVOLUTION +cerebral I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +neuroimágenes, I-EVOLUTION +se I-EVOLUTION +logró I-EVOLUTION +el I-EVOLUTION +control I-EVOLUTION +definitivo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +PIC. I-EVOLUTION +Completó I-EVOLUTION +~13 I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +hipotermia I-EVOLUTION +moderada, I-EVOLUTION +sin I-EVOLUTION +evidenciarse I-EVOLUTION +arritmias, I-EVOLUTION +trastornos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +coagulación I-EVOLUTION +o I-EVOLUTION +electrolíticos. I-EVOLUTION +Presentó B-TREATMENT +una I-TREATMENT +traqueobronquitis I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +ventilación I-TREATMENT +mecánica, I-TREATMENT +resuelta I-TREATMENT +satisfactoriamente I-TREATMENT +con I-TREATMENT +antibioticoterapia. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +suspendió I-TREATMENT +progresivamente I-TREATMENT +la I-TREATMENT +sedación, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +adquirió I-TREATMENT +vigilia I-TREATMENT +y B-EVOLUTION +se I-EVOLUTION +objetivó I-EVOLUTION +una I-EVOLUTION +hemiparesia I-EVOLUTION +leve I-EVOLUTION +con I-EVOLUTION +heminegligencia I-EVOLUTION +y I-EVOLUTION +hemianopsia I-EVOLUTION +homónima I-EVOLUTION +izquierda. I-EVOLUTION +Una I-EVOLUTION +vez I-EVOLUTION +extubado I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +lenguaje I-EVOLUTION +apropiado. I-EVOLUTION +Se B-TREATMENT +inició I-TREATMENT +neurorrehabilitación I-TREATMENT +y B-EVOLUTION +finalmente, I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +40 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización, I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION +Dos I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +se I-EVOLUTION +encuentraen I-EVOLUTION +Rankin I-EVOLUTION +2, I-EVOLUTION +con I-EVOLUTION +hemiparesia I-EVOLUTION +izquierda I-EVOLUTION +espástica I-EVOLUTION +leve I-EVOLUTION +y I-EVOLUTION +completando I-EVOLUTION +sus I-EVOLUTION +estudios I-EVOLUTION +universitarios. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +conocidos. I-PAST_MEDICAL_HISTORY +Presentó B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +odinofagia, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +precordial I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +reposo. I-PRESENT_ILLNESS +Consultó B-EXPLORATION +en I-EXPLORATION +centro I-EXPLORATION +de I-EXPLORATION +atención I-EXPLORATION +primaria I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +solicita I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +destacando I-EXPLORATION +gran I-EXPLORATION +cardiomegalia I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +congestión I-EXPLORATION +pulmonar. I-EXPLORATION +Se B-PAST_MEDICAL_HISTORY +contaba I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +examen I-PAST_MEDICAL_HISTORY +físico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +radiografía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tórax I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +ninguna I-PAST_MEDICAL_HISTORY +alteración. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Fue B-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +atención I-DERIVED_FROM/TO +terciaria I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +cuarto I-DERIVED_FROM/TO +día I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +cuadro. I-DERIVED_FROM/TO +Hemodinamia B-EVOLUTION +siempre I-EVOLUTION +estable. I-EVOLUTION +Se B-EXPLORATION +objetivó I-EXPLORATION +en I-EXPLORATION +electrocardiograma I-EXPLORATION +(ECG) I-EXPLORATION +taquicardia I-EXPLORATION +auricular I-EXPLORATION +intermitente, I-EXPLORATION +tratada I-EXPLORATION +inicialmente I-EXPLORATION +con I-EXPLORATION +amiodarona. I-EXPLORATION + I-EXPLORATION +Ingresó I-EXPLORATION +a I-EXPLORATION +nuestro I-EXPLORATION +servicio I-EXPLORATION +hipotenso I-EXPLORATION +(84/56 I-EXPLORATION +mmHg), I-EXPLORATION +taquicárdico I-EXPLORATION +(116 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +irregular), I-EXPLORATION +afebril, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +de I-EXPLORATION +18 I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +y I-EXPLORATION +saturando I-EXPLORATION +92% I-EXPLORATION +con I-EXPLORATION +oxígeno I-EXPLORATION +ambiental, I-EXPLORATION +bien I-EXPLORATION +perfundido. I-EXPLORATION +La I-EXPLORATION +faringe I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +algo I-EXPLORATION +enrojecida, I-EXPLORATION +yugulares I-EXPLORATION +ingurgitadas. I-EXPLORATION +Sin I-EXPLORATION +congestión I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +examen I-EXPLORATION +cardíaco I-EXPLORATION +demostró I-EXPLORATION +tercer I-EXPLORATION +ruido I-EXPLORATION +y I-EXPLORATION +ritmo I-EXPLORATION +de I-EXPLORATION +galope. I-EXPLORATION +Extremidades I-EXPLORATION +sin I-EXPLORATION +edema. I-EXPLORATION + I-EXPLORATION +De I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaba I-EXPLORATION +discreta I-EXPLORATION +leucocitosis, I-EXPLORATION +PCR I-EXPLORATION +baja, I-EXPLORATION +enzimas I-EXPLORATION +cardíacas I-EXPLORATION +y I-EXPLORATION +troponinas I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +ecocardiograma I-EXPLORATION +realizado I-EXPLORATION +en I-EXPLORATION +nuestra I-EXPLORATION +unidad I-EXPLORATION +mostró I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +(VI) I-EXPLORATION +severamente I-EXPLORATION +dilatado I-EXPLORATION +(82/74 I-EXPLORATION +mm) I-EXPLORATION +con I-EXPLORATION +disfunción I-EXPLORATION +sistólica I-EXPLORATION +global I-EXPLORATION +severa I-EXPLORATION +[fracción I-EXPLORATION +de I-EXPLORATION +eyección I-EXPLORATION +(FE): I-EXPLORATION +20%], I-EXPLORATION +hipokinesia I-EXPLORATION +difusa, I-EXPLORATION +disfunción I-EXPLORATION +diastólica I-EXPLORATION +tipo I-EXPLORATION +III I-EXPLORATION +de I-EXPLORATION +IV. I-EXPLORATION +AI I-EXPLORATION +de I-EXPLORATION +49 I-EXPLORATION +mm, I-EXPLORATION +con I-EXPLORATION +disfunción I-EXPLORATION +sistólica I-EXPLORATION +ventricular I-EXPLORATION +derecha, I-EXPLORATION +leve I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +cavidades I-EXPLORATION +derechas I-EXPLORATION +e I-EXPLORATION +hipertensión I-EXPLORATION +pulmonar I-EXPLORATION +(HTP) I-EXPLORATION +moderada. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +cardiaca I-EXPLORATION +que I-EXPLORATION +concluyó I-EXPLORATION +miocardiopatía I-EXPLORATION +dilatada, I-EXPLORATION +sin I-EXPLORATION +elementos I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +ni I-EXPLORATION +necrosis, I-EXPLORATION +con I-EXPLORATION +disfunción I-EXPLORATION +sistólica I-EXPLORATION +severa. I-EXPLORATION + I-EXPLORATION +Paciente B-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +taquicárdico, I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +en I-EVOLUTION +límite I-EVOLUTION +bajo, I-EVOLUTION +en I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +inhibi I-EVOLUTION +dores I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enzima I-EVOLUTION +convertidora I-EVOLUTION +de I-EVOLUTION +angiotensina I-EVOLUTION +(IECA) I-EVOLUTION +y I-EVOLUTION +betabloqueo I-EVOLUTION +en I-EVOLUTION +dosis I-EVOLUTION +bajas. I-EVOLUTION + I-EVOLUTION +Dentro B-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +solicitado: I-EXPLORATION +función I-EXPLORATION +tiroidea I-EXPLORATION +normal; I-EXPLORATION +VHB I-EXPLORATION +(-), I-EXPLORATION +VHC I-EXPLORATION +(-), I-EXPLORATION +VIH I-EXPLORATION +(-), I-EXPLORATION +citomegalovirus I-EXPLORATION +(-), I-EXPLORATION +Chagas I-EXPLORATION +(-), I-EXPLORATION +IgM I-EXPLORATION +Mycoplasma I-EXPLORATION +pneumoniae I-EXPLORATION +(+) I-EXPLORATION +Se I-EXPLORATION +trato I-EXPLORATION +con I-EXPLORATION +azitromicina I-EXPLORATION +por I-EXPLORATION +5 I-EXPLORATION +días. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +endomiocárdica I-EXPLORATION +que I-EXPLORATION +concluyó I-EXPLORATION +cambios I-EXPLORATION +inespecíficos, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +miocardiopatía I-EXPLORATION +dilatada, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +inflamatoria I-EXPLORATION +activa. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +Holter I-EXPLORATION +de I-EXPLORATION +ECG I-EXPLORATION +evidenció I-EXPLORATION +taquicardia I-EXPLORATION +auricular I-EXPLORATION +incesante I-EXPLORATION +sobre I-EXPLORATION +90% I-EXPLORATION +del I-EXPLORATION +tiempo. I-EXPLORATION +Se I-EXPLORATION +planteo I-EXPLORATION +el I-EXPLORATION +diagnostico I-EXPLORATION +de I-EXPLORATION +taquicardiomiopatía. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amiodarona, I-TREATMENT +bisoprolol I-TREATMENT +y I-TREATMENT +digitálicos I-TREATMENT +no I-TREATMENT +fueron I-TREATMENT +efectivas I-TREATMENT +en I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +taquiarritmia. I-TREATMENT +Se I-TREATMENT +decidió I-TREATMENT +mapeo I-TREATMENT +y I-TREATMENT +ablación I-TREATMENT +de I-TREATMENT +taquicardia I-TREATMENT +auricular I-TREATMENT +incesante I-TREATMENT +usando I-TREATMENT +el I-TREATMENT +sistema I-TREATMENT +EnSite I-TREATMENT +Navx™. I-TREATMENT +Se I-TREATMENT +identificó I-TREATMENT +y I-TREATMENT +realizó I-TREATMENT +ablación I-TREATMENT +a I-TREATMENT +foco I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +superior I-TREATMENT +y I-TREATMENT +vena I-TREATMENT +pulmonar I-TREATMENT +superior I-TREATMENT +derecha, I-TREATMENT +convirtiendo I-TREATMENT +a I-TREATMENT +ritmo I-TREATMENT +sinusal I-TREATMENT +con I-TREATMENT +85 I-TREATMENT +latidos I-TREATMENT +por I-TREATMENT +minuto. I-TREATMENT + I-TREATMENT +Dado B-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +21 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +admisión. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +en I-EVOLUTION +capacidad I-EVOLUTION +funcional I-EVOLUTION +I, I-EVOLUTION +ritmo I-EVOLUTION +sinusal, I-EVOLUTION +con I-EVOLUTION +frecuencia I-EVOLUTION +cardíaca I-EVOLUTION +alrededor I-EVOLUTION +de I-EVOLUTION +70 I-EVOLUTION +latidos I-EVOLUTION +por I-EVOLUTION +minuto, I-EVOLUTION +regular I-EVOLUTION +y I-EVOLUTION +normotenso. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +posterior I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +ablación, I-EVOLUTION +el I-EVOLUTION +ecocardiograma I-EVOLUTION +evidenció I-EVOLUTION +marcada I-EVOLUTION +reducción I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +cámaras I-EVOLUTION +cardiacas I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +sistólica I-EVOLUTION +del I-EVOLUTION +VI I-EVOLUTION +y I-EVOLUTION +mínimo I-EVOLUTION +reflujo I-EVOLUTION +mitral. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +capacidad I-EVOLUTION +funcional I-EVOLUTION +I I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +ecocardiograma I-EVOLUTION +en I-EVOLUTION +límite I-EVOLUTION +normal I-EVOLUTION +con I-EVOLUTION +radiografía I-EVOLUTION +de I-EVOLUTION +tórax I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Escolar B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +residencia I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +IX I-PAST_MEDICAL_HISTORY +región. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +manifestaciones I-PRESENT_ILLNESS +clínicas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +hipertensión I-PRESENT_ILLNESS +intracraneana I-PRESENT_ILLNESS +(cefalea I-PRESENT_ILLNESS +holocránea I-PRESENT_ILLNESS +recurrente I-PRESENT_ILLNESS +[2-3 I-PRESENT_ILLNESS +veces I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +semana], I-PRESENT_ILLNESS +mareos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +ocasionales) I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +irritativa I-PRESENT_ILLNESS +(dos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +convulsivas I-PRESENT_ILLNESS +tónico-clónicas I-PRESENT_ILLNESS +generalizadas). I-PRESENT_ILLNESS +El B-EXPLORATION +electroencefalograma I-EXPLORATION +(EEG) I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +cerebral I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +quiste I-EXPLORATION +intraxial I-EXPLORATION +temporal I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +65 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +bien I-EXPLORATION +delimitado I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +severo I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa, I-EXPLORATION +desviación I-EXPLORATION +de I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +8 I-EXPLORATION +mm, I-EXPLORATION +herniación I-EXPLORATION +uncal I-EXPLORATION +e I-EXPLORATION +hidrocefalia. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +mostró I-EXPLORATION +además I-EXPLORATION +un I-EXPLORATION +doble I-EXPLORATION +contorno I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +periferia, I-EXPLORATION +por I-EXPLORATION +desprendimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +germinal, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +ligera I-EXPLORATION +impregnación I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +gadolinio. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +demostró I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +papila I-EXPLORATION +bilateral, I-EXPLORATION +sin I-EXPLORATION +evidenciarse I-EXPLORATION +déficit I-EXPLORATION +motor I-EXPLORATION +ni I-EXPLORATION +sensitivo I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico. I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +resultaron I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +demostrarse I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +quísticas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +(Rx) I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal. I-EXPLORATION +Se B-TREATMENT +planteó I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +hidatidosis I-TREATMENT +cerebral I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +completa I-TREATMENT +e I-TREATMENT +intacta I-TREATMENT +del I-TREATMENT +quiste, I-TREATMENT +confirmando I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +histopatológico I-TREATMENT +la I-TREATMENT +etiología I-TREATMENT +hidatídica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +asintomático, I-EVOLUTION +sin I-EVOLUTION +déficit I-EVOLUTION +neurológico I-EVOLUTION +ni I-EVOLUTION +complicaciones I-EVOLUTION +post I-EVOLUTION +operatorias. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +19 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +residencia I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +IX I-PAST_MEDICAL_HISTORY +región, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipertensión I-PRESENT_ILLNESS +intracraneana I-PRESENT_ILLNESS +(cefalea I-PRESENT_ILLNESS +recurrente I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +asociada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +vómitos, I-PRESENT_ILLNESS +refractaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +papilar I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +acentuado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +fondo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ojo). I-PRESENT_ILLNESS +La B-EXPLORATION +TC I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +RM I-EXPLORATION +mostraron I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +formación I-EXPLORATION +quística I-EXPLORATION +intraxial I-EXPLORATION +temporal I-EXPLORATION +izquierda, I-EXPLORATION +de I-EXPLORATION +60 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +anteriores I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +moderado I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +adyacente I-EXPLORATION +y I-EXPLORATION +sistema I-EXPLORATION +ventricular, I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +de I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +5, I-EXPLORATION +5 I-EXPLORATION +mm. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +lesiones I-EXPLORATION +quísticas. I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +eosinofilia I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +hidatídico I-EXPLORATION +temporal I-EXPLORATION +izquierdo. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +intacta I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +confirmando I-TREATMENT +el I-TREATMENT +estudio I-TREATMENT +histopatológico I-TREATMENT +la I-TREATMENT +etiología I-TREATMENT +hidatídica. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +sin I-EVOLUTION +déficit I-EVOLUTION +neurológico I-EVOLUTION +ni I-EVOLUTION +complicaciones I-EVOLUTION +post I-EVOLUTION +operatorias. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +hepática I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +alcohol I-PAST_MEDICAL_HISTORY +Child-Pugh I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2004 I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +várices I-PAST_MEDICAL_HISTORY +esofágicas I-PAST_MEDICAL_HISTORY +ligadas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +erradicadas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +2009 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +desorientación, I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +demostrándose I-PRESENT_ILLNESS +anemia I-PRESENT_ILLNESS +severa I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hemoglobina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4, I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +g/dL. I-PRESENT_ILLNESS +Una B-EXPLORATION +primera I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +(EDA) I-EXPLORATION +mostró I-EXPLORATION +EVA I-EXPLORATION +tipo I-EXPLORATION +watermelon I-EXPLORATION +stomach I-EXPLORATION +manejándose B-TREATMENT +con I-TREATMENT +APC I-TREATMENT +y I-TREATMENT +transfusiones I-TREATMENT +de I-TREATMENT +plaquetas, I-TREATMENT +plasma I-TREATMENT +y I-TREATMENT +glóbulos I-TREATMENT +rojos, I-TREATMENT +en I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +cuidados I-TREATMENT +intermedios. I-TREATMENT + I-TREATMENT +Dos B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +reinició I-EVOLUTION +la I-EVOLUTION +disnea, I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +nueva I-EXPLORATION +EDA I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +EVA, I-EXPLORATION +realizándose B-TREATMENT +una I-TREATMENT +nueva I-TREATMENT +sesión I-TREATMENT +de I-TREATMENT +APC. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +3, I-EVOLUTION +5 I-EVOLUTION +y I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +presentó I-EVOLUTION +otros I-EVOLUTION +tres I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +hematemesis, I-EVOLUTION +requiriendo B-TREATMENT +en I-TREATMENT +todos I-TREATMENT +hospitalización, I-TREATMENT +transfusiones I-TREATMENT +y B-EXPLORATION +EDA, I-EXPLORATION +encontrando I-EXPLORATION +siempre I-EXPLORATION +la I-EXPLORATION +EVA I-EXPLORATION +sangrando I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +hicieron I-TREATMENT +3 I-TREATMENT +sesiones I-TREATMENT +más I-TREATMENT +de I-TREATMENT +APC. I-TREATMENT + I-TREATMENT +De B-EXPLORATION +la I-EXPLORATION +última I-EXPLORATION +hospitalización I-EXPLORATION +se I-EXPLORATION +dio I-EXPLORATION +el I-EXPLORATION +alta I-EXPLORATION +programando I-EXPLORATION +un I-EXPLORATION +control I-EXPLORATION +endoscópico I-EXPLORATION +ambulatorio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +un I-EXPLORATION +estómago I-EXPLORATION +con I-EXPLORATION +sangre I-EXPLORATION +fresca I-EXPLORATION +y I-EXPLORATION +EVA, I-EXPLORATION +realizando B-TREATMENT +ligadura I-TREATMENT +endoscópica I-TREATMENT +con I-TREATMENT +8 I-TREATMENT +bandas. I-TREATMENT + I-TREATMENT +Un B-EXPLORATION +mes I-EXPLORATION +despuês I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +EDA I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +franca I-EXPLORATION +reducción I-EXPLORATION +del I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +watermelon I-EXPLORATION +stomach, I-EXPLORATION +realizando B-TREATMENT +nuevas I-TREATMENT +ligaduras I-TREATMENT +al I-TREATMENT +antro. I-TREATMENT + I-TREATMENT + +Los B-PRESENT_ILLNESS +casos I-PRESENT_ILLNESS +fueron I-PRESENT_ILLNESS +recolectados I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +retrospectiva I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presentan I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Tabla1; I-PRESENT_ILLNESS +sólo I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +detalla I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último. I-PRESENT_ILLNESS +Eran I-PRESENT_ILLNESS +hombres I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +media, I-PRESENT_ILLNESS +4/5 I-PRESENT_ILLNESS +heterosexuales, I-PRESENT_ILLNESS +todos I-PRESENT_ILLNESS +VIH I-PRESENT_ILLNESS +negativos. I-PRESENT_ILLNESS +Presentaron I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +subagudo; I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +casos I-PRESENT_ILLNESS +destacó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +apatía, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ánimo I-PRESENT_ILLNESS +subido. I-PRESENT_ILLNESS +Todos I-PRESENT_ILLNESS +tenían I-PRESENT_ILLNESS +amnesias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Korsakoff. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +existían I-PRESENT_ILLNESS +signos I-PRESENT_ILLNESS +piramidales I-PRESENT_ILLNESS +discretos; I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +retención I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +orina, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +uno I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ellos I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +ataxia. I-PRESENT_ILLNESS +Cuando I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +aplicaron I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +pruebas I-PRESENT_ILLNESS +Minimental I-PRESENT_ILLNESS +test I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Folstein I-PRESENT_ILLNESS +(MM), I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +mide I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +eficiencia I-PRESENT_ILLNESS +cognitiva I-PRESENT_ILLNESS +global, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Frontal I-PRESENT_ILLNESS +Assessment I-PRESENT_ILLNESS +Battery I-PRESENT_ILLNESS +(FAB), I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +evalúa I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +funciones I-PRESENT_ILLNESS +frontales, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esta I-PRESENT_ILLNESS +confirmó I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +disejecutivo. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +existía I-PRESENT_ILLNESS +laconismo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +afasia. I-PRESENT_ILLNESS +Dos I-PRESENT_ILLNESS +casos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +isquemia I-PRESENT_ILLNESS +cerebral I-PRESENT_ILLNESS +tenían I-PRESENT_ILLNESS +factores I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +riesgo I-PRESENT_ILLNESS +vascular. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-EXPLORATION +líquido I-EXPLORATION +cefaloraquídeo I-EXPLORATION +(LCR) I-EXPLORATION +fue I-EXPLORATION +siempre I-EXPLORATION +inflamatorio I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +VDRL I-EXPLORATION +reactivo; I-EXPLORATION +en I-EXPLORATION +uno I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +El I-EXPLORATION +electroencefalograma I-EXPLORATION +(EEG) I-EXPLORATION +estuvo I-EXPLORATION +alterado I-EXPLORATION +en I-EXPLORATION +3/3 I-EXPLORATION +casos; I-EXPLORATION +en I-EXPLORATION +cambio I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +estructurales I-EXPLORATION +no I-EXPLORATION +siempre I-EXPLORATION +fueron I-EXPLORATION +anormales. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +caso I-EXPLORATION +T I-EXPLORATION +una I-EXPLORATION +angiografía I-EXPLORATION +(indicada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +infarto I-EXPLORATION +cerebral I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +hombre I-EXPLORATION +joven I-EXPLORATION +con I-EXPLORATION +VDRL I-EXPLORATION +no I-EXPLORATION +reactivo I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +antes I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +LCR) I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +vasculitis. I-EXPLORATION +Todos B-TREATMENT +recibieron I-TREATMENT +altas I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +penicilina I-TREATMENT +sódica I-TREATMENT +ev, I-TREATMENT +pero B-EVOLUTION +la I-EVOLUTION +mejoría I-EVOLUTION +fue I-EVOLUTION +parcial I-EVOLUTION +y I-EVOLUTION +quedaron I-EVOLUTION +con I-EVOLUTION +secuelas I-EVOLUTION +cognitivas. I-EVOLUTION + I-EVOLUTION +W B-PRESENT_ILLNESS +tenía I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +era B-PAST_MEDICAL_HISTORY +supervisor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ventas, I-PAST_MEDICAL_HISTORY +soltero; I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia I-PAST_MEDICAL_HISTORY +salvo I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +promiscuo; I-PAST_MEDICAL_HISTORY +fumaba I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bebía I-PAST_MEDICAL_HISTORY +poco, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +consumía I-PAST_MEDICAL_HISTORY +drogas. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +2° I-PRESENT_ILLNESS +semestre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2008 I-PRESENT_ILLNESS +aparecieron I-PRESENT_ILLNESS +tendencia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +aislarse, I-PRESENT_ILLNESS +olvidos, I-PRESENT_ILLNESS +insomnio, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +libido, I-PRESENT_ILLNESS +disartria, I-PRESENT_ILLNESS +cefaleas. I-PRESENT_ILLNESS +Existía I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mezcla I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +labilidad I-PRESENT_ILLNESS +emocional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +apatía. I-PRESENT_ILLNESS +Perdió I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +trabajo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +abril I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2009. I-PRESENT_ILLNESS +En B-DERIVED_FROM/TO +mayo I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +psiquiatra I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +neurólogo, I-DERIVED_FROM/TO +quien I-DERIVED_FROM/TO +pidió I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +batería I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +exámenes, I-DERIVED_FROM/TO +entre I-DERIVED_FROM/TO +ellos I-DERIVED_FROM/TO +VDRL I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +sangre I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +reactivo. I-DERIVED_FROM/TO +El B-EXPLORATION +examen I-EXPLORATION +general I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +mostraba I-EXPLORATION +alerta I-EXPLORATION +y I-EXPLORATION +colaboraba I-EXPLORATION +al I-EXPLORATION +examen; I-EXPLORATION +destacaban I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +frontal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +afasia I-EXPLORATION +no I-EXPLORATION +fluente I-EXPLORATION +mixta. I-EXPLORATION +Existían I-EXPLORATION +nistagmo I-EXPLORATION +en I-EXPLORATION +miradas I-EXPLORATION +extremas, I-EXPLORATION +paramimesis, I-EXPLORATION +enganche I-EXPLORATION +digital, I-EXPLORATION +tics I-EXPLORATION +de I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +hombros. I-EXPLORATION +Una I-EXPLORATION +discreta I-EXPLORATION +ataxia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +marcha, I-EXPLORATION +arreflexia I-EXPLORATION +tendinosa I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +retención I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +configuraban I-EXPLORATION +una I-EXPLORATION +tabes I-EXPLORATION +dorsal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +síndrome I-EXPLORATION +frontal I-EXPLORATION +se I-EXPLORATION +expresaba I-EXPLORATION +en I-EXPLORATION +apatía, I-EXPLORATION +abulia I-EXPLORATION +y I-EXPLORATION +conducta I-EXPLORATION +de I-EXPLORATION +imitación. I-EXPLORATION +Fue I-EXPLORATION +incapaz I-EXPLORATION +de I-EXPLORATION +comprender I-EXPLORATION +escenas I-EXPLORATION +complejas I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +interpretar I-EXPLORATION +proverbios; I-EXPLORATION +perseveraba I-EXPLORATION +con I-EXPLORATION +frecuencia. I-EXPLORATION +Tenía I-EXPLORATION +defectos I-EXPLORATION +atencionales I-EXPLORATION +(cálculo, I-EXPLORATION +retención I-EXPLORATION +de I-EXPLORATION +cifras, I-EXPLORATION +inversión I-EXPLORATION +de I-EXPLORATION +series I-EXPLORATION +automáticas) I-EXPLORATION +y I-EXPLORATION +existía I-EXPLORATION +una I-EXPLORATION +afasia I-EXPLORATION +no I-EXPLORATION +fluente I-EXPLORATION +mixta. I-EXPLORATION +En I-EXPLORATION +MM I-EXPLORATION +obtuvo I-EXPLORATION +9/30 I-EXPLORATION +puntos, I-EXPLORATION +en I-EXPLORATION +FAB I-EXPLORATION +3/18 I-EXPLORATION +puntos; I-EXPLORATION +fue I-EXPLORATION +incapaz I-EXPLORATION +de I-EXPLORATION +abstraer. I-EXPLORATION +Rindió I-EXPLORATION +mejor I-EXPLORATION +en I-EXPLORATION +Matrices I-EXPLORATION +Progresivas I-EXPLORATION +Coloreadas I-EXPLORATION +(MPC, I-EXPLORATION +25/36 I-EXPLORATION +puntos) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +asociación I-EXPLORATION +semántica I-EXPLORATION +del I-EXPLORATION +4° I-EXPLORATION +excluido I-EXPLORATION +(acertó I-EXPLORATION +en I-EXPLORATION +7/8 I-EXPLORATION +ensayos). I-EXPLORATION +No I-EXPLORATION +existían I-EXPLORATION +agnosias I-EXPLORATION +visuales I-EXPLORATION +ni I-EXPLORATION +espaciales, I-EXPLORATION +apraxia I-EXPLORATION +constructiva, I-EXPLORATION +ideatoria, I-EXPLORATION +ideomotora I-EXPLORATION +ni I-EXPLORATION +del I-EXPLORATION +vestir. I-EXPLORATION +Tampoco I-EXPLORATION +tenía I-EXPLORATION +agnosia I-EXPLORATION +digital I-EXPLORATION +ni I-EXPLORATION +desorientación I-EXPLORATION +derecha-izquierda. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +LCR I-EXPLORATION +mostró I-EXPLORATION +pleocitosis I-EXPLORATION +(130 I-EXPLORATION +mononuclea-res, I-EXPLORATION +88% I-EXPLORATION +de I-EXPLORATION +linfocitos, I-EXPLORATION +10% I-EXPLORATION +de I-EXPLORATION +polinucleares I-EXPLORATION +y I-EXPLORATION +2% I-EXPLORATION +de I-EXPLORATION +monocitos), I-EXPLORATION +glucosa I-EXPLORATION +21 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +proteínas I-EXPLORATION +180 I-EXPLORATION +mg/dL. I-EXPLORATION +El I-EXPLORATION +VRDL I-EXPLORATION +fue I-EXPLORATION +reactivo I-EXPLORATION +1/128. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +cerebral I-EXPLORATION +mostró I-EXPLORATION +atrofia I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +frontotemporal I-EXPLORATION +izquierdo, I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +EEG I-EXPLORATION +actividad I-EXPLORATION +irritativa I-EXPLORATION +y I-EXPLORATION +lenta I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +zona. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +fue I-EXPLORATION +negativa, I-EXPLORATION +y I-EXPLORATION +otros I-EXPLORATION +exámenes I-EXPLORATION +humorales I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +(función I-EXPLORATION +hepática, I-EXPLORATION +coagulación, I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +VHS, I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +vitamina I-EXPLORATION +B12, I-EXPLORATION +Na, I-EXPLORATION +K I-EXPLORATION +y I-EXPLORATION +Cl, I-EXPLORATION +perfil I-EXPLORATION +bioquímico, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva, I-EXPLORATION +PCR I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +herpes I-EXPLORATION +simple I-EXPLORATION +en I-EXPLORATION +LCR). I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +sódica I-TREATMENT +4.000.000 I-TREATMENT +ui I-TREATMENT +ev I-TREATMENT +c/4 I-TREATMENT +horas I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días, I-TREATMENT +betametasona I-TREATMENT +4 I-TREATMENT +mg I-TREATMENT +ev I-TREATMENT +c/8 I-TREATMENT +horas I-TREATMENT +por I-TREATMENT +3 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +fenitoina I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +c/8 I-TREATMENT +horas. I-TREATMENT +El B-EVOLUTION +tratamiento I-EVOLUTION +fue I-EVOLUTION +bien I-EVOLUTION +tolerado I-EVOLUTION +y I-EVOLUTION +parcialmente I-EVOLUTION +eficaz. I-EVOLUTION +A B-EXPLORATION +comienzos I-EXPLORATION +de I-EXPLORATION +2010 I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +básico I-EXPLORATION +era I-EXPLORATION +normal, I-EXPLORATION +en I-EXPLORATION +MM I-EXPLORATION +obtuvo I-EXPLORATION +28/30 I-EXPLORATION +puntos, I-EXPLORATION +en I-EXPLORATION +MPC I-EXPLORATION +31/36, I-EXPLORATION +en I-EXPLORATION +FAB I-EXPLORATION +13/18. I-EXPLORATION +Persistía I-EXPLORATION +un I-EXPLORATION +síndrome I-EXPLORATION +frontal, I-EXPLORATION +con I-EXPLORATION +actitud I-EXPLORATION +pueril, I-EXPLORATION +fallas I-EXPLORATION +de I-EXPLORATION +juicio I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +coherencia I-EXPLORATION +del I-EXPLORATION +discurso. I-EXPLORATION +El I-EXPLORATION +LCR I-EXPLORATION +era I-EXPLORATION +normal, I-EXPLORATION +con I-EXPLORATION +serología I-EXPLORATION +reactiva I-EXPLORATION +a I-EXPLORATION +1/32, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +unido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +crisis I-EXPLORATION +convulsivas I-EXPLORATION +llevó B-TREATMENT +a I-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +penicilina, I-TREATMENT +de I-TREATMENT +21 I-TREATMENT +días, I-TREATMENT +y I-TREATMENT +a I-TREATMENT +indicar I-TREATMENT +ácido I-TREATMENT +valproico I-TREATMENT +en I-TREATMENT +vez I-TREATMENT +de I-TREATMENT +fenitoína. I-TREATMENT +Fue B-EVOLUTION +jubilado I-EVOLUTION +por I-EVOLUTION +invalidez I-EVOLUTION +y I-EVOLUTION +vive I-EVOLUTION +con I-EVOLUTION +sus I-EVOLUTION +padres. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Brasil, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dermatitis I-PAST_MEDICAL_HISTORY +seborreica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +lupus I-PAST_MEDICAL_HISTORY +cutáneo I-PAST_MEDICAL_HISTORY +subagudo, I-PAST_MEDICAL_HISTORY +fue B-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +desarrollo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +cutáneo I-DERIVED_FROM/TO +abrupto I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +semana I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +localizado I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +región I-DERIVED_FROM/TO +centrofacial I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +torácica I-DERIVED_FROM/TO +anterior. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +aplicado I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +corticoide I-PRESENT_ILLNESS +tópico I-PRESENT_ILLNESS +(mometasona I-PRESENT_ILLNESS +furoato I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +1%) I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +veces I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +intentar I-PRESENT_ILLNESS +controlar I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +lesiones. I-PRESENT_ILLNESS +Reseñaba B-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +pustulosas I-PAST_MEDICAL_HISTORY +aisladas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cara I-PAST_MEDICAL_HISTORY +ocasionales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enrojecimiento I-PAST_MEDICAL_HISTORY +facial I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +calor I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alcohol. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Clínicamente B-EXPLORATION +mostraba, I-EXPLORATION +eritema I-EXPLORATION +facial I-EXPLORATION +y I-EXPLORATION +lesiones I-EXPLORATION +pápulo-pustulosas I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +frente, I-EXPLORATION +mejillas, I-EXPLORATION +región I-EXPLORATION +perioral I-EXPLORATION +y I-EXPLORATION +tórax. I-EXPLORATION +Además I-EXPLORATION +presentaba I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +comedones I-EXPLORATION +y I-EXPLORATION +padecía I-EXPLORATION +afectación I-EXPLORATION +ocular I-EXPLORATION +con I-EXPLORATION +inyección I-EXPLORATION +conjuntival I-EXPLORATION +acompañado I-EXPLORATION +de I-EXPLORATION +fotofobia I-EXPLORATION +y I-EXPLORATION +lagrimeo. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +fiebre I-EXPLORATION +ni I-EXPLORATION +otra I-EXPLORATION +clínica I-EXPLORATION +sistémica. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +con I-EXPLORATION +bioquímica I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +hemograma I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +juicio I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +rosácea I-TREATMENT +fulminans I-TREATMENT +con I-TREATMENT +afectación I-TREATMENT +ocular I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +40 I-TREATMENT +mg/día, I-TREATMENT +metronidazol I-TREATMENT +500 I-TREATMENT +mg/12 I-TREATMENT +horas, I-TREATMENT +isotretinoína I-TREATMENT +50 I-TREATMENT +mg/día I-TREATMENT +(0, I-TREATMENT +7 I-TREATMENT +mg/kg/día), I-TREATMENT +y I-TREATMENT +lágrimas I-TREATMENT +artificiales. I-TREATMENT +El I-TREATMENT +metronidazol I-TREATMENT +y I-TREATMENT +la I-TREATMENT +prednisona I-TREATMENT +se I-TREATMENT +suspendieron I-TREATMENT +tras I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +(la I-TREATMENT +última I-TREATMENT +en I-TREATMENT +pauta I-TREATMENT +descendente). I-TREATMENT +Por I-TREATMENT +último, I-TREATMENT +la I-TREATMENT +isotretinoína I-TREATMENT +oral I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +tras I-TREATMENT +tres I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +realizando I-TREATMENT +descenso I-TREATMENT +progresivo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +dosis. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +importante I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +desaparición I-EVOLUTION +completa I-EVOLUTION +tras I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +recaídas I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +posteriores I-EVOLUTION +seis I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcoholismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +policonsumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +drogas, I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ánimo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2005. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Infectología I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +febrero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2011 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +tumores I-PRESENT_ILLNESS +eritemato-violáceos I-PRESENT_ILLNESS +dolorosos, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crecimiento I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +asociados I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna, I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diarrea. I-PRESENT_ILLNESS +Por B-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +inicialmente I-EXPLORATION +sarcoma I-EXPLORATION +de I-EXPLORATION +Kaposi I-EXPLORATION +(SK) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +ELISA I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +y I-EXPLORATION +confirmado I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +de I-EXPLORATION +Chile. I-EXPLORATION + I-EXPLORATION +Dada B-TREATMENT +la I-TREATMENT +extensión I-TREATMENT +de I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas I-TREATMENT +y I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +fiebre I-TREATMENT +se I-TREATMENT +hospitalizó I-TREATMENT +para I-TREATMENT +mayor I-TREATMENT +estudio. I-TREATMENT +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +en I-EXPLORATION +regulares I-EXPLORATION +condiciones I-EXPLORATION +generales, I-EXPLORATION +hipotenso, I-EXPLORATION +febril, I-EXPLORATION +enflaquecido I-EXPLORATION +(índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +17), I-EXPLORATION +con I-EXPLORATION +adenopatías I-EXPLORATION +inguinales I-EXPLORATION +induradas, I-EXPLORATION +indoloras I-EXPLORATION +y I-EXPLORATION +poco I-EXPLORATION +móviles. I-EXPLORATION +Presentaba I-EXPLORATION +tumores I-EXPLORATION +eritemato-violáceos I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +supraciliar I-EXPLORATION +derecho, I-EXPLORATION +en I-EXPLORATION +mentón I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +pierna I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +cara, I-EXPLORATION +paladar, I-EXPLORATION +tronco I-EXPLORATION +y I-EXPLORATION +extremidades I-EXPLORATION +presentaba I-EXPLORATION +múltiples I-EXPLORATION +pápulas I-EXPLORATION +erite-matosas I-EXPLORATION +brillantes I-EXPLORATION +y I-EXPLORATION +nódulos I-EXPLORATION +dolorosos I-EXPLORATION +subcutáneos I-EXPLORATION +sin I-EXPLORATION +cambios I-EXPLORATION +de I-EXPLORATION +coloración. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +pesquisó I-EXPLORATION +visceromegalia. I-EXPLORATION +De I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +generales I-EXPLORATION +destacaba: I-EXPLORATION +hematocrito I-EXPLORATION +28, I-EXPLORATION +3%; I-EXPLORATION +leucocitos I-EXPLORATION +6.200 I-EXPLORATION +céls/mm3, I-EXPLORATION +sin I-EXPLORATION +desviación I-EXPLORATION +izquierda; I-EXPLORATION +VHS I-EXPLORATION +100 I-EXPLORATION +mm/h; I-EXPLORATION +PCR I-EXPLORATION +9, I-EXPLORATION +1 I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +1); I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +normal; I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +normales, I-EXPLORATION +excepto I-EXPLORATION +por I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +elevada I-EXPLORATION +(211 I-EXPLORATION +U/L); I-EXPLORATION +albúmina I-EXPLORATION +3 I-EXPLORATION +g/dl; I-EXPLORATION +LDH I-EXPLORATION +159 I-EXPLORATION +U/L. I-EXPLORATION +Del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +patología I-EXPLORATION +de I-EXPLORATION +base I-EXPLORATION +tenía I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +para I-EXPLORATION +VIH I-EXPLORATION +de I-EXPLORATION +875.000 I-EXPLORATION +copias I-EXPLORATION +ARN I-EXPLORATION +viral/ml I-EXPLORATION +y I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +CD4 I-EXPLORATION +de I-EXPLORATION +87, I-EXPLORATION +6 I-EXPLORATION +céls/ I-EXPLORATION +mm3. I-EXPLORATION +Los I-EXPLORATION +hemocultivos, I-EXPLORATION +urocultivos, I-EXPLORATION +RPR, I-EXPLORATION +PPD I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +IgG I-EXPLORATION +para I-EXPLORATION +toxoplasma I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +reevaluar I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico I-EXPLORATION +se I-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +AB. I-EXPLORATION +Al B-PAST_MEDICAL_HISTORY +preguntar I-PAST_MEDICAL_HISTORY +dirigidamente I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +viajes I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +extranjero: I-PAST_MEDICAL_HISTORY +Bolivia I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +Perú I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +México I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Además I-PAST_MEDICAL_HISTORY +vivió I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +casa I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +gatos, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +rasguñaban I-PAST_MEDICAL_HISTORY +ocasionalmente. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +solicitó I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +Bartonella I-EXPLORATION +henselae I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativa. I-EXPLORATION +La I-EXPLORATION +nasofibroscopia I-EXPLORATION +informó I-EXPLORATION +lesiones I-EXPLORATION +angiomatosas I-EXPLORATION +en I-EXPLORATION +fosas I-EXPLORATION +nasales, I-EXPLORATION +rinofaringe I-EXPLORATION +y I-EXPLORATION +laringe. I-EXPLORATION +La I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +no I-EXPLORATION +detectó I-EXPLORATION +lesiones. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +mostró I-EXPLORATION +hígado I-EXPLORATION +normal, I-EXPLORATION +leve I-EXPLORATION +esplenomegalia, I-EXPLORATION +adenopatías I-EXPLORATION +inguinales I-EXPLORATION +izquierdas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +secundario I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +musculatura I-EXPLORATION +paravertebral I-EXPLORATION +lumbar. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +Doppler I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores I-EXPLORATION +mostró I-EXPLORATION +nódulos I-EXPLORATION +hipervascularizados I-EXPLORATION +inespecíficos I-EXPLORATION +en I-EXPLORATION +dermis, I-EXPLORATION +tejido I-EXPLORATION +subcutáneo I-EXPLORATION +y I-EXPLORATION +plano I-EXPLORATION +muscular. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +cutáneas I-EXPLORATION +mostró I-EXPLORATION +orto-queratosis, I-EXPLORATION +hipogranulosis, I-EXPLORATION +atrofia I-EXPLORATION +epidérmica, I-EXPLORATION +exocitosis I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +e I-EXPLORATION +hiperpigmentación I-EXPLORATION +basal; I-EXPLORATION +dermis I-EXPLORATION +reticular I-EXPLORATION +con I-EXPLORATION +proliferación I-EXPLORATION +vascular, I-EXPLORATION +nodular, I-EXPLORATION +multifocal, I-EXPLORATION +compuesta I-EXPLORATION +por I-EXPLORATION +vasos I-EXPLORATION +capilares I-EXPLORATION +pequeños, I-EXPLORATION +endotelio I-EXPLORATION +prominente, I-EXPLORATION +con I-EXPLORATION +extravasación I-EXPLORATION +de I-EXPLORATION +eritrocitos I-EXPLORATION +e I-EXPLORATION +infiltrado I-EXPLORATION +leve I-EXPLORATION +disperso I-EXPLORATION +de I-EXPLORATION +linfocitos, I-EXPLORATION +neutrófilos I-EXPLORATION +y I-EXPLORATION +eritrocitos. I-EXPLORATION +Además, I-EXPLORATION +había I-EXPLORATION +acúmulos I-EXPLORATION +eosinófilos, I-EXPLORATION +extracelulares, I-EXPLORATION +granulares, I-EXPLORATION +multifocales. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Warthin-Starry I-EXPLORATION +mostró I-EXPLORATION +numerosos I-EXPLORATION +bacilos, I-EXPLORATION +siendo I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +AB. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +envió I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +al I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +microbiología I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +Católica I-EXPLORATION +para I-EXPLORATION +realizar I-EXPLORATION +PCR I-EXPLORATION +universal I-EXPLORATION +con I-EXPLORATION +amplificación I-EXPLORATION +y I-EXPLORATION +secuenciación I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +que I-EXPLORATION +codifica I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +subu-nidad I-EXPLORATION +ribosomal I-EXPLORATION +16S. I-EXPLORATION +La I-EXPLORATION +extracción I-EXPLORATION +del I-EXPLORATION +ADN I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +subcutáneo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +utilizando I-EXPLORATION +un I-EXPLORATION +método I-EXPLORATION +comercial I-EXPLORATION +(QIAamp I-EXPLORATION +Tissue I-EXPLORATION +kit, I-EXPLORATION +Qiagen®), I-EXPLORATION +según I-EXPLORATION +las I-EXPLORATION +recomendaciones I-EXPLORATION +del I-EXPLORATION +fabricante. I-EXPLORATION +La I-EXPLORATION +amplificación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +que I-EXPLORATION +codifica I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +16S I-EXPLORATION +ARNr I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +con I-EXPLORATION +partidores I-EXPLORATION +universales. I-EXPLORATION +Posteriormente, I-EXPLORATION +se I-EXPLORATION +secuenció I-EXPLORATION +el I-EXPLORATION +producto I-EXPLORATION +amplificado I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +evaluó I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +analizador I-EXPLORATION +genético I-EXPLORATION +ABI-310 I-EXPLORATION +(Applied-Biosystems, I-EXPLORATION +Foster I-EXPLORATION +City, I-EXPLORATION +CA). I-EXPLORATION +Para I-EXPLORATION +la I-EXPLORATION +comparación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +nucleotídica I-EXPLORATION +obtenida I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +secuencias I-EXPLORATION +depositadas I-EXPLORATION +en I-EXPLORATION +banco I-EXPLORATION +de I-EXPLORATION +genes I-EXPLORATION +Genebank, I-EXPLORATION +se I-EXPLORATION +utilizó I-EXPLORATION +al I-EXPLORATION +programa I-EXPLORATION +BLAST. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +homología I-EXPLORATION +de I-EXPLORATION +100% I-EXPLORATION +sobre I-EXPLORATION +421 I-EXPLORATION +pares I-EXPLORATION +de I-EXPLORATION +bases I-EXPLORATION +depositadas I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +especie I-EXPLORATION +B. I-EXPLORATION +quintana I-EXPLORATION +cepa I-EXPLORATION +Toulouse. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antiretroviral I-TREATMENT +para I-TREATMENT +el I-TREATMENT +VIH I-TREATMENT +y I-TREATMENT +profilaxis I-TREATMENT +para I-TREATMENT +Pneumocystis I-TREATMENT +jiroveci. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +AB I-TREATMENT +con I-TREATMENT +Azitromicina I-TREATMENT +500 I-TREATMENT +mg/ I-TREATMENT +día I-TREATMENT +vo I-TREATMENT +y I-TREATMENT +Ciprofloxacino I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +c/12 I-TREATMENT +h I-TREATMENT +vo. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente, I-EVOLUTION +con I-EVOLUTION +regresión I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +síntomas I-EVOLUTION +sistémicos I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +cutáneas I-EVOLUTION +en I-EVOLUTION +pocos I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +detenido I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +flegmón I-PAST_MEDICAL_HISTORY +apendicular I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Dos B-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +consultar I-PRESENT_ILLNESS +inició I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +difuso, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +predominio I-PRESENT_ILLNESS +vespertino, I-PRESENT_ILLNESS +postprandiales I-PRESENT_ILLNESS +mediatos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +kilos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +período. I-PRESENT_ILLNESS +La B-EXPLORATION +endoscopía I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +mostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +pliegues I-EXPLORATION +gástricos I-EXPLORATION +prominentes I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +difusa, I-EXPLORATION +lesiones I-EXPLORATION +solevantadas I-EXPLORATION +sésiles I-EXPLORATION +con I-EXPLORATION +ulceración I-EXPLORATION +central I-EXPLORATION +de I-EXPLORATION +fondo I-EXPLORATION +rojo I-EXPLORATION +y I-EXPLORATION +lesiones I-EXPLORATION +ulceradas I-EXPLORATION +duodenales, I-EXPLORATION +con I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +ureasa I-EXPLORATION +positivo. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +biopsias I-EXPLORATION +informadas I-EXPLORATION +como I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +inespecífica I-EXPLORATION +y I-EXPLORATION +duodenitis. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostró: I-EXPLORATION +GOT I-EXPLORATION +50 I-EXPLORATION +UI/L, I-EXPLORATION +GPT I-EXPLORATION +56 I-EXPLORATION +UI/L, I-EXPLORATION +GGT I-EXPLORATION +85 I-EXPLORATION +UI/L, I-EXPLORATION +FA I-EXPLORATION +81 I-EXPLORATION +UI/L, I-EXPLORATION +hematocrito I-EXPLORATION +55%, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +100%, I-EXPLORATION +creatininemia I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +g/dL, I-EXPLORATION +calcio I-EXPLORATION +total I-EXPLORATION +7, I-EXPLORATION +8 I-EXPLORATION +mg/ I-EXPLORATION +dL, I-EXPLORATION +proteinemia I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +g/dL, I-EXPLORATION +albuminemia I-EXPLORATION +2, I-EXPLORATION +3 I-EXPLORATION +g/dL I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +229 I-EXPLORATION +UI/ml. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +esteatosis I-EXPLORATION +hepática. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +erradicación I-TREATMENT +para I-TREATMENT +Helicobacter I-TREATMENT +pylori I-TREATMENT +durante I-TREATMENT +14 I-TREATMENT +días, I-TREATMENT +observándose B-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +vómitos, I-EVOLUTION +con I-EVOLUTION +intolerancia I-EVOLUTION +a I-EVOLUTION +alimentación I-EVOLUTION +oral, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +hospitalizar I-EVOLUTION +para I-EVOLUTION +manejo I-EVOLUTION +nutricional I-EVOLUTION +y I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +macrobiopsias I-EVOLUTION +gástricas. I-EVOLUTION + I-EVOLUTION +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +Gastroenterología I-EXPLORATION +de I-EXPLORATION +nuestro I-EXPLORATION +Hospital I-EXPLORATION +destacaba I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +hemodinamia I-EXPLORATION +estable, I-EXPLORATION +afebril, I-EXPLORATION +mesomorfo, I-EXPLORATION +sin I-EXPLORATION +edema, I-EXPLORATION +ni I-EXPLORATION +palidez. I-EXPLORATION +Sin I-EXPLORATION +signos I-EXPLORATION +carenciales I-EXPLORATION +en I-EXPLORATION +piel, I-EXPLORATION +mucosas I-EXPLORATION +ni I-EXPLORATION +fanéreos. I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +confirmaron I-EXPLORATION +proteínas I-EXPLORATION +totales I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +g/dL, I-EXPLORATION +albuminemia I-EXPLORATION +1, I-EXPLORATION +9 I-EXPLORATION +g/dL, I-EXPLORATION +proteinuria I-EXPLORATION +negativa I-EXPLORATION +y I-EXPLORATION +hemograma I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Evolución I-EXPLORATION +y I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +posteriores I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +efectúa I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +abdomen-pelvis I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +pliegues I-EXPLORATION +gástricos I-EXPLORATION +prominentes, I-EXPLORATION +enteroclisis I-EXPLORATION +por I-EXPLORATION +TAC I-EXPLORATION +informó I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +lesiones I-EXPLORATION +radiológicas I-EXPLORATION +en I-EXPLORATION +intestino I-EXPLORATION +delgado. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +endoscopía I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +pliegues I-EXPLORATION +gástricos I-EXPLORATION +difusamente I-EXPLORATION +engrosados, I-EXPLORATION +algunos I-EXPLORATION +erosionados, I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +ureasa I-EXPLORATION +negativo. I-EXPLORATION +Las I-EXPLORATION +biopsias I-EXPLORATION +fueron I-EXPLORATION +informadas I-EXPLORATION +como I-EXPLORATION +mucosa I-EXPLORATION +gástrica I-EXPLORATION +con I-EXPLORATION +hiperplasia I-EXPLORATION +foveolar I-EXPLORATION +difusa, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +atrofia I-EXPLORATION +glandular I-EXPLORATION +con I-EXPLORATION +dilataciones I-EXPLORATION +quísticas I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +mucinosas. I-EXPLORATION +Erosión I-EXPLORATION +epitelial I-EXPLORATION +superficial I-EXPLORATION +focal I-EXPLORATION +con I-EXPLORATION +acúmulos I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +polimorfonucleares, I-EXPLORATION +lámina I-EXPLORATION +propia I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +escaso I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +linfoplasmocitario, I-EXPLORATION +con I-EXPLORATION +algunos I-EXPLORATION +eosinófilos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +complementó I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +endosonografía I-EXPLORATION +demostrándose I-EXPLORATION +engrosamiento I-EXPLORATION +gástrico I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +profunda I-EXPLORATION +y I-EXPLORATION +áreas I-EXPLORATION +quísticas. I-EXPLORATION + I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +extensión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +el I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +transformación I-TREATMENT +neoplásica I-TREATMENT +y I-TREATMENT +la I-TREATMENT +no I-TREATMENT +disponibilidad I-TREATMENT +de I-TREATMENT +cetuximab, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +tratamiento I-TREATMENT +quirúrgico. I-TREATMENT +Se B-EVOLUTION +solicitó I-EVOLUTION +evaluación I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +equipo I-EVOLUTION +de I-EVOLUTION +nutrición, I-EVOLUTION +demostrándose I-EVOLUTION +preal-búmina, I-EVOLUTION +niveles I-EVOLUTION +de I-EVOLUTION +vitamina I-EVOLUTION +B12 I-EVOLUTION +y I-EVOLUTION +folato I-EVOLUTION +eritrocitario I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +rangos I-EVOLUTION +normales. I-EVOLUTION +Se B-TREATMENT +controlaron I-TREATMENT +los I-TREATMENT +vómitos I-TREATMENT +con I-TREATMENT +ondasentron, I-TREATMENT +logrando I-TREATMENT +ingesta I-TREATMENT +oral I-TREATMENT +adecuada, I-TREATMENT +se I-TREATMENT +apoyó I-TREATMENT +con I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +por I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +aumentó I-TREATMENT +la I-TREATMENT +albuminemia I-TREATMENT +a I-TREATMENT +2, I-TREATMENT +3 I-TREATMENT +gr/dl. I-TREATMENT +A I-TREATMENT +los I-TREATMENT +14 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +gastrectomía I-TREATMENT +total, I-TREATMENT +sin I-TREATMENT +incidentes I-TREATMENT +y B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +macroscópico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +operatoria I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +pared I-EXPLORATION +gástrica I-EXPLORATION +de I-EXPLORATION +espesor I-EXPLORATION +engrosado I-EXPLORATION +homogéneamente, I-EXPLORATION +mucosa I-EXPLORATION +con I-EXPLORATION +pliegues I-EXPLORATION +difusamente I-EXPLORATION +engrosados, I-EXPLORATION +congestivos, I-EXPLORATION +algunos I-EXPLORATION +con I-EXPLORATION +erosión I-EXPLORATION +superficial; I-EXPLORATION +rodete I-EXPLORATION +duodenal I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +polipoide I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +centímetro I-EXPLORATION +de I-EXPLORATION +eje I-EXPLORATION +mayor. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +histología I-EXPLORATION +se I-EXPLORATION +confirmaron I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +descritos I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +biopsias I-EXPLORATION +endoscópicas, I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +gástrico I-EXPLORATION +difuso, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +duodeno I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +descrita I-EXPLORATION +de I-EXPLORATION +lesión I-EXPLORATION +polipoide I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +metaplasia I-EXPLORATION +fúndica I-EXPLORATION +focal I-EXPLORATION +con I-EXPLORATION +hiperplasia I-EXPLORATION +foveolar I-EXPLORATION +y I-EXPLORATION +atrofia I-EXPLORATION +glandular, I-EXPLORATION +con I-EXPLORATION +dilatación I-EXPLORATION +quística I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +mucinosas. I-EXPLORATION +Se I-EXPLORATION +concluyó I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Ménétrier I-EXPLORATION +gástrica I-EXPLORATION +difusa I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +duodenal I-EXPLORATION +focal. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +oriundo B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Marchigüe, I-PAST_MEDICAL_HISTORY +VI I-PAST_MEDICAL_HISTORY +Región I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Chile, I-PAST_MEDICAL_HISTORY +quien I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +laboral I-PAST_MEDICAL_HISTORY +trabajó I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +faenador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +corderos. I-PAST_MEDICAL_HISTORY +Tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +dislipidemia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +quiste I-PAST_MEDICAL_HISTORY +hidatídico I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +operado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1996. I-PAST_MEDICAL_HISTORY +Quince I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +después, I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +vascular I-PAST_MEDICAL_HISTORY +encefálico, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +referir I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sintomatología I-PAST_MEDICAL_HISTORY +cardiovascular. I-PAST_MEDICAL_HISTORY +Dentro B-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +etiológico I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +(TAC) I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +ruptura. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +además I-EXPLORATION +una I-EXPLORATION +ecotomografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +quistes I-EXPLORATION +hepáticos. I-EXPLORATION +Tampoco B-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +síntomas I-PAST_MEDICAL_HISTORY +previos I-PAST_MEDICAL_HISTORY +sugerentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +anafilaxia. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Posteriormente, B-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +precordial I-EVOLUTION +opresivo I-EVOLUTION +sin I-EVOLUTION +irradiación, I-EVOLUTION +de I-EVOLUTION +intensidad I-EVOLUTION +EVA I-EVOLUTION +6/10. I-EVOLUTION +Evaluado B-TREATMENT +por I-TREATMENT +cardiología I-TREATMENT +en I-TREATMENT +su I-TREATMENT +hospital I-TREATMENT +base I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +anticoagulación I-TREATMENT +oral I-TREATMENT +siendo B-DERIVED_FROM/TO +derivado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Instituto I-DERIVED_FROM/TO +Nacional I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Tórax I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hidatidosis I-DERIVED_FROM/TO +cardiaca. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +El B-EXPLORATION +paciente I-EXPLORATION +ingresó I-EXPLORATION +en I-EXPLORATION +buenas I-EXPLORATION +condiciones I-EXPLORATION +generales, I-EXPLORATION +afebril I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +hemodinámicas, I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +130/85 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +90 I-EXPLORATION +latidos I-EXPLORATION +por I-EXPLORATION +min. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +ingurgitación I-EXPLORATION +yugular, I-EXPLORATION +roces I-EXPLORATION +ni I-EXPLORATION +soplos I-EXPLORATION +cardiacos I-EXPLORATION +(que I-EXPLORATION +fueron I-EXPLORATION +exhaustivamente I-EXPLORATION +buscados) I-EXPLORATION +ni I-EXPLORATION +tampoco I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +insuficiencia I-EXPLORATION +cardiaca. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +pulmonar I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +eosinofilia I-EXPLORATION +de I-EXPLORATION +21%, I-EXPLORATION +sin I-EXPLORATION +leucocitosis. I-EXPLORATION +El I-EXPLORATION +perfil I-EXPLORATION +bioquímico I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +IgG I-EXPLORATION +anti-Echinococcus I-EXPLORATION +granulosus I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +realizada. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +electrocardiograma I-EXPLORATION +presentaba I-EXPLORATION +ritmo I-EXPLORATION +sinusal, I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +negativas I-EXPLORATION +en I-EXPLORATION +DII I-EXPLORATION +y I-EXPLORATION +alteraciones I-EXPLORATION +inespecíficas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +repolarización. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecocardiografía I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +servicio I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +poliquística, I-EXPLORATION +ovalada I-EXPLORATION +y I-EXPLORATION +adherida I-EXPLORATION +al I-EXPLORATION +macizo I-EXPLORATION +de I-EXPLORATION +músculos I-EXPLORATION +papilares I-EXPLORATION +anterolaterales, I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +bien I-EXPLORATION +delimitados I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +libre I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +medía I-EXPLORATION +4, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +3, I-EXPLORATION +2 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +7 I-EXPLORATION +cm, I-EXPLORATION +sin I-EXPLORATION +derrame I-EXPLORATION +pericárdico. I-EXPLORATION +Estos I-EXPLORATION +hallazgos I-EXPLORATION +fueron I-EXPLORATION +confirmados I-EXPLORATION +por I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RNM). I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +preoperatorio I-EXPLORATION +fue I-EXPLORATION +completado I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +coronariografía, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +bajo I-TREATMENT +esternotomía I-TREATMENT +media I-TREATMENT +y I-TREATMENT +circulación I-TREATMENT +extracorpórea, I-TREATMENT +poniendo I-TREATMENT +principal I-TREATMENT +atención I-TREATMENT +en I-TREATMENT +la I-TREATMENT +manipulación I-TREATMENT +cardiaca I-TREATMENT +para I-TREATMENT +no I-TREATMENT +lesionar I-TREATMENT +el I-TREATMENT +quiste. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +puesto I-TREATMENT +el I-TREATMENT +clamp I-TREATMENT +aórtico, I-TREATMENT +se I-TREATMENT +disecó I-TREATMENT +la I-TREATMENT +superficie I-TREATMENT +del I-TREATMENT +quiste, I-TREATMENT +se I-TREATMENT +aisló I-TREATMENT +el I-TREATMENT +campo I-TREATMENT +con I-TREATMENT +compresas I-TREATMENT +embebidas I-TREATMENT +en I-TREATMENT +cloruro I-TREATMENT +de I-TREATMENT +sodio I-TREATMENT +al I-TREATMENT +10% I-TREATMENT +y I-TREATMENT +se I-TREATMENT +puncionó I-TREATMENT +el I-TREATMENT +quiste I-TREATMENT +vaciándolo I-TREATMENT +parcialmente I-TREATMENT +e I-TREATMENT +inyectando I-TREATMENT +solución I-TREATMENT +salina I-TREATMENT +hipertónica I-TREATMENT +al I-TREATMENT +30%. I-TREATMENT +Posteriormente, I-TREATMENT +se I-TREATMENT +abrió I-TREATMENT +el I-TREATMENT +quiste I-TREATMENT +hacia I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +anterior I-TREATMENT +del I-TREATMENT +ventrículo I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +vació, I-TREATMENT +retirando I-TREATMENT +las I-TREATMENT +membranas I-TREATMENT +y I-TREATMENT +vesículas I-TREATMENT +hijas. I-TREATMENT +Se I-TREATMENT +completó I-TREATMENT +el I-TREATMENT +aseo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +con I-TREATMENT +sodio I-TREATMENT +hipertónico I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +quistectomía I-TREATMENT +parcial I-TREATMENT +y I-TREATMENT +cierre I-TREATMENT +por I-TREATMENT +capitonaje I-TREATMENT +del I-TREATMENT +remanente. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +complicaciones I-EVOLUTION +intraoperatorias I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +fue I-EVOLUTION +favorable. I-EVOLUTION +En I-EVOLUTION +control I-EVOLUTION +ambulatorio I-EVOLUTION +post-quirúrgico, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +asintomático, I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +complicaciones I-EVOLUTION +o I-EVOLUTION +recidivas I-EVOLUTION +y B-EXPLORATION +se I-EXPLORATION +controlará I-EXPLORATION +semestralmente I-EXPLORATION +con I-EXPLORATION +ecocardiografía I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +E. I-EXPLORATION +granulosus. I-EXPLORATION + I-EXPLORATION + +La B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +índice I-PRESENT_ILLNESS +(PAF19) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +(2004) I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +anémico. I-PRESENT_ILLNESS +Como B-EXPLORATION +parte I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +estudio I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +completa I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +pólipos I-EXPLORATION +sésiles I-EXPLORATION +(más I-EXPLORATION +de I-EXPLORATION +100) I-EXPLORATION +y I-EXPLORATION +pediculados I-EXPLORATION +(más I-EXPLORATION +de I-EXPLORATION +15), I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +margen I-EXPLORATION +anal I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +ciego. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +cecal I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +proliferativa I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +cuya I-EXPLORATION +biopsia I-EXPLORATION +confirmó I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +tubular I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +preliminar I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +PAF I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +cecal. I-EXPLORATION +El B-TREATMENT +estudio I-TREATMENT +de I-TREATMENT +etapificación I-TREATMENT +con I-TREATMENT +TAC I-TREATMENT +(tomografía I-TREATMENT +abdominal I-TREATMENT +computarizada) I-TREATMENT +de I-TREATMENT +abdomen I-TREATMENT +y I-TREATMENT +pelvis I-TREATMENT +no I-TREATMENT +mostró I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +diseminación I-TREATMENT +tumoral, I-TREATMENT +realizándose I-TREATMENT +una I-TREATMENT +colectomía I-TREATMENT +total I-TREATMENT +con I-TREATMENT +íleorrectoanastomosis. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +tumoral I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +con I-EXPLORATION +invasión I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +subserosa I-EXPLORATION +y I-EXPLORATION +compromiso I-EXPLORATION +linfonodal. I-EXPLORATION +La I-EXPLORATION +mucosa I-EXPLORATION +del I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +resecada I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +centenar I-EXPLORATION +de I-EXPLORATION +pólipos I-EXPLORATION +sésiles I-EXPLORATION +y I-EXPLORATION +pediculados, I-EXPLORATION +abollonados I-EXPLORATION +y I-EXPLORATION +lisos I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +2 I-EXPLORATION +a I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor. I-EXPLORATION +Por B-TREATMENT +tratarse I-TREATMENT +de I-TREATMENT +una I-TREATMENT +paciente I-TREATMENT +en I-TREATMENT +etapa I-TREATMENT +III I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +adyuvante I-TREATMENT +en I-TREATMENT +base I-TREATMENT +a I-TREATMENT +5-fluorouracilo I-TREATMENT +y I-TREATMENT +leucovorina. I-TREATMENT +Hasta B-EVOLUTION +la I-EVOLUTION +fecha I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +ha I-EVOLUTION +completado I-EVOLUTION +70 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION +Debido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +historia I-DERIVED_FROM/TO +clínica I-DERIVED_FROM/TO +(poliposis I-DERIVED_FROM/TO +colónica I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +CCR I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +edad I-DERIVED_FROM/TO +temprana), I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +registro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tumores I-DERIVED_FROM/TO +hereditarios I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +definir I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +genético I-DERIVED_FROM/TO +apropiado. I-DERIVED_FROM/TO +Este I-DERIVED_FROM/TO +registro I-DERIVED_FROM/TO +incorpora I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +pacientes I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +sospecha I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +enfermedades I-DERIVED_FROM/TO +hereditarias I-DERIVED_FROM/TO +(poliposis I-DERIVED_FROM/TO +adenomatosa I-DERIVED_FROM/TO +familiar, I-DERIVED_FROM/TO +síndrome I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Lynch, I-DERIVED_FROM/TO +síndrome I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Peutz-Jeghers, I-DERIVED_FROM/TO +entre I-DERIVED_FROM/TO +otros) I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +finalidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +educar I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +pacientes I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +familiares I-DERIVED_FROM/TO +respecto I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +enfermedad, I-DERIVED_FROM/TO +predisposición I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +desarrollarla I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +transmitirla I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +descendencia, I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +este I-DERIVED_FROM/TO +modo I-DERIVED_FROM/TO +prevenir I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +desarrollo I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +CCR I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +aquellos I-DERIVED_FROM/TO +familiares I-DERIVED_FROM/TO +asintomáticos. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +El B-FAMILY_HISTORY +análisis I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +genealogía I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +índice I-FAMILY_HISTORY +demostró I-FAMILY_HISTORY +consanguinidad I-FAMILY_HISTORY +de I-FAMILY_HISTORY +los I-FAMILY_HISTORY +padres, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +historia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +poliposis I-FAMILY_HISTORY +o I-FAMILY_HISTORY +CCR I-FAMILY_HISTORY +en I-FAMILY_HISTORY +ellos. I-FAMILY_HISTORY +Además I-FAMILY_HISTORY +permitió I-FAMILY_HISTORY +identificar I-FAMILY_HISTORY +a I-FAMILY_HISTORY +una I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +(de I-FAMILY_HISTORY +un I-FAMILY_HISTORY +total I-FAMILY_HISTORY +de I-FAMILY_HISTORY +12 I-FAMILY_HISTORY +hermanos) I-FAMILY_HISTORY +que I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +CCR, I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +que I-FAMILY_HISTORY +identificamos I-FAMILY_HISTORY +como I-FAMILY_HISTORY +PAF585. I-FAMILY_HISTORY +Ella I-FAMILY_HISTORY +presentó I-FAMILY_HISTORY +un I-FAMILY_HISTORY +cáncer I-FAMILY_HISTORY +de I-FAMILY_HISTORY +colon I-FAMILY_HISTORY +derecho I-FAMILY_HISTORY +con I-FAMILY_HISTORY +invasión I-FAMILY_HISTORY +hasta I-FAMILY_HISTORY +la I-FAMILY_HISTORY +subserosa I-FAMILY_HISTORY +y I-FAMILY_HISTORY +compromiso I-FAMILY_HISTORY +linfonodal I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +53 I-FAMILY_HISTORY +años I-FAMILY_HISTORY +que I-FAMILY_HISTORY +fue I-FAMILY_HISTORY +tratado I-FAMILY_HISTORY +con I-FAMILY_HISTORY +cirugía I-FAMILY_HISTORY +y I-FAMILY_HISTORY +quimioterapia I-FAMILY_HISTORY +adyuvante. I-FAMILY_HISTORY +Un I-FAMILY_HISTORY +año I-FAMILY_HISTORY +después, I-FAMILY_HISTORY +la I-FAMILY_HISTORY +colonoscopia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +control I-FAMILY_HISTORY +mostró I-FAMILY_HISTORY +dos I-FAMILY_HISTORY +nuevos I-FAMILY_HISTORY +tumores I-FAMILY_HISTORY +sincrónicos, I-FAMILY_HISTORY +uno I-FAMILY_HISTORY +en I-FAMILY_HISTORY +colon I-FAMILY_HISTORY +sigmoides I-FAMILY_HISTORY +a I-FAMILY_HISTORY +35 I-FAMILY_HISTORY +cm I-FAMILY_HISTORY +del I-FAMILY_HISTORY +margen I-FAMILY_HISTORY +anal I-FAMILY_HISTORY +y I-FAMILY_HISTORY +otro I-FAMILY_HISTORY +cáncer I-FAMILY_HISTORY +en I-FAMILY_HISTORY +recto I-FAMILY_HISTORY +inferior I-FAMILY_HISTORY +(adenocarcinoma I-FAMILY_HISTORY +tubular I-FAMILY_HISTORY +invasor). I-FAMILY_HISTORY +Cabe I-FAMILY_HISTORY +destacar I-FAMILY_HISTORY +que I-FAMILY_HISTORY +el I-FAMILY_HISTORY +informe I-FAMILY_HISTORY +médico I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +no I-FAMILY_HISTORY +registra I-FAMILY_HISTORY +la I-FAMILY_HISTORY +presencia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +poliposis I-FAMILY_HISTORY +adenomatosa I-FAMILY_HISTORY +colónica. I-FAMILY_HISTORY +La I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +evolucionó I-FAMILY_HISTORY +tórpidamente I-FAMILY_HISTORY +falleciendo I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +4 I-FAMILY_HISTORY +meses I-FAMILY_HISTORY +posterior I-FAMILY_HISTORY +a I-FAMILY_HISTORY +la I-FAMILY_HISTORY +cirugía I-FAMILY_HISTORY +debido I-FAMILY_HISTORY +a I-FAMILY_HISTORY +un I-FAMILY_HISTORY +cuadro I-FAMILY_HISTORY +séptico I-FAMILY_HISTORY +secundario. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Con I-FAMILY_HISTORY +respecto I-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +demás I-FAMILY_HISTORY +hermanos, I-FAMILY_HISTORY +cinco I-FAMILY_HISTORY +de I-FAMILY_HISTORY +ellos I-FAMILY_HISTORY +fallecieron I-FAMILY_HISTORY +en I-FAMILY_HISTORY +la I-FAMILY_HISTORY +infancia I-FAMILY_HISTORY +por I-FAMILY_HISTORY +accidentes I-FAMILY_HISTORY +y I-FAMILY_HISTORY +enfermedades I-FAMILY_HISTORY +no I-FAMILY_HISTORY +relacionadas I-FAMILY_HISTORY +al I-FAMILY_HISTORY +cáncer. I-FAMILY_HISTORY +En I-FAMILY_HISTORY +los I-FAMILY_HISTORY +cinco I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +vivos, I-FAMILY_HISTORY +la I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +índice I-FAMILY_HISTORY +no I-FAMILY_HISTORY +declara I-FAMILY_HISTORY +más I-FAMILY_HISTORY +casos I-FAMILY_HISTORY +afectados I-FAMILY_HISTORY +de I-FAMILY_HISTORY +poliposis I-FAMILY_HISTORY +o I-FAMILY_HISTORY +CCR, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +embargo, I-FAMILY_HISTORY +desconocemos I-FAMILY_HISTORY +si I-FAMILY_HISTORY +ellos I-FAMILY_HISTORY +se I-FAMILY_HISTORY +han I-FAMILY_HISTORY +realizado I-FAMILY_HISTORY +estudios I-FAMILY_HISTORY +colonoscópicos. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Estudio B-EXPLORATION +genético I-EXPLORATION + I-EXPLORATION +Obtención I-EXPLORATION +del I-EXPLORATION +ADN I-EXPLORATION +genómico I-EXPLORATION +desde I-EXPLORATION +sangre I-EXPLORATION +periférica: I-EXPLORATION +el I-EXPLORATION +ADN I-EXPLORATION +genómico I-EXPLORATION +fue I-EXPLORATION +aislado I-EXPLORATION +a I-EXPLORATION +partir I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +ml I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +venosa I-EXPLORATION +periférica, I-EXPLORATION +utilizando I-EXPLORATION +el I-EXPLORATION +protocolo I-EXPLORATION +descrito I-EXPLORATION +por I-EXPLORATION +Lahiri I-EXPLORATION +y I-EXPLORATION +Nurnberger I-EXPLORATION +(1991 I-EXPLORATION +) I-EXPLORATION +9. I-EXPLORATION + I-EXPLORATION +Este I-EXPLORATION +ADN I-EXPLORATION +fue I-EXPLORATION +previamente I-EXPLORATION +estudiado I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +molecular I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +APC, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +resultó I-EXPLORATION +negativo8. I-EXPLORATION + I-EXPLORATION +Análisis I-EXPLORATION +mutacional I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +MUTYH: I-EXPLORATION +Los I-EXPLORATION +16 I-EXPLORATION +exones I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +MUTYH I-EXPLORATION +fueron I-EXPLORATION +amplificados I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +(reacción I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +polimerasa) I-EXPLORATION +usando I-EXPLORATION +los I-EXPLORATION +partidores I-EXPLORATION +descritos I-EXPLORATION +por I-EXPLORATION +Kim I-EXPLORATION +y I-EXPLORATION +colaboradores, I-EXPLORATION +en I-EXPLORATION +200610. I-EXPLORATION +Reacciones I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +fueron I-EXPLORATION +realizadas I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +volumen I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +Ql I-EXPLORATION +que I-EXPLORATION +contiene I-EXPLORATION +100 I-EXPLORATION +ng I-EXPLORATION +de I-EXPLORATION +ADN I-EXPLORATION +genómico, I-EXPLORATION +25 I-EXPLORATION +pmoles I-EXPLORATION +de I-EXPLORATION +cada I-EXPLORATION +partidor, I-EXPLORATION +0, I-EXPLORATION +2 I-EXPLORATION +mM I-EXPLORATION +de I-EXPLORATION +cada I-EXPLORATION +uno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +dNTPs, I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +mM I-EXPLORATION +MgCl2 I-EXPLORATION +1X I-EXPLORATION +del I-EXPLORATION +amortiguador I-EXPLORATION +suministrado I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +enzima I-EXPLORATION +y I-EXPLORATION +1U I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enzima I-EXPLORATION +Platinum I-EXPLORATION +Taq I-EXPLORATION +ADN I-EXPLORATION +polimerasa I-EXPLORATION +(Invitrogen, I-EXPLORATION +Sao I-EXPLORATION +Paulo, I-EXPLORATION +Brasil). I-EXPLORATION +La I-EXPLORATION +amplificación I-EXPLORATION +fue I-EXPLORATION +realizada I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +siguiente I-EXPLORATION +protocolo: I-EXPLORATION +una I-EXPLORATION +desnaturación I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +min I-EXPLORATION +a I-EXPLORATION +95°C, I-EXPLORATION +seguido I-EXPLORATION +por I-EXPLORATION +30 I-EXPLORATION +ciclos I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +seg I-EXPLORATION +a I-EXPLORATION +95°C, I-EXPLORATION +30 I-EXPLORATION +seg I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +apareamiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +partidores I-EXPLORATION +(rango I-EXPLORATION +50-58°C), I-EXPLORATION +30 I-EXPLORATION +seg I-EXPLORATION +a I-EXPLORATION +72°C, I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +paso I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +final I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +min I-EXPLORATION +a I-EXPLORATION +72°C. I-EXPLORATION +Los I-EXPLORATION +productos I-EXPLORATION +amplificados I-EXPLORATION +fueron I-EXPLORATION +posteriormente I-EXPLORATION +analizados I-EXPLORATION +mediante I-EXPLORATION +dos I-EXPLORATION +técnicas I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +sensibilidad I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +secuencia I-EXPLORATION +del I-EXPLORATION +ADN, I-EXPLORATION +que I-EXPLORATION +incluye I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +SSCP I-EXPLORATION +(single I-EXPLORATION +strand I-EXPLORATION +conformation I-EXPLORATION +polymorphism) I-EXPLORATION +y I-EXPLORATION +secuenciación I-EXPLORATION +de I-EXPLORATION +ADN. I-EXPLORATION +Brevemente, I-EXPLORATION +los I-EXPLORATION +productos I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +fueron I-EXPLORATION +desnaturados I-EXPLORATION +a I-EXPLORATION +95°C I-EXPLORATION +por I-EXPLORATION +5 I-EXPLORATION +min, I-EXPLORATION +enfriados I-EXPLORATION +en I-EXPLORATION +hielo I-EXPLORATION +por I-EXPLORATION +5 I-EXPLORATION +min, I-EXPLORATION +y I-EXPLORATION +resueltos I-EXPLORATION +por I-EXPLORATION +electroforesis I-EXPLORATION +en I-EXPLORATION +geles I-EXPLORATION +de I-EXPLORATION +poliacrilamida I-EXPLORATION +MDE I-EXPLORATION +0, I-EXPLORATION +5X I-EXPLORATION + I-EXPLORATION +(FMC I-EXPLORATION +Bioproducts), I-EXPLORATION +aplicando I-EXPLORATION +una I-EXPLORATION +corriente I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +W I-EXPLORATION +a I-EXPLORATION +18°C I-EXPLORATION +por I-EXPLORATION +12 I-EXPLORATION +h. I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +electroforesis, I-EXPLORATION +los I-EXPLORATION +geles I-EXPLORATION +fueron I-EXPLORATION +teñidos I-EXPLORATION +con I-EXPLORATION +nitrato I-EXPLORATION +de I-EXPLORATION +plata I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +fin I-EXPLORATION +de I-EXPLORATION +visualizar I-EXPLORATION +las I-EXPLORATION +bandas I-EXPLORATION +de I-EXPLORATION +ADN. I-EXPLORATION +Los I-EXPLORATION +productos I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +que I-EXPLORATION +presentaron I-EXPLORATION +una I-EXPLORATION +migración I-EXPLORATION +anormal I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +al I-EXPLORATION +control, I-EXPLORATION +fueron I-EXPLORATION +secuenciados. I-EXPLORATION +Las I-EXPLORATION +mutaciones I-EXPLORATION +fueron I-EXPLORATION +analizadas I-EXPLORATION +y I-EXPLORATION +confirmadas I-EXPLORATION +por I-EXPLORATION +dos I-EXPLORATION +reacciones I-EXPLORATION +de I-EXPLORATION +PCR I-EXPLORATION +independientes I-EXPLORATION +y I-EXPLORATION +por I-EXPLORATION +secuenciación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +dos I-EXPLORATION +hebras I-EXPLORATION +de I-EXPLORATION +ADN. I-EXPLORATION +La I-EXPLORATION +mutación I-EXPLORATION +se I-EXPLORATION +nombró I-EXPLORATION +de I-EXPLORATION +acuerdo I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +nomenclatura I-EXPLORATION +propuesta I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +Human I-EXPLORATION +Genome I-EXPLORATION +Variation I-EXPLORATION +Society I-EXPLORATION +(www. I-EXPLORATION +hgvs.org/mutnomen/). I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +suspendido I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alergia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +aspirina I-PAST_MEDICAL_HISTORY +caracterizado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +eritema I-PAST_MEDICAL_HISTORY +generalizado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +edema I-PAST_MEDICAL_HISTORY +glótico. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +primera I-PAST_MEDICAL_HISTORY +ocasión I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +1974 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +vuelve I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +repetir I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +única I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +1983, I-PAST_MEDICAL_HISTORY +motivo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +nunca I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +vuelve I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +recibir I-PAST_MEDICAL_HISTORY +aspirina. I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +noviembre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2010 I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +angina I-PRESENT_ILLNESS +inestable. I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +coronariografía I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +estenosis I-EXPLORATION +significativa I-EXPLORATION +en I-EXPLORATION +arteria I-EXPLORATION +descendente I-EXPLORATION +anterior, I-EXPLORATION +ante I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +angioplastía I-EXPLORATION +con I-EXPLORATION +stent I-EXPLORATION +en I-EXPLORATION +dicho I-EXPLORATION +vaso. I-EXPLORATION +Por B-TREATMENT +antecedentes I-TREATMENT +de I-TREATMENT +alergia I-TREATMENT +a I-TREATMENT +la I-TREATMENT +aspirina I-TREATMENT +se I-TREATMENT +deja I-TREATMENT +con I-TREATMENT +clopidogrel I-TREATMENT +y I-TREATMENT +cilostazol. I-TREATMENT +Tres B-EVOLUTION +semanas I-EVOLUTION +posterior I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +alta, I-EVOLUTION +presenta I-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +torácico I-EVOLUTION +retroesternal I-EVOLUTION +opresivo I-EVOLUTION +prolongado I-EVOLUTION +y B-EXPLORATION +la I-EXPLORATION +corona-riografía I-EXPLORATION +demuestra I-EXPLORATION +una I-EXPLORATION +trombosis I-EXPLORATION +intra-stent. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +angioplastía I-TREATMENT +con I-TREATMENT +balón, I-TREATMENT +bajo I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +tirofibán I-TREATMENT +endovenoso, I-TREATMENT +consiguiendo B-EVOLUTION +un I-EVOLUTION +buen I-EVOLUTION +resultado I-EVOLUTION +clínico. I-EVOLUTION +Posterior B-TREATMENT +a I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +desensibilización I-TREATMENT +a I-TREATMENT +aspirina, I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT +Desde I-TREATMENT +entonces I-TREATMENT +se I-TREATMENT +mantiene I-TREATMENT +con I-TREATMENT +aspirina I-TREATMENT +y I-TREATMENT +clopidrogel. I-TREATMENT +Completado B-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +adherencia I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +terapia, I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +efectos I-EVOLUTION +adversos, I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +mantiene I-EVOLUTION +sin I-EVOLUTION +angina I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +HAAS. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +(20 I-PAST_MEDICAL_HISTORY +paquetes/año) I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +Endoscopia B-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +(EDA) I-EXPLORATION +demostró I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +estenosante I-EXPLORATION +del I-EXPLORATION +esófago I-EXPLORATION +a I-EXPLORATION +30 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arcada I-EXPLORATION +dentaria. I-EXPLORATION +Biopsia I-EXPLORATION +confirmó I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +escamoso I-EXPLORATION +moderadamente I-EXPLORATION +diferenciado. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +etapi-ficación I-EXPLORATION +con I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +infiltrante I-EXPLORATION +en I-EXPLORATION +tercio I-EXPLORATION +medio I-EXPLORATION +del I-EXPLORATION +esófago I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +largo, I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +cayado I-EXPLORATION +aórtico I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +venas I-EXPLORATION +pulmonares I-EXPLORATION +derechas; I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +aspecto I-EXPLORATION +posterior I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +que I-EXPLORATION +rodeaba I-EXPLORATION +y I-EXPLORATION +aparentemente I-EXPLORATION +infiltraba I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +en I-EXPLORATION +más I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +50% I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +circunferencia. I-EXPLORATION +Presentaba I-EXPLORATION +además I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +pulmonar I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +x I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +caudado, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +localizaciones I-EXPLORATION +secundarias I-EXPLORATION +(T4NxM1). I-EXPLORATION +Considerando B-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +tenía I-TREATMENT +un I-TREATMENT +cáncer I-TREATMENT +metastásico, I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +paliativo I-TREATMENT +para I-TREATMENT +alivio I-TREATMENT +de I-TREATMENT +su I-TREATMENT +disfagia I-TREATMENT +con I-TREATMENT +QRT I-TREATMENT +concomitante I-TREATMENT +con I-TREATMENT +cisplatino I-TREATMENT +(radioterapia I-TREATMENT +51 I-TREATMENT +Gy I-TREATMENT +en I-TREATMENT +17 I-TREATMENT +fracciones I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +Gy I-TREATMENT +y I-TREATMENT +cisplatino I-TREATMENT +40 I-TREATMENT +mg/ I-TREATMENT +m2 I-TREATMENT +semanales). I-TREATMENT + I-TREATMENT +Dos B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +completado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +consultó I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Urgencia I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +hematemesis; I-EVOLUTION +al I-EVOLUTION +ingreso I-EVOLUTION +hipotenso I-EVOLUTION +y I-EVOLUTION +taquicárdico I-EVOLUTION +recuperando I-EVOLUTION +su I-EVOLUTION +hemodinamia I-EVOLUTION +mediante I-EVOLUTION +aporte I-EVOLUTION +de I-EVOLUTION +cristaloides. I-EVOLUTION +Hematocrito B-EXPLORATION +de I-EXPLORATION +21%. I-EXPLORATION +AngioTAC I-EXPLORATION +mostró I-EXPLORATION +reducción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +tumoral I-EXPLORATION +esofágica I-EXPLORATION +con I-EXPLORATION +componente I-EXPLORATION +necrótico I-EXPLORATION +central I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +activo; I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +eran I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +FAE. I-EXPLORATION +Fue B-TREATMENT +llevado I-TREATMENT +a I-TREATMENT +pabellón I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +implantó I-TREATMENT +una I-TREATMENT +endoprótesis I-TREATMENT +Valiant I-TREATMENT +28 I-TREATMENT +x I-TREATMENT +15 I-TREATMENT +(Medtronic, I-TREATMENT +Minnesota, I-TREATMENT +Estados I-TREATMENT +Unidos I-TREATMENT +de I-TREATMENT +Norteamérica) I-TREATMENT +en I-TREATMENT +aorta I-TREATMENT +torácica I-TREATMENT +descendente I-TREATMENT +proximal, I-TREATMENT +distal I-TREATMENT +a I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +subclavia I-TREATMENT +izquierda, I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +femoral I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +cobertura I-TREATMENT +antibiótica I-TREATMENT +en I-TREATMENT +base I-TREATMENT +a I-TREATMENT +ce-ftriaxona I-TREATMENT +y I-TREATMENT +clindamicina. I-TREATMENT +No B-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +hemorragia I-EVOLUTION +digestiva, I-EVOLUTION +iniciando I-EVOLUTION +alimentación I-EVOLUTION +oral I-EVOLUTION +progresiva I-EVOLUTION +el I-EVOLUTION +4° I-EVOLUTION +día I-EVOLUTION +postoperatorio, I-EVOLUTION +bien I-EVOLUTION +tolerado I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +disfagia. I-EVOLUTION +Fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +8° I-EVOLUTION +día I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +oral I-EVOLUTION +y I-EVOLUTION +afebril. I-EVOLUTION +Completó B-TREATMENT +14 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +antibióticos I-TREATMENT +endovenosos I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +amoxicilina/ácido I-TREATMENT +clavulánico I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +amoxicilina I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +indefinida. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +controles I-EVOLUTION +ambulatorios I-EVOLUTION +evolucionó I-EVOLUTION +adecuadamente, I-EVOLUTION +sin I-EVOLUTION +disfagia I-EVOLUTION +ni I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +aumento I-EVOLUTION +progresivo I-EVOLUTION +del I-EVOLUTION +peso I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +kg. I-EVOLUTION +AngioTAC I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +meses I-EVOLUTION +mostró I-EVOLUTION +adecuada I-EVOLUTION +posición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +endoprótesis I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +fugas, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +progresión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +metástasis I-EVOLUTION +hepática I-EVOLUTION +conocida. I-EVOLUTION +Continuó I-EVOLUTION +con I-EVOLUTION +cuidados I-EVOLUTION +paliativos I-EVOLUTION +y I-EVOLUTION +evolucionó I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +importantes I-EVOLUTION +hasta I-EVOLUTION +un I-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +11 I-EVOLUTION +meses I-EVOLUTION +post I-EVOLUTION +procedimiento I-EVOLUTION +en I-EVOLUTION +que I-EVOLUTION +refirió I-EVOLUTION +compromiso I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +disfagia I-EVOLUTION +a I-EVOLUTION +sólidos I-EVOLUTION +y I-EVOLUTION +baja I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +de I-EVOLUTION +10 I-EVOLUTION +kilos. I-EVOLUTION +EDA B-EXPLORATION +demostró I-EXPLORATION +lesión I-EXPLORATION +esofágica I-EXPLORATION +estenosante I-EXPLORATION +desde I-EXPLORATION +los I-EXPLORATION +30 I-EXPLORATION +a I-EXPLORATION +35 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arcada I-EXPLORATION +dentaria I-EXPLORATION +con I-EXPLORATION +exposición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +endoprótesis I-EXPLORATION +aórtica. I-EXPLORATION +Mantuvo B-EVOLUTION +manejo I-EVOLUTION +paliativo, I-EVOLUTION +falleciendo I-EVOLUTION +finalmente I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +13 I-EVOLUTION +meses I-EVOLUTION +post I-EVOLUTION +cirugía I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +sepsis I-EVOLUTION +ni I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +sangrado. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +adenopat��as I-PRESENT_ILLNESS +occipitales, I-PRESENT_ILLNESS +yugulares, I-PRESENT_ILLNESS +submandibulares I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inguinales I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sensibles, I-PRESENT_ILLNESS +asociadas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +fatiga, I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +máculo-petequiales I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ambos I-PRESENT_ILLNESS +pies. I-PRESENT_ILLNESS +El B-EXPLORATION +hemograma I-EXPLORATION +mostraba I-EXPLORATION +3.400 I-EXPLORATION +leucocitos I-EXPLORATION +x I-EXPLORATION +mm3, I-EXPLORATION +46% I-EXPLORATION +de I-EXPLORATION +linfo I-EXPLORATION +citos I-EXPLORATION +y I-EXPLORATION +50% I-EXPLORATION +de I-EXPLORATION +neutro I-EXPLORATION +filos. I-EXPLORATION +La I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +(VHS) I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +2 I-EXPLORATION +mg/L I-EXPLORATION +y I-EXPLORATION +28 I-EXPLORATION +mm/h, I-EXPLORATION +respectivamente. I-EXPLORATION +El I-EXPLORATION +perfil I-EXPLORATION +hepático, I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +complementario I-EXPLORATION +fue I-EXPLORATION +negativo: I-EXPLORATION +hemocultivos, I-EXPLORATION +urocultivo, I-EXPLORATION +coprocultivo, I-EXPLORATION +inmunofluorescencia I-EXPLORATION +directa I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +respiratorios, I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +Epstein-Barr I-EXPLORATION +(VEB), I-EXPLORATION +Bartonella I-EXPLORATION +hensenlae, I-EXPLORATION +parvovirus I-EXPLORATION +B-19, I-EXPLORATION +citomegalovirus I-EXPLORATION +(CMV), I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii I-EXPLORATION +y I-EXPLORATION +ELISA I-EXPLORATION +para I-EXPLORATION +VIH. I-EXPLORATION +No I-EXPLORATION +hubo I-EXPLORATION +hallazgos I-EXPLORATION +significativos I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +eco I-EXPLORATION +cardiografía I-EXPLORATION +transtorácica. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +mostró I-EXPLORATION +adenopatías I-EXPLORATION +bilaterales, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +triángulos I-EXPLORATION +cervicales I-EXPLORATION +anteriores I-EXPLORATION +y I-EXPLORATION +posteriores, I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +inespecífico. I-EXPLORATION + I-EXPLORATION +Durante B-EVOLUTION +la I-EVOLUTION +hospitalización I-EVOLUTION +apareció I-EVOLUTION +un I-EVOLUTION +exantema I-EVOLUTION +máculo-papular I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +malar, I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +extremidades I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +artralgias. I-EVOLUTION +Los B-EXPLORATION +anticuerpos I-EXPLORATION +anti-nucleares I-EXPLORATION +(ANA) I-EXPLORATION +y I-EXPLORATION +anti-DNA I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +anticuerpos I-EXPLORATION +anti-antígenos I-EXPLORATION +nucleares I-EXPLORATION +extraíbles I-EXPLORATION +(ENA) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +factor I-EXPLORATION +reumatoide I-EXPLORATION +(FR) I-EXPLORATION +no I-EXPLORATION +presentaron I-EXPLORATION +alteraciones. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +complemento I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +C4 I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +131 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +45 I-EXPLORATION +mg/dL I-EXPLORATION +respectivamente. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +adenopatía I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +distorsión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arquitectura, I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +fibrinoide I-EXPLORATION +y I-EXPLORATION +restos I-EXPLORATION +apoptóticos I-EXPLORATION +rodeados I-EXPLORATION +de I-EXPLORATION +abundantes I-EXPLORATION +histiocitos, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +linfadenitis I-EXPLORATION +necrotizante I-EXPLORATION +histiocitaria. I-EXPLORATION +El B-EVOLUTION +cuadro I-EVOLUTION +se I-EVOLUTION +resolvió I-EVOLUTION +espontáneamente I-EVOLUTION +en I-EVOLUTION +1 I-EVOLUTION +mes I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +recurrencias. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +poliartralgias I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +activo. I-PAST_MEDICAL_HISTORY +Refiere B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +persistente, I-PRESENT_ILLNESS +sudo-ración I-PRESENT_ILLNESS +nocturna, I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +poliartralgias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +sensible. I-PRESENT_ILLNESS +Relata B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hermana I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +EKF I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +contacto I-PAST_MEDICAL_HISTORY +directo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +gato. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +realizaron I-PRESENT_ILLNESS +ecografía I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +mostraba I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +linfonodos I-PRESENT_ILLNESS +cervicales I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +Le B-TREATMENT +indicaron I-TREATMENT +amoxicilina-ácido I-TREATMENT +clavulánico I-TREATMENT +durante I-TREATMENT +5 I-TREATMENT +días I-TREATMENT +sin I-TREATMENT +mejoría I-TREATMENT +clínica I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +hospitalizó. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +cervical I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +sensible I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +visceromegalia. I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +mostró I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +56 I-EXPLORATION +mm/h I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +PCR I-EXPLORATION +y I-EXPLORATION +ferritina I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +77 I-EXPLORATION +mg/L I-EXPLORATION +y I-EXPLORATION +1.789 I-EXPLORATION +ng/mL I-EXPLORATION +respectivamente. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cuello, I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +constatar I-EXPLORATION +adenopatías I-EXPLORATION +cervicales I-EXPLORATION +y I-EXPLORATION +mediastínicas, I-EXPLORATION +reveló I-EXPLORATION +opacidades I-EXPLORATION +pulmonares I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +esmerilado. I-EXPLORATION +Paralelamente, I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +VIH, I-EXPLORATION +VEB, I-EXPLORATION +CMV, I-EXPLORATION +virus I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +sífilis I-EXPLORATION +y I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii. I-EXPLORATION +La I-EXPLORATION +IgM I-EXPLORATION +para I-EXPLORATION +Bartonella I-EXPLORATION +hensenlae I-EXPLORATION +fue I-EXPLORATION +negativa, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +IgG I-EXPLORATION +resultó I-EXPLORATION +positiva I-EXPLORATION +(1/64). I-EXPLORATION +Se I-EXPLORATION +indicó I-EXPLORATION +azitromicina I-EXPLORATION +lg I-EXPLORATION +al I-EXPLORATION +día I-EXPLORATION +durante I-EXPLORATION +6 I-EXPLORATION +días, I-EXPLORATION +sin I-EXPLORATION +respuesta. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunológico I-EXPLORATION +fue I-EXPLORATION +prácticamente I-EXPLORATION +normal, I-EXPLORATION +solamente I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +ANA I-EXPLORATION +positivo I-EXPLORATION +a I-EXPLORATION +título I-EXPLORATION +bajo I-EXPLORATION +(1/40). I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +realizar I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +adenopatía I-EXPLORATION +cervical. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +para I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +bacterias I-EXPLORATION +resultaron I-EXPLORATION +negativos, I-EXPLORATION +mientras I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +reveló I-EXPLORATION +linfadenitis I-EXPLORATION +necrotizante I-EXPLORATION +histiocitaria. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +prednisona I-TREATMENT +30 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +con I-TREATMENT +disminución I-TREATMENT +progresiva I-TREATMENT +de I-TREATMENT +las I-TREATMENT +dosis I-TREATMENT +completando I-TREATMENT +45 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +terapia. I-TREATMENT +Los B-EVOLUTION +síntomas I-EVOLUTION +desaparecen I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +tratamiento. I-EVOLUTION +Dos B-EXPLORATION +meses I-EXPLORATION +después I-EXPLORATION +asiste I-EXPLORATION +a I-EXPLORATION +control I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +imágenes I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +esmerilado. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +pulmonar I-EXPLORATION +revelando I-EXPLORATION +hallazgos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +neumonía I-EXPLORATION +intersticial I-EXPLORATION +usual I-EXPLORATION +en I-EXPLORATION +fase I-EXPLORATION +tardía. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +sintoma-tología I-EVOLUTION +respiratoria I-EVOLUTION +ni I-EVOLUTION +alteraciones I-EVOLUTION +significativas I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +de I-EVOLUTION +función I-EVOLUTION +pulmonar. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +que B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +mostró I-EXPLORATION +tumor I-EXPLORATION +ovárico I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +13 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +ascitis. I-EXPLORATION +Resto I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Cal25 I-EXPLORATION += I-EXPLORATION +2.526 I-EXPLORATION +(U/ml). I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +cirugía I-TREATMENT +oncoló I-TREATMENT +gica. I-TREATMENT +Cal25 B-EXPLORATION +post-operatorio I-EXPLORATION +174 I-EXPLORATION +(U/ml). I-EXPLORATION +Biopsia I-EXPLORATION +mostró I-EXPLORATION +adenocarcinoma I-EXPLORATION +endometrioide I-EXPLORATION +Grado I-EXPLORATION +3. I-EXPLORATION +Etapificada I-EXPLORATION +como I-EXPLORATION +IC, I-EXPLORATION +se I-EXPLORATION +tomó I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +ascitis I-EXPLORATION +para I-EXPLORATION +block I-EXPLORATION +celular I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +cultivó I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +QS I-EXPLORATION +in I-EXPLORATION +vitro. I-EXPLORATION +Se B-TREATMENT +administró I-TREATMENT +QMT I-TREATMENT +de I-TREATMENT +carboplatino-paclitaxel, I-TREATMENT +con I-TREATMENT +normalización I-TREATMENT +del I-TREATMENT +Cal25. I-TREATMENT +El B-EVOLUTION +seguimiento I-EVOLUTION +a I-EVOLUTION +tres I-EVOLUTION +años I-EVOLUTION +fue I-EVOLUTION +normal. I-EVOLUTION +Estudio B-EXPLORATION +in I-EXPLORATION +vitro I-EXPLORATION +mostró I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +citotoxicidad I-EXPLORATION +al I-EXPLORATION +esquema I-EXPLORATION +carboplatino-paclitaxel I-EXPLORATION +mayor I-EXPLORATION +al I-EXPLORATION +70%, I-EXPLORATION +correlacionándose I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +respuesta I-EXPLORATION +clínica. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento, I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +(IMC I-PAST_MEDICAL_HISTORY +32) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +suspendido. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +distensión I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +persistentes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +kilos I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +ese I-PRESENT_ILLNESS +período. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +hubo I-PRESENT_ILLNESS +evidencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemorragia I-PRESENT_ILLNESS +gastrointestinal I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +anemia. I-PRESENT_ILLNESS + B-EXPLORATION +La I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +reveló I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +gástrico I-EXPLORATION +submucoso, I-EXPLORATION +localizado I-EXPLORATION +en I-EXPLORATION +antro I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +curvatura I-EXPLORATION +menor I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +lumen I-EXPLORATION +antral. I-EXPLORATION +La I-EXPLORATION +mucosa, I-EXPLORATION +examinada I-EXPLORATION +por I-EXPLORATION +endoscopia, I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +tomaron I-EXPLORATION +biopsias. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +gástrica I-EXPLORATION +homogénea, I-EXPLORATION +hiperecogénica I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +definidos. I-EXPLORATION +El I-EXPLORATION +estudió I-EXPLORATION +se I-EXPLORATION +completó I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +con I-EXPLORATION +densidad I-EXPLORATION +grasa, I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +cm, I-EXPLORATION +ocupando I-EXPLORATION +una I-EXPLORATION +parte I-EXPLORATION +importante I-EXPLORATION +del I-EXPLORATION +lumen I-EXPLORATION +antral I-EXPLORATION +gástrico, I-EXPLORATION +con I-EXPLORATION +baja I-EXPLORATION +captura I-EXPLORATION +de I-EXPLORATION +contraste. I-EXPLORATION +La I-EXPLORATION +lesión I-EXPLORATION +fue I-EXPLORATION +sospechosa I-EXPLORATION +de I-EXPLORATION +GIST I-EXPLORATION +con I-EXPLORATION +diferenciación I-EXPLORATION +lipomatosa I-EXPLORATION +o I-EXPLORATION +un I-EXPLORATION +lipoma I-EXPLORATION +gástrico. I-EXPLORATION +La I-EXPLORATION +resección I-EXPLORATION +quirúrgica I-EXPLORATION +fue I-EXPLORATION +recomendada. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +gastrectomía I-TREATMENT +subtotal I-TREATMENT +distal I-TREATMENT +laparoscópica. I-TREATMENT +Se I-TREATMENT +utilizaron I-TREATMENT +5 I-TREATMENT +trocares; I-TREATMENT +supraumbilical I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +mm I-TREATMENT +para I-TREATMENT +el I-TREATMENT +laparoscopio, I-TREATMENT +subxifoideo I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mm I-TREATMENT +para I-TREATMENT +separación I-TREATMENT +hepática I-TREATMENT +y I-TREATMENT +trocares I-TREATMENT +subcostal I-TREATMENT +izquierdo I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +mm, I-TREATMENT +flanco I-TREATMENT +derecho I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +flanco I-TREATMENT +izquierdo I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +mm. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +intraoperatorio, I-TREATMENT +se I-TREATMENT +confirmó I-TREATMENT +una I-TREATMENT +gran I-TREATMENT +masa I-TREATMENT +antral I-TREATMENT +sin I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +serosa. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +endoscopia I-TREATMENT +intraoperatoria I-TREATMENT +para I-TREATMENT +definir I-TREATMENT +el I-TREATMENT +margen I-TREATMENT +proximal I-TREATMENT +de I-TREATMENT +resección. I-TREATMENT +Se I-TREATMENT +seccionó I-TREATMENT +el I-TREATMENT +duodeno I-TREATMENT +y I-TREATMENT +el I-TREATMENT +estómago I-TREATMENT +con I-TREATMENT +cargas I-TREATMENT +lineares I-TREATMENT +de I-TREATMENT +60 I-TREATMENT +mm I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +linfadenectomía I-TREATMENT +D1. I-TREATMENT +La I-TREATMENT +pieza I-TREATMENT +fue I-TREATMENT +extraída I-TREATMENT +por I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +Pfannenstiel I-TREATMENT +y I-TREATMENT +los I-TREATMENT +márgenes I-TREATMENT +negativos I-TREATMENT +fueron I-TREATMENT +confirmados I-TREATMENT +por I-TREATMENT +biopsia I-TREATMENT +rápida. I-TREATMENT +Se I-TREATMENT +reconstruyó I-TREATMENT +el I-TREATMENT +tránsito I-TREATMENT +con I-TREATMENT +una I-TREATMENT +Y I-TREATMENT +de I-TREATMENT +Roux I-TREATMENT +de I-TREATMENT +50 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +largo, I-TREATMENT +realizando I-TREATMENT +la I-TREATMENT +anastomosis I-TREATMENT +gastro-yeyunal I-TREATMENT +y I-TREATMENT +yeyuno-yeyunal I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +mecánica I-TREATMENT +e I-TREATMENT +intracorpórea. I-TREATMENT +El B-EVOLUTION +tiempo I-EVOLUTION +operatorio I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +h I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +sangrado I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +200 I-EVOLUTION +cc. I-EVOLUTION + I-EVOLUTION +La I-EVOLUTION +recuperación I-EVOLUTION +post I-EVOLUTION +operatoria I-EVOLUTION +fue I-EVOLUTION +sin I-EVOLUTION +incidentes. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +realimentó I-EVOLUTION +con I-EVOLUTION +líquidos I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +5o I-EVOLUTION +día I-EVOLUTION +post I-EVOLUTION +operatorio. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +macroscópico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +fue I-EXPLORATION +consistente I-EXPLORATION +con I-EXPLORATION +tumor I-EXPLORATION +gástrico I-EXPLORATION +submucoso, I-EXPLORATION +de I-EXPLORATION +11, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +6x7 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +apariencia I-EXPLORATION +lipomatosa. I-EXPLORATION +La I-EXPLORATION +microscopía I-EXPLORATION +fue I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +lipoma I-EXPLORATION +gástrico I-EXPLORATION +benigno I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +libres I-EXPLORATION +y I-EXPLORATION +15 I-EXPLORATION +linfonodos I-EXPLORATION +perigástricos I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +institución I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síncope I-PRESENT_ILLNESS +recurrente. I-PRESENT_ILLNESS +Estando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +reposo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +casa, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hora I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +finalizado I-PRESENT_ILLNESS +entrenamiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +boxeo, I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +súbito I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +minuto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +recuperación I-PRESENT_ILLNESS +completa I-PRESENT_ILLNESS +posterior. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +siguientes I-PRESENT_ILLNESS +repitió I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +sincopales I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +similares I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +oportunidades. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hall I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +acceso I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +sincopal, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +trasladado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +box I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +evaluación I-PRESENT_ILLNESS +inmediata. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +126/82 I-EXPLORATION +mmHg, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +82 I-EXPLORATION +lpm, I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +99% I-EXPLORATION +y I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +de I-EXPLORATION +36°C. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +refería I-EXPLORATION +comorbilidades I-EXPLORATION +significativas I-EXPLORATION +ni I-EXPLORATION +antecedentes I-EXPLORATION +familiares I-EXPLORATION +de I-EXPLORATION +cardiopatía. I-EXPLORATION +Durante I-EXPLORATION +realización I-EXPLORATION +del I-EXPLORATION +ECG I-EXPLORATION +inicial I-EXPLORATION +paciente I-EXPLORATION +repitió I-EXPLORATION +síncope, I-EXPLORATION +objetivándose I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +trazado I-EXPLORATION +fibrilación I-EXPLORATION +ventricular. I-EXPLORATION +Se I-EXPLORATION +iniciaron I-EXPLORATION +maniobras I-EXPLORATION +de I-EXPLORATION +reanimación I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +convirtió I-EXPLORATION +a I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +después I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +segundos. I-EXPLORATION +Se I-EXPLORATION +repitió I-EXPLORATION +un I-EXPLORATION +ECG, I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +bloqueo I-EXPLORATION +incompleto I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +derecha, I-EXPLORATION +supradesnivel I-EXPLORATION +del I-EXPLORATION +ST I-EXPLORATION +e I-EXPLORATION +inversión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +T I-EXPLORATION +en I-EXPLORATION +precordiales I-EXPLORATION +derechas, I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +patrón I-EXPLORATION +Bragada I-EXPLORATION +tipo I-EXPLORATION +1. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +pocos I-EXPLORATION +minutos I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +nuevo I-EXPLORATION +episodio I-EXPLORATION +de I-EXPLORATION +fibrilación I-EXPLORATION +ventricular I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +inmediata I-EXPLORATION +desfibrilación I-EXPLORATION +con I-EXPLORATION +200 I-EXPLORATION +Joules I-EXPLORATION +de I-EXPLORATION +corriente I-EXPLORATION +bifásica, I-EXPLORATION +dando I-EXPLORATION +salida I-EXPLORATION +a I-EXPLORATION +ritmo I-EXPLORATION +sinusal. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +hospitalizado I-TREATMENT +en I-TREATMENT +Unidad I-TREATMENT +Coronaria, I-TREATMENT +donde I-TREATMENT +fue I-TREATMENT +sedado I-TREATMENT +con I-TREATMENT +lorazepam I-TREATMENT +y I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +isoproterenol I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +25 I-TREATMENT +ug/min. I-TREATMENT +Se B-EXPLORATION +registra I-EXPLORATION +ECG I-EXPLORATION +durante I-EXPLORATION +infusión I-EXPLORATION +de I-EXPLORATION +isoproterenol, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +regresión I-EXPLORATION +del I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +Brugada I-EXPLORATION +dado I-EXPLORATION +por I-EXPLORATION +normalización I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +en I-EXPLORATION +V1-V2, I-EXPLORATION +desaparición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +bloqueo I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +restauración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +polaridad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +T. I-EXPLORATION +Ecocardiograma I-EXPLORATION +descartó I-EXPLORATION +patología I-EXPLORATION +estructural I-EXPLORATION +y I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones I-EXPLORATION +significativas I-EXPLORATION +del I-EXPLORATION +medio I-EXPLORATION +interno. I-EXPLORATION +Evolucionó B-EVOLUTION +favorablemente, I-EVOLUTION +suspendiendo I-EVOLUTION +infusión I-EVOLUTION +antiarrítmica I-EVOLUTION +al I-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +e I-EVOLUTION +implantando I-EVOLUTION +cardiodesfibrilador I-EVOLUTION +bicameral I-EVOLUTION +(Protecta I-EVOLUTION +CRT-D, I-EVOLUTION +Medtronic) I-EVOLUTION +sin I-EVOLUTION +incidentes. I-EVOLUTION +Fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +al I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +sin I-EVOLUTION +medicación I-EVOLUTION +antiarrítmica. I-EVOLUTION +En I-EVOLUTION +control I-EVOLUTION +ambulatorio I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +registraron I-EVOLUTION +eventos I-EVOLUTION +arrítmicos I-EVOLUTION +en I-EVOLUTION +chequeo I-EVOLUTION +del I-EVOLUTION +dispositivo. I-EVOLUTION + I-EVOLUTION + +La B-EXPLORATION +isquemia I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +es I-EXPLORATION +una I-EXPLORATION +complicación I-EXPLORATION +a I-EXPLORATION +largo I-EXPLORATION +plazo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +diabetes. I-EXPLORATION +Los I-EXPLORATION +pacientes I-EXPLORATION +evolucionan I-EXPLORATION +con I-EXPLORATION +claudicación I-EXPLORATION +intermitente I-EXPLORATION +y, I-EXPLORATION +posteriormente, I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +de I-EXPLORATION +reposo I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensibilidad10, I-EXPLORATION +11. I-EXPLORATION +Pueden I-EXPLORATION +presentar I-EXPLORATION +alteraciones I-EXPLORATION +tróficas I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades, I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +uñas, I-EXPLORATION +xerosis, I-EXPLORATION +edema, I-EXPLORATION +linfangitis, I-EXPLORATION +pulsos I-EXPLORATION +disminuidos, I-EXPLORATION +piel I-EXPLORATION +fría, I-EXPLORATION +eritema, I-EXPLORATION +palidez I-EXPLORATION +o I-EXPLORATION +cianosis. I-EXPLORATION +Finalmente, I-EXPLORATION +aparecen I-EXPLORATION +úlceras I-EXPLORATION +y I-EXPLORATION +necrosis12, I-EXPLORATION +13. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +Doppler I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +angiografía I-EXPLORATION +permiten I-EXPLORATION +cuantificar I-EXPLORATION +la I-EXPLORATION +magnitud I-EXPLORATION +del I-EXPLORATION +deterioro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +circulación I-EXPLORATION +arterial. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +incluye I-TREATMENT +ejercicio I-TREATMENT +físico, I-TREATMENT +manejo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +diabetes I-TREATMENT +y I-TREATMENT +de I-TREATMENT +los I-TREATMENT +otros I-TREATMENT +factores I-TREATMENT +de I-TREATMENT +riesgo14. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +definitivo I-TREATMENT +es I-TREATMENT +la I-TREATMENT +revascularización15. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +70 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +retroesternal I-PRESENT_ILLNESS +opresivo, I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +10/10, I-PRESENT_ILLNESS +irradiado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +epigastrio, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +min I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duración, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +profusa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +palpitaciones. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Refería I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +similares I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes, I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +motivó I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +evaluada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +electrocardiograma I-PRESENT_ILLNESS +(ECG) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +enzimas I-PRESENT_ILLNESS +cardiacas; I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +impresionando I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +origen I-PRESENT_ILLNESS +coronario, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +derivó I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +domicilio. I-PRESENT_ILLNESS +Dentro B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destacaba I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +data I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +precisada, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +atenolol I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mama I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +radioterapia. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +ni B-FAMILY_HISTORY +tenía I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +cardiopatía I-FAMILY_HISTORY +coronaria. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Al B-EXPLORATION +ingreso, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +sudorosa, I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +dolor. I-EXPLORATION +La I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +era I-EXPLORATION +100/60 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +87 I-EXPLORATION +lpm. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacaban I-EXPLORATION +yugulares I-EXPLORATION +colapsables I-EXPLORATION +en I-EXPLORATION +inspiración, I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardiaca I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +soplos I-EXPLORATION +ni I-EXPLORATION +galope I-EXPLORATION +y I-EXPLORATION +había I-EXPLORATION +sensibilidad I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +epigástrica. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +no I-EXPLORATION +era I-EXPLORATION +destacable. I-EXPLORATION +Al B-PRESENT_ILLNESS +interrogatorio, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +historia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +similares I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +clara I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +esfuerzos I-PRESENT_ILLNESS +físicos, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +principio I-PRESENT_ILLNESS +eran I-PRESENT_ILLNESS +esporádicos I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +última I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +hicieron I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +frecuentes, I-PRESENT_ILLNESS +casi I-PRESENT_ILLNESS +diarios. I-PRESENT_ILLNESS +El B-EXPLORATION +ECG I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +discreto I-EXPLORATION +supradesnivel I-EXPLORATION +del I-EXPLORATION +segmento I-EXPLORATION +ST I-EXPLORATION +(SDST) I-EXPLORATION +anteroseptal I-EXPLORATION +con I-EXPLORATION +inversión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +T I-EXPLORATION +de I-EXPLORATION +V1 I-EXPLORATION +a I-EXPLORATION +V3, I-EXPLORATION +que I-EXPLORATION +ya I-EXPLORATION +era I-EXPLORATION +evidente I-EXPLORATION +en I-EXPLORATION +ECG I-EXPLORATION +tomado I-EXPLORATION +2 I-EXPLORATION +días I-EXPLORATION +antes I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +evolutivo. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +silueta I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +congestión I-EXPLORATION +pulmonar. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +admitida I-TREATMENT +a I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +coronaria, I-TREATMENT +con I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +coronario I-TREATMENT +agudo I-TREATMENT +sin I-TREATMENT +SDST. I-TREATMENT +La B-EXPLORATION +troponina I-EXPLORATION +I I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +07 I-EXPLORATION +pg/ml I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +0, I-EXPLORATION +05) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +CK I-EXPLORATION +total I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +117 I-EXPLORATION +U/L I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fracción I-EXPLORATION +MB I-EXPLORATION +de I-EXPLORATION +25. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +pocas I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +ingreso I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +con I-EVOLUTION +crisis I-EVOLUTION +de I-EVOLUTION +angor I-EVOLUTION +intenso, I-EVOLUTION +10/10, I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +disnea, I-EVOLUTION +palpitaciones, I-EVOLUTION +cefalea, I-EVOLUTION +sudoración I-EVOLUTION +y I-EVOLUTION +enrojecimiento I-EVOLUTION +facial. I-EVOLUTION +Se B-EXPLORATION +constató I-EXPLORATION +alza I-EXPLORATION +de I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +hasta I-EXPLORATION +260/130 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +monitor I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +taquicardia I-EXPLORATION +sinusal I-EXPLORATION +con I-EXPLORATION +extrasistolía I-EXPLORATION +supraventricular I-EXPLORATION +y I-EXPLORATION +ventricular I-EXPLORATION +frecuentes, I-EXPLORATION +y I-EXPLORATION +conducción I-EXPLORATION +aberrante I-EXPLORATION +con I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +bloqueo I-EXPLORATION +completo I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +5 I-EXPLORATION +min I-EXPLORATION +de I-EXPLORATION +duración. I-EXPLORATION +No I-EXPLORATION +hubo I-EXPLORATION +episodios I-EXPLORATION +de I-EXPLORATION +hipotensión I-EXPLORATION +ni I-EXPLORATION +síncope. I-EXPLORATION +Dado I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +del I-EXPLORATION +episodio I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +feocromocitoma. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +heparina, I-TREATMENT +se I-TREATMENT +aportó I-TREATMENT +solución I-TREATMENT +fisiológica I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +doxazosina I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h. I-TREATMENT +Se B-EXPLORATION +midió I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +crisis I-EXPLORATION +catecolaminas I-EXPLORATION +plasmáticas I-EXPLORATION +y I-EXPLORATION +metanefrinas I-EXPLORATION +urinarias I-EXPLORATION +(previo I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +doxazosina), I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +marcadamente I-EXPLORATION +elevadas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +de I-EXPLORATION +abdomen, I-EXPLORATION +que I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico, I-EXPLORATION +evidenciando I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +suprarrenal I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +cintigrama I-EXPLORATION +con I-EXPLORATION +123-I-metaiodobencilguanidina I-EXPLORATION +(MIBG) I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +captación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +descrita I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +metástasis. I-EXPLORATION + I-EXPLORATION +Adicionalmente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +transtorácico, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +hipertrofia I-EXPLORATION +ventricular I-EXPLORATION +izquierda I-EXPLORATION +leve I-EXPLORATION +y I-EXPLORATION +compromiso I-EXPLORATION +leve I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +global, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fracción I-EXPLORATION +de I-EXPLORATION +eyección I-EXPLORATION +(FE) I-EXPLORATION +estimada I-EXPLORATION +por I-EXPLORATION +Simpson I-EXPLORATION +de I-EXPLORATION +42%, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +coronariografía I-EXPLORATION +sin I-EXPLORATION +incidentes I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +procedimiento, I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +coronaria. I-EXPLORATION +La I-EXPLORATION +disfunción I-EXPLORATION +ventricular I-EXPLORATION +fue I-EXPLORATION +asumida I-EXPLORATION +en I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +daño I-EXPLORATION +miocárdico I-EXPLORATION +por I-EXPLORATION +catecolaminas. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +preparó I-TREATMENT +para I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +bloqueo I-TREATMENT +α I-TREATMENT +y I-TREATMENT +β-adrenérgico I-TREATMENT +escalonado I-TREATMENT +con I-TREATMENT +doxazosina I-TREATMENT +y, I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +días, I-TREATMENT +propanolol. I-TREATMENT +La I-TREATMENT +cirugía I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +11 I-TREATMENT +días I-TREATMENT +después, I-TREATMENT +sin I-TREATMENT +complicaciones I-TREATMENT +hemodinámicas I-TREATMENT +significativas I-TREATMENT +y I-TREATMENT +cursó I-TREATMENT +con I-TREATMENT +un I-TREATMENT +postoperatorio I-TREATMENT +favorable. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones. I-EVOLUTION +Desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +clínico, I-EVOLUTION +cursó I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +progresiva I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +antihipertensivos I-EVOLUTION +y I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +ventricular I-EVOLUTION +en I-EVOLUTION +ecocardiografía I-EVOLUTION +de I-EVOLUTION +control. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +suspendido, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +celiaca, I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +luego I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +iodo I-PAST_MEDICAL_HISTORY +radioactivo I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Graves. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +julio I-EXPLORATION +de I-EXPLORATION +2007 I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +vasculitis I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +ANCA I-EXPLORATION +(GPA), I-EXPLORATION +en I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +vías I-EXPLORATION +aéreas I-EXPLORATION +superiores I-EXPLORATION +(VAS), I-EXPLORATION +masa I-EXPLORATION +palpable I-EXPLORATION +supraclavicular I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +hipogastrio10. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +incluyen I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +eritrosedimentación I-EXPLORATION +(VSG) I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +120 I-EXPLORATION +mm, I-EXPLORATION +ANCA I-EXPLORATION +c I-EXPLORATION +positivos, I-EXPLORATION +el I-EXPLORATION +enzimoinmunoensayo I-EXPLORATION +(ELISA) I-EXPLORATION +reveló I-EXPLORATION +especificidad I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +antígeno I-EXPLORATION +proteinasa I-EXPLORATION +3 I-EXPLORATION +(PR3), I-EXPLORATION +sin I-EXPLORATION +microhematuria I-EXPLORATION +o I-EXPLORATION +insuficiencia I-EXPLORATION +renal. I-EXPLORATION +Presentó I-EXPLORATION +masa I-EXPLORATION +pulmonar I-EXPLORATION +apical I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +central I-EXPLORATION +sin I-EXPLORATION +cavitación. I-EXPLORATION +Se I-EXPLORATION +tomó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +supraclavicular I-EXPLORATION +cuya I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informó I-EXPLORATION +infamación I-EXPLORATION +granulomatosa I-EXPLORATION +necrotizante. I-EXPLORATION +En I-EXPLORATION +base I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +expuesto I-EXPLORATION +previamente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +GPA I-EXPLORATION +temprana I-EXPLORATION +sistémica I-EXPLORATION +del I-EXPLORATION +EUVAS I-EXPLORATION +(Registro I-EXPLORATION +Europeo I-EXPLORATION +de I-EXPLORATION +vasculitis) I-EXPLORATION +o I-EXPLORATION +localizada I-EXPLORATION +dado I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +renal. I-EXPLORATION +Recibió B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciclofosfamida I-TREATMENT +y I-TREATMENT +prednisolona I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +la I-TREATMENT +clínica. I-TREATMENT + I-TREATMENT +Presentó B-EVOLUTION +recaídas I-EVOLUTION +con I-EVOLUTION +síntomas I-EVOLUTION +respiratorios I-EVOLUTION +y I-EVOLUTION +nódulos I-EVOLUTION +pulmonares, I-EVOLUTION +pero I-EVOLUTION +con I-EVOLUTION +curva I-EVOLUTION +flujo I-EVOLUTION +volumen I-EVOLUTION +(CFV) I-EVOLUTION +normal, I-EVOLUTION +estando I-EVOLUTION +bajo I-EVOLUTION +tratamiento I-EVOLUTION +inmunosupresor I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +años I-EVOLUTION +2008, I-EVOLUTION +2009 I-EVOLUTION +y I-EVOLUTION +2010. I-EVOLUTION +Se B-TREATMENT +interpretó I-TREATMENT +como I-TREATMENT +enfermedad I-TREATMENT +refractaria I-TREATMENT +y I-TREATMENT +se I-TREATMENT +rotó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +micofenolato I-TREATMENT +3 I-TREATMENT +g/día I-TREATMENT +que I-TREATMENT +es I-TREATMENT +con I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +está I-TREATMENT +en I-TREATMENT +la I-TREATMENT +actualidad. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +inicios I-EVOLUTION +de I-EVOLUTION +mayo I-EVOLUTION +de I-EVOLUTION +2011 I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +disnea I-EVOLUTION +de I-EVOLUTION +esfuerzo, I-EVOLUTION +estridor I-EVOLUTION +inspiratorio, I-EVOLUTION +sibilancias I-EVOLUTION +y I-EVOLUTION +expectoración I-EVOLUTION +hemoptoica. I-EVOLUTION +Presentó B-EXPLORATION +analítica I-EXPLORATION +normal I-EXPLORATION +que I-EXPLORATION +incluyó I-EXPLORATION +VSG I-EXPLORATION +y I-EXPLORATION +ANCA. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +CFV I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +aplanamiento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +flujos I-EXPLORATION +inspiratorio I-EXPLORATION +y I-EXPLORATION +espiratorio, I-EXPLORATION +descripto I-EXPLORATION +como I-EXPLORATION +curva I-EXPLORATION +cajón. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +laringe I-EXPLORATION +y I-EXPLORATION +tráquea I-EXPLORATION +mostró I-EXPLORATION +ESG I-EXPLORATION +con I-EXPLORATION +indemnidad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +anillos I-EXPLORATION +traqueales. I-EXPLORATION +La I-EXPLORATION +fibrobroncoscopía I-EXPLORATION +mostró I-EXPLORATION +indemnidad I-EXPLORATION +de I-EXPLORATION +cuerdas I-EXPLORATION +vocales I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +sub-glótico I-EXPLORATION +mucosa I-EXPLORATION +friable I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +granulomas I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +actividad I-EXPLORATION +local I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +luz I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +mm. I-EXPLORATION + I-EXPLORATION +A I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +encontrarse I-EXPLORATION +con I-EXPLORATION +altas I-EXPLORATION +dosis I-EXPLORATION +de I-EXPLORATION +inmunosupresores, I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +intercurrencia I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +ESG, I-EXPLORATION +siendo I-EXPLORATION +dificultoso I-EXPLORATION +diferenciar, I-EXPLORATION +si I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +recaída I-EXPLORATION +o I-EXPLORATION +la I-EXPLORATION +cicatrización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +prexistente. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +duda I-TREATMENT +se I-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tres I-TREATMENT +pulsos I-TREATMENT +de I-TREATMENT +solumedrol I-TREATMENT +de I-TREATMENT +un I-TREATMENT +gramo I-TREATMENT +e I-TREATMENT +inició I-TREATMENT +plasmáferesis I-TREATMENT +con I-TREATMENT +el I-TREATMENT +objetivo I-TREATMENT +de I-TREATMENT +remover I-TREATMENT +complejos I-TREATMENT +antígeno-anticuerpo. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +analítica I-TREATMENT +tuvo I-TREATMENT +recuento I-TREATMENT +de I-TREATMENT +CD20 I-TREATMENT +normales I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +administraron I-TREATMENT +4 I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +rituximab I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +375 I-TREATMENT +mg/m2/semana I-TREATMENT +durante I-TREATMENT +4 I-TREATMENT +semanas I-TREATMENT +con I-TREATMENT +excelente I-TREATMENT +tolerancia. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +broncoscopia I-TREATMENT +rígida I-TREATMENT +terapéutica I-TREATMENT +(con I-TREATMENT +dilatación I-TREATMENT +y I-TREATMENT +electrocauterio). I-TREATMENT +Normalizó B-EVOLUTION +la I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +espirometría I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +a I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +del I-EVOLUTION +evento. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +multípara B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +5, I-PAST_MEDICAL_HISTORY +IMC I-PAST_MEDICAL_HISTORY +25, I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +kg/m2, I-PAST_MEDICAL_HISTORY +puérpera I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +(parto I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otra I-PAST_MEDICAL_HISTORY +institución), I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +levotiroxina I-PAST_MEDICAL_HISTORY +75 I-PAST_MEDICAL_HISTORY +mcg/día. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Santiago I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +retroesternal I-PRESENT_ILLNESS +opresivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +súbito I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +máxima I-PRESENT_ILLNESS +intensidad. I-PRESENT_ILLNESS +Ingresa B-EXPLORATION +sin I-EXPLORATION +compromiso I-EXPLORATION +hemodinámico, I-EXPLORATION +afebril, I-EXPLORATION +con I-EXPLORATION +examen I-EXPLORATION +cardiopulmonar I-EXPLORATION +normal. I-EXPLORATION +Electrocardiograma I-EXPLORATION +(ECG) I-EXPLORATION +muestra I-EXPLORATION +infradesnivel I-EXPLORATION +del I-EXPLORATION +ST I-EXPLORATION +difuso. I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +manejo I-TREATMENT +médico I-TREATMENT +con I-TREATMENT +aspirina, I-TREATMENT +morfina I-TREATMENT +y I-TREATMENT +nitroglicerina I-TREATMENT +sublingual; I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +solicitan I-EXPLORATION +enzimas I-EXPLORATION +cardíacas I-EXPLORATION +y I-EXPLORATION +dímero I-EXPLORATION +D. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +evidencian: I-EXPLORATION +hemoglobina I-EXPLORATION +14, I-EXPLORATION +9 I-EXPLORATION +g/dL, I-EXPLORATION +hematocrito I-EXPLORATION +43, I-EXPLORATION +7%, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +288.000/uL, I-EXPLORATION +eosinóflos I-EXPLORATION +2, I-EXPLORATION +9%, I-EXPLORATION +VHS I-EXPLORATION +17 I-EXPLORATION +mm/h, I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +43 I-EXPLORATION +mg/dL, I-EXPLORATION +troponina I-EXPLORATION +0, I-EXPLORATION +45 I-EXPLORATION +ng/ml, I-EXPLORATION +creatincinasa I-EXPLORATION +(CK) I-EXPLORATION +72 I-EXPLORATION +U/L, I-EXPLORATION +Ck-mb I-EXPLORATION +2, I-EXPLORATION +8 I-EXPLORATION +U/L; I-EXPLORATION +dímero I-EXPLORATION +D I-EXPLORATION +554 I-EXPLORATION +ng/ml. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicita I-EXPLORATION +AngioTAC I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +dímero I-EXPLORATION +D I-EXPLORATION +elevado, I-EXPLORATION +que I-EXPLORATION +descarta I-EXPLORATION +tromboembolismo I-EXPLORATION +pulmonar. I-EXPLORATION + I-EXPLORATION +Persiste I-EXPLORATION +con I-EXPLORATION +dolor I-EXPLORATION +y I-EXPLORATION +ECG I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +evidencia I-EXPLORATION +QS I-EXPLORATION +en I-EXPLORATION +AVL, I-EXPLORATION +qR I-EXPLORATION +en I-EXPLORATION +DI I-EXPLORATION +y I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +amplitud I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +onda I-EXPLORATION +R I-EXPLORATION +en I-EXPLORATION +V4-V6. I-EXPLORATION +Enzimas I-EXPLORATION +cardiacas I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +con I-EXPLORATION +troponina I-EXPLORATION +> I-EXPLORATION +50 I-EXPLORATION +ng/ml, I-EXPLORATION +CK I-EXPLORATION +3.800 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +Ck-mb I-EXPLORATION +> I-EXPLORATION +300 I-EXPLORATION +U/L. I-EXPLORATION +Coronariografía I-EXPLORATION +muestra I-EXPLORATION +disección I-EXPLORATION +de I-EXPLORATION +tronco I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +coronaria I-EXPLORATION +izquierda, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +circunfleja I-EXPLORATION +(Cx) I-EXPLORATION +proximal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +rama I-EXPLORATION +marginal I-EXPLORATION +pequeña. I-EXPLORATION +Arteria I-EXPLORATION +descendente I-EXPLORATION +anterior I-EXPLORATION +(ADA) I-EXPLORATION +y I-EXPLORATION +coronaria I-EXPLORATION +derecha I-EXPLORATION +sin I-EXPLORATION +lesiones. I-EXPLORATION +Se B-TREATMENT +instala I-TREATMENT +balón I-TREATMENT +de I-TREATMENT +contrapulsación I-TREATMENT +aórtica I-TREATMENT +y I-TREATMENT +se I-TREATMENT +traslada I-TREATMENT +a I-TREATMENT +cirugía, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +bypass I-TREATMENT +con I-TREATMENT +arteria I-TREATMENT +mamaria I-TREATMENT +interna I-TREATMENT +(LIMA) I-TREATMENT +a I-TREATMENT +ADA I-TREATMENT +y I-TREATMENT +puente I-TREATMENT +safeno I-TREATMENT +a I-TREATMENT +lateral I-TREATMENT +Cx, I-TREATMENT +sin I-TREATMENT +incidentes. I-TREATMENT + I-TREATMENT +Evoluciona B-EVOLUTION +favorablemente I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +post I-EVOLUTION +operatorio, I-EVOLUTION +con B-TREATMENT +retiro I-TREATMENT +de I-TREATMENT +drogas I-TREATMENT +vasoactivas I-TREATMENT +y I-TREATMENT +balón I-TREATMENT +de I-TREATMENT +contrapulsación I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +h. I-TREATMENT + I-TREATMENT +Ecocardiograma B-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +con I-EXPLORATION +acinesia I-EXPLORATION +no I-EXPLORATION +adelgazada I-EXPLORATION +anterolateral I-EXPLORATION +con I-EXPLORATION +fracción I-EXPLORATION +de I-EXPLORATION +eyección I-EXPLORATION +de I-EXPLORATION +42%. I-EXPLORATION +Se B-TREATMENT +optimiza I-TREATMENT +control I-TREATMENT +farmacológico I-TREATMENT +de I-TREATMENT +insuficiencia I-TREATMENT +cardíaca I-TREATMENT +con I-TREATMENT +bisoprolol I-TREATMENT +1, I-TREATMENT +25 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +espironolactona I-TREATMENT +25 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +enalapril I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +atorvastatina I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Se B-DERIVED_FROM/TO +traslada I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +quinto I-DERIVED_FROM/TO +día I-DERIVED_FROM/TO +post I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +otro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +motivos I-DERIVED_FROM/TO +previsionales. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-EVOLUTION +controla I-EVOLUTION +en I-EVOLUTION +policlínico I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +alta, I-EVOLUTION +encontrándose I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +asintomática, I-EVOLUTION +sin I-EVOLUTION +angina, I-EVOLUTION +en I-EVOLUTION +capacidad I-EVOLUTION +funcional I-EVOLUTION +I, I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +ya I-EVOLUTION +descrito, I-EVOLUTION +sin I-EVOLUTION +lactancia I-EVOLUTION +materna. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +46 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +intensas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +le I-PRESENT_ILLNESS +impedían I-PRESENT_ILLNESS +deambular. I-PRESENT_ILLNESS +Destacaba B-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +presencia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +T4 I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +mcg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +bypass I-PAST_MEDICAL_HISTORY +intestinal I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +adelgazamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +70 I-PAST_MEDICAL_HISTORY +Kg I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +ese I-PAST_MEDICAL_HISTORY +entonces. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +deposiciones I-PAST_MEDICAL_HISTORY +pastosas I-PAST_MEDICAL_HISTORY +diarias. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +vigil, I-EXPLORATION +eupneica I-EXPLORATION +y I-EXPLORATION +apirética. I-EXPLORATION +Presentaba I-EXPLORATION +adelgazamiento I-EXPLORATION +con I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +(IMC) I-EXPLORATION +de I-EXPLORATION +19. I-EXPLORATION +Tenía I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +de I-EXPLORATION +hidratación I-EXPLORATION +y I-EXPLORATION +sus I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +(TA) I-EXPLORATION +eran I-EXPLORATION +120/70 I-EXPLORATION +mmHg. I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +neuromuscular I-EXPLORATION +mostró I-EXPLORATION +hipotonía I-EXPLORATION +generalizada, I-EXPLORATION +paresia I-EXPLORATION +de I-EXPLORATION +cuatro I-EXPLORATION +miembros I-EXPLORATION +sin I-EXPLORATION +fasciculaciones I-EXPLORATION +y I-EXPLORATION +reflejos I-EXPLORATION +osteotendinosos I-EXPLORATION +presentes. I-EXPLORATION +Presentaba I-EXPLORATION +un I-EXPLORATION +potasio I-EXPLORATION +plasmático I-EXPLORATION +(K+pl) I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +1 I-EXPLORATION +mEq/L I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +CK. I-EXPLORATION +La I-EXPLORATION +dosificación I-EXPLORATION +de I-EXPLORATION +TSH I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +inició I-EXPLORATION +reposición I-EXPLORATION +hidroelectrolítica I-EXPLORATION +con I-EXPLORATION +mejoría I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paresia I-EXPLORATION +muscular, I-EXPLORATION +disminución I-EXPLORATION +progresiva I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mialgias I-EXPLORATION +y I-EXPLORATION +normalización I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +K+pl I-EXPLORATION +y I-EXPLORATION +CK. I-EXPLORATION +La I-EXPLORATION +hipopotasemia I-EXPLORATION +se I-EXPLORATION +atribuyó I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +pérdidas I-EXPLORATION +de I-EXPLORATION +origen I-EXPLORATION +digestivo, I-EXPLORATION +secundarias I-EXPLORATION +al I-EXPLORATION +procedimiento I-EXPLORATION +quirúrgico. I-EXPLORATION +Si I-EXPLORATION +bien I-EXPLORATION +la I-EXPLORATION +severidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +puede I-EXPLORATION +ser I-EXPLORATION +causa I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +manifestaciones I-EXPLORATION +neuromusculares, I-EXPLORATION +el I-EXPLORATION +hallazgo I-EXPLORATION +de I-EXPLORATION +niveles I-EXPLORATION +elevados I-EXPLORATION +de I-EXPLORATION +CK I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +RM I-EXPLORATION +asociada. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +paresia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +distal I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +instalación I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +horas. I-PRESENT_ILLNESS +Destacaba B-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +hipertensa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +enalapril, I-PAST_MEDICAL_HISTORY +atenolol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +furosemida. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +hipopotasemia I-PAST_MEDICAL_HISTORY +asintomática I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +indicó I-PAST_MEDICAL_HISTORY +suplemento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +potasio I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +oral. I-PAST_MEDICAL_HISTORY +Presentaba B-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +apirética I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +TA I-EXPLORATION +de I-EXPLORATION +150/90 I-EXPLORATION +mmHg. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +neuromuscular I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +cuadriparesia I-EXPLORATION +a I-EXPLORATION +predominio I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +con I-EXPLORATION +reflejos I-EXPLORATION +osteotendinosos I-EXPLORATION +conservados. I-EXPLORATION +El I-EXPLORATION +K+pl I-EXPLORATION +era I-EXPLORATION +1, I-EXPLORATION +4 I-EXPLORATION +mEq/L, I-EXPLORATION +con I-EXPLORATION +potasiuria I-EXPLORATION +en I-EXPLORATION +muestra I-EXPLORATION +aislada I-EXPLORATION +de I-EXPLORATION +26, I-EXPLORATION +7 I-EXPLORATION +mEq/L I-EXPLORATION +y I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +CK. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +diurético I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +reposición I-TREATMENT +hidroelectrolítica I-TREATMENT +obteniéndose B-EVOLUTION +una I-EVOLUTION +rápida I-EVOLUTION +respuesta I-EVOLUTION +clínica I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +K+pl I-EVOLUTION +y I-EVOLUTION +CK. I-EVOLUTION +En B-EXPLORATION +este I-EXPLORATION +caso, I-EXPLORATION +a I-EXPLORATION +diferencia I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +anteriores, I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hipopotasemia I-EXPLORATION +fueron I-EXPLORATION +las I-EXPLORATION +pérdidas I-EXPLORATION +renales I-EXPLORATION +de I-EXPLORATION +potasio, I-EXPLORATION +secundarias I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +diuréticos I-EXPLORATION +de I-EXPLORATION +asa. I-EXPLORATION +El I-EXPLORATION +hallazgo I-EXPLORATION +de I-EXPLORATION +26, I-EXPLORATION +7 I-EXPLORATION +mEq/L I-EXPLORATION +de I-EXPLORATION +potasiuria I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +aislada, I-EXPLORATION +es I-EXPLORATION +concordante I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +origen I-EXPLORATION +renal I-EXPLORATION +del I-EXPLORATION +disturbio. I-EXPLORATION + I-EXPLORATION + +Mujer, B-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Cinco B-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +trató I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cáncer I-PAST_MEDICAL_HISTORY +cervicouterino. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +rutinario, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +encontró I-PRESENT_ILLNESS +hidronefrosis I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +atrofia I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +riñón I-PRESENT_ILLNESS +derecho. I-PRESENT_ILLNESS +Se B-TREATMENT +instalaron I-TREATMENT +catéteres I-TREATMENT +ureterales I-TREATMENT +y I-TREATMENT +se I-TREATMENT +intentó I-TREATMENT +infructuosamente I-TREATMENT +efectuar I-TREATMENT +ureterolisis. I-TREATMENT +La B-EXPLORATION +biopsia I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +retroperitoneal I-EXPLORATION +reveló I-EXPLORATION +FRP I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +tumor. I-EXPLORATION +Se B-TREATMENT +prescribió I-TREATMENT +defazacort I-TREATMENT +30 I-TREATMENT +mg/día I-TREATMENT +y I-TREATMENT +colchicina I-TREATMENT +1, I-TREATMENT +0 I-TREATMENT +mg/día. I-TREATMENT +Al B-EVOLUTION +año I-EVOLUTION +la I-EVOLUTION +masa I-EVOLUTION +retroperitoneal I-EVOLUTION +había I-EVOLUTION +desaparecido I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +era I-EVOLUTION +normal. I-EVOLUTION +A I-EVOLUTION +16 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +FRP, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +estaba I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +cáncer. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +53 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +IC I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +2008 I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dilatación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +VI I-PAST_MEDICAL_HISTORY +(FE I-PAST_MEDICAL_HISTORY +35%) I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ecocardiograma. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +coronariografía I-PRESENT_ILLNESS +demostró I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +vasos, I-PRESENT_ILLNESS +realizándose I-PRESENT_ILLNESS +angioplastía I-PRESENT_ILLNESS +sobre I-PRESENT_ILLNESS +arteria I-PRESENT_ILLNESS +descendente I-PRESENT_ILLNESS +anterior. I-PRESENT_ILLNESS +En B-EXPLORATION +enero I-EXPLORATION +de I-EXPLORATION +2013 I-EXPLORATION +se I-EXPLORATION +hospitalizó I-EXPLORATION +con I-EXPLORATION +IC I-EXPLORATION +descompensada, I-EXPLORATION +con I-EXPLORATION +FE I-EXPLORATION +20% I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +ecocardiograma. I-EXPLORATION +Un I-EXPLORATION +SPECT I-EXPLORATION +miocàrdico I-EXPLORATION +descartó I-EXPLORATION +isquemia. I-EXPLORATION +En B-EVOLUTION +julio I-EVOLUTION +de I-EVOLUTION +2013 I-EVOLUTION +se I-EVOLUTION +re-hospitalizó, I-EVOLUTION +en I-EVOLUTION +CF I-EVOLUTION +IV, I-EVOLUTION +compensándose B-TREATMENT +con I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +levosimendan I-TREATMENT +0, I-TREATMENT +1 I-TREATMENT +mg/kg/min. I-TREATMENT +En I-TREATMENT +agosto I-TREATMENT +de I-TREATMENT +2013, I-TREATMENT +por I-TREATMENT +la I-TREATMENT +severa I-TREATMENT +disfunción I-TREATMENT +ventricular I-TREATMENT +y I-TREATMENT +escasa I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +trasplante, I-TREATMENT +se I-TREATMENT +implantó I-TREATMENT +un I-TREATMENT +HVAD I-TREATMENT +con I-TREATMENT +técnica I-TREATMENT +mínimamente I-TREATMENT +invasiva. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +post I-EVOLUTION +operatoria I-EVOLUTION +ocurrió I-EVOLUTION +sin I-EVOLUTION +incidentes, I-EVOLUTION +alcanzando I-EVOLUTION +un I-EVOLUTION +índice I-EVOLUTION +cardiaco I-EVOLUTION +de I-EVOLUTION +2, I-EVOLUTION +5 I-EVOLUTION +L/m2 I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +post-implante. I-EVOLUTION +Egresó I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +post-cirugía, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +9 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +permanece I-EVOLUTION +en I-EVOLUTION +CF I-EVOLUTION +I. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +Con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mesenquimopatía I-PAST_MEDICAL_HISTORY +indiferenciada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +nariz I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +silla I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +montar, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +condritis. I-PAST_MEDICAL_HISTORY +Anticuerpos I-PAST_MEDICAL_HISTORY +antinucleares I-PAST_MEDICAL_HISTORY +(ANA) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anti-Ro I-PAST_MEDICAL_HISTORY ++. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +alopecia, I-PRESENT_ILLNESS +artritis, I-PRESENT_ILLNESS +úlceras I-PRESENT_ILLNESS +orales I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +nasales. I-PRESENT_ILLNESS +Presentaba B-EXPLORATION +soplo I-EXPLORATION +aórtico I-EXPLORATION +sistólico I-EXPLORATION +V/VI I-EXPLORATION +irradiado I-EXPLORATION +al I-EXPLORATION +cuello. I-EXPLORATION +Tenía I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +eritrosedimentación I-EXPLORATION +(VHS) I-EXPLORATION +64 I-EXPLORATION +mm/h, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +(PCR) I-EXPLORATION +5 I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +10 I-EXPLORATION +mg/L), I-EXPLORATION +creatininemia I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +mg/dl, I-EXPLORATION +ANA I-EXPLORATION +1/160 I-EXPLORATION +moteado, I-EXPLORATION +anti-Ro I-EXPLORATION +22, I-EXPLORATION +5 I-EXPLORATION +U I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +15), I-EXPLORATION +anti-B2 I-EXPLORATION +glicoproteína I-EXPLORATION +1 I-EXPLORATION +IgM I-EXPLORATION +31, I-EXPLORATION +2 I-EXPLORATION +MPL I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +8) I-EXPLORATION +e I-EXPLORATION +IgG I-EXPLORATION +17 I-EXPLORATION +GPL I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +8), I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +normal. I-EXPLORATION +Ecocardiograma: I-EXPLORATION +aceleración I-EXPLORATION +del I-EXPLORATION +flujo I-EXPLORATION +de I-EXPLORATION +aorta I-EXPLORATION +torácica I-EXPLORATION +y I-EXPLORATION +vasos I-EXPLORATION +del I-EXPLORATION +cuello. I-EXPLORATION +aTAC I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +cuello I-EXPLORATION +y I-EXPLORATION +cerebral: I-EXPLORATION +engrosamiento I-EXPLORATION +segmentario I-EXPLORATION +y I-EXPLORATION +realce I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +aórtica I-EXPLORATION +y I-EXPLORATION +sus I-EXPLORATION +ramas I-EXPLORATION +principales, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +estenosis I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +alternadas. I-EXPLORATION +Estenosis I-EXPLORATION +moderada I-EXPLORATION +de I-EXPLORATION +carótida I-EXPLORATION +derecha, I-EXPLORATION +origen I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +celíaco I-EXPLORATION +y I-EXPLORATION +arteria I-EXPLORATION +mesentérica I-EXPLORATION +superior. I-EXPLORATION +Vasos I-EXPLORATION +cerebrales I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +corticoides, I-TREATMENT +hidroxicloroquina I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +pulsos I-TREATMENT +de I-TREATMENT +ciclofosfamida, I-TREATMENT +luego I-TREATMENT +azatioprina I-TREATMENT +y I-TREATMENT +prednisona. I-TREATMENT +El B-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +demostró I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +inflamación I-EVOLUTION +de I-EVOLUTION +aorta I-EVOLUTION +abdominal, I-EVOLUTION +tronco I-EVOLUTION +celíaco I-EVOLUTION +y I-EVOLUTION +arteria I-EVOLUTION +mesentérica I-EVOLUTION +superior, I-EVOLUTION +estenosis I-EVOLUTION +de I-EVOLUTION +50% I-EVOLUTION +del I-EVOLUTION +origen I-EVOLUTION +del I-EVOLUTION +tronco I-EVOLUTION +celíaco I-EVOLUTION +con I-EVOLUTION +dilatación I-EVOLUTION +post I-EVOLUTION +estenótica I-EVOLUTION +y I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios. I-EVOLUTION +A I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +exámenes I-EVOLUTION +normales. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +37 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumador B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +60 I-PAST_MEDICAL_HISTORY +cigarrillos/día I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +adolescencia, I-PAST_MEDICAL_HISTORY +hospitalizado B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +síncope I-PRESENT_ILLNESS +recurrente. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso, I-EXPLORATION +se I-EXPLORATION +registró I-EXPLORATION +TV I-EXPLORATION +monoforma I-EXPLORATION +con I-EXPLORATION +frecuencia I-EXPLORATION +de I-EXPLORATION +233 I-EXPLORATION +lpm I-EXPLORATION +en I-EXPLORATION +trazado I-EXPLORATION +de I-EXPLORATION +monitor, I-EXPLORATION +que I-EXPLORATION +convirtió I-EXPLORATION +espontáneamente I-EXPLORATION +a I-EXPLORATION +ritmo I-EXPLORATION +sinusal. I-EXPLORATION +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +consumidor I-PAST_MEDICAL_HISTORY +ocasional I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso. I-PAST_MEDICAL_HISTORY +Negó B-PRESENT_ILLNESS +tener I-PRESENT_ILLNESS +angina I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +disnea. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +ECG I-EXPLORATION +post-conversión I-EXPLORATION +a I-EXPLORATION +ritmo I-EXPLORATION +sinusal I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +(-) I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +derivaciones I-EXPLORATION +precordiales I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +inferior. I-EXPLORATION +La I-EXPLORATION +troponina I-EXPLORATION +I I-EXPLORATION +alcanzó I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +máximo I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +ng/ml I-EXPLORATION +[VN I-EXPLORATION +< I-EXPLORATION +0, I-EXPLORATION +4 I-EXPLORATION +ng/ml]. I-EXPLORATION +Un I-EXPLORATION +ecocardiograma I-EXPLORATION +reveló I-EXPLORATION +leve I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +diámetros I-EXPLORATION +internos I-EXPLORATION +del I-EXPLORATION +VI, I-EXPLORATION +disquinesia I-EXPLORATION +apical I-EXPLORATION +y I-EXPLORATION +lateroapical I-EXPLORATION +con I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +global I-EXPLORATION +levemente I-EXPLORATION +disminuida I-EXPLORATION +[FE I-EXPLORATION +45%, I-EXPLORATION +Simpson]. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +del I-EXPLORATION +VD I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +anormalidades. I-EXPLORATION +Con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +presuntivo I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +coronaria, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +angiográfico I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +arterias I-EXPLORATION +coronarias I-EXPLORATION +normales. I-EXPLORATION +Para I-EXPLORATION +avanzar I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +diagnóstico, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +RC. I-EXPLORATION +Las I-EXPLORATION +imágenes I-EXPLORATION +con I-EXPLORATION +secuencias I-EXPLORATION +de I-EXPLORATION +eco-gradiente I-EXPLORATION +en I-EXPLORATION +4-cavidades I-EXPLORATION +y I-EXPLORATION +eje I-EXPLORATION +corto, I-EXPLORATION +mostraron I-EXPLORATION +dilatación I-EXPLORATION +del I-EXPLORATION +VD I-EXPLORATION +[VDVD/ASC I-EXPLORATION +122/m2] I-EXPLORATION +con I-EXPLORATION +acentuada I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +espesor I-EXPLORATION +parietal I-EXPLORATION +especialmente I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +lateral, I-EXPLORATION +microaneurismas I-EXPLORATION +(flechas I-EXPLORATION +amarillas), I-EXPLORATION +disquinesia I-EXPLORATION +de I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +basal I-EXPLORATION +e I-EXPLORATION +inferior I-EXPLORATION +(flechas I-EXPLORATION +azules) I-EXPLORATION +y I-EXPLORATION +función I-EXPLORATION +global I-EXPLORATION +severamente I-EXPLORATION +disminuida I-EXPLORATION +(FE I-EXPLORATION +19%). I-EXPLORATION +Al I-EXPLORATION +mismo I-EXPLORATION +tiempo, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +leve I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +diámetros I-EXPLORATION +internos I-EXPLORATION +del I-EXPLORATION +VI I-EXPLORATION +con I-EXPLORATION +moderada I-EXPLORATION +diminución I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +función I-EXPLORATION +sistólica I-EXPLORATION +global I-EXPLORATION +(FE I-EXPLORATION +38%), I-EXPLORATION +dos I-EXPLORATION +zonas I-EXPLORATION +con I-EXPLORATION +disquinesia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +apical I-EXPLORATION +con I-EXPLORATION +adelgazamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +miocárdica I-EXPLORATION +(flechas I-EXPLORATION +azules) I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +aquinesia I-EXPLORATION +con I-EXPLORATION +miocardio I-EXPLORATION +adelgazado I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +(flecha I-EXPLORATION +roja) I-EXPLORATION +e I-EXPLORATION +infiltración I-EXPLORATION +grasa I-EXPLORATION +adyacente I-EXPLORATION +(flecha I-EXPLORATION +verde). I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +axial I-EXPLORATION +potenciada I-EXPLORATION +en I-EXPLORATION +T1, I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +infiltración I-EXPLORATION +grasa I-EXPLORATION +subepicárdica I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +del I-EXPLORATION +VD, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +y I-EXPLORATION +ápex I-EXPLORATION +del I-EXPLORATION +VI I-EXPLORATION +(flechas I-EXPLORATION +verdes). I-EXPLORATION +A I-EXPLORATION +su I-EXPLORATION +vez, I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +4-cavidades I-EXPLORATION +con I-EXPLORATION +secuencias I-EXPLORATION +de I-EXPLORATION +inversión-recuperación I-EXPLORATION +para I-EXPLORATION +evaluar I-EXPLORATION +viabilidad, I-EXPLORATION +luego I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +gadolinio I-EXPLORATION +endovenoso, I-EXPLORATION +mostró I-EXPLORATION +extensa I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +(realce I-EXPLORATION +tardío) I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +del I-EXPLORATION +VD I-EXPLORATION +y I-EXPLORATION +región I-EXPLORATION +subtricuspídea I-EXPLORATION +(flechas I-EXPLORATION +naranjas). I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +descritos I-EXPLORATION +son I-EXPLORATION +diagnósticos I-EXPLORATION +para I-EXPLORATION +DAVD I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +VI, I-EXPLORATION +en I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tres I-EXPLORATION +criterios I-EXPLORATION +diagnósticos I-EXPLORATION +mayores: I-EXPLORATION +ondas I-EXPLORATION +T I-EXPLORATION +invertidas I-EXPLORATION +en I-EXPLORATION +derivaciones I-EXPLORATION +precordiales I-EXPLORATION +derechas I-EXPLORATION +(V1 I-EXPLORATION +a I-EXPLORATION +V6) I-EXPLORATION +en I-EXPLORATION +individuo I-EXPLORATION +> I-EXPLORATION +14 I-EXPLORATION +años I-EXPLORATION +sin I-EXPLORATION +bloqueo I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +derecho, I-EXPLORATION +disquinesia I-EXPLORATION +regionales I-EXPLORATION +del I-EXPLORATION +VD I-EXPLORATION +más I-EXPLORATION +cociente I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +telediastólico I-EXPLORATION +del I-EXPLORATION +VD I-EXPLORATION +> I-EXPLORATION +110 I-EXPLORATION +ml/m2 I-EXPLORATION +(varones); I-EXPLORATION +TV I-EXPLORATION +documentada. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +incluyó I-TREATMENT +la I-TREATMENT +implantación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +CDI. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +coronaria, I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +uropatía I-PAST_MEDICAL_HISTORY +obstructiva, I-PAST_MEDICAL_HISTORY +portador I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +cistostomía I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +fue B-PRESENT_ILLNESS +hospitalizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +medicina I-PRESENT_ILLNESS +interna I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cambio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +catéter I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemodiálisis, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +contexto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +catéter I-PRESENT_ILLNESS +disfuncional; I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +llamó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +atención I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cistostomía I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +estaba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +estado, I-PRESENT_ILLNESS +objetivándose I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +orina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +color I-PRESENT_ILLNESS +púrpura I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +bolsa I-PRESENT_ILLNESS +colectora. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Dentro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +medicamentos I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +usaba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +crónica, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +destacó I-PRESENT_ILLNESS +ninguno I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +pudiese I-PRESENT_ILLNESS +relacionarse I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +cambio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +coloración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +orina. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +buenas I-EXPLORATION +condiciones I-EXPLORATION +generales, I-EXPLORATION +afebril, I-EXPLORATION +hemodinámicamente I-EXPLORATION +estable, I-EXPLORATION +con I-EXPLORATION +cistostomía I-EXPLORATION +in I-EXPLORATION +situ, I-EXPLORATION +funcionante, I-EXPLORATION +pero I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +deficiente I-EXPLORATION +autocuidado, I-EXPLORATION +sucia I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +muy I-EXPLORATION +mal I-EXPLORATION +olor. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +un I-EXPLORATION +sedimento I-EXPLORATION +urinario I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +leucocitos I-EXPLORATION +5-10 I-EXPLORATION +x I-EXPLORATION +campo I-EXPLORATION +[valor I-EXPLORATION +normal I-EXPLORATION +(VN): I-EXPLORATION +1-5], I-EXPLORATION +abundantes I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +fosfatos I-EXPLORATION +amorfos I-EXPLORATION +abundantes I-EXPLORATION +x I-EXPLORATION +campo. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +completo I-EXPLORATION +destacó I-EXPLORATION +el I-EXPLORATION +color I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +turbio, I-EXPLORATION +pH I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +8 I-EXPLORATION +[VN: I-EXPLORATION +4, I-EXPLORATION +5-8, I-EXPLORATION +0] I-EXPLORATION +y I-EXPLORATION +nitritos I-EXPLORATION +positivos. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +urocultivo I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +un I-EXPLORATION +recuento I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +100.000 I-EXPLORATION +UFC/ml I-EXPLORATION +de I-EXPLORATION +Citrobacter I-EXPLORATION +freundii I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +cefadroxilo, I-EXPLORATION +ciprofloxacino I-EXPLORATION +y I-EXPLORATION +nitrofurantoína. I-EXPLORATION +Entre I-EXPLORATION +los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +sangre, I-EXPLORATION +destacó I-EXPLORATION +una I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +10.600 I-EXPLORATION +x I-EXPLORATION +mm3 I-EXPLORATION +[VN: I-EXPLORATION +4.000-9.000], I-EXPLORATION +una I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +34 I-EXPLORATION +mg/dL I-EXPLORATION +[VN: I-EXPLORATION +0-5] I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +VHS I-EXPLORATION +de I-EXPLORATION +54 I-EXPLORATION +mm/h I-EXPLORATION +[VN: I-EXPLORATION +2-10]. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +prostática, I-EXPLORATION +procedimiento I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +técnicamente I-EXPLORATION +limitado I-EXPLORATION +por I-EXPLORATION +parcial I-EXPLORATION +distensión I-EXPLORATION +vesical, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +volumen I-EXPLORATION +al I-EXPLORATION +momento I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +26 I-EXPLORATION +cc, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +no I-EXPLORATION +fue I-EXPLORATION +posible I-EXPLORATION +evaluar I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +prostática. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +2 I-TREATMENT +g/día I-TREATMENT +endovenoso I-TREATMENT +y I-TREATMENT +se I-TREATMENT +solicitó I-TREATMENT +evaluación I-TREATMENT +por I-TREATMENT +urología, I-TREATMENT +quienes I-TREATMENT +decidieron I-TREATMENT +realizar I-TREATMENT +un I-TREATMENT +recambio I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cistostomía, I-TREATMENT +en I-TREATMENT +contexto I-TREATMENT +de I-TREATMENT +la I-TREATMENT +infección I-TREATMENT +urinaria I-TREATMENT +y I-TREATMENT +el I-TREATMENT +aspecto I-TREATMENT +mal I-TREATMENT +cuidado I-TREATMENT +de I-TREATMENT +ésta. I-TREATMENT + I-TREATMENT +Con B-EVOLUTION +el I-EVOLUTION +transcurso I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +días, I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +un I-EVOLUTION +aclaramiento I-EVOLUTION +progresivo I-EVOLUTION +del I-EVOLUTION +color I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +orina, I-EVOLUTION +retornando I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +color I-EVOLUTION +natural I-EVOLUTION +tras I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +antibioterapia. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +chofer, B-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento. I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +pantorrilla I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +poplítea I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +metros I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +marcha. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +claudicación I-PAST_MEDICAL_HISTORY +intermitente. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destaca I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +temperatura I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +pierna I-EXPLORATION +y I-EXPLORATION +pie I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +poplíteo I-EXPLORATION +y I-EXPLORATION +distal I-EXPLORATION +en I-EXPLORATION +esa I-EXPLORATION +extremidad. I-EXPLORATION +En I-EXPLORATION +extremidad I-EXPLORATION +inferior I-EXPLORATION +derecha I-EXPLORATION +pulsos I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +laboratorio I-EXPLORATION +vascular I-EXPLORATION +no I-EXPLORATION +invasivo I-EXPLORATION +confirma I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +clínico I-EXPLORATION +de I-EXPLORATION +obliteración I-EXPLORATION +femoro-poplítea I-EXPLORATION +izquierda, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +hospitaliza I-EXPLORATION +para I-EXPLORATION +angiografía. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +estudio I-EXPLORATION +angiográfico I-EXPLORATION +; I-EXPLORATION +observándose I-EXPLORATION +en I-EXPLORATION +arteria I-EXPLORATION +poplítea I-EXPLORATION +izquierda I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +segmento I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +largo, I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +93%, I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +lisa, I-EXPLORATION +que I-EXPLORATION +sugiere I-EXPLORATION +compresión I-EXPLORATION +extrínseca. I-EXPLORATION +Resto I-EXPLORATION +del I-EXPLORATION +árbol I-EXPLORATION +arterial I-EXPLORATION +sano, I-EXPLORATION +sin I-EXPLORATION +imágenes I-EXPLORATION +endoluminales. I-EXPLORATION + I-EXPLORATION +Llama B-EVOLUTION +la I-EVOLUTION +atención I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +pulso I-EVOLUTION +poplíteo I-EVOLUTION +y I-EVOLUTION +distal I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +extremidad I-EVOLUTION +afectada I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +del I-EVOLUTION +estudio. I-EVOLUTION + I-EVOLUTION +Al I-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +post I-EVOLUTION +angiografía I-EVOLUTION +se I-EVOLUTION +indica I-EVOLUTION +marcha I-EVOLUTION +al I-EVOLUTION +paciente, I-EVOLUTION +reproduciendo I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +pantorrilla I-EVOLUTION +izquierda. I-EVOLUTION +Examinado B-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +momento I-EXPLORATION +se I-EXPLORATION +pesquisa I-EXPLORATION +nuevamente I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulso I-EXPLORATION +poplíteo I-EXPLORATION +y I-EXPLORATION +distal. I-EXPLORATION +Estudio I-EXPLORATION +no I-EXPLORATION +invasivo I-EXPLORATION +PVR I-EXPLORATION +(registro I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +pulsos) I-EXPLORATION +y I-EXPLORATION +PPG I-EXPLORATION +muestra I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +curvas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +poplítea I-EXPLORATION +a I-EXPLORATION +distal I-EXPLORATION +con I-EXPLORATION +PPG I-EXPLORATION +plano I-EXPLORATION +en I-EXPLORATION +ortejos.. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +hipótesis I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +atrapamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +poplítea I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +muestra I-EXPLORATION +compresión I-EXPLORATION +extrínseca I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +por I-EXPLORATION +estructura I-EXPLORATION +alguna, I-EXPLORATION +destacando I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +pared I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +hiperintensa I-EXPLORATION +en I-EXPLORATION +secuencia I-EXPLORATION +T1que I-EXPLORATION +determina I-EXPLORATION +estenosis I-EXPLORATION +y I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +hematoma. I-EXPLORATION +Estudio I-EXPLORATION +con I-EXPLORATION +angiografía I-EXPLORATION +por I-EXPLORATION +tomografía I-EXPLORATION +computada I-EXPLORATION +de I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +(AngioTC I-EXPLORATION +de I-EXPLORATION +EEII) I-EXPLORATION +muestra I-EXPLORATION +en I-EXPLORATION +arteria I-EXPLORATION +poplítea I-EXPLORATION +izquierda, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +estenosis, I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +baja I-EXPLORATION +densidad I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +pared, I-EXPLORATION +sin I-EXPLORATION +realce I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +contraste I-EXPLORATION +endovenoso, I-EXPLORATION +que I-EXPLORATION +hace I-EXPLORATION +plantear I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +degeneración I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +poplítea. I-EXPLORATION + I-EXPLORATION +Intervenido B-TREATMENT +quirúrgicamente I-TREATMENT +mediante I-TREATMENT +abordaje I-TREATMENT +posterior, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +puente I-TREATMENT +poplíteo I-TREATMENT +con I-TREATMENT +vena I-TREATMENT +safena I-TREATMENT +invertida, I-TREATMENT +resecando I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +poplítea I-TREATMENT +en I-TREATMENT +su I-TREATMENT +tercio I-TREATMENT +medio, I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +aprecia I-TREATMENT +de I-TREATMENT +coloración I-TREATMENT +violácea I-TREATMENT +y I-TREATMENT +contorno I-TREATMENT +irregular. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +enviada I-EXPLORATION +a I-EXPLORATION +biopsia I-EXPLORATION +concluye I-EXPLORATION +“degeneración I-EXPLORATION +quística I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +media”. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +con I-EVOLUTION +pulsos I-EVOLUTION +conservados I-EVOLUTION +y I-EVOLUTION +simétricos I-EVOLUTION +en I-EVOLUTION +ambas I-EVOLUTION +EEII, I-EVOLUTION +sin I-EVOLUTION +claudicación I-EVOLUTION +intermitente I-EVOLUTION +y I-EVOLUTION +pudiendo I-EVOLUTION +reintegrarse I-EVOLUTION +rápidamente I-EVOLUTION +a I-EVOLUTION +sus I-EVOLUTION +labores I-EVOLUTION +habituales. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +controles I-EVOLUTION +posteriores I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático, I-EVOLUTION +con I-EVOLUTION +examen I-EVOLUTION +físico I-EVOLUTION +y I-EVOLUTION +estudio I-EVOLUTION +vascular I-EVOLUTION +no I-EVOLUTION +invasivo I-EVOLUTION +normal I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +palpebral I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +sonarse I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +nariz I-PRESENT_ILLNESS +(maniobra I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Valsalva). I-PRESENT_ILLNESS +Esa I-PRESENT_ILLNESS +misma I-PRESENT_ILLNESS +madrugada I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sufrido I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +altura I-PRESENT_ILLNESS +golpeándose I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cara I-PRESENT_ILLNESS +lateral I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +nariz, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +altura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +huesos I-PRESENT_ILLNESS +propios, I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +epistaxis I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +autolimitada. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +oftalmológico I-EXPLORATION +reveló I-EXPLORATION +visión I-EXPLORATION +20/20 I-EXPLORATION +en I-EXPLORATION +cada I-EXPLORATION +ojo, I-EXPLORATION +reflejos I-EXPLORATION +pupilares I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +motilidad I-EXPLORATION +ocular I-EXPLORATION +conservada, I-EXPLORATION +sin I-EXPLORATION +edema I-EXPLORATION +ni I-EXPLORATION +hiperemia I-EXPLORATION +conjuntival, I-EXPLORATION +sólo I-EXPLORATION +discreta I-EXPLORATION +equimosis I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +medial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hemicara I-EXPLORATION +izquierda I-EXPLORATION +acompañada I-EXPLORATION +de I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +palpebral I-EXPLORATION +crepitante I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +El I-EXPLORATION +marco I-EXPLORATION +óseo I-EXPLORATION +orbitario I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +pirámide I-EXPLORATION +nasal I-EXPLORATION +estaban I-EXPLORATION +sin I-EXPLORATION +dolor. I-EXPLORATION +Los I-EXPLORATION +signos I-EXPLORATION +vitales I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +cráneo-facial I-EXPLORATION +corroboró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +enfisema I-EXPLORATION +subcutáneo I-EXPLORATION +y I-EXPLORATION +orbitario, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lámina I-EXPLORATION +papirácea I-EXPLORATION +del I-EXPLORATION +etmoides I-EXPLORATION +ipsilateral. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +hospitalizado I-EVOLUTION +y I-EVOLUTION +observado I-EVOLUTION +por I-EVOLUTION +24 I-EVOLUTION +h, I-EVOLUTION +posteriormente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +precaución I-EVOLUTION +de I-EVOLUTION +evitar I-EVOLUTION +maniobras I-EVOLUTION +que I-EVOLUTION +pudieran I-EVOLUTION +aumentar I-EVOLUTION +la I-EVOLUTION +presión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +vía I-EVOLUTION +aérea I-EVOLUTION +superior, I-EVOLUTION +durante I-EVOLUTION +dos I-EVOLUTION +semanas. I-EVOLUTION +El I-EVOLUTION +enfisema I-EVOLUTION +se I-EVOLUTION +resolvió I-EVOLUTION +espontáneamente I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +y I-EVOLUTION +durante I-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +semanas I-EVOLUTION +siguientes I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +desarrolló I-EVOLUTION +complicaciones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +22 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +caucásico, I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +CUC I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +biopsia I-PAST_MEDICAL_HISTORY +compatible. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +mesalazina I-PAST_MEDICAL_HISTORY +1.000 I-PAST_MEDICAL_HISTORY +mg I-PAST_MEDICAL_HISTORY +c/8 I-PAST_MEDICAL_HISTORY +h I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +prednisona I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +decrecientes I-PAST_MEDICAL_HISTORY +(5 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +actividad I-PAST_MEDICAL_HISTORY +inflamatoria I-PAST_MEDICAL_HISTORY +actual. I-PAST_MEDICAL_HISTORY +Tres B-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +intensa I-PRESENT_ILLNESS +persistente, I-PRESENT_ILLNESS +agregándose I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +trastorno I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +lenguaje. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +fotofobia I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +visuales. I-PRESENT_ILLNESS +No B-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +signología I-EXPLORATION +focal I-EXPLORATION +ni I-EXPLORATION +movimientos I-EXPLORATION +anormales. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +examen, I-EXPLORATION +afebril, I-EXPLORATION +normotenso, I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +98% I-EXPLORATION +ambiental, I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +perfusión. I-EXPLORATION +Ritmo I-EXPLORATION +cardiaco I-EXPLORATION +regular I-EXPLORATION +de I-EXPLORATION +88 I-EXPLORATION +lpm. I-EXPLORATION +Sin I-EXPLORATION +alteraciones I-EXPLORATION +pleuropulmonares. I-EXPLORATION +Abdomen I-EXPLORATION +indoloro. I-EXPLORATION +Neurológicamente I-EXPLORATION +estaba I-EXPLORATION +vigil I-EXPLORATION +pero I-EXPLORATION +confuso, I-EXPLORATION +con I-EXPLORATION +afasia I-EXPLORATION +fluente I-EXPLORATION +y I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +comprensión. I-EXPLORATION +Sin I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +oculomotricidad. I-EXPLORATION +Sector I-EXPLORATION +espinal I-EXPLORATION +y I-EXPLORATION +meníngeo I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +Valoración I-EXPLORATION +general I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +sin I-EXPLORATION +elementos I-EXPLORATION +a I-EXPLORATION +destacar. I-EXPLORATION + I-EXPLORATION +Tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +encéfalo I-EXPLORATION +mostró I-EXPLORATION +imagen I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +cortical I-EXPLORATION +con I-EXPLORATION +infarto I-EXPLORATION +parenquimatoso I-EXPLORATION +temporo-basal I-EXPLORATION +izquierdo. I-EXPLORATION +Resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +con I-EXPLORATION +angiorresonancia I-EXPLORATION +en I-EXPLORATION +tiempo I-EXPLORATION +venoso I-EXPLORATION +informó I-EXPLORATION +infarto I-EXPLORATION +hemorrágico I-EXPLORATION +temporal I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +superficial I-EXPLORATION +y I-EXPLORATION +seno I-EXPLORATION +venoso I-EXPLORATION +sigmoideo I-EXPLORATION +homolateral.. I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +búsqueda I-EXPLORATION +de I-EXPLORATION +trombofilias I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +(proteínas I-EXPLORATION +C, I-EXPLORATION +S, I-EXPLORATION +antitrombina I-EXPLORATION +III, I-EXPLORATION +resistencia I-EXPLORATION +a I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +activada, I-EXPLORATION +homocisteinemia, I-EXPLORATION +factor I-EXPLORATION +20210A, I-EXPLORATION +FV I-EXPLORATION +Leiden, I-EXPLORATION +metil I-EXPLORATION +tetra I-EXPLORATION +hidro I-EXPLORATION +folato I-EXPLORATION +reductasa, I-EXPLORATION +lipoproteína I-EXPLORATION +(a), I-EXPLORATION +factor I-EXPLORATION +VIII, I-EXPLORATION +anticuerpos I-EXPLORATION +anticardiolipinas, I-EXPLORATION +anti I-EXPLORATION +beta2 I-EXPLORATION +glicoproteína, I-EXPLORATION +inhibidor I-EXPLORATION +lúpico, I-EXPLORATION +inhibidor I-EXPLORATION +del I-EXPLORATION +activador I-EXPLORATION +tisular I-EXPLORATION +del I-EXPLORATION +plasminógeno). I-EXPLORATION +Todos I-EXPLORATION +fueron I-EXPLORATION +solicitados I-EXPLORATION +posteriormente I-EXPLORATION +al I-EXPLORATION +inicio I-EXPLORATION +del I-EXPLORATION +tratamiento I-EXPLORATION +anticoagulante. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +anticoagulación I-TREATMENT +con I-TREATMENT +enoxaparina I-TREATMENT +(1 I-TREATMENT +mg/Kg I-TREATMENT +subcutánea I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h) I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +evolución. I-TREATMENT +Se I-TREATMENT +mantuvo I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +CUC I-TREATMENT +con I-TREATMENT +mesalazina I-TREATMENT +y I-TREATMENT +prednisona. I-TREATMENT +Se B-EVOLUTION +otorgó I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +10º I-EVOLUTION +día, I-EVOLUTION +asintomático, I-EVOLUTION +continuando B-TREATMENT +anticoagulación I-TREATMENT +con I-TREATMENT +enoxaparina I-TREATMENT +subcutánea I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +con I-TREATMENT +dicumarínicos I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT + I-TREATMENT + +Paciente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sexo I-PAST_MEDICAL_HISTORY +masculino I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +crónico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol. I-PAST_MEDICAL_HISTORY +Diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cirrosis I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2002 I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +48 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +estudió I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +2004, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +PCR I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +VHC I-PAST_MEDICAL_HISTORY +positiva, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +carga I-PAST_MEDICAL_HISTORY +viral I-PAST_MEDICAL_HISTORY +280.998 I-PAST_MEDICAL_HISTORY +UI/ml I-PAST_MEDICAL_HISTORY +(Log I-PAST_MEDICAL_HISTORY +5, I-PAST_MEDICAL_HISTORY +45) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +genotipo I-PAST_MEDICAL_HISTORY +3a. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento. I-PAST_MEDICAL_HISTORY +Derivado B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +2005 I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presencia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +compatibles I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +hepatocarcinoma. I-DERIVED_FROM/TO +Quimioembolización B-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +octubre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2005, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +quimioembolizaciones I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alcoholizaciones I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +julio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2006 I-PAST_MEDICAL_HISTORY +cuando I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +trasplantado. I-PAST_MEDICAL_HISTORY +Post B-TREATMENT +trasplante I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +inmunosupresión I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +ciclosporina. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +meses I-EVOLUTION +post I-EVOLUTION +trasplante, I-EVOLUTION +con I-EVOLUTION +transaminasas I-EVOLUTION +hasta I-EVOLUTION +12 I-EVOLUTION +veces I-EVOLUTION +el I-EVOLUTION +valor I-EVOLUTION +normal, I-EVOLUTION +se I-EVOLUTION +planteó I-EVOLUTION +rechazo I-EVOLUTION +vs I-EVOLUTION +reactivación I-EVOLUTION +de I-EVOLUTION +VHC. I-EVOLUTION +Se B-TREATMENT +agregó I-TREATMENT +sirolimus. I-TREATMENT +Biopsia B-EXPLORATION +hepática I-EXPLORATION +mostró I-EXPLORATION +esteatosis I-EXPLORATION +y I-EXPLORATION +hepatitis I-EXPLORATION +aguda I-EXPLORATION +leve, I-EXPLORATION +sin I-EXPLORATION +elementos I-EXPLORATION +de I-EXPLORATION +especificidad. I-EXPLORATION +Carga I-EXPLORATION +viral I-EXPLORATION +3.000.694 I-EXPLORATION +UI/ml I-EXPLORATION +(Log I-EXPLORATION +6, I-EXPLORATION +48). I-EXPLORATION +Persistió B-EVOLUTION +con I-EVOLUTION +transaminasas I-EVOLUTION +1, I-EVOLUTION +5 I-EVOLUTION +a I-EVOLUTION +3 I-EVOLUTION +veces I-EVOLUTION +el I-EVOLUTION +valor I-EVOLUTION +normal. I-EVOLUTION +Debido I-EVOLUTION +a I-EVOLUTION +pancitopenia I-EVOLUTION +se I-EVOLUTION +suspendió I-EVOLUTION +sirolimus. I-EVOLUTION +A B-TREATMENT +los I-TREATMENT +3 I-TREATMENT +años I-TREATMENT +y I-TREATMENT +medio I-TREATMENT +post I-TREATMENT +trasplante I-TREATMENT +se I-TREATMENT +vuelve I-TREATMENT +a I-TREATMENT +plantear I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +VHC I-TREATMENT +con B-EXPLORATION +nueva I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +hepatitis I-EXPLORATION +crónica I-EXPLORATION +con I-EXPLORATION +leve I-EXPLORATION +inflamación I-EXPLORATION +portal I-EXPLORATION +de I-EXPLORATION +interfase I-EXPLORATION +y I-EXPLORATION +lobulillar, I-EXPLORATION +fibrosis I-EXPLORATION +perisinusoideal I-EXPLORATION +leve, I-EXPLORATION +colangitis I-EXPLORATION +linfocítica I-EXPLORATION +focal I-EXPLORATION +y I-EXPLORATION +esteatosis I-EXPLORATION +hepática I-EXPLORATION +mínima. I-EXPLORATION +En B-EVOLUTION +ese I-EVOLUTION +momento I-EVOLUTION +evoluciona I-EVOLUTION +con I-EVOLUTION +colestasia, I-EVOLUTION +que I-EVOLUTION +resulta I-EVOLUTION +ser I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +estenosis I-EVOLUTION +de I-EVOLUTION +anastomosis I-EVOLUTION +biliar. I-EVOLUTION +Se I-EVOLUTION +controló I-EVOLUTION +con I-EVOLUTION +nueva I-EVOLUTION +carga I-EVOLUTION +viral I-EVOLUTION +con I-EVOLUTION +355.882 I-EVOLUTION +UI/ml I-EVOLUTION +(Log I-EVOLUTION +5, I-EVOLUTION +55) I-EVOLUTION +en I-EVOLUTION +octubre I-EVOLUTION +de I-EVOLUTION +2010. I-EVOLUTION +Con B-EXPLORATION +intención I-EXPLORATION +de I-EXPLORATION +iniciar I-EXPLORATION +tratamiento I-EXPLORATION +en I-EXPLORATION +marzo I-EXPLORATION +de I-EXPLORATION +2011 I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +nueva I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +negativa; I-EXPLORATION +además I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +PCR I-EXPLORATION +para I-EXPLORATION +VHC, I-EXPLORATION +también I-EXPLORATION +negativa, I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +confirma I-EXPLORATION +con I-EXPLORATION +nueva I-EXPLORATION +muestra. I-EXPLORATION +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +perfil I-TREATMENT +hepático I-TREATMENT +normal, I-TREATMENT +recibiendo I-TREATMENT +inmunosupresión I-TREATMENT +con I-TREATMENT +ciclosporina I-TREATMENT +100 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Se B-EVOLUTION +interpretó I-EVOLUTION +como I-EVOLUTION +eliminación I-EVOLUTION +espontánea I-EVOLUTION +del I-EVOLUTION +VHC. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +cutáneas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +que, I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +dos, I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +piodermitis, I-PAST_MEDICAL_HISTORY +sarna I-PAST_MEDICAL_HISTORY +corporis, I-PAST_MEDICAL_HISTORY +candidiasis I-PAST_MEDICAL_HISTORY +esofágica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +cuadros I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abscesos I-PAST_MEDICAL_HISTORY +cutáneos I-PAST_MEDICAL_HISTORY +ubicados I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +codo I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones, I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +dorso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mano I-PAST_MEDICAL_HISTORY +izquierda, I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +deja I-PAST_MEDICAL_HISTORY +secuelas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +movilidad I-PAST_MEDICAL_HISTORY +extensora I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +compromiso I-PAST_MEDICAL_HISTORY +tendinoso, I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dorso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mano I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +escapular I-PAST_MEDICAL_HISTORY +izquierda, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +cuales I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +cultivo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +lesiones I-PAST_MEDICAL_HISTORY +resultó I-PAST_MEDICAL_HISTORY +positivo I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +Staphylococcus I-PAST_MEDICAL_HISTORY +aureus I-PAST_MEDICAL_HISTORY +multisensible. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +glúteo I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +se B-TREATMENT +diagnosticó I-TREATMENT +celulitis I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +clindamicina I-TREATMENT +y I-TREATMENT +cefazolina. I-TREATMENT +Al B-EVOLUTION +séptimo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +hospitalización I-EVOLUTION +presentó I-EVOLUTION +necrosis I-EVOLUTION +distal I-EVOLUTION +del I-EVOLUTION +pulpejo I-EVOLUTION +del I-EVOLUTION +cuarto I-EVOLUTION +dedo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mano I-EVOLUTION +derecha, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +dejó I-EVOLUTION +a I-EVOLUTION +evolución I-EVOLUTION +natural I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +encontrarse I-EVOLUTION +fuera I-EVOLUTION +de I-EVOLUTION +alcance I-EVOLUTION +quirúrgico. I-EVOLUTION +Luego B-TREATMENT +de I-TREATMENT +12 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +esquema I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +mala I-TREATMENT +respuesta I-TREATMENT +clínica, I-TREATMENT +iniciándose I-TREATMENT +metronidazol, I-TREATMENT +ceftriaxona I-TREATMENT +y I-TREATMENT +vancomicina. I-TREATMENT +Se B-EXPLORATION +realizaron I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +inmunológicos I-EXPLORATION +e I-EXPLORATION +infecciosos, I-EXPLORATION +en I-EXPLORATION +busca I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +patología I-EXPLORATION +subyacente, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Tabla I-EXPLORATION +1 I-EXPLORATION +(A), I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +del I-EXPLORATION +factor I-EXPLORATION +reumatoide, I-EXPLORATION +ANCA-p, I-EXPLORATION +ANCA-c, I-EXPLORATION +anti I-EXPLORATION +ANA, I-EXPLORATION +anti I-EXPLORATION +ENA, I-EXPLORATION +anti-DNA, I-EXPLORATION +anticardiolipina, I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Coombs I-EXPLORATION +indirecto, I-EXPLORATION +antígenos I-EXPLORATION +de I-EXPLORATION +VHB I-EXPLORATION +y I-EXPLORATION +VHC I-EXPLORATION +fueron I-EXPLORATION +negativos; I-EXPLORATION +destacaron I-EXPLORATION +valores I-EXPLORATION +elevados I-EXPLORATION +de I-EXPLORATION +IgE I-EXPLORATION +sérica I-EXPLORATION +(3.740 I-EXPLORATION +UI/ml) I-EXPLORATION +y I-EXPLORATION +precipitación I-EXPLORATION +en I-EXPLORATION +frío I-EXPLORATION +de I-EXPLORATION +crioglobulinas I-EXPLORATION +positiva. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +además I-EXPLORATION +ecografía I-EXPLORATION +glútea I-EXPLORATION +izquierda, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +inflamatorio, I-EXPLORATION +sin I-EXPLORATION +colecciones. I-EXPLORATION +Tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +sugirió I-EXPLORATION +fibrosis I-EXPLORATION +basal I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +pleural I-EXPLORATION +e I-EXPLORATION +imagen I-EXPLORATION +nodular I-EXPLORATION +periférica I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +hemitórax. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +manos, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +cintura I-EXPLORATION +escapular, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorsolumbar, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +codos, I-EXPLORATION +ecografía I-EXPLORATION +abdominal, I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +ecocardiograma I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +zona I-EXPLORATION +medial I-EXPLORATION +del I-EXPLORATION +brazo I-EXPLORATION +derecho I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +dermatitis I-EXPLORATION +crónica I-EXPLORATION +en I-EXPLORATION +granulación I-EXPLORATION +con I-EXPLORATION +calcificación I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +distrófica, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +vasculitis. I-EXPLORATION +Una B-EVOLUTION +vez I-EVOLUTION +completado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +antibiótico I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +sospecha I-EVOLUTION +diagnóstica I-EVOLUTION +de I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +hiper I-EVOLUTION +IgE I-EVOLUTION +y I-EVOLUTION +crioglobulinemia. I-EVOLUTION + I-EVOLUTION +Un I-EVOLUTION +mes I-EVOLUTION +posterior I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +nuevo I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +glúteo I-EVOLUTION +izquierdo, I-EVOLUTION +calor I-EVOLUTION +local I-EVOLUTION +y I-EVOLUTION +supuración. I-EVOLUTION +Se B-TREATMENT +realizó I-TREATMENT +drenaje I-TREATMENT +manual I-TREATMENT +y I-TREATMENT +pasivo I-TREATMENT +con I-TREATMENT +penrose. I-TREATMENT +Fue I-TREATMENT +hospitalizado I-TREATMENT +por I-TREATMENT +absceso I-TREATMENT +en I-TREATMENT +glúteo I-TREATMENT +izquierdo I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +y I-TREATMENT +clindamicina. I-TREATMENT +Se B-EXPLORATION +realizaron I-EXPLORATION +exámenes I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Tabla I-EXPLORATION +1 I-EXPLORATION +(B) I-EXPLORATION +donde I-EXPLORATION +nuevamente I-EXPLORATION +destacó I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +IgE I-EXPLORATION +elevados, I-EXPLORATION +una I-EXPLORATION +primera I-EXPLORATION +muestra I-EXPLORATION +con I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +4.170 I-EXPLORATION +UI/ml I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +muestra I-EXPLORATION +el I-EXPLORATION +día I-EXPLORATION +siguiente I-EXPLORATION +de I-EXPLORATION +4.210 I-EXPLORATION +UI/ml. I-EXPLORATION +Se I-EXPLORATION +aplicó I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +de I-EXPLORATION +Grimbacher9 I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +consignó I-EXPLORATION +el I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +IgE, I-EXPLORATION +candidiasis I-EXPLORATION +sistémica, I-EXPLORATION +infecciones I-EXPLORATION +graves, I-EXPLORATION +infecciones I-EXPLORATION +cutáneas I-EXPLORATION +recurrentes, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +paladar I-EXPLORATION +alto, I-EXPLORATION +dientes I-EXPLORATION +primarios I-EXPLORATION +retenidos, I-EXPLORATION +hiperextensibilidad I-EXPLORATION +articular, I-EXPLORATION +nariz I-EXPLORATION +amplia I-EXPLORATION +con I-EXPLORATION +distancia I-EXPLORATION +interalar I-EXPLORATION +mayor I-EXPLORATION +a I-EXPLORATION +2 I-EXPLORATION +DS I-EXPLORATION +y I-EXPLORATION +facies I-EXPLORATION +característica, I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +dio I-EXPLORATION +un I-EXPLORATION +resultado I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +50 I-EXPLORATION +puntos, I-EXPLORATION +confirmándose I-EXPLORATION +clínicamente I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION +Tras B-TREATMENT +21 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +se I-TREATMENT +dio I-TREATMENT +de I-TREATMENT +alta, I-TREATMENT +utilizando I-TREATMENT +profilaxis I-TREATMENT +antibiótica I-TREATMENT +con I-TREATMENT +trimetoprim/sulfametoxazol. I-TREATMENT +En B-EVOLUTION +1 I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable I-EVOLUTION +sin I-EVOLUTION +nuevos I-EVOLUTION +cuadros I-EVOLUTION +de I-EVOLUTION +infecciones I-EVOLUTION +cutáneas, I-EVOLUTION +sistémicas I-EVOLUTION +o I-EVOLUTION +eventos I-EVOLUTION +trombóticos. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sano, I-PAST_MEDICAL_HISTORY +sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +diabetes, I-FAMILY_HISTORY +comenzó B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +temblor, I-PRESENT_ILLNESS +sudoración, I-PRESENT_ILLNESS +debilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +síncope I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +aparecían I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ayunas, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ejercicio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cedían I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +comer. I-PRESENT_ILLNESS +Estuvo B-TREATMENT +en I-TREATMENT +control I-TREATMENT +neurológico I-TREATMENT +por I-TREATMENT +probable I-TREATMENT +epilepsia, I-TREATMENT +tratándose I-TREATMENT +con I-TREATMENT +carbamazepina I-TREATMENT +algunas I-TREATMENT +semanas, I-TREATMENT +sin I-TREATMENT +otros I-TREATMENT +fármacos. I-TREATMENT +Por B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +nuevo I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencia I-PRESENT_ILLNESS +pesquisándose I-PRESENT_ILLNESS +hipoglicemia I-PRESENT_ILLNESS +recurrente, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +menor I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +mg/dl, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +hospitalizado. I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +sin I-EXPLORATION +acantosis I-EXPLORATION +nigricans I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +25, I-EXPLORATION +6 I-EXPLORATION +kg/m2. I-EXPLORATION +La I-EXPLORATION +función I-EXPLORATION +tiroidea I-EXPLORATION +y I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +cortisol I-EXPLORATION +matinal I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +Una I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +tolerancia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +glucosa I-EXPLORATION +oral I-EXPLORATION +(PTGO) I-EXPLORATION +informó I-EXPLORATION +glicemia I-EXPLORATION +basal I-EXPLORATION +de I-EXPLORATION +88 I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +120 I-EXPLORATION +min I-EXPLORATION +185 I-EXPLORATION +mg/dl, I-EXPLORATION +e I-EXPLORATION +insulinemia I-EXPLORATION +basal I-EXPLORATION +de I-EXPLORATION +2.759 I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +120 I-EXPLORATION +min I-EXPLORATION +de I-EXPLORATION +5.942 I-EXPLORATION +µUI/ml I-EXPLORATION +(MEIA, I-EXPLORATION +Axym, I-EXPLORATION +Abbott). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +ayuno I-EXPLORATION +presentando I-EXPLORATION +glicemia I-EXPLORATION +de I-EXPLORATION +46 I-EXPLORATION +mg/dl I-EXPLORATION +e I-EXPLORATION +insulinemia I-EXPLORATION +de I-EXPLORATION +588 I-EXPLORATION +µUI/ml I-EXPLORATION +(RIA, I-EXPLORATION +Diagnostic I-EXPLORATION +Products, I-EXPLORATION +Co I-EXPLORATION +[DPC]) I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +15 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +ayuno, I-EXPLORATION +con I-EXPLORATION +sintomatología I-EXPLORATION +asociada. I-EXPLORATION +Una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +(TAC) I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +estimulación I-EXPLORATION +intraarterial I-EXPLORATION +selectiva I-EXPLORATION +con I-EXPLORATION +calcio I-EXPLORATION +para I-EXPLORATION +localización I-EXPLORATION +de I-EXPLORATION +insulinomas I-EXPLORATION +según I-EXPLORATION +protocolo2, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +no I-EXPLORATION +permitió I-EXPLORATION +la I-EXPLORATION +localización I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +arteriografía I-EXPLORATION +se I-EXPLORATION +describió I-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +lesión I-EXPLORATION +nodular I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +del I-EXPLORATION +páncreas, I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +1, I-EXPLORATION +4 I-EXPLORATION +cm, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +laparatomía I-EXPLORATION +exploratoria I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tumor. I-EXPLORATION +Se I-EXPLORATION +midieron I-EXPLORATION +los I-EXPLORATION +anticuerpos I-EXPLORATION +antiinsulina I-EXPLORATION +mediante I-EXPLORATION +inmunoensayo I-EXPLORATION +enzimático I-EXPLORATION +(ELISA) I-EXPLORATION +con I-EXPLORATION +kits I-EXPLORATION +comerciales I-EXPLORATION +Medizym® I-EXPLORATION +(Medipan I-EXPLORATION +GmbH, I-EXPLORATION +Berlín, I-EXPLORATION +Alemania) I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +positivos. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +antitiroideos I-EXPLORATION +y I-EXPLORATION +antinucleares I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +No I-EXPLORATION +presentó I-EXPLORATION +manifestaciones I-EXPLORATION +de I-EXPLORATION +otra I-EXPLORATION +enfermedad I-EXPLORATION +autoinmune. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +trató I-TREATMENT +con I-TREATMENT +dieta I-TREATMENT +restringida I-TREATMENT +en I-TREATMENT +carbohidratos I-TREATMENT +refinados I-TREATMENT +y I-TREATMENT +comidas I-TREATMENT +frecuentes I-TREATMENT +en I-TREATMENT +pequeñas I-TREATMENT +cantidades, I-TREATMENT +manteniéndose I-TREATMENT +asintomático, I-TREATMENT +sin I-TREATMENT +presentar I-TREATMENT +nuevas I-TREATMENT +hipoglicemias. I-TREATMENT +Al B-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +PTGO I-EVOLUTION +que I-EVOLUTION +informó I-EVOLUTION +glicemia I-EVOLUTION +basal I-EVOLUTION +84 I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +120 I-EVOLUTION +min I-EVOLUTION +240 I-EVOLUTION +mg/dl I-EVOLUTION +e I-EVOLUTION +insulinemia I-EVOLUTION +basal I-EVOLUTION +de I-EVOLUTION +434 I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +120 I-EVOLUTION +min I-EVOLUTION +de I-EVOLUTION +793 I-EVOLUTION +µUI/ml I-EVOLUTION +(RIA). I-EVOLUTION +Se I-EVOLUTION +mantenía I-EVOLUTION +asintomático I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +tres I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento. I-EVOLUTION + I-EVOLUTION + +Una B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +previamente B-PAST_MEDICAL_HISTORY +sana I-PAST_MEDICAL_HISTORY +ingresó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +compromiso I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +alteración I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pruebas I-PRESENT_ILLNESS +hepáticas. I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +decaída I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +que I-EXPLORATION +mostraron I-EXPLORATION +pancitopenia I-EXPLORATION +(hemoglobina I-EXPLORATION +10 I-EXPLORATION +gr%, I-EXPLORATION +leucocitos I-EXPLORATION +1.900/uL, I-EXPLORATION +plaquetas I-EXPLORATION +43.000/mL) I-EXPLORATION +y I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +(GOT I-EXPLORATION +1.800 I-EXPLORATION +U/L, I-EXPLORATION +GPT I-EXPLORATION +1.300 I-EXPLORATION +U/L). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +enfermedades I-EXPLORATION +infecciosas I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +(hemocultivo, I-EXPLORATION +urocultivo, I-EXPLORATION +virus I-EXPLORATION +hepatotropos, I-EXPLORATION +mycoplasma, I-EXPLORATION +toxoplasma, I-EXPLORATION +leptospira, I-EXPLORATION +bartonella, I-EXPLORATION +brucella, I-EXPLORATION +rubéola, I-EXPLORATION +sarampión, I-EXPLORATION +VIH, I-EXPLORATION +parvovirus I-EXPLORATION +B19, I-EXPLORATION +citomegalovirus I-EXPLORATION +y I-EXPLORATION +Epstein I-EXPLORATION +Barr). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +reumatológico I-EXPLORATION +donde I-EXPLORATION +resultó I-EXPLORATION +ANA I-EXPLORATION +1: I-EXPLORATION +40 I-EXPLORATION +patrón I-EXPLORATION +moteado I-EXPLORATION +y I-EXPLORATION +anti I-EXPLORATION +DNA I-EXPLORATION +por I-EXPLORATION +FARR, I-EXPLORATION +factor I-EXPLORATION +reumatoide I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +ENA I-EXPLORATION +negativos I-EXPLORATION +con I-EXPLORATION +complemento I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +continuó I-EXPLORATION +con I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +hepáticas I-EXPLORATION +en I-EXPLORATION +deterioro. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +linfonodos I-EXPLORATION +pequeños I-EXPLORATION +difusos, I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +laminar I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +hepatoesplenomegalia. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +linfonodos I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +adenitis I-EXPLORATION +no I-EXPLORATION +específica. I-EXPLORATION +Los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +ferritina I-EXPLORATION +resultaron I-EXPLORATION +en I-EXPLORATION +23.460 I-EXPLORATION +U/L. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +medular I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +hiperplasia I-EXPLORATION +linfoide I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +abundantes I-EXPLORATION +hemofagocitos. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +protocolo I-TREATMENT +HLH I-TREATMENT +04 I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +clínica, I-TREATMENT +con I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +pruebas I-TREATMENT +hepáticas I-TREATMENT +y I-TREATMENT +descenso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ferritina I-TREATMENT +hasta I-TREATMENT +valores I-TREATMENT +normales. I-TREATMENT +Al B-EVOLUTION +momento I-EVOLUTION +de I-EVOLUTION +redactar I-EVOLUTION +este I-EVOLUTION +reporte I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +lleva I-EVOLUTION +24 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +dispone I-EVOLUTION +de I-EVOLUTION +hermanos I-EVOLUTION +HLA I-EVOLUTION +compatibles. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos; I-PAST_MEDICAL_HISTORY +consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +asintomática I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +muslo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Se B-TREATMENT +trató I-TREATMENT +como I-TREATMENT +piodermia I-TREATMENT +con I-TREATMENT +múltiples I-TREATMENT +antibióticos I-TREATMENT +orales, I-TREATMENT +sin I-TREATMENT +respuesta. I-TREATMENT +Al B-EXPLORATION +examen, I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +eritematoso I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +8 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +pequeñas I-EXPLORATION +ulceraciones I-EXPLORATION +y I-EXPLORATION +erosiones. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +compresión I-EXPLORATION +no I-EXPLORATION +hubo I-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +exudado I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +granos. I-EXPLORATION +Además, I-EXPLORATION +presentaba I-EXPLORATION +dos I-EXPLORATION +adenopatías I-EXPLORATION +inguinales I-EXPLORATION +ipsilaterales, I-EXPLORATION +no I-EXPLORATION +dolorosas, I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +1 I-EXPLORATION +cm. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palparon I-EXPLORATION +otras I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +visceromegalia. I-EXPLORATION +Se I-EXPLORATION +planteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +cutáneo I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +actinomicetoma, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +exámenes I-EXPLORATION +serológicos, I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TAC) I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +(TAC-TAP), I-EXPLORATION +múltiples I-EXPLORATION +cultivos I-EXPLORATION +bacterianos-micológicos I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel. I-EXPLORATION +Tenía I-EXPLORATION +hemograma, I-EXPLORATION +deshidrogensa I-EXPLORATION +láctica I-EXPLORATION +(LDH) I-EXPLORATION +y I-EXPLORATION +calcio I-EXPLORATION +sérico I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales; I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +HTLV-1 I-EXPLORATION +negativa. I-EXPLORATION +El I-EXPLORATION +TAC-TAP I-EXPLORATION +mostró I-EXPLORATION +sólo I-EXPLORATION +las I-EXPLORATION +adenopatías I-EXPLORATION +ipsilaterales I-EXPLORATION +pesquisadas I-EXPLORATION +clínicamente. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +histopatología I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +dérmico I-EXPLORATION +ulcerado, I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +linfoides I-EXPLORATION +grandes, I-EXPLORATION +con I-EXPLORATION +pleomorfismo I-EXPLORATION +nuclear I-EXPLORATION +y I-EXPLORATION +mitosis I-EXPLORATION +atípicas. I-EXPLORATION +Además, I-EXPLORATION +había I-EXPLORATION +abundantes I-EXPLORATION +eosinófilos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +(IHQ) I-EXPLORATION +mostró I-EXPLORATION +reacción I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +CD30 I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +grandes I-EXPLORATION +y I-EXPLORATION +reacción I-EXPLORATION +negativa I-EXPLORATION +para I-EXPLORATION +ALK-1 I-EXPLORATION +y I-EXPLORATION +CD25. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +además I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +arquitectura I-EXPLORATION +y I-EXPLORATION +celularidad I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +todos I-EXPLORATION +estos I-EXPLORATION +elementos I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +un I-EXPLORATION +LACGPC. I-EXPLORATION +Se B-TREATMENT +planteó I-TREATMENT +realizar I-TREATMENT +radioterapia I-TREATMENT +(RT) I-TREATMENT +local, I-TREATMENT +pero I-TREATMENT +cuando I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +volvió I-TREATMENT +a I-TREATMENT +consultar I-TREATMENT +al I-TREATMENT +mes, I-TREATMENT +presentaba I-TREATMENT +clara I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +del I-TREATMENT +muslo, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +no I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento. I-TREATMENT +Se B-EVOLUTION +controló I-EVOLUTION +cada I-EVOLUTION +4 I-EVOLUTION +meses I-EVOLUTION +y I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +24 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +en I-EVOLUTION +regresión I-EVOLUTION +total. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +comunica I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +72 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +fumador, I-PRESENT_ILLNESS +evaluado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sala I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +seca, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +moderada. I-PRESENT_ILLNESS +Sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +rinitis I-PAST_MEDICAL_HISTORY +alérgica, I-PAST_MEDICAL_HISTORY +tampoco I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +medicamentos; I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +niega I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +antiinflamatorios I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +esteroidales, I-PAST_MEDICAL_HISTORY +antibioterapia I-PAST_MEDICAL_HISTORY +previa I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +u I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +drogas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +abuso. I-PAST_MEDICAL_HISTORY +La B-EXPLORATION +hemodinamia I-EXPLORATION +y I-EXPLORATION +oximetría I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +segmentario I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +crépitos I-EXPLORATION +en I-EXPLORATION +base I-EXPLORATION +pulmonar I-EXPLORATION +izquierda, I-EXPLORATION +sin I-EXPLORATION +sibilancias I-EXPLORATION +ni I-EXPLORATION +otros I-EXPLORATION +ruidos I-EXPLORATION +agregados; I-EXPLORATION +sin I-EXPLORATION +hipocratismo I-EXPLORATION +digital I-EXPLORATION +ni I-EXPLORATION +otros I-EXPLORATION +signos I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +patología I-EXPLORATION +pulmonar I-EXPLORATION +previa I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +foco I-EXPLORATION +de I-EXPLORATION +consolidación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lóbulo I-EXPLORATION +inferior I-EXPLORATION +izquierdo I-EXPLORATION +(LII). I-EXPLORATION +Dentro I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +destacaba I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +13.200 I-EXPLORATION +cel/dL, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +eritrosedimentación I-EXPLORATION +(VHS) I-EXPLORATION +de I-EXPLORATION +65 I-EXPLORATION +mm, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +< I-EXPLORATION +5), I-EXPLORATION +perfil I-EXPLORATION +bioquímico I-EXPLORATION +normal. I-EXPLORATION +Con B-TREATMENT +estos I-TREATMENT +hallazgos I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +hospitalización I-TREATMENT +y I-TREATMENT +se I-TREATMENT +dio I-TREATMENT +inicio I-TREATMENT +a I-TREATMENT +antibioterapia I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +2 I-TREATMENT +g/día I-TREATMENT +ev I-TREATMENT +y I-TREATMENT +levofloxacino I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +vo. I-TREATMENT +Posterior B-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +tratamiento, I-EVOLUTION +no I-EVOLUTION +hubo I-EVOLUTION +mejoría I-EVOLUTION +clínica. I-EVOLUTION +Estudios B-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +con I-EXPLORATION +hemograma I-EXPLORATION +mostraron I-EXPLORATION +hematocrito I-EXPLORATION +38%, I-EXPLORATION +hemoglobina I-EXPLORATION +12 I-EXPLORATION +g/dL, I-EXPLORATION +VCM I-EXPLORATION +89, I-EXPLORATION +leucocitos I-EXPLORATION +12.500 I-EXPLORATION +cel/mm3, I-EXPLORATION +eosinófilos I-EXPLORATION +16, I-EXPLORATION +9%, I-EXPLORATION +plaquetas I-EXPLORATION +234, I-EXPLORATION +000 I-EXPLORATION +cel/mm3, I-EXPLORATION +VHS I-EXPLORATION +35 I-EXPLORATION +mm, I-EXPLORATION +PCR I-EXPLORATION +15 I-EXPLORATION +(límite I-EXPLORATION +< I-EXPLORATION +5) I-EXPLORATION +Ig I-EXPLORATION +E I-EXPLORATION +128, I-EXPLORATION +2 I-EXPLORATION +UI/ml. I-EXPLORATION +Tomografía I-EXPLORATION +computarizada I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +(TAC) I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +mayor I-EXPLORATION +consolidación I-EXPLORATION +de I-EXPLORATION +LII I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +izquierdo I-EXPLORATION +(LSI), I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +opacidades I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +esmerilado, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +izquierdo I-EXPLORATION +moderado. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +broncoscopia I-EXPLORATION +flexible I-EXPLORATION +con I-EXPLORATION +lavado I-EXPLORATION +broncoalveolar I-EXPLORATION +(LBA) I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +107 I-EXPLORATION +células, I-EXPLORATION +con I-EXPLORATION +95% I-EXPLORATION +de I-EXPLORATION +eosinófilos I-EXPLORATION +; I-EXPLORATION +los I-EXPLORATION +cultivos, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +medios I-EXPLORATION +corrientes I-EXPLORATION +como I-EXPLORATION +micobacterias, I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +galactomanano I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +transbronquial I-EXPLORATION +mostró I-EXPLORATION +numerosos I-EXPLORATION +granulocitos I-EXPLORATION +eosinófilos I-EXPLORATION +en I-EXPLORATION +alvéolos I-EXPLORATION +e I-EXPLORATION +intersticio, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +cierto I-EXPLORATION +grado I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +intersticial. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +arrojó I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +x I-EXPLORATION +103 I-EXPLORATION +células, I-EXPLORATION +con I-EXPLORATION +85% I-EXPLORATION +de I-EXPLORATION +eosinófilos, I-EXPLORATION +proteínas I-EXPLORATION +4, I-EXPLORATION +1 I-EXPLORATION +mg/dL, I-EXPLORATION +glucosa I-EXPLORATION +75 I-EXPLORATION +mg/dL, I-EXPLORATION +lactato I-EXPLORATION +deshidrogenasa I-EXPLORATION +232 I-EXPLORATION +y I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +37. I-EXPLORATION + I-EXPLORATION +Dentro I-EXPLORATION +del I-EXPLORATION +estudio I-EXPLORATION +complementario, I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +anticuerpo I-EXPLORATION +antinucleares I-EXPLORATION +(ANA), I-EXPLORATION +anti I-EXPLORATION +DNA, I-EXPLORATION +anti-citoplasma I-EXPLORATION +de I-EXPLORATION +neutrófilos I-EXPLORATION +(ANCA), I-EXPLORATION +todos I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +(VIH) I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +descarto I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +parásitos I-EXPLORATION +(Ascaris I-EXPLORATION +lumbricoide, I-EXPLORATION +Trichinella, I-EXPLORATION +Fasciola, I-EXPLORATION +Schistosoma I-EXPLORATION +y I-EXPLORATION +Strongyloides), I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +Aspergillus I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION +Dado B-TREATMENT +el I-TREATMENT +hallazgo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +neumonía I-TREATMENT +eosinofílica, I-TREATMENT +asociado I-TREATMENT +a I-TREATMENT +al I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +eosinofilia I-TREATMENT +periférica, I-TREATMENT +en I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +causas I-TREATMENT +infecciosas I-TREATMENT +o I-TREATMENT +secundarias I-TREATMENT +a I-TREATMENT +drogas I-TREATMENT +o I-TREATMENT +fármacos, I-TREATMENT +se I-TREATMENT +planteó I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +NEC, I-TREATMENT +iniciándose I-TREATMENT +prednisona I-TREATMENT +1 I-TREATMENT +mg/kg I-TREATMENT +peso, I-TREATMENT +obteniendo I-TREATMENT +una I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fiebre I-TREATMENT +al I-TREATMENT +segundo I-TREATMENT +día I-TREATMENT +y I-TREATMENT +disminución I-TREATMENT +de I-TREATMENT +los I-TREATMENT +requerimientos I-TREATMENT +de I-TREATMENT +oxígeno I-TREATMENT +y I-TREATMENT +de I-TREATMENT +la I-TREATMENT +eosinofilia I-TREATMENT +a I-TREATMENT +los I-TREATMENT +5 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +una I-TREATMENT +resolución I-TREATMENT +de I-TREATMENT +las I-TREATMENT +condensaciones I-TREATMENT +pulmonares I-TREATMENT +y I-TREATMENT +al I-TREATMENT +mes I-TREATMENT +de I-TREATMENT +tratamiento, I-TREATMENT +logrando I-TREATMENT +suspender I-TREATMENT +de I-TREATMENT +manera I-TREATMENT +escalonada I-TREATMENT +los I-TREATMENT +corticoides. I-TREATMENT +Dentro B-EVOLUTION +del I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +dos I-EVOLUTION +recurrencias I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +respiratorio, I-EVOLUTION +de I-EVOLUTION +similares I-EVOLUTION +características, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +respuesta I-EVOLUTION +a I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +corticoides. I-EVOLUTION +Actualmente B-TREATMENT +se I-TREATMENT +encuentra I-TREATMENT +con I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +mantención I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día I-TREATMENT +de I-TREATMENT +prednisona, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +confirma I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +NEC. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +chilena, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Sjögren, I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +únicamente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lágrimas I-PAST_MEDICAL_HISTORY +artificiales. I-PAST_MEDICAL_HISTORY +Tiene I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +vitíligo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hermana I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Sjögren. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +medicamentos I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +tabaquismo. I-PAST_MEDICAL_HISTORY +Sin B-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +cáncer I-FAMILY_HISTORY +digestivo. I-FAMILY_HISTORY +Niega B-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hemorragia I-PRESENT_ILLNESS +digestiva, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +diarrea, I-PRESENT_ILLNESS +fatiga I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +Fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +Reumatología I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Dermatología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +Padre I-DERIVED_FROM/TO +Hurtado I-DERIVED_FROM/TO +debido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +aparición I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +bandas I-DERIVED_FROM/TO +hiperpigmentadas I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +uñas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +pies I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +hacía I-DERIVED_FROM/TO +5 I-DERIVED_FROM/TO +años, I-DERIVED_FROM/TO +seguidas I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +uñas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +manos. I-DERIVED_FROM/TO +Hacía B-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +habían I-PRESENT_ILLNESS +aparecido I-PRESENT_ILLNESS +máculas I-PRESENT_ILLNESS +color I-PRESENT_ILLNESS +café I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +mucosa I-PRESENT_ILLNESS +oral, I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +hiperpigmentación I-PRESENT_ILLNESS +periungueal I-PRESENT_ILLNESS +progresiva. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +oral I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +mácula I-EXPLORATION +café I-EXPLORATION +en I-EXPLORATION +labio I-EXPLORATION +inferior I-EXPLORATION +hacia I-EXPLORATION +comisura I-EXPLORATION +labial I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +uñas I-EXPLORATION +de I-EXPLORATION +manos I-EXPLORATION +y I-EXPLORATION +pies I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +máculas I-EXPLORATION +café I-EXPLORATION +periungueales I-EXPLORATION +y I-EXPLORATION +melanoniquia. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +histopatología I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +oral I-EXPLORATION +mostró I-EXPLORATION +acantosis I-EXPLORATION +leve I-EXPLORATION +e I-EXPLORATION +hipermelanosis. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +dermoepidérmica I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +numerosos I-EXPLORATION +melanófagos, I-EXPLORATION +con I-EXPLORATION +capilares I-EXPLORATION +prominentes I-EXPLORATION +en I-EXPLORATION +dermis. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +mostraron: I-EXPLORATION +Leucopenia I-EXPLORATION +leve I-EXPLORATION +(3, I-EXPLORATION +700/uL I-EXPLORATION +con I-EXPLORATION +1, I-EXPLORATION +370/uL I-EXPLORATION +linfocitos). I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +hemograma, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +eritrosedimentasión, I-EXPLORATION +hormonas I-EXPLORATION +tiroideas, I-EXPLORATION +cortisol I-EXPLORATION +plasmático I-EXPLORATION +y I-EXPLORATION +ACTH I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +anti-Ro I-EXPLORATION +(43, I-EXPLORATION +7 I-EXPLORATION +U/mL) I-EXPLORATION +y I-EXPLORATION +anti-La I-EXPLORATION +(> I-EXPLORATION +48 I-EXPLORATION +U/mL) I-EXPLORATION +fueron I-EXPLORATION +positivos, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +también I-EXPLORATION +los I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(1/2560) I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +moteado. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +anti-dsDNA, I-EXPLORATION +anti-Sm I-EXPLORATION +y I-EXPLORATION +anticardiolipinas I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +factor I-EXPLORATION +reumatoideo, I-EXPLORATION +anticoagulante I-EXPLORATION +lúpico I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cuantificación I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +resultaron I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +endoscopía I-EXPLORATION +digestiva I-EXPLORATION +alta I-EXPLORATION +y I-EXPLORATION +colonoscopía, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +muestran I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +pólipos, I-EXPLORATION +hiperpigmentación I-EXPLORATION +u I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +continúa I-EVOLUTION +en I-EVOLUTION +seguimiento I-EVOLUTION +clínico, I-EVOLUTION +sin I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +lesiones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +género I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +excepción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +proctitis I-PAST_MEDICAL_HISTORY +ulcerosa I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +1994. I-PAST_MEDICAL_HISTORY +Inicialmente B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +líquidas I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mucosidades. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +colonoscopia I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +inflamatorio I-EXPLORATION +continuo I-EXPLORATION +del I-EXPLORATION +recto I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +friable I-EXPLORATION +y I-EXPLORATION +pequeñas I-EXPLORATION +erosiones I-EXPLORATION +cubiertas I-EXPLORATION +por I-EXPLORATION +fibrina I-EXPLORATION +(Subíndice I-EXPLORATION +Endoscópico I-EXPLORATION +Mayo I-EXPLORATION +2). I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +biopsias I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +inflamación I-EXPLORATION +aguda I-EXPLORATION +(criptitis I-EXPLORATION +y I-EXPLORATION +abscesos I-EXPLORATION +crípticos) I-EXPLORATION +y I-EXPLORATION +crónica I-EXPLORATION +reflejada I-EXPLORATION +como I-EXPLORATION +alteraciones I-EXPLORATION +estructurales I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +criptas I-EXPLORATION +(acortamiento I-EXPLORATION +y I-EXPLORATION +ramificación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +glándulas I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +caliciformes). I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +mesalazina I-TREATMENT +oral I-TREATMENT +(3 I-TREATMENT +g/día) I-TREATMENT +y I-TREATMENT +rectal I-TREATMENT +(supositorios I-TREATMENT +de I-TREATMENT +500 I-TREATMENT +mg/noche), I-TREATMENT +con I-TREATMENT +remisión I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +endoscópica I-TREATMENT +(curación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mucosa) I-TREATMENT +(colonoscopia I-TREATMENT +2007, I-TREATMENT +Subíndice I-TREATMENT +Endoscópico I-TREATMENT +Mayo I-TREATMENT +0). I-TREATMENT +Posteriormente, B-EVOLUTION +abandona I-EVOLUTION +tratamiento I-EVOLUTION +y I-EVOLUTION +control, I-EVOLUTION +manteniéndose I-EVOLUTION +asintomática I-EVOLUTION +hasta I-EVOLUTION +agosto I-EVOLUTION +de I-EVOLUTION +2015 I-EVOLUTION +donde I-EVOLUTION +consulta I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +desde I-EVOLUTION +hace I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +malestar I-EVOLUTION +abdominal I-EVOLUTION +asociado I-EVOLUTION +a I-EVOLUTION +deposiciones I-EVOLUTION +líquidas I-EVOLUTION +una I-EVOLUTION +a I-EVOLUTION +dos I-EVOLUTION +veces I-EVOLUTION +al I-EVOLUTION +día I-EVOLUTION +sin I-EVOLUTION +sangre I-EVOLUTION +ni I-EVOLUTION +mucosidades. I-EVOLUTION +No I-EVOLUTION +refería I-EVOLUTION +compromiso I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +fiebre, I-EVOLUTION +baja I-EVOLUTION +de I-EVOLUTION +peso, I-EVOLUTION +dolor I-EVOLUTION +abdominal I-EVOLUTION +y/o I-EVOLUTION +articular. I-EVOLUTION +Sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo, I-PAST_MEDICAL_HISTORY +transgresión I-PAST_MEDICAL_HISTORY +alimentaria I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +uso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fármacos I-PAST_MEDICAL_HISTORY +(específicamente I-PAST_MEDICAL_HISTORY +antiinflamatorios I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +esteroidales, I-PAST_MEDICAL_HISTORY +antibióticos, I-PAST_MEDICAL_HISTORY +inhibidores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +bomba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +protones, I-PAST_MEDICAL_HISTORY +hormonas I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +antidepresivos). I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +solicitaron I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +que I-EXPLORATION +incluyó I-EXPLORATION +hemograma, I-EXPLORATION +VHS, I-EXPLORATION +PCR I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +hepático, I-EXPLORATION +todos I-EXPLORATION +normales. I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +enfermedad I-EXPLORATION +celíaca I-EXPLORATION +con I-EXPLORATION +anticuerpos I-EXPLORATION +anti-transglutaminasa I-EXPLORATION +negativos I-EXPLORATION +e I-EXPLORATION +inmunoglobulina I-EXPLORATION +A I-EXPLORATION +en I-EXPLORATION +valores I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +completa I-EXPLORATION +donde I-EXPLORATION +sólo I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +erosiones I-EXPLORATION +mínimas I-EXPLORATION +e I-EXPLORATION +inespecíficas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +recto. I-EXPLORATION +Se I-EXPLORATION +tomaron I-EXPLORATION +biopsias I-EXPLORATION +escalonadas I-EXPLORATION +de I-EXPLORATION +íleon, I-EXPLORATION +colon I-EXPLORATION +y I-EXPLORATION +recto I-EXPLORATION +en I-EXPLORATION +frascos I-EXPLORATION +separados I-EXPLORATION +las I-EXPLORATION +cuales I-EXPLORATION +fueron I-EXPLORATION +consistentes I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +CL I-EXPLORATION +dado I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +> I-EXPLORATION +40 I-EXPLORATION +linfocitos/100 I-EXPLORATION +células I-EXPLORATION +epiteliales I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +obtenidas I-EXPLORATION +desde I-EXPLORATION +colon I-EXPLORATION +transverso I-EXPLORATION +a I-EXPLORATION +recto. I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +describieron I-EXPLORATION +alteraciones I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +CU I-EXPLORATION +(leve I-EXPLORATION +distorsión I-EXPLORATION +de I-EXPLORATION +arquitectura I-EXPLORATION +glandular, I-EXPLORATION +criptitis I-EXPLORATION +y I-EXPLORATION +microabscesos) I-EXPLORATION +exclusivamente I-EXPLORATION +en I-EXPLORATION +sigmoides I-EXPLORATION +y I-EXPLORATION +recto. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +budesonida I-TREATMENT +9 I-TREATMENT +mg/día, I-TREATMENT +presentando I-TREATMENT +una I-TREATMENT +respuesta I-TREATMENT +favorable I-TREATMENT +a I-TREATMENT +la I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +un I-TREATMENT +descenso I-TREATMENT +progresivo I-TREATMENT +del I-TREATMENT +fármaco I-TREATMENT +hasta I-TREATMENT +suspenderlo I-TREATMENT +al I-TREATMENT +tercer I-TREATMENT +mes. I-TREATMENT +Luego B-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +ha I-EVOLUTION +mantenido I-EVOLUTION +asintomática I-EVOLUTION +(remisión I-EVOLUTION +clínica) I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +control I-EVOLUTION +con I-EVOLUTION +calprotectina I-EVOLUTION +fecal I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +rango I-EVOLUTION +normal. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dermatitis I-PAST_MEDICAL_HISTORY +seborreica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cuero I-PAST_MEDICAL_HISTORY +cabelludo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +viaje I-PAST_MEDICAL_HISTORY +reciente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Ilhabela, I-PAST_MEDICAL_HISTORY +Brasil. I-PAST_MEDICAL_HISTORY +Después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +permanecer I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +fuera I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +país, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +retornó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Chile. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +dermatólogo I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +regreso, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +zona I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cuero I-PRESENT_ILLNESS +cabelludo I-PRESENT_ILLNESS +parieto I-PRESENT_ILLNESS +occipital, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +objetos I-PRESENT_ILLNESS +extraños I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mueven I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +cabeza. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico, I-EXPLORATION +se I-EXPLORATION +identificaro I-EXPLORATION +3 I-EXPLORATION +úlceras I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +aproximadamente, I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +supuraba I-EXPLORATION +abundante I-EXPLORATION +contenido I-EXPLORATION +seropurulento, I-EXPLORATION +en I-EXPLORATION +cuyos I-EXPLORATION +fondos I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +múltiples I-EXPLORATION +larvas I-EXPLORATION +vivas I-EXPLORATION +y I-EXPLORATION +móviles. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +extracción I-TREATMENT +manual I-TREATMENT +en I-TREATMENT +la I-TREATMENT +sala I-TREATMENT +de I-TREATMENT +atención, I-TREATMENT +mediante I-TREATMENT +pinzas, I-TREATMENT +con I-TREATMENT +bastante I-TREATMENT +facilidad I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +molestias I-TREATMENT +para I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +procedimiento, I-TREATMENT +obteniéndose I-TREATMENT +25 I-TREATMENT +especímenes. I-TREATMENT +Se I-TREATMENT +indicó I-TREATMENT +ivermectina I-TREATMENT +oral I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +única I-TREATMENT +de I-TREATMENT +200 I-TREATMENT +ug/kg. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +presentó I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +sintomatología, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +cirugía I-TREATMENT +exploratoria I-TREATMENT +y I-TREATMENT +aseo I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +local, I-TREATMENT +se I-TREATMENT +logró I-TREATMENT +extraer I-TREATMENT +4 I-TREATMENT +larvas I-TREATMENT +más. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +ecografía I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas, I-EXPLORATION +no I-EXPLORATION +evidenciándose I-EXPLORATION +más I-EXPLORATION +larvas, I-EXPLORATION +y I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +cráneo, I-EXPLORATION +que I-EXPLORATION +descartó I-EXPLORATION +compromiso I-EXPLORATION +óseo. I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +antibioterapia I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +curaciones I-TREATMENT +de I-TREATMENT +sitio I-TREATMENT +operatorio, I-TREATMENT +presentando B-EVOLUTION +una I-EVOLUTION +rápida I-EVOLUTION +y I-EVOLUTION +favorable I-EVOLUTION +respuesta I-EVOLUTION +clínica, I-EVOLUTION +logrando I-EVOLUTION +cierre I-EVOLUTION +por I-EVOLUTION +segunda I-EVOLUTION +intención I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +heridas I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +recurrencias I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +fecha. I-EVOLUTION + I-EVOLUTION +Todas B-EXPLORATION +las I-EXPLORATION +larvas I-EXPLORATION +obtenidas I-EXPLORATION +fueron I-EXPLORATION +analizadas I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +Parasitología I-EXPLORATION +Básico-Clínico I-EXPLORATION +del I-EXPLORATION +Instituto I-EXPLORATION +de I-EXPLORATION +Ciencias I-EXPLORATION +Biomédicas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Facultad I-EXPLORATION +de I-EXPLORATION +Medicina I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Chile, I-EXPLORATION +identificándose I-EXPLORATION +larvas I-EXPLORATION +en I-EXPLORATION +estado I-EXPLORATION +L2 I-EXPLORATION +y I-EXPLORATION +L3 I-EXPLORATION +de I-EXPLORATION +Cochliomyia I-EXPLORATION +hominivorax. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +DM1 I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +hemoglobina I-PAST_MEDICAL_HISTORY +glicosilada I-PAST_MEDICAL_HISTORY +(HbA1c) I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8, I-PAST_MEDICAL_HISTORY +5%. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +fiebre. I-PRESENT_ILLNESS +Debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +estaba I-PRESENT_ILLNESS +ingiriendo I-PRESENT_ILLNESS +alimentos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cantidad I-PRESENT_ILLNESS +adecuada, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +omitió I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +dosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +insulina I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +mismo I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Dirigidamente, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +ayuno I-PRESENT_ILLNESS +prolongado, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +alcohol I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +riesgo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +embarazo I-PRESENT_ILLNESS +previo I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +síntomas. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +vigil, I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +leve I-EXPLORATION +déficit I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +extra I-EXPLORATION +celular I-EXPLORATION +(VEC). I-EXPLORATION +Su I-EXPLORATION +Índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +era I-EXPLORATION +29 I-EXPLORATION +Kg/m2. I-EXPLORATION +En I-EXPLORATION +sus I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +al I-EXPLORATION +ingreso, I-EXPLORATION +destacaba: I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +26.000 I-EXPLORATION +x I-EXPLORATION +mm3, I-EXPLORATION +glicemia I-EXPLORATION +200 I-EXPLORATION +mg/dl, I-EXPLORATION +gases I-EXPLORATION +arteriales I-EXPLORATION +con I-EXPLORATION +acidosis I-EXPLORATION +metabólica I-EXPLORATION +severa I-EXPLORATION +(pH I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +y I-EXPLORATION +bicarbonato I-EXPLORATION +de I-EXPLORATION +7 I-EXPLORATION +meq/L), I-EXPLORATION +cetonemia++++++ I-EXPLORATION +(no I-EXPLORATION +se I-EXPLORATION +dispone I-EXPLORATION +de I-EXPLORATION +medición I-EXPLORATION +cuantitativa), I-EXPLORATION +cetonuria I-EXPLORATION ++++, I-EXPLORATION +glucosuria. I-EXPLORATION +La I-EXPLORATION +proteína I-EXPLORATION +c I-EXPLORATION +reactiva, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +amilasemia I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +electrolitos I-EXPLORATION +plasmáticos I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +Una I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +resultó I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION + I-EXPLORATION +Ingresó B-TREATMENT +a I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Intensivos I-TREATMENT +(UCI), I-TREATMENT +iniciándose I-TREATMENT +hidratación I-TREATMENT +parenteral I-TREATMENT +e I-TREATMENT +insulina I-TREATMENT +cristalina I-TREATMENT +endovenosa, I-TREATMENT +en I-TREATMENT +infusión I-TREATMENT +continua. I-TREATMENT +Evolucionó B-EVOLUTION +favorablemente. I-EVOLUTION +Dada I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +Cetoacidosis I-EVOLUTION +diabética I-EVOLUTION +(CAD) I-EVOLUTION +sin I-EVOLUTION +un I-EVOLUTION +desencadenante I-EVOLUTION +claro I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +glucosuria I-EVOLUTION +inapropiadamente I-EVOLUTION +alta I-EVOLUTION +para I-EVOLUTION +tal I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +hiperglicemia, I-EVOLUTION +se I-EVOLUTION +reinterroga I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +acerca I-EVOLUTION +del I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +otros I-EVOLUTION +medicamentos; I-EVOLUTION +entonces B-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +iniciado I-PAST_MEDICAL_HISTORY +canaglifozina I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +cuadro. I-PAST_MEDICAL_HISTORY +Una B-TREATMENT +vez I-TREATMENT +estabilizada, I-TREATMENT +se I-TREATMENT +reajustó I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +insulina I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +dada I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +al I-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +de I-TREATMENT +hospitalización. I-TREATMENT + I-TREATMENT +Se B-EVOLUTION +realizó I-EVOLUTION +la I-EVOLUTION +notificación I-EVOLUTION +al I-EVOLUTION +Instituto I-EVOLUTION +de I-EVOLUTION +Salud I-EVOLUTION +Pública I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +informó I-EVOLUTION +al I-EVOLUTION +Laboratorio I-EVOLUTION +Janssen I-EVOLUTION +Chile, I-EVOLUTION +constituyéndose I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +caso I-EVOLUTION +descrito I-EVOLUTION +de I-EVOLUTION +CAD I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +estos I-EVOLUTION +medicamentos I-EVOLUTION +en I-EVOLUTION +nuestro I-EVOLUTION +país. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +mórbidos I-PAST_MEDICAL_HISTORY +conocidos, I-PAST_MEDICAL_HISTORY +consulta B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +Unidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Emergencia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +astenia I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +palidez, I-PRESENT_ILLNESS +mialgias, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +escalofríos. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +destacan I-EXPLORATION +en I-EXPLORATION +paladar I-EXPLORATION +numerosas I-EXPLORATION +lesiones I-EXPLORATION +herpetiformes, I-EXPLORATION +hemograma I-EXPLORATION +evidencia I-EXPLORATION +pancitopenia, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +hospitalizar. I-EXPLORATION +Se I-EXPLORATION +efectúa I-EXPLORATION +estudio I-EXPLORATION +con I-EXPLORATION +mielograma, I-EXPLORATION +inmunofenotipo I-EXPLORATION +y I-EXPLORATION +cariograma, I-EXPLORATION +diagnosticándose I-EXPLORATION +LMA I-EXPLORATION +indiferenciada I-EXPLORATION +con I-EXPLORATION +expresión I-EXPLORATION +aberrante I-EXPLORATION +CD7. I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +quimioterapia I-TREATMENT +de I-TREATMENT +inducción I-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +3+7 I-TREATMENT +(daunorrubicina I-TREATMENT ++ I-TREATMENT +citarabina) I-TREATMENT +presentando I-TREATMENT +al I-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +del I-TREATMENT +primer I-TREATMENT +ciclo I-TREATMENT +diarrea I-TREATMENT +y I-TREATMENT +fiebre, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +toman I-TREATMENT +hemocultivos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +terapia I-TREATMENT +antibiótica I-TREATMENT +empírica I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro. I-TREATMENT +Los B-EXPLORATION +hemocultivos I-EXPLORATION +resultaron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +Klebsiella I-EXPLORATION +pneumoniae I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +cefalosporinas I-EXPLORATION +de I-EXPLORATION +tercera I-EXPLORATION +generación, I-EXPLORATION +manteniéndose I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +antibiótico I-EXPLORATION +inicial. I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +persiste I-EVOLUTION +febril I-EVOLUTION +sin I-EVOLUTION +clínica I-EVOLUTION +que I-EVOLUTION +sugiera I-EVOLUTION +el I-EVOLUTION +foco I-EVOLUTION +infeccioso; I-EVOLUTION +cursa I-EVOLUTION +con I-EVOLUTION +neutropenia I-EVOLUTION +grave I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +prolonga I-EVOLUTION +por I-EVOLUTION +20 I-EVOLUTION +días, I-EVOLUTION +con I-EVOLUTION +parámetros I-EVOLUTION +inflamatorios I-EVOLUTION +en I-EVOLUTION +ascenso I-EVOLUTION +y I-EVOLUTION +alteración I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pruebas I-EVOLUTION +hepáticas I-EVOLUTION +con I-EVOLUTION +patrón I-EVOLUTION +colestásico. I-EVOLUTION +Se B-TREATMENT +decide I-TREATMENT +agregar I-TREATMENT +tratamiento I-TREATMENT +antifúngico I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +anidulafungina I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +tomografia I-EXPLORATION +computada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +pelvis I-EXPLORATION +en I-EXPLORATION +que I-EXPLORATION +destaca I-EXPLORATION +hepatoesplenomegalia I-EXPLORATION +con I-EXPLORATION +lesiones I-EXPLORATION +focales I-EXPLORATION +esplénicas I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +compromiso I-EXPLORATION +inflamatorio-infeccioso. I-EXPLORATION +Además I-EXPLORATION +presenta I-EXPLORATION +coriorretinitis I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +sugerente I-EXPLORATION +de I-EXPLORATION +micosis. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +hemocultivo I-EXPLORATION +de I-EXPLORATION +hongos I-EXPLORATION +(medio I-EXPLORATION +Sabourand) I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +negativos, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +MALDI I-EXPLORATION +TOF I-EXPLORATION +MS I-EXPLORATION +(Matrix-Assisted I-EXPLORATION +Laser I-EXPLORATION +Desorption/Ionization I-EXPLORATION +time I-EXPLORATION +of I-EXPLORATION +flight I-EXPLORATION +mass I-EXPLORATION +espectrometry) I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +resulta I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +S. I-EXPLORATION +capitata, I-EXPLORATION +agregándose I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +voriconazol I-EXPLORATION +(200 I-EXPLORATION +mg/12 I-EXPLORATION +h). I-EXPLORATION +Por B-TREATMENT +falta I-TREATMENT +de I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +se I-TREATMENT +reemplaza I-TREATMENT +la I-TREATMENT +anidulafungina I-TREATMENT +por I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +liposomal I-TREATMENT +(50 I-TREATMENT +mg/día), I-TREATMENT +se I-TREATMENT +practica I-TREATMENT +ecocardiografía I-TREATMENT +que I-TREATMENT +descarta I-TREATMENT +endocarditis. I-TREATMENT +Nuevo B-EXPLORATION +TC I-EXPLORATION +muestra I-EXPLORATION +múltiples I-EXPLORATION +áreas I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +esmerilado I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +lóbulos I-EXPLORATION +pulmonares I-EXPLORATION +superiores I-EXPLORATION +y I-EXPLORATION +lóbulo I-EXPLORATION +medio, I-EXPLORATION +atelectasias I-EXPLORATION +bibasales I-EXPLORATION +y I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +moderado I-EXPLORATION +izquierdo, I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas I-EXPLORATION +e I-EXPLORATION +hiliares I-EXPLORATION +bilaterales, I-EXPLORATION +hepatoesplenomagalia I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +focales I-EXPLORATION +hipovasculares, I-EXPLORATION +en I-EXPLORATION +hígado, I-EXPLORATION +bazo I-EXPLORATION +y I-EXPLORATION +riñón. I-EXPLORATION +Los I-EXPLORATION +cultivos I-EXPLORATION +realizados I-EXPLORATION +de I-EXPLORATION +catéteres I-EXPLORATION +resultados I-EXPLORATION +todos I-EXPLORATION +negativos. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +toracocentesis I-TREATMENT +evacuadora I-TREATMENT +con I-TREATMENT +estudio I-TREATMENT +de I-TREATMENT +líquido I-TREATMENT +pleural I-TREATMENT +que I-TREATMENT +muestra I-TREATMENT +exudado I-TREATMENT +de I-TREATMENT +predominio I-TREATMENT +mononuclear. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +invalidante I-EVOLUTION +en I-EVOLUTION +hipocondrio I-EVOLUTION +y I-EVOLUTION +flanco I-EVOLUTION +izquierdos, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +realiza I-EVOLUTION +control I-EVOLUTION +radiológico I-EVOLUTION +que I-EVOLUTION +evidencia I-EVOLUTION +regresión I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +hepáticas I-EVOLUTION +y I-EVOLUTION +renales, I-EVOLUTION +pero I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +izquierdo I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +esplénicas I-EVOLUTION +que I-EVOLUTION +ahora I-EVOLUTION +son I-EVOLUTION +de I-EVOLUTION +aspecto I-EVOLUTION +hemorrágico. I-EVOLUTION +Analizado B-TREATMENT +el I-TREATMENT +caso I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +multidisciplinaria I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +esplenectomía I-TREATMENT +de I-TREATMENT +desfocamiento I-TREATMENT +y I-TREATMENT +VTC, I-TREATMENT +para I-TREATMENT +evacuación I-TREATMENT +y I-TREATMENT +aseo I-TREATMENT +pleural I-TREATMENT +y, I-TREATMENT +definir I-TREATMENT +diagnóstico I-TREATMENT +diferencial I-TREATMENT +(neoplásico, I-TREATMENT +tuberculoso I-TREATMENT +y I-TREATMENT +micosis I-TREATMENT +invasora). I-TREATMENT +Se I-TREATMENT +efectúa I-TREATMENT +VTC I-TREATMENT +con I-TREATMENT +evacuación I-TREATMENT +de I-TREATMENT +2.000 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +derrame I-TREATMENT +pleural, I-TREATMENT +aseo I-TREATMENT +con I-TREATMENT +solución I-TREATMENT +salina, I-TREATMENT +biopsia I-TREATMENT +pleural I-TREATMENT +y I-TREATMENT +drenaje, I-TREATMENT +observándose B-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +4 I-EXPLORATION +mm I-EXPLORATION +distribuidas I-EXPLORATION +difusamente I-EXPLORATION +en I-EXPLORATION +pleura I-EXPLORATION +parietal, I-EXPLORATION +visceral I-EXPLORATION +y I-EXPLORATION +diafragmática. I-EXPLORATION +Se I-EXPLORATION +efectúa I-EXPLORATION +laparotomía I-EXPLORATION +observándose I-EXPLORATION +esplenomegalia I-EXPLORATION +hemorrágica I-EXPLORATION +más I-EXPLORATION +abscesos I-EXPLORATION +esplénicos, I-EXPLORATION +se B-TREATMENT +practica I-TREATMENT +esplenectomía I-TREATMENT +para I-TREATMENT +limpieza I-TREATMENT +del I-TREATMENT +foco. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +tomadas I-EXPLORATION +durante I-EXPLORATION +la I-EXPLORATION +VTC I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +laparotomía I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +hifas I-EXPLORATION +septadas. I-EXPLORATION +Los I-EXPLORATION +cultivos I-EXPLORATION +intraoperatorios I-EXPLORATION +resultaron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +S. I-EXPLORATION +capitata I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +72 I-EXPLORATION +h. I-EXPLORATION +Posterior B-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +favorablemente I-EVOLUTION +y B-TREATMENT +se I-TREATMENT +completan I-TREATMENT +58 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +liposomal I-TREATMENT +(alcanzando I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +acumulada I-TREATMENT +de I-TREATMENT +2, I-TREATMENT +9 I-TREATMENT +g I-TREATMENT +sin I-TREATMENT +manifestar I-TREATMENT +efectos I-TREATMENT +adversos) I-TREATMENT +y I-TREATMENT +80 I-TREATMENT +días I-TREATMENT +con I-TREATMENT +voriconazol I-TREATMENT +(dosis I-TREATMENT +acumulada I-TREATMENT +de I-TREATMENT +32 I-TREATMENT +g I-TREATMENT +sin I-TREATMENT +efectos I-TREATMENT +adversos). I-TREATMENT +Se B-EVOLUTION +da I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +en I-EVOLUTION +buenas I-EVOLUTION +condiciones, I-EVOLUTION +finalizando I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +oncológico I-EVOLUTION +manteniéndose I-EVOLUTION +durante I-EVOLUTION +los I-EVOLUTION +ciclos I-EVOLUTION +de I-EVOLUTION +quimioterapia I-EVOLUTION +con I-EVOLUTION +profilaxis I-EVOLUTION +con I-EVOLUTION +voriconazol. I-EVOLUTION +A I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en B-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +trastorno I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +personalidad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ánimo, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +intentos I-PAST_MEDICAL_HISTORY +suicidas. I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +febrero I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2017 I-PRESENT_ILLNESS +ingirió I-PRESENT_ILLNESS +bupropión I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +dosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +g, I-PRESENT_ILLNESS +clorpromazina I-PRESENT_ILLNESS +1, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +g I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +copas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vino. I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +familiares I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +encontraron I-PRESENT_ILLNESS +alterada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +llevaron I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Salvador, I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +ingresó I-PRESENT_ILLNESS +comprometida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conciencia I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Glasgow I-PRESENT_ILLNESS +10, I-PRESENT_ILLNESS +presión I-PRESENT_ILLNESS +arterial I-PRESENT_ILLNESS +90/60, I-PRESENT_ILLNESS +taquicárdica I-PRESENT_ILLNESS +115 I-PRESENT_ILLNESS +lpm, I-PRESENT_ILLNESS +electrocardiograma I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +segmento I-PRESENT_ILLNESS +Q-t I-PRESENT_ILLNESS +alargado I-PRESENT_ILLNESS +(550 I-PRESENT_ILLNESS +ms) I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ácido I-PRESENT_ILLNESS +láctico I-PRESENT_ILLNESS +elevado I-PRESENT_ILLNESS +(32, I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +mg/dl). I-PRESENT_ILLNESS +Dentro B-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +presentó I-EVOLUTION +dos I-EVOLUTION +breves I-EVOLUTION +episodios I-EVOLUTION +convulsivos, I-EVOLUTION +de I-EVOLUTION +30 I-EVOLUTION +seg I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +menos I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +minuto. I-EVOLUTION +El B-EXPLORATION +electroencefalograma I-EXPLORATION +(EEG) I-EXPLORATION +mostró I-EXPLORATION +actividad I-EXPLORATION +delta-theta I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +voltaje, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +epilepsia. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +(TAC) I-EXPLORATION +sin I-EXPLORATION +contraste I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +tenía I-EXPLORATION +escaza I-EXPLORATION +reactividad I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +alterada I-EXPLORATION +de I-EXPLORATION +conciencia, I-EXPLORATION +con I-EXPLORATION +mioclonías I-EXPLORATION +generalizadas I-EXPLORATION +y I-EXPLORATION +movimientos I-EXPLORATION +involuntarios I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades; I-EXPLORATION +tono I-EXPLORATION +muscular I-EXPLORATION +aumentado, I-EXPLORATION +reflejos I-EXPLORATION +osteotendíneos I-EXPLORATION +(ROT) I-EXPLORATION +policinéticos I-EXPLORATION +y I-EXPLORATION +reflejos I-EXPLORATION +plantares I-EXPLORATION +flexores. I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +mañana I-EVOLUTION +del I-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +sufrió I-EVOLUTION +paro I-EVOLUTION +cardiorrespiratorio I-EVOLUTION +por I-EVOLUTION +asistolia, I-EVOLUTION +recibió B-TREATMENT +reanimación I-TREATMENT +inmediata, I-TREATMENT +adrenalina, I-TREATMENT +intubación, I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +min I-TREATMENT +logró I-TREATMENT +actividad I-TREATMENT +cardiaca I-TREATMENT +espontánea. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +habían I-EVOLUTION +desaparecido I-EVOLUTION +las I-EVOLUTION +mioclonías, I-EVOLUTION +estaba I-EVOLUTION +inconsciente I-EVOLUTION +y I-EVOLUTION +mantenía I-EVOLUTION +una I-EVOLUTION +persistente I-EVOLUTION +apertura I-EVOLUTION +palpebral I-EVOLUTION +con I-EVOLUTION +escaso I-EVOLUTION +pestañeo I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +sobre-elevación I-EVOLUTION +anormal I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +ojos, I-EVOLUTION +como I-EVOLUTION +mirando I-EVOLUTION +hacia I-EVOLUTION +atrás. I-EVOLUTION +Las I-EVOLUTION +pupilas I-EVOLUTION +estaban I-EVOLUTION +iguales I-EVOLUTION +y I-EVOLUTION +reactivas I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +luz, I-EVOLUTION +con I-EVOLUTION +reflejos I-EVOLUTION +oculocefálicos I-EVOLUTION +conservados. I-EVOLUTION +Sus I-EVOLUTION +extremidades I-EVOLUTION +se I-EVOLUTION +mostraban I-EVOLUTION +hipotónicas I-EVOLUTION +y I-EVOLUTION +tenía I-EVOLUTION +los I-EVOLUTION +ROT I-EVOLUTION +exaltados I-EVOLUTION +con I-EVOLUTION +Babinski I-EVOLUTION +bilateral. I-EVOLUTION +Los B-EXPLORATION +estímulos I-EXPLORATION +nociceptivos I-EXPLORATION +desencadenaban I-EXPLORATION +respuestas I-EXPLORATION +extensoras I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cuatro I-EXPLORATION +extremidades I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +simultáneo I-EXPLORATION +cierre I-EXPLORATION +palpebral I-EXPLORATION +con I-EXPLORATION +descenso I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +globos I-EXPLORATION +oculares, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +reapertura I-EXPLORATION +palpebral I-EXPLORATION +volvían I-EXPLORATION +a I-EXPLORATION +elevarse I-EXPLORATION +simulando I-EXPLORATION +un I-EXPLORATION +rebote I-EXPLORATION +ocular. I-EXPLORATION +El I-EXPLORATION +fen��meno I-EXPLORATION +se I-EXPLORATION +repetía I-EXPLORATION +con I-EXPLORATION +cualquier I-EXPLORATION +estímulo. I-EXPLORATION +La I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +realizada I-EXPLORATION +al I-EXPLORATION +octavo I-EXPLORATION +día, I-EXPLORATION +mostró I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +difusión I-EXPLORATION +imágenes I-EXPLORATION +hiperintensas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sustancia I-EXPLORATION +blanca I-EXPLORATION +del I-EXPLORATION +centro I-EXPLORATION +oval I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +calloso I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +secuencia I-EXPLORATION +FLAIR I-EXPLORATION +áreas I-EXPLORATION +menores I-EXPLORATION +hiperintensas I-EXPLORATION +en I-EXPLORATION +ganglios I-EXPLORATION +basales I-EXPLORATION +y I-EXPLORATION +corteza, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +encefalopatía I-EXPLORATION +hipóxico-isquémica. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +supraversión I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mirada I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +al I-EVOLUTION +menos I-EVOLUTION +diez I-EVOLUTION +días, I-EVOLUTION +luego I-EVOLUTION +la I-EVOLUTION +mirada I-EVOLUTION +se I-EVOLUTION +hizo I-EVOLUTION +central, I-EVOLUTION +mientras I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +seguía I-EVOLUTION +en I-EVOLUTION +coma I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +variaciones I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +mes. I-EVOLUTION +Las I-EVOLUTION +pupilas I-EVOLUTION +se I-EVOLUTION +mantenían I-EVOLUTION +iguales I-EVOLUTION +con I-EVOLUTION +respuesta I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +luz I-EVOLUTION +y I-EVOLUTION +reflejos I-EVOLUTION +oculocefálicos I-EVOLUTION +conservados, I-EVOLUTION +los I-EVOLUTION +ROT I-EVOLUTION +estaban I-EVOLUTION +vivos I-EVOLUTION +con I-EVOLUTION +reflejos I-EVOLUTION +plantares I-EVOLUTION +extensores. I-EVOLUTION +Los I-EVOLUTION +estímulos I-EVOLUTION +nociseptivos I-EVOLUTION +seguían I-EVOLUTION +generando I-EVOLUTION +respuestas I-EVOLUTION +extensoras. I-EVOLUTION +El I-EVOLUTION +EEG I-EVOLUTION +estaba I-EVOLUTION +prácticamente I-EVOLUTION +plano. I-EVOLUTION +La B-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +definida I-EXPLORATION +atrofia I-EXPLORATION +cerebral, I-EXPLORATION +con I-EXPLORATION +hiperintensidades I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +núcleos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +distintas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +corteza I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +cerebelosa. I-EXPLORATION +Había B-EVOLUTION +desaparecido I-EVOLUTION +la I-EVOLUTION +hiperintensidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +substancia I-EVOLUTION +blanca. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +47 I-EVOLUTION +días. I-EVOLUTION + I-EVOLUTION + +Ingresa B-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +Hematología I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +masculino I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +LLA I-PAST_MEDICAL_HISTORY +común, I-PAST_MEDICAL_HISTORY +(Philadelphia I-PAST_MEDICAL_HISTORY +negativo). I-PAST_MEDICAL_HISTORY +Inducción B-TREATMENT +con I-TREATMENT +esquema I-TREATMENT +LLA I-TREATMENT +15-30 I-TREATMENT +según I-TREATMENT +protocolo, I-TREATMENT +con I-TREATMENT +rápida I-TREATMENT +respuesta I-TREATMENT +y I-TREATMENT +remisión I-TREATMENT +completa. I-TREATMENT +En I-TREATMENT +la I-TREATMENT +etapa I-TREATMENT +de I-TREATMENT +consolidación I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +QI I-TREATMENT +triple I-TREATMENT +(Metrotrexato I-TREATMENT +15 I-TREATMENT +mg, I-TREATMENT +Citarabina I-TREATMENT +50 I-TREATMENT +mg, I-TREATMENT +Betametasona I-TREATMENT +4 I-TREATMENT +mg). I-TREATMENT +Durante B-EVOLUTION +esta I-EVOLUTION +etapa I-EVOLUTION +apareció I-EVOLUTION +neutropenia I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +mielograma I-EVOLUTION +mostró I-EVOLUTION +71% I-EVOLUTION +de I-EVOLUTION +linfoblastos I-EVOLUTION +y I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +blastos I-EVOLUTION +en I-EVOLUTION +LCR, I-EVOLUTION +sin I-EVOLUTION +síntomas I-EVOLUTION +neurológicos. I-EVOLUTION +Se I-EVOLUTION +definió I-EVOLUTION +como I-EVOLUTION +una I-EVOLUTION +recaída I-EVOLUTION +combinada I-EVOLUTION +precoz. I-EVOLUTION +En B-TREATMENT +la I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +rescate, I-TREATMENT +recibió I-TREATMENT +seis I-TREATMENT +pulsos I-TREATMENT +de I-TREATMENT +QI, I-TREATMENT +lográndose I-TREATMENT +remisión I-TREATMENT +completa I-TREATMENT +y I-TREATMENT +desaparición I-TREATMENT +de I-TREATMENT +los I-TREATMENT +blastos I-TREATMENT +del I-TREATMENT +LCR. I-TREATMENT +Al I-TREATMENT +octavo I-TREATMENT +mes I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +con I-TREATMENT +block I-TREATMENT +R2. I-TREATMENT +Después B-EVOLUTION +del I-EVOLUTION +primer I-EVOLUTION +procedimiento I-EVOLUTION +intratecal I-EVOLUTION +inició I-EVOLUTION +inestabilidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +marcha. I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +neurológico I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +vigil, I-EXPLORATION +orientado, I-EXPLORATION +sin I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +pares I-EXPLORATION +craneanos, I-EXPLORATION +ni I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +potencia I-EXPLORATION +muscular, I-EXPLORATION +ROT I-EXPLORATION +preservados, I-EXPLORATION +marcha I-EXPLORATION +insegura, I-EXPLORATION +Romberg I-EXPLORATION +positivo I-EXPLORATION +y I-EXPLORATION +alteración I-EXPLORATION +propioceptiva I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +EEII, I-EXPLORATION +prueba I-EXPLORATION +índice-nariz I-EXPLORATION +y I-EXPLORATION +talón-rodilla I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +quimioterapia, I-TREATMENT +iniciándose I-TREATMENT +Tiamina I-TREATMENT +90 I-TREATMENT +mg I-TREATMENT +c/12 I-TREATMENT +h, I-TREATMENT +Piridoxina I-TREATMENT +150 I-TREATMENT +mg I-TREATMENT +c/12 I-TREATMENT +h, I-TREATMENT +Leucovorina I-TREATMENT +50 I-TREATMENT +mg I-TREATMENT +c/12 I-TREATMENT +h, I-TREATMENT +Cianocobalamina I-TREATMENT +2 I-TREATMENT +ampollas I-TREATMENT +y I-TREATMENT +c/24 I-TREATMENT +h I-TREATMENT +Meteonina I-TREATMENT +S-adenosylmetionina. I-TREATMENT + I-TREATMENT +Dos B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +paciente I-EVOLUTION +vigil I-EVOLUTION +con I-EVOLUTION +funciones I-EVOLUTION +superiores I-EVOLUTION +preservadas, I-EVOLUTION +había I-EVOLUTION +progresado I-EVOLUTION +la I-EVOLUTION +inestabilidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +marcha, I-EVOLUTION +agregándose I-EVOLUTION +hipostesia I-EVOLUTION +táctil, I-EVOLUTION +dificultad I-EVOLUTION +para I-EVOLUTION +la I-EVOLUTION +bipedestación I-EVOLUTION +por I-EVOLUTION +debilidad I-EVOLUTION +proximal I-EVOLUTION +de I-EVOLUTION +EEII, I-EVOLUTION +hiperreflexia, I-EVOLUTION +Babinski I-EVOLUTION +e I-EVOLUTION +incontinencia I-EVOLUTION +urinaria. I-EVOLUTION +RM B-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +mostró I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +en I-EXPLORATION +cordones I-EXPLORATION +posteriores I-EXPLORATION +desde I-EXPLORATION +cervical I-EXPLORATION +a I-EXPLORATION +T11. I-EXPLORATION + I-EXPLORATION +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +aumentó I-EVOLUTION +la I-EVOLUTION +debilidad I-EVOLUTION +en I-EVOLUTION +EEII I-EVOLUTION +y I-EVOLUTION +pared I-EVOLUTION +abdominal, I-EVOLUTION +ROT I-EVOLUTION +apagados, I-EVOLUTION +Babinski, I-EVOLUTION +las I-EVOLUTION +alteraciones I-EVOLUTION +propioceptivas I-EVOLUTION +persistían, I-EVOLUTION +tenía I-EVOLUTION +preservada I-EVOLUTION +la I-EVOLUTION +sensibilidad I-EVOLUTION +dolorosa, I-EVOLUTION +sin I-EVOLUTION +compromiso I-EVOLUTION +en I-EVOLUTION +EESS. I-EVOLUTION +En I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +decimosegundo I-EVOLUTION +tenía I-EVOLUTION +paraplejia I-EVOLUTION +fláccida, I-EVOLUTION +ROT I-EVOLUTION +abolidos, I-EVOLUTION +sin I-EVOLUTION +nivel I-EVOLUTION +sensitivo. I-EVOLUTION +Un I-EVOLUTION +hemograma I-EVOLUTION +con I-EVOLUTION +recaída I-EVOLUTION +leucémica I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +decimonono I-EVOLUTION +obligó I-EVOLUTION +a I-EVOLUTION +continuar I-EVOLUTION +con I-EVOLUTION +cuidados I-EVOLUTION +paliativos I-EVOLUTION +en I-EVOLUTION +su I-EVOLUTION +domicilio. I-EVOLUTION +El I-EVOLUTION +compromiso I-EVOLUTION +neurológico I-EVOLUTION +no I-EVOLUTION +progresó, I-EVOLUTION +falleciendo I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +LLA. I-EVOLUTION + I-EVOLUTION + +Mujer, B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +21 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +hijos. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +17 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +diagnosticó I-PAST_MEDICAL_HISTORY +DM I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +polidipsia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +poliuria, I-PAST_MEDICAL_HISTORY +asociada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +glicemia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ayunas I-PAST_MEDICAL_HISTORY +130 I-PAST_MEDICAL_HISTORY +mg/dl, I-PAST_MEDICAL_HISTORY +confirmada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +prueba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tolerancia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +glucosa I-PAST_MEDICAL_HISTORY +oral I-PAST_MEDICAL_HISTORY +(PTGO) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +75 I-PAST_MEDICAL_HISTORY +g: I-PAST_MEDICAL_HISTORY +116 I-PAST_MEDICAL_HISTORY +mg/dl I-PAST_MEDICAL_HISTORY +ayunas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +234 I-PAST_MEDICAL_HISTORY +mg/dl I-PAST_MEDICAL_HISTORY +post I-PAST_MEDICAL_HISTORY +carga. I-PAST_MEDICAL_HISTORY +Se B-EXPLORATION +descartó I-EXPLORATION +DM1 I-EXPLORATION +por I-EXPLORATION +autoanticuerpos I-EXPLORATION +negativos I-EXPLORATION +y I-EXPLORATION +péptido I-EXPLORATION +C I-EXPLORATION +normal, I-EXPLORATION +HbA1c I-EXPLORATION +6, I-EXPLORATION +8% I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +y I-EXPLORATION +orina I-EXPLORATION +sin I-EXPLORATION +glucosuria. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +RI, I-EXPLORATION +talla I-EXPLORATION +1, I-EXPLORATION +56 I-EXPLORATION +m I-EXPLORATION +y I-EXPLORATION +peso I-EXPLORATION +44, I-EXPLORATION +5 I-EXPLORATION +kg, I-EXPLORATION +IMC I-EXPLORATION +18 I-EXPLORATION +kg/m2. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +no I-TREATMENT +farmacológico I-TREATMENT +y I-TREATMENT +metformina I-TREATMENT +850 I-TREATMENT +mg/2 I-TREATMENT +veces I-TREATMENT +al I-TREATMENT +día. I-TREATMENT +Evolucionó B-EVOLUTION +satisfactoriamente I-EVOLUTION +durante I-EVOLUTION +4 I-EVOLUTION +años, I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +complicaciones, I-EVOLUTION +mantuvo I-EVOLUTION +HbA1c I-EVOLUTION +entre I-EVOLUTION +6-7%. I-EVOLUTION +En B-TREATMENT +enero I-TREATMENT +de I-TREATMENT +2015 I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +metformina I-TREATMENT +por I-TREATMENT +intolerancia I-TREATMENT +gástrica I-TREATMENT +y I-TREATMENT +considerando I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +y B-FAMILY_HISTORY +los I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +DM, I-FAMILY_HISTORY +se B-TREATMENT +planteó I-TREATMENT +que I-TREATMENT +podría I-TREATMENT +presentar I-TREATMENT +MODY. I-TREATMENT + I-TREATMENT +Se B-FAMILY_HISTORY +estudió I-FAMILY_HISTORY +la I-FAMILY_HISTORY +DM I-FAMILY_HISTORY +en I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +con I-FAMILY_HISTORY +PTGO, I-FAMILY_HISTORY +pesquisándose I-FAMILY_HISTORY +DM I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +padre. I-FAMILY_HISTORY +Su I-FAMILY_HISTORY +hermano I-FAMILY_HISTORY +presentaba I-FAMILY_HISTORY +anormalidad I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +glicemia. I-FAMILY_HISTORY +La I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +no I-FAMILY_HISTORY +tenía I-FAMILY_HISTORY +DM. I-FAMILY_HISTORY + I-FAMILY_HISTORY +*Rango I-FAMILY_HISTORY +normal: I-FAMILY_HISTORY +1, I-FAMILY_HISTORY +1 I-FAMILY_HISTORY +– I-FAMILY_HISTORY +4, I-FAMILY_HISTORY +4 I-FAMILY_HISTORY +ng/ml. I-FAMILY_HISTORY + I-FAMILY_HISTORY +De I-FAMILY_HISTORY +la I-FAMILY_HISTORY +anamnesis I-FAMILY_HISTORY +familiar I-FAMILY_HISTORY +destaca I-FAMILY_HISTORY +una I-FAMILY_HISTORY +fuerte I-FAMILY_HISTORY +presencia I-FAMILY_HISTORY +de I-FAMILY_HISTORY +DM I-FAMILY_HISTORY +por I-FAMILY_HISTORY +la I-FAMILY_HISTORY +línea I-FAMILY_HISTORY +paterna, I-FAMILY_HISTORY +donde I-FAMILY_HISTORY +8 I-FAMILY_HISTORY +de I-FAMILY_HISTORY +9 I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +del I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +del I-FAMILY_HISTORY +caso I-FAMILY_HISTORY +índice, I-FAMILY_HISTORY +están I-FAMILY_HISTORY +diagnosticados I-FAMILY_HISTORY +con I-FAMILY_HISTORY +DM2, I-FAMILY_HISTORY +además I-FAMILY_HISTORY +de I-FAMILY_HISTORY +ambos I-FAMILY_HISTORY +abuelos. I-FAMILY_HISTORY +Por I-FAMILY_HISTORY +la I-FAMILY_HISTORY +línea I-FAMILY_HISTORY +materna, I-FAMILY_HISTORY +solamente I-FAMILY_HISTORY +la I-FAMILY_HISTORY +abuela I-FAMILY_HISTORY +y I-FAMILY_HISTORY +una I-FAMILY_HISTORY +tía I-FAMILY_HISTORY +tienen I-FAMILY_HISTORY +DM2. I-FAMILY_HISTORY + I-FAMILY_HISTORY +Se B-EXPLORATION +utilizó I-EXPLORATION +la I-EXPLORATION +aplicación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +de I-EXPLORATION +Exeter5, I-EXPLORATION +estimándose I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presenta I-EXPLORATION +MODY I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +probabilidad I-EXPLORATION +de I-EXPLORATION +75, I-EXPLORATION +5%. I-EXPLORATION +Se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +genético I-EXPLORATION +familiar, I-EXPLORATION +para I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +contaba I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +consentimiento I-EXPLORATION +informado I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +participantes I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +aprobación I-EXPLORATION +del I-EXPLORATION +Comité I-EXPLORATION +de I-EXPLORATION +Ética I-EXPLORATION +del I-EXPLORATION +Hospital I-EXPLORATION +San I-EXPLORATION +Juan I-EXPLORATION +de I-EXPLORATION +Dios. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +análisis I-EXPLORATION +genético-molecular I-EXPLORATION +(Laboratorio I-EXPLORATION +de I-EXPLORATION +Genética I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Red I-EXPLORATION +UC-Christus I-EXPLORATION +Santiago, I-EXPLORATION +Chile) I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +exones I-EXPLORATION +1 I-EXPLORATION +a I-EXPLORATION +10 I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +GCK I-EXPLORATION +mediante I-EXPLORATION +secuenciación I-EXPLORATION +directa I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +regiones I-EXPLORATION +codificantes I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +uniones I-EXPLORATION +intrón-exón. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +mutación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +posición I-EXPLORATION +1343 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +exón I-EXPLORATION +10 I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +GCK, I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +cambio I-EXPLORATION +de I-EXPLORATION +guanina I-EXPLORATION +por I-EXPLORATION +adenina I-EXPLORATION +(1343 I-EXPLORATION +G>A); I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +otro I-EXPLORATION +alelo I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +dicha I-EXPLORATION +mutación I-EXPLORATION +(paciente I-EXPLORATION +heterocigota). I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +padre I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +hermano I-EXPLORATION +presentan I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +mutación I-EXPLORATION +del I-EXPLORATION +gen I-EXPLORATION +GCK I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +heterocigota. I-EXPLORATION +La I-EXPLORATION +madre I-EXPLORATION +mostró I-EXPLORATION +ambos I-EXPLORATION +alelos I-EXPLORATION +silvestres, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +MODY2 I-EXPLORATION +ni I-EXPLORATION +tiene I-EXPLORATION +DM. I-EXPLORATION +La I-EXPLORATION +variante I-EXPLORATION +encontrada I-EXPLORATION +probablemente I-EXPLORATION +es I-EXPLORATION +patogénica, I-EXPLORATION +pues I-EXPLORATION +genera I-EXPLORATION +un I-EXPLORATION +cambio I-EXPLORATION +no I-EXPLORATION +sinónimo I-EXPLORATION +o I-EXPLORATION +missense I-EXPLORATION +del I-EXPLORATION +aminoácido I-EXPLORATION +(aa) I-EXPLORATION +glicina I-EXPLORATION +por I-EXPLORATION +ácido I-EXPLORATION +aspártico I-EXPLORATION +(Gly448Asp) I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +enzima I-EXPLORATION +glucoquinasa I-EXPLORATION +(GCK). I-EXPLORATION +Estos I-EXPLORATION +resultados I-EXPLORATION +permiten I-EXPLORATION +establecer I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +MODY2 I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +familia I-EXPLORATION +chilena I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +mutación I-EXPLORATION +no I-EXPLORATION +descrita I-EXPLORATION +previamente. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +obesidad, I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +(HTA), I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +pulmonar I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +asociada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +subclínico. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +evaluó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +mal I-PRESENT_ILLNESS +control I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +HTA I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +diabetes I-PRESENT_ILLNESS +mellitus. I-PRESENT_ILLNESS +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +facies I-EXPLORATION +cushingoide I-EXPLORATION +y I-EXPLORATION +relleno I-EXPLORATION +de I-EXPLORATION +huecos I-EXPLORATION +supraclaviculares. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +cortisol I-EXPLORATION +libre I-EXPLORATION +urinario I-EXPLORATION +(CLU): I-EXPLORATION +236 I-EXPLORATION +ug/24 I-EXPLORATION +h I-EXPLORATION +(VN I-EXPLORATION +hasta I-EXPLORATION +100 I-EXPLORATION +ug/24 I-EXPLORATION +h), I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Nugent I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +supresión I-EXPLORATION +nocturna I-EXPLORATION +con I-EXPLORATION +dexametasona I-EXPLORATION +(Dx) I-EXPLORATION +1 I-EXPLORATION +mg: I-EXPLORATION +11, I-EXPLORATION +1 I-EXPLORATION +ug/dl I-EXPLORATION +(VN I-EXPLORATION +< I-EXPLORATION +1, I-EXPLORATION +8 I-EXPLORATION +ug/dl), I-EXPLORATION +ACTH I-EXPLORATION +32, I-EXPLORATION +1pg/ml I-EXPLORATION +(VN I-EXPLORATION +hasta I-EXPLORATION +46 I-EXPLORATION +pg/ml). I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +funcional: I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Dx/ I-EXPLORATION +desmopresina, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +respuesta I-EXPLORATION +de I-EXPLORATION +cortisol I-EXPLORATION +postestímulo, I-EXPLORATION +sugiriendo I-EXPLORATION +origen I-EXPLORATION +hipofisiario. I-EXPLORATION +Se I-EXPLORATION +solicitó I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +silla I-EXPLORATION +turca I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +adenoma I-EXPLORATION +posterolateral I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +6 I-EXPLORATION +mm, I-EXPLORATION +que I-EXPLORATION +determina I-EXPLORATION +leve I-EXPLORATION +remodelación I-EXPLORATION +del I-EXPLORATION +piso I-EXPLORATION +selar. I-EXPLORATION +Por B-TREATMENT +distintas I-TREATMENT +razones, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +no I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +cirugía. I-TREATMENT +En B-EXPLORATION +controles I-EXPLORATION +sucesivos I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +normalización I-EXPLORATION +del I-EXPLORATION +CLU I-EXPLORATION +sin I-EXPLORATION +mediar I-EXPLORATION +tratamiento. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +3 I-EXPLORATION +años I-EXPLORATION +tuvo I-EXPLORATION +un I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Nugent I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +ng/dl, I-EXPLORATION +ACTH: I-EXPLORATION +54, I-EXPLORATION +8 I-EXPLORATION +pg/ml I-EXPLORATION +y I-EXPLORATION +CLU: I-EXPLORATION +50, I-EXPLORATION +1 I-EXPLORATION +ug/24 I-EXPLORATION +h. I-EXPLORATION +Una I-EXPLORATION +nueva I-EXPLORATION +RM I-EXPLORATION +de I-EXPLORATION +silla I-EXPLORATION +turca I-EXPLORATION +mostró I-EXPLORATION +adenoma I-EXPLORATION +de I-EXPLORATION +similares I-EXPLORATION +características, I-EXPLORATION +sin I-EXPLORATION +evidencias I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +intratumoral. I-EXPLORATION +A I-EXPLORATION +los I-EXPLORATION +7 I-EXPLORATION +años I-EXPLORATION +tiene I-EXPLORATION +CLU I-EXPLORATION +28, I-EXPLORATION +8 I-EXPLORATION +ug/24 I-EXPLORATION +h, I-EXPLORATION +la I-EXPLORATION +diabetes I-EXPLORATION +mellitus I-EXPLORATION +mantiene I-EXPLORATION +un I-EXPLORATION +control I-EXPLORATION +adecuado I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +(HbA1c: I-EXPLORATION +7, I-EXPLORATION +6%) I-EXPLORATION +y I-EXPLORATION +ha I-EXPLORATION +disminuido I-EXPLORATION +10 I-EXPLORATION +kilos I-EXPLORATION +de I-EXPLORATION +peso I-EXPLORATION +desde I-EXPLORATION +su I-EXPLORATION +evaluación I-EXPLORATION +inicial. I-EXPLORATION + I-EXPLORATION +Ambas B-EVOLUTION +pacientes I-EVOLUTION +aún I-EVOLUTION +sobreviven, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +82 I-EVOLUTION +y I-EVOLUTION +88 I-EVOLUTION +años, I-EVOLUTION +respectivamente I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +manifiestan I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +hiperfunción I-EVOLUTION +endocrina. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +zurdo, B-PAST_MEDICAL_HISTORY +hipertenso, I-PAST_MEDICAL_HISTORY +despertó I-PAST_MEDICAL_HISTORY +desorientado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +disártrico, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +déficit I-PAST_MEDICAL_HISTORY +sensitivo-motor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +extremidades I-PAST_MEDICAL_HISTORY +derechas. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +vigilia, I-PRESENT_ILLNESS +cumplía I-PRESENT_ILLNESS +órdenes I-PRESENT_ILLNESS +simples, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +mantenía I-PRESENT_ILLNESS +cerrados I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +ojos, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +apertura I-PRESENT_ILLNESS +mecánica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +párpados I-PRESENT_ILLNESS +mostró I-PRESENT_ILLNESS +pupilas I-PRESENT_ILLNESS +iguales, I-PRESENT_ILLNESS +oculomotilidad I-PRESENT_ILLNESS +conservada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mirada I-PRESENT_ILLNESS +preferencial I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +izquierda, I-PRESENT_ILLNESS +hemiplejia I-PRESENT_ILLNESS +faciobraquiocrural I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hemianopsia. I-PRESENT_ILLNESS +La B-EXPLORATION +TC I-EXPLORATION +de I-EXPLORATION +cerebro I-EXPLORATION +mostró I-EXPLORATION +hematoma I-EXPLORATION +fronto-parietal I-EXPLORATION +izquierdo. I-EXPLORATION +Al B-TREATMENT +segundo I-TREATMENT +día, I-TREATMENT +debido I-TREATMENT +al I-TREATMENT +progresivo I-TREATMENT +deterioro I-TREATMENT +clínico, I-TREATMENT +fue I-TREATMENT +necesario I-TREATMENT +drenar I-TREATMENT +el I-TREATMENT +hematoma, I-TREATMENT +que B-EVOLUTION +evolucionó I-EVOLUTION +sin I-EVOLUTION +complicaciones. I-EVOLUTION +Permaneció I-EVOLUTION +comprometido I-EVOLUTION +de I-EVOLUTION +conciencia I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +sexto I-EVOLUTION +día. I-EVOLUTION +Cuando I-EVOLUTION +recuperó I-EVOLUTION +la I-EVOLUTION +vigilancia I-EVOLUTION +podía I-EVOLUTION +apretar I-EVOLUTION +la I-EVOLUTION +mano I-EVOLUTION +izquierda, I-EVOLUTION +pero I-EVOLUTION +era I-EVOLUTION +incapaz I-EVOLUTION +de I-EVOLUTION +abrir I-EVOLUTION +voluntariamente I-EVOLUTION +los I-EVOLUTION +ojos, I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +comprobar I-EVOLUTION +que I-EVOLUTION +conservaba I-EVOLUTION +la I-EVOLUTION +oculomotilidad I-EVOLUTION +voluntaria I-EVOLUTION +y I-EVOLUTION +dirigía I-EVOLUTION +la I-EVOLUTION +mirada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +orden. I-EVOLUTION +Desde I-EVOLUTION +el I-EVOLUTION +octavo I-EVOLUTION +día I-EVOLUTION +inició I-EVOLUTION +apertura I-EVOLUTION +palpebral I-EVOLUTION +parcial I-EVOLUTION +y I-EVOLUTION +transitoria I-EVOLUTION +del I-EVOLUTION +ojo I-EVOLUTION +izquierdo. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +subsiguientes I-EVOLUTION +lograba I-EVOLUTION +la I-EVOLUTION +elevación I-EVOLUTION +transitoria I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +párpados, I-EVOLUTION +notándose I-EVOLUTION +al I-EVOLUTION +decimosegundo I-EVOLUTION +día I-EVOLUTION +mayor I-EVOLUTION +apertura I-EVOLUTION +del I-EVOLUTION +ojo I-EVOLUTION +derecho. I-EVOLUTION +Después I-EVOLUTION +del I-EVOLUTION +decimotercer I-EVOLUTION +día I-EVOLUTION +tenía I-EVOLUTION +elevación I-EVOLUTION +persistente I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +párpados. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EF, I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +miocardiopatía. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +inicia I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +quemante I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +manos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pies I-PAST_MEDICAL_HISTORY +desencadenadas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ejercicio, I-PAST_MEDICAL_HISTORY +exposición I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +sol I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fiebre. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +disminución I-PAST_MEDICAL_HISTORY +progresiva I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +crisis. I-PAST_MEDICAL_HISTORY +Ocasionalmente I-PAST_MEDICAL_HISTORY +sensación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mareo I-PAST_MEDICAL_HISTORY +subjetivo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estitiquez-diarrea. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +42 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +parte I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +familiar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +medición I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +niveles I-PAST_MEDICAL_HISTORY +enzimáticos. I-PAST_MEDICAL_HISTORY +Inició I-PAST_MEDICAL_HISTORY +terapia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +reemplazo I-PAST_MEDICAL_HISTORY +enzimático I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +45 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +52 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +diagnostica I-PRESENT_ILLNESS +miocardiopatía I-PRESENT_ILLNESS +hipertrófica I-PRESENT_ILLNESS +y B-TREATMENT +se I-TREATMENT +instala I-TREATMENT +marcapaso. I-TREATMENT +Escasos B-EXPLORATION +angioqueratomas. I-EXPLORATION +El I-EXPLORATION +examen I-EXPLORATION +clínico I-EXPLORATION +neurológico I-EXPLORATION +mostro I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +polineuropatía I-EXPLORATION +sensitiva I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +neurofisiológica I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +polineuropatía I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +sensitivo I-EXPLORATION +axonal I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +mielínicas I-EXPLORATION +gruesas I-EXPLORATION +y I-EXPLORATION +severo I-EXPLORATION +compromiso I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +mielínicas I-EXPLORATION +delgadas I-EXPLORATION +y I-EXPLORATION +amielínicas, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +radiculopatía I-EXPLORATION +L5-S1 I-EXPLORATION +izquierda. I-EXPLORATION +Ausencia I-EXPLORATION +generalizada I-EXPLORATION +de I-EXPLORATION +RSC. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +evaluación I-EXPLORATION +intervalo I-EXPLORATION +R-R, I-EXPLORATION +debido I-EXPLORATION +al I-EXPLORATION +uso I-EXPLORATION +de I-EXPLORATION +marcapasos. I-EXPLORATION + I-EXPLORATION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +inicia I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +caracterizado I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +quemante I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +manos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pies, I-PRESENT_ILLNESS +desencadenados I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ejercicio, I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +calor I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +frío. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pies I-PRESENT_ILLNESS +congelados, I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +pone I-PRESENT_ILLNESS +pies I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +agua I-PRESENT_ILLNESS +tibia I-PRESENT_ILLNESS +o I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +abriga. I-PRESENT_ILLNESS +Ocasionalmente I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pinchazos. I-PRESENT_ILLNESS +Distensión I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +ocasional. I-PRESENT_ILLNESS +Escasos B-EXPLORATION +angioqueratomas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +reciente I-EXPLORATION +en I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +estudio I-EXPLORATION +familiar, I-EXPLORATION +con I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +enzimáticos. I-EXPLORATION +Inicio B-TREATMENT +reciente I-TREATMENT +de I-TREATMENT +terapia I-TREATMENT +de I-TREATMENT +remplazo I-TREATMENT +enzimática. I-TREATMENT +Evaluación B-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +neurofisiológica I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +compromiso I-EXPLORATION +neuropático I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +mielínicas I-EXPLORATION +delgadas I-EXPLORATION +y I-EXPLORATION +amielínicas. I-EXPLORATION +Ausencia I-EXPLORATION +generalizada I-EXPLORATION +de I-EXPLORATION +RSC I-EXPLORATION +y I-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +intervalo I-EXPLORATION +R-R I-EXPLORATION +en I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +trasladado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +UCI I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +disnea, I-PRESENT_ILLNESS +hipotensión I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desaturación, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +39.5°C. I-PRESENT_ILLNESS +Se B-EXPLORATION +diagnostica I-EXPLORATION +de I-EXPLORATION +shock I-EXPLORATION +séptico I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +colitis I-EXPLORATION +infecciosa. I-EXPLORATION +A B-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +drogas I-TREATMENT +vasoactivas I-TREATMENT +(noradrenalina I-TREATMENT +a I-TREATMENT +0.1 I-TREATMENT +ugr/kg/min I-TREATMENT +y I-TREATMENT +dopamina I-TREATMENT +a I-TREATMENT +6 I-TREATMENT +ugr/kg/min) I-TREATMENT +y I-TREATMENT +cobertura I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +de I-TREATMENT +amplio I-TREATMENT +espectro. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +pocas I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +llegada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +UCI, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +comienza I-EVOLUTION +a I-EVOLUTION +realizar I-EVOLUTION +deposiciones I-EVOLUTION +con I-EVOLUTION +aspecto I-EVOLUTION +melénico I-EVOLUTION +en I-EVOLUTION +cantidad I-EVOLUTION +abundante. I-EVOLUTION +Para B-EXPLORATION +facilitar I-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +exacta I-EXPLORATION +del I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +heces, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mismas I-EXPLORATION +se I-EXPLORATION +coloca I-EXPLORATION +un I-EXPLORATION +dispositivo I-EXPLORATION +de I-EXPLORATION +incontinencia I-EXPLORATION +fecal I-EXPLORATION +Flexi-Seal I-EXPLORATION +FMS. I-EXPLORATION +Dicho I-EXPLORATION +dispositivo I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +colocado I-EXPLORATION +durante I-EXPLORATION +6 I-EXPLORATION +días I-EXPLORATION +sin I-EXPLORATION +la I-EXPLORATION +aparición I-EXPLORATION +de I-EXPLORATION +ninguna I-EXPLORATION +complicación, I-EXPLORATION +procediéndose I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +retirada I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +volumen I-EXPLORATION +de I-EXPLORATION +heces, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +consistencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mismas. I-EXPLORATION +En B-TREATMENT +su I-TREATMENT +8º I-TREATMENT +día I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +aporte I-TREATMENT +nutricional I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +enteral, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +mala I-TREATMENT +tolerancia I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +paciente, I-TREATMENT +realizando I-TREATMENT +varias I-TREATMENT +deposiciones I-TREATMENT +diarias I-TREATMENT +aunque I-TREATMENT +en I-TREATMENT +escasa I-TREATMENT +cantidad. I-TREATMENT +Además, I-TREATMENT +una I-TREATMENT +vez I-TREATMENT +solucionado I-TREATMENT +el I-TREATMENT +episodio I-TREATMENT +de I-TREATMENT +sangrado I-TREATMENT +digestivo I-TREATMENT +se I-TREATMENT +inicio I-TREATMENT +profilaxis I-TREATMENT +antitrombótica I-TREATMENT +con I-TREATMENT +enoxaparina I-TREATMENT +40 I-TREATMENT +mg/día I-TREATMENT +subcutáneo. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +día I-EVOLUTION +25º I-EVOLUTION +tras I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +retirada I-EVOLUTION +del I-EVOLUTION +dispositivo, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +comienza I-EVOLUTION +de I-EVOLUTION +manera I-EVOLUTION +brusca I-EVOLUTION +con I-EVOLUTION +dos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +rectorragia I-EVOLUTION +importante, I-EVOLUTION +sin I-EVOLUTION +producirse I-EVOLUTION +inestabilización I-EVOLUTION +hemodinámica. I-EVOLUTION +Se B-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +urgente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +normal I-EXPLORATION +hasta I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +recto I-EXPLORATION +distal, I-EXPLORATION +lugar I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +una I-EXPLORATION +ulceración I-EXPLORATION +que I-EXPLORATION +abarca I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +circunferencia, I-EXPLORATION +existiendo I-EXPLORATION +además I-EXPLORATION +depósitos I-EXPLORATION +de I-EXPLORATION +fibrina I-EXPLORATION +y I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +necrótico, I-EXPLORATION +que I-EXPLORATION +impresiona I-EXPLORATION +de I-EXPLORATION +ulceración I-EXPLORATION +por I-EXPLORATION +sonda. I-EXPLORATION + I-EXPLORATION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +natural B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +procedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +municipio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Puerto I-PAST_MEDICAL_HISTORY +Guzmán, I-PAST_MEDICAL_HISTORY +Putumayo, I-PAST_MEDICAL_HISTORY +llevada B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +lesión I-PRESENT_ILLNESS +supurante I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +cuello I-PRESENT_ILLNESS +presente I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +nacimiento, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +cual I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cedió I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +antibióticos. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +que I-EXPLORATION +sugería I-EXPLORATION +una I-EXPLORATION +fístula, I-EXPLORATION +según I-EXPLORATION +lo I-EXPLORATION +referido I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +historia I-EXPLORATION +clínica. I-EXPLORATION +Con B-TREATMENT +este I-TREATMENT +diagnóstico I-TREATMENT +se I-TREATMENT +programó I-TREATMENT +para I-TREATMENT +cirugía. I-TREATMENT +En B-EXPLORATION +exámenes I-EXPLORATION +prequirúrgicos I-EXPLORATION +se I-EXPLORATION +reportó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tripomastigotes I-EXPLORATION +de I-EXPLORATION +T. I-EXPLORATION +cruzi I-EXPLORATION +en I-EXPLORATION +extendido I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica. I-EXPLORATION +Se B-TREATMENT +prescribió I-TREATMENT +tratamiento I-TREATMENT +etiológico I-TREATMENT +con I-TREATMENT +benzonidazol I-TREATMENT +por I-TREATMENT +60 I-TREATMENT +días. I-TREATMENT +El B-EXPLORATION +diagnóstico I-EXPLORATION +fue I-EXPLORATION +confirmado I-EXPLORATION +mediante I-EXPLORATION +aislamiento, I-EXPLORATION +cultivo, I-EXPLORATION +isoenzimas, I-EXPLORATION +inoculación I-EXPLORATION +en I-EXPLORATION +ratón I-EXPLORATION +y I-EXPLORATION +PCR. I-EXPLORATION + I-EXPLORATION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +municipio I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +Peñón, I-PAST_MEDICAL_HISTORY +Santander. I-PAST_MEDICAL_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +consistente I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +eritema I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +edema I-PRESENT_ILLNESS +palpebral I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +secreción I-PRESENT_ILLNESS +ocular I-PRESENT_ILLNESS +purulenta. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +edema I-EXPLORATION +palpebral I-EXPLORATION +y I-EXPLORATION +conjuntiva I-EXPLORATION +izquierda I-EXPLORATION +hiperémica I-EXPLORATION +sin I-EXPLORATION +secreciones. I-EXPLORATION +Se B-TREATMENT +hizo I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +celulitis I-TREATMENT +periorbitaria I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +manejo I-TREATMENT +antibiótico I-TREATMENT +ambulatorio. I-TREATMENT +Un B-EVOLUTION +año I-EVOLUTION +después I-EVOLUTION +consultó I-EVOLUTION +por I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +tres I-EVOLUTION +días I-EVOLUTION +consistente I-EVOLUTION +en I-EVOLUTION +debilidad, I-EVOLUTION +fiebre I-EVOLUTION +subjetiva, I-EVOLUTION +disnea, I-EVOLUTION +cefalea, I-EVOLUTION +malestar I-EVOLUTION +general I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +faríngeo. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +ficha I-EXPLORATION +epide-miológica I-EXPLORATION +se I-EXPLORATION +consignó I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Romaña I-EXPLORATION +positivo I-EXPLORATION +(probablemente I-EXPLORATION +en I-EXPLORATION +retrospectiva). I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +pruebas I-EXPLORATION +serológicas, I-EXPLORATION +reportadas I-EXPLORATION +como I-EXPLORATION +Elisa I-EXPLORATION +positivo I-EXPLORATION +e I-EXPLORATION +IFI I-EXPLORATION +reactivo I-EXPLORATION +con I-EXPLORATION +título I-EXPLORATION +de I-EXPLORATION +1: I-EXPLORATION +32, I-EXPLORATION +por I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +Laboratorio I-EXPLORATION +Departamental I-EXPLORATION +de I-EXPLORATION +Salud I-EXPLORATION +Pública I-EXPLORATION +de I-EXPLORATION +Santander. I-EXPLORATION +Se B-TREATMENT +administró I-TREATMENT +tratamiento I-TREATMENT +etiológico I-TREATMENT +con I-TREATMENT +benzonidazol I-TREATMENT +a I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +250 I-TREATMENT +mg/día I-TREATMENT +durante I-TREATMENT +60 I-TREATMENT +días. I-TREATMENT +El B-EXPLORATION +diagnóstico I-EXPLORATION +fue I-EXPLORATION +confirmado I-EXPLORATION +mediante I-EXPLORATION +serología I-EXPLORATION +por I-EXPLORATION +IFI I-EXPLORATION +reactiva I-EXPLORATION +1: I-EXPLORATION +64 I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +INS. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +para I-EXPLORATION +cultivo. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +procedente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +rural I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +municipio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Carepa, I-PAST_MEDICAL_HISTORY +quien B-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +llevada I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuatro I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +rinorrea I-PRESENT_ILLNESS +hialina I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +diarreicas I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +moco I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +sangre. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +día I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +epistaxis. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Al B-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +hipoactiva, I-EXPLORATION +con I-EXPLORATION +palidez I-EXPLORATION +generalizada I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +epistaxis I-EXPLORATION +reciente I-EXPLORATION +en I-EXPLORATION +narina I-EXPLORATION +derecha, I-EXPLORATION +temperatura I-EXPLORATION +axilar I-EXPLORATION +de I-EXPLORATION +37, I-EXPLORATION +5 I-EXPLORATION +°C, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +96 I-EXPLORATION +por I-EXPLORATION +minuto I-EXPLORATION +y I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +de I-EXPLORATION +32 I-EXPLORATION +por I-EXPLORATION +minuto. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +hepatoesplenomegalia. I-EXPLORATION +Con B-TREATMENT +esta I-TREATMENT +historia I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +una I-TREATMENT +impresión I-TREATMENT +diagnóstica I-TREATMENT +de I-TREATMENT +dengue I-TREATMENT +con I-TREATMENT +manifestaciones I-TREATMENT +hemorrágicas I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +líquidos I-TREATMENT +y I-TREATMENT +antipiréticos. I-TREATMENT + I-TREATMENT +Los B-EXPLORATION +exámenes I-EXPLORATION +paraclínicos I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +reportaron I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +g/dl, I-EXPLORATION +hematocrito I-EXPLORATION +18, I-EXPLORATION +4%, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +8.600/ml, I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +30.000/µl, I-EXPLORATION +bilirrubina I-EXPLORATION +total I-EXPLORATION +2, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +directa I-EXPLORATION +0, I-EXPLORATION +7 I-EXPLORATION +mg/dl. I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +hospitalización, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +persistió I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +por B-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +gota I-EXPLORATION +gruesa, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +P. I-EXPLORATION +vivax. I-EXPLORATION +Con B-TREATMENT +este I-TREATMENT +resultado I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cloroquina. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +cuadro I-EVOLUTION +febril. I-EVOLUTION +A B-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +su I-TREATMENT +estado I-TREATMENT +hematológico, I-TREATMENT +no I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +ninguna I-TREATMENT +intervención. I-TREATMENT +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +realizó I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +consultas I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +largo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +oído I-PRESENT_ILLNESS +tapado I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipoacusia I-PRESENT_ILLNESS +ligera, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +manejada I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +tapón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cerumen I-PRESENT_ILLNESS +repetidamente I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +medicina I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lavados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +oído. I-PRESENT_ILLNESS +Sin I-PRESENT_ILLNESS +embargo, I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +incrementaron I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +profundizó I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +hipoacusia I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +llegar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sordera I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +conducción I-PRESENT_ILLNESS +definida I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +otorrinolaringólogo. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +con I-EXPLORATION +este I-EXPLORATION +especialista, I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +pequeña I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +apariencia I-EXPLORATION +tumoral I-EXPLORATION +que I-EXPLORATION +protruía I-EXPLORATION +del I-EXPLORATION +oído I-EXPLORATION +medio I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +membrana I-EXPLORATION +timpánica. I-EXPLORATION +Fue B-TREATMENT +llevada I-TREATMENT +a I-TREATMENT +cirugía I-TREATMENT +para I-TREATMENT +resección-biopsia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión I-TREATMENT +y I-TREATMENT +se I-TREATMENT +obtuvieron, I-TREATMENT +mediante I-TREATMENT +miringotomía, I-TREATMENT +múltiples I-TREATMENT +fragmentos I-TREATMENT +de I-TREATMENT +tejido I-TREATMENT +de I-TREATMENT +consistencia I-TREATMENT +firme, I-TREATMENT +de I-TREATMENT +color I-TREATMENT +parduzco, I-TREATMENT +con I-TREATMENT +escaso I-TREATMENT +sangrado. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +mencionó I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +especialista I-TREATMENT +el I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cadena I-TREATMENT +de I-TREATMENT +huesecillos I-TREATMENT +ni I-TREATMENT +del I-TREATMENT +nervio I-TREATMENT +facial. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +histológico, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +fragmento I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +recubierto I-EXPLORATION +por I-EXPLORATION +epitelio I-EXPLORATION +escamoso I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +epitelial I-EXPLORATION +benigno I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +expansivo, I-EXPLORATION +compuesto I-EXPLORATION +por I-EXPLORATION +estructuras I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +trabécula I-EXPLORATION +y I-EXPLORATION +tubulares I-EXPLORATION +revestidas I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +capa I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +rectangulares I-EXPLORATION +sin I-EXPLORATION +atipias I-EXPLORATION +ni I-EXPLORATION +mitosis, I-EXPLORATION +con I-EXPLORATION +secreción I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +luz, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +áreas I-EXPLORATION +sólidas I-EXPLORATION +compuestas I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +escaso I-EXPLORATION +citoplasma I-EXPLORATION +y I-EXPLORATION +núcleo I-EXPLORATION +pequeño I-EXPLORATION +hipercromático. I-EXPLORATION +El I-EXPLORATION +estroma I-EXPLORATION +estaba I-EXPLORATION +ricamente I-EXPLORATION +irrigado. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +histoquímica I-EXPLORATION +con I-EXPLORATION +coloraciones I-EXPLORATION +de I-EXPLORATION +ácido I-EXPLORATION +peryódico I-EXPLORATION +de I-EXPLORATION +Schiff I-EXPLORATION +(PAS), I-EXPLORATION +Ziehl-Nielsen I-EXPLORATION +(ZN) I-EXPLORATION +y I-EXPLORATION +azul I-EXPLORATION +alciano I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Patología I-EXPLORATION +Interfacultades I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +Nacional I-EXPLORATION +de I-EXPLORATION +Colombia, I-EXPLORATION +acorde I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +metodología I-EXPLORATION +adaptada I-EXPLORATION +del I-EXPLORATION +Armed I-EXPLORATION +Forces I-EXPLORATION +Institute I-EXPLORATION +of I-EXPLORATION +Pathology I-EXPLORATION +(AFIP) I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +Estados I-EXPLORATION +Unidos I-EXPLORATION +(10), I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +secreción I-EXPLORATION +de I-EXPLORATION +mucoproteínas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +y I-EXPLORATION +mínimo I-EXPLORATION +componente I-EXPLORATION +intracitoplasmático I-EXPLORATION +; I-EXPLORATION +igualmente, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +pigmento I-EXPLORATION +pardo I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +citoplasma I-EXPLORATION +celular. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +las I-EXPLORATION +tinciones I-EXPLORATION +de I-EXPLORATION +inmunohistoquímica, I-EXPLORATION +se I-EXPLORATION +empleó I-EXPLORATION +la I-EXPLORATION +metodología I-EXPLORATION +propia I-EXPLORATION +del I-EXPLORATION +Laboratorio I-EXPLORATION +de I-EXPLORATION +Patología I-EXPLORATION +Interfacultades I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Universidad I-EXPLORATION +Nacional I-EXPLORATION +de I-EXPLORATION +Colombia, I-EXPLORATION +adaptada I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +insertos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +reactivos. I-EXPLORATION +Previa I-EXPLORATION +inhibición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +actividad I-EXPLORATION +peroxidasa I-EXPLORATION +endógena I-EXPLORATION +con I-EXPLORATION +H2O2 I-EXPLORATION +al I-EXPLORATION +3%, I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +la I-EXPLORATION +recuperación I-EXPLORATION +antigénica I-EXPLORATION +en I-EXPLORATION +Target I-EXPLORATION +10x I-EXPLORATION +(Dako®) I-EXPLORATION +y I-EXPLORATION +lavados I-EXPLORATION +seriados I-EXPLORATION +con I-EXPLORATION +TBS, I-EXPLORATION +se I-EXPLORATION +incubó I-EXPLORATION +por I-EXPLORATION +30 I-EXPLORATION +minutos I-EXPLORATION +con I-EXPLORATION +cromogranín I-EXPLORATION +A I-EXPLORATION +en I-EXPLORATION +dilución I-EXPLORATION +1: I-EXPLORATION +200 I-EXPLORATION +(Novocastra®) I-EXPLORATION +y I-EXPLORATION +RTU-S100p I-EXPLORATION +prediluida I-EXPLORATION +(Novocastra®), I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +valoró I-EXPLORATION +la I-EXPLORATION +reactividad I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +sistema I-EXPLORATION +de I-EXPLORATION +estreptavidina-HRP I-EXPLORATION +(Dako®), I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +usó I-EXPLORATION +como I-EXPLORATION +cromógeno I-EXPLORATION +diaminobencidina I-EXPLORATION +(DAB). I-EXPLORATION +Luego I-EXPLORATION +del I-EXPLORATION +montaje I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +láminas, I-EXPLORATION +se I-EXPLORATION +pudo I-EXPLORATION +demostrar I-EXPLORATION +la I-EXPLORATION +positividad, I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +cromogranina I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +S100 I-EXPLORATION +con I-EXPLORATION +intensidad I-EXPLORATION +leve I-EXPLORATION +a I-EXPLORATION +moderada, I-EXPLORATION +en I-EXPLORATION +todos I-EXPLORATION +los I-EXPLORATION +patrones I-EXPLORATION +observados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +lesión. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +mioepiteliales I-EXPLORATION +con I-EXPLORATION +S100. I-EXPLORATION + I-EXPLORATION + +El B-PRESENT_ILLNESS +primer I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +es I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +licor I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +fin I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +semana I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +embriaguez, I-PAST_MEDICAL_HISTORY +cuatro B-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +purulenta, I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +moderados I-PRESENT_ILLNESS +esfuerzos, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5°C, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +pleurítico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hemitórax I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +automedicación I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +dosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dexametasona I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +mg I-PRESENT_ILLNESS +intramuscular I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +admisión. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Ingresó B-EXPLORATION +febril, I-EXPLORATION +taquicárdico, I-EXPLORATION +taquipneico, I-EXPLORATION +hipo-xémico I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +y I-EXPLORATION +consolidación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +derecha. I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +muestra I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +14.500 I-EXPLORATION +por I-EXPLORATION +mm3, I-EXPLORATION +neutrofilia I-EXPLORATION +de I-EXPLORATION +96%, I-EXPLORATION +hiperglucemia I-EXPLORATION +de I-EXPLORATION +638 I-EXPLORATION +mg/dl, I-EXPLORATION +hiperazoemia I-EXPLORATION +(nitrógeno I-EXPLORATION +ureico I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +de I-EXPLORATION +27, I-EXPLORATION +45 I-EXPLORATION +mg/dl). I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +hospitalizado I-EVOLUTION +con I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +neumonía I-EVOLUTION +grave I-EVOLUTION +extrahospitalaria I-EVOLUTION +IIIA, I-EVOLUTION +según I-EVOLUTION +las I-EVOLUTION +guías I-EVOLUTION +nacionales I-EVOLUTION +de I-EVOLUTION +manejo I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +enfermedad I-EVOLUTION +(6). I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +progresó I-EVOLUTION +rápidamente I-EVOLUTION +a I-EVOLUTION +falla I-EVOLUTION +respiratoria I-EVOLUTION +hipoxémica, I-EVOLUTION +con I-EVOLUTION +choque I-EVOLUTION +séptico I-EVOLUTION +y, I-EVOLUTION +posteriormente, I-EVOLUTION +disfunción I-EVOLUTION +orgánica I-EVOLUTION +múltiple. I-EVOLUTION +Se B-DERIVED_FROM/TO +trasladó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cuidados I-DERIVED_FROM/TO +intensivos, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se B-TREATMENT +inició I-TREATMENT +manejo I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +ceftriaxona, I-TREATMENT +2 I-TREATMENT +g I-TREATMENT +endovenosos I-TREATMENT +al I-TREATMENT +día, I-TREATMENT +y I-TREATMENT +claritromicina, I-TREATMENT +500 I-TREATMENT +mg I-TREATMENT +endovenosos I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computadorizada I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +consolidación I-EXPLORATION +multilobar I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +lóbulos I-EXPLORATION +inferiores I-EXPLORATION +con I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +bilateral, I-EXPLORATION +no I-EXPLORATION +libre I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudió I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +indicó I-EXPLORATION +empiema I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +cocos I-EXPLORATION +Gram I-EXPLORATION +positivos. I-EXPLORATION +Requirió B-TREATMENT +toracostomía I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +cerrado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +posteriormente I-TREATMENT +toracotomía I-TREATMENT +más I-TREATMENT +decorticación. I-TREATMENT +Durante B-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +72 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +postoperatorio, I-EVOLUTION +persistieron I-EVOLUTION +los I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +respuesta I-EVOLUTION +inflamatoria I-EVOLUTION +sistémica. I-EVOLUTION +Ante B-TREATMENT +el I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal, I-TREATMENT +requirió I-TREATMENT +soporte I-TREATMENT +dialítico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +antibiótico I-TREATMENT +a I-TREATMENT +linezolide. I-TREATMENT +Posterior B-EVOLUTION +al I-EVOLUTION +cambio I-EVOLUTION +de I-EVOLUTION +antimicrobiano I-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +fue I-EVOLUTION +adecuada, I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +permitió I-EVOLUTION +retirarlo I-EVOLUTION +del I-EVOLUTION +respirador I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +soporte I-EVOLUTION +vasopresor. I-EVOLUTION +Se I-EVOLUTION +completaron I-EVOLUTION +21 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +respuesta I-EVOLUTION +satisfactoria I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +terapia I-EVOLUTION +antimicrobiana I-EVOLUTION +ambulatoria I-EVOLUTION +adicional. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +manejo I-PAST_MEDICAL_HISTORY +farmacológico, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alcoholismo, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +clínico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +súbito I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sensación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +mareo; I-PAST_MEDICAL_HISTORY +cuatro B-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +disartria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +hemiparesia I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Consultó B-EXPLORATION +al I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +urgencias I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +encontró I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +de I-EXPLORATION +120/70 I-EXPLORATION +mm I-EXPLORATION +Hg I-EXPLORATION +y I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +100 I-EXPLORATION +por I-EXPLORATION +minuto; I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +general I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +Estaba I-EXPLORATION +alerta, I-EXPLORATION +orientado I-EXPLORATION +en I-EXPLORATION +persona, I-EXPLORATION +tiempo I-EXPLORATION +y I-EXPLORATION +espacio, I-EXPLORATION +con I-EXPLORATION +disartria, I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +esfera I-EXPLORATION +mental, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +meníngeos; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cráneo I-EXPLORATION +ni I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +vertebral; I-EXPLORATION +había I-EXPLORATION +isocoria I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +pupila I-EXPLORATION +de I-EXPLORATION +Argyll I-EXPLORATION +Robertson, I-EXPLORATION +parálisis I-EXPLORATION +facial I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +escasa I-EXPLORATION +elevación I-EXPLORATION +del I-EXPLORATION +velo I-EXPLORATION +del I-EXPLORATION +paladar I-EXPLORATION +y I-EXPLORATION +trastornos I-EXPLORATION +dinámicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +deglución, I-EXPLORATION +sin I-EXPLORATION +otras I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +nervios I-EXPLORATION +craneales. I-EXPLORATION + I-EXPLORATION +Presentaba I-EXPLORATION +hemiparesia I-EXPLORATION +izquierda, I-EXPLORATION +con I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fuerza I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +miembro I-EXPLORATION +superior I-EXPLORATION +(3/5) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +inferior I-EXPLORATION +(4/5), I-EXPLORATION +con I-EXPLORATION +hiperreflexia I-EXPLORATION +generalizada I-EXPLORATION +simétrica, I-EXPLORATION +con I-EXPLORATION +respuesta I-EXPLORATION +plantar I-EXPLORATION +izquierda I-EXPLORATION +neutra I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +flexión I-EXPLORATION +contralateral; I-EXPLORATION +además, I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +temblor I-EXPLORATION +de I-EXPLORATION +acción I-EXPLORATION +y I-EXPLORATION +postural I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mano I-EXPLORATION +derecha, I-EXPLORATION +sin I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sensibilidad. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computadorizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +hipodensa, I-EXPLORATION +lacunar, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cápsula I-EXPLORATION +interna. I-EXPLORATION +Ese I-EXPLORATION +mismo I-EXPLORATION +día I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +cerebral I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +un I-EXPLORATION +infarto I-EXPLORATION +póntico I-EXPLORATION +extenso, I-EXPLORATION +con I-EXPLORATION +estenosis I-EXPLORATION +crítica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +basilar I-EXPLORATION +y I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +vertebral I-EXPLORATION +izquierda, I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +circulación I-EXPLORATION +anterior. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +sometió I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +endovascular I-TREATMENT +en I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +estenosis I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +tercio I-TREATMENT +inferior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +basilar, I-TREATMENT +sin I-TREATMENT +flujo I-TREATMENT +distal, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +stent I-TREATMENT +sin I-TREATMENT +complicaciones, I-TREATMENT +quedando I-TREATMENT +con I-TREATMENT +una I-TREATMENT +estenosis I-TREATMENT +residual I-TREATMENT +de I-TREATMENT +24 I-TREATMENT +%. I-TREATMENT + I-TREATMENT +Durante B-EXPLORATION +la I-EXPLORATION +hospitalización I-EXPLORATION +se I-EXPLORATION +hicieron I-EXPLORATION +estudios I-EXPLORATION +para I-EXPLORATION +accidente I-EXPLORATION +cerebrovascular I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +era I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +VIH, I-EXPLORATION +el I-EXPLORATION +VDRL I-EXPLORATION +en I-EXPLORATION +suero I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +(1:256) I-EXPLORATION +con I-EXPLORATION +FTA-ABS, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +compromiso I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +nervioso I-EXPLORATION +central. I-EXPLORATION +Se I-EXPLORATION +encontró I-EXPLORATION +pleocitosis I-EXPLORATION +de I-EXPLORATION +65 I-EXPLORATION +leucocitos I-EXPLORATION +por I-EXPLORATION +mm3 I-EXPLORATION +con I-EXPLORATION +10 I-EXPLORATION +% I-EXPLORATION +de I-EXPLORATION +polimorfonucleares I-EXPLORATION +y I-EXPLORATION +90 I-EXPLORATION +% I-EXPLORATION +de I-EXPLORATION +mononucleares, I-EXPLORATION +glucosa I-EXPLORATION +de I-EXPLORATION +71 I-EXPLORATION +mg/dl, I-EXPLORATION +proteínas I-EXPLORATION +de I-EXPLORATION +33 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +VDRL I-EXPLORATION +reactivo I-EXPLORATION +(1:2). I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +estos I-TREATMENT +hallazgos I-TREATMENT +se I-TREATMENT +confirmó I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +neurosífilis I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +24 I-TREATMENT +millones I-TREATMENT +de I-TREATMENT +unidades I-TREATMENT +de I-TREATMENT +penicilina I-TREATMENT +cristalina I-TREATMENT +al I-TREATMENT +día I-TREATMENT +durante I-TREATMENT +21 I-TREATMENT +días. I-TREATMENT +Durante I-TREATMENT +su I-TREATMENT +estadía I-TREATMENT +en I-TREATMENT +la I-TREATMENT +unidad I-TREATMENT +de I-TREATMENT +cuidados I-TREATMENT +intensivos, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +requirió I-TREATMENT +intubación I-TREATMENT +orotraqueal I-TREATMENT +por I-TREATMENT +riesgo I-TREATMENT +de I-TREATMENT +compromiso I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +aérea I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +su I-TREATMENT +infarto I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tallo I-TREATMENT +cerebral. I-TREATMENT +Presentó B-EVOLUTION +una I-EVOLUTION +neumonía I-EVOLUTION +tardía I-EVOLUTION +asociada I-EVOLUTION +al I-EVOLUTION +respirador I-EVOLUTION +por I-EVOLUTION +Serratia I-EVOLUTION +marcescens, I-EVOLUTION +para B-TREATMENT +la I-TREATMENT +cual I-TREATMENT +recibió I-TREATMENT +tratamiento I-TREATMENT +antibiótico, I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT + I-TREATMENT +Durante B-EVOLUTION +su I-EVOLUTION +hospitalización, I-EVOLUTION +no I-EVOLUTION +recuperó I-EVOLUTION +la I-EVOLUTION +funcionalidad I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +nervios I-EVOLUTION +craneales I-EVOLUTION +bulbares, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +fue I-TREATMENT +necesario I-TREATMENT +practicar I-TREATMENT +traqueostomía I-TREATMENT +y I-TREATMENT +gastrostomía. I-TREATMENT +Antes B-EXPLORATION +de I-EXPLORATION +dar I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +al I-EXPLORATION +paciente, I-EXPLORATION +se I-EXPLORATION +hizo I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +importante I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pleocitosis I-EXPLORATION +y I-EXPLORATION +proteinorraquia; I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +el I-EXPLORATION +VDRL I-EXPLORATION +fue I-EXPLORATION +reactivo I-EXPLORATION +(1:8), I-EXPLORATION +probablemente I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +reacción I-EXPLORATION +inflamatoria I-EXPLORATION +posterior I-EXPLORATION +al I-EXPLORATION +tratamiento. I-EXPLORATION + I-EXPLORATION +Fue B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con I-EVOLUTION +disartria, I-EVOLUTION +parálisis I-EVOLUTION +supranuclear I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mirada, I-EVOLUTION +hemiparesia I-EVOLUTION +izquierda, I-EVOLUTION +traqueostomía, I-EVOLUTION +gastrostomía I-EVOLUTION +percutánea I-EVOLUTION +y B-TREATMENT +manejo I-TREATMENT +ambulatorio I-TREATMENT +dual I-TREATMENT +con I-TREATMENT +antiagregación I-TREATMENT +plaquetaria. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +mujer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +71 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +proveniente B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Palmira I-PAST_MEDICAL_HISTORY +(población I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +suroccidente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Colombia I-PAST_MEDICAL_HISTORY +cerca I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +Costa I-PAST_MEDICAL_HISTORY +Pacífica), I-PAST_MEDICAL_HISTORY +referida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Clínica I-DERIVED_FROM/TO +Sebastián I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Belalcázar I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cali, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +historia I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +20 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +fiebre I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +tos I-DERIVED_FROM/TO +productiva, I-DERIVED_FROM/TO +asociada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +pérdida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +peso I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +seis I-DERIVED_FROM/TO +meses I-DERIVED_FROM/TO +(4 I-DERIVED_FROM/TO +kg) I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +infección I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +vías I-DERIVED_FROM/TO +aéreas I-DERIVED_FROM/TO +superiores I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +antibiótico I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +tórpida. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +hepatoesplenomegalia I-EXPLORATION +y I-EXPLORATION +adenopatía I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +axila I-EXPLORATION +derecha; I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +manifestaciones I-EXPLORATION +cutáneas. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +hemático I-EXPLORATION +inicialmente I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +anemia I-EXPLORATION +y I-EXPLORATION +leucopenia, I-EXPLORATION +seguidas I-EXPLORATION +por I-EXPLORATION +leucocitosis, I-EXPLORATION +linfocitosis I-EXPLORATION +(11.000/mm I-EXPLORATION +3 I-EXPLORATION +) I-EXPLORATION +y I-EXPLORATION +neutropenia I-EXPLORATION +absoluta. I-EXPLORATION +Se I-EXPLORATION +encontraron I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +deshigrogenasa I-EXPLORATION +láctica I-EXPLORATION +de I-EXPLORATION +300 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +calcio I-EXPLORATION +sérico I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +1 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +obtuvieron I-EXPLORATION +biopsias I-EXPLORATION +de I-EXPLORATION +ganglio I-EXPLORATION +linfático I-EXPLORATION +y I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +fin I-EXPLORATION +de I-EXPLORATION +descartar I-EXPLORATION +un I-EXPLORATION +linfoma. I-EXPLORATION +Estos I-EXPLORATION +dos I-EXPLORATION +tejidos I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +sangre I-EXPLORATION +estaban I-EXPLORATION +infiltrados I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +T I-EXPLORATION +con I-EXPLORATION +importante I-EXPLORATION +pleomorfismo I-EXPLORATION +nuclear. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +extendidos I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +"células I-EXPLORATION +flor" I-EXPLORATION +( I-EXPLORATION +flower I-EXPLORATION +cells I-EXPLORATION +) I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +identificó I-EXPLORATION +un I-EXPLORATION +fenotipo I-EXPLORATION +CD3+, I-EXPLORATION +CD2+, I-EXPLORATION +CD4+, I-EXPLORATION +CD5+, I-EXPLORATION +CD7-, I-EXPLORATION +CD8-, I-EXPLORATION +CD56- I-EXPLORATION +y I-EXPLORATION +TdTen I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +ganglio I-EXPLORATION +linfático I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +citometría I-EXPLORATION +de I-EXPLORATION +flujo I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +periférica. I-EXPLORATION + I-EXPLORATION +Teniendo I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +anteriores, I-EXPLORATION +se I-EXPLORATION +sospechó I-EXPLORATION +una I-EXPLORATION +leucemia/linfoma I-EXPLORATION +de I-EXPLORATION +célula I-EXPLORATION +T I-EXPLORATION +del I-EXPLORATION +adulto; I-EXPLORATION +por I-EXPLORATION +consiguiente, I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +ELISA I-EXPLORATION +y I-EXPLORATION +Western I-EXPLORATION +Blot I-EXPLORATION +para I-EXPLORATION +HTLV I-EXPLORATION +1-2, I-EXPLORATION +las I-EXPLORATION +cuales I-EXPLORATION +resultaron I-EXPLORATION +positivas, I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +diagnóstico. I-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +del I-EXPLORATION +Western I-EXPLORATION +blot I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +HTLV-1 I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +bandas I-EXPLORATION +p19, I-EXPLORATION +GD21 I-EXPLORATION +y I-EXPLORATION +rgp46-I. I-EXPLORATION +La B-EVOLUTION +forma I-EVOLUTION +de I-EVOLUTION +leucemia I-EVOLUTION +identificada I-EVOLUTION +correspondió I-EVOLUTION +a I-EVOLUTION +leucemia I-EVOLUTION +aguda. I-EVOLUTION +La I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +antes I-EVOLUTION +de I-EVOLUTION +iniciar I-EVOLUTION +el I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +61 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cervical I-PRESENT_ILLNESS +posterior, I-PRESENT_ILLNESS +cuya I-PRESENT_ILLNESS +intensidad I-PRESENT_ILLNESS +aumentó I-PRESENT_ILLNESS +hasta I-PRESENT_ILLNESS +dificultar I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente, I-PRESENT_ILLNESS +además, I-PRESENT_ILLNESS +tuvo I-PRESENT_ILLNESS +picos I-PRESENT_ILLNESS +febriles I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuantificados, I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +retroocular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +entró I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +estado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +estupor I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ingresar I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +registró I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +sistólico I-EXPLORATION +mitral I-EXPLORATION +de I-EXPLORATION +grado I-EXPLORATION +II/IV, I-EXPLORATION +rigidez I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +nuca I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +puntaje I-EXPLORATION +de I-EXPLORATION +8/15 I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +de I-EXPLORATION +coma I-EXPLORATION +de I-EXPLORATION +Glasgow. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +ordenaron I-EXPLORATION +tomografías I-EXPLORATION +computadorizadas I-EXPLORATION +(TC), I-EXPLORATION +una I-EXPLORATION +cerebral I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +contrastada, I-EXPLORATION +con I-EXPLORATION +resultados I-EXPLORATION +normales. I-EXPLORATION +Debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +meningitis I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +hizo I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +con I-EXPLORATION +análisis I-EXPLORATION +citoquímico I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +mostró I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +células, I-EXPLORATION +hipoglucorraquia I-EXPLORATION +e I-EXPLORATION +hiperproteinorraquia, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +cocos I-EXPLORATION +Gram I-EXPLORATION +positivos. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +(2 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas), I-TREATMENT +vancomicina I-TREATMENT +(1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas) I-TREATMENT +y I-TREATMENT +dexametasona I-TREATMENT +(8 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +horas I-TREATMENT +por I-TREATMENT +4 I-TREATMENT +días). I-TREATMENT +En B-EXPLORATION +dos I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo, I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +Streptococcus I-EXPLORATION +pneumoniae, I-EXPLORATION +serotipo I-EXPLORATION +18C, I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +horas, I-EXPLORATION +con I-EXPLORATION +concentración I-EXPLORATION +inhibitoria I-EXPLORATION +mínima I-EXPLORATION +(CIM) I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +06 I-EXPLORATION +µg/ml I-EXPLORATION +para I-EXPLORATION +penicilina I-EXPLORATION +y I-EXPLORATION +eritromicina, I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +03 I-EXPLORATION +µg/ml I-EXPLORATION +para I-EXPLORATION +ceftriaxona I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +05 I-EXPLORATION +µg/ml I-EXPLORATION +para I-EXPLORATION +trimetoprim- I-EXPLORATION +sulfametoxazol I-EXPLORATION +y I-EXPLORATION +vancomicina, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +microorganismo I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +varios I-EXPLORATION +antibióticos. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +base I-TREATMENT +en I-TREATMENT +estos I-TREATMENT +resultados, I-TREATMENT +al I-TREATMENT +cuarto I-TREATMENT +día I-TREATMENT +de I-TREATMENT +tra I-TREATMENT +tamiento I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +suspender I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +vancomicina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +continuó I-TREATMENT +el I-TREATMENT +manejo I-TREATMENT +con I-TREATMENT +ceftriaxona I-TREATMENT +dirigido I-TREATMENT +específicamente I-TREATMENT +al I-TREATMENT +microorganismo I-TREATMENT +aislado. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +siguió I-EVOLUTION +siendo I-EVOLUTION +irregular, I-EVOLUTION +con I-EVOLUTION +picos I-EVOLUTION +febriles I-EVOLUTION +durante I-EVOLUTION +su I-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidados I-EVOLUTION +intensivos, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +leucocitosis, I-EVOLUTION +neutrófilos I-EVOLUTION +en I-EVOLUTION +cayado I-EVOLUTION +y I-EVOLUTION +elevación I-EVOLUTION +constante I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +reactantes I-EVOLUTION +de I-EVOLUTION +fase I-EVOLUTION +aguda. I-EVOLUTION +Los B-EXPLORATION +hemocultivos I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +para I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +hongos I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +al I-EXPLORATION +octavo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +hospitalización I-EXPLORATION +se I-EXPLORATION +registró I-EXPLORATION +hipoventilación I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +estertores I-EXPLORATION +basales I-EXPLORATION +en I-EXPLORATION +pulmón I-EXPLORATION +derecho; I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +infiltrados I-EXPLORATION +alveolares I-EXPLORATION +basales I-EXPLORATION +en I-EXPLORATION +dicho I-EXPLORATION +pulmón I-EXPLORATION +y I-EXPLORATION +broncograma I-EXPLORATION +aéreo. I-EXPLORATION +Dado B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +neumonía I-TREATMENT +asociada I-TREATMENT +y I-TREATMENT +la I-TREATMENT +deficiente I-TREATMENT +progresión I-TREATMENT +clínica, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +comenzar I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +cefepime I-TREATMENT +(2 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas) I-TREATMENT +y I-TREATMENT +linezolid I-TREATMENT +(600 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas). I-TREATMENT + I-TREATMENT +Ante B-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +soplo I-EXPLORATION +cardiaco I-EXPLORATION +mitral, I-EXPLORATION +se I-EXPLORATION +obtuvo I-EXPLORATION +un I-EXPLORATION +ecocardiograma I-EXPLORATION +transesofágico, I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +evidenció I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +grave I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +ruptura I-EXPLORATION +del I-EXPLORATION +festón I-EXPLORATION +medial I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +subsiguiente I-EXPLORATION +prolapso, I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +cuatro I-EXPLORATION +vegetaciones I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +auricular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +valva I-EXPLORATION +posterior, I-EXPLORATION +de I-EXPLORATION +20 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +mm, I-EXPLORATION +11 I-EXPLORATION +x I-EXPLORATION +3 I-EXPLORATION +mm, I-EXPLORATION +7 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +mm I-EXPLORATION +y I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +mm. I-EXPLORATION +Ante B-TREATMENT +el I-TREATMENT +hallazgo I-TREATMENT +de I-TREATMENT +endocarditis I-TREATMENT +sobre I-TREATMENT +válvula I-TREATMENT +mitral I-TREATMENT +nativa, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +continuar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +durante I-TREATMENT +6 I-TREATMENT +semanas I-TREATMENT +más I-TREATMENT +y B-DERIVED_FROM/TO +remitir I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +institución I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +IV I-DERIVED_FROM/TO +nivel I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +reemplazo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +válvula. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +El B-EVOLUTION +paciente I-EVOLUTION +ingresó I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidados I-EVOLUTION +intensivos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +institución I-EVOLUTION +de I-EVOLUTION +nivel I-EVOLUTION +IV I-EVOLUTION +en I-EVOLUTION +malas I-EVOLUTION +condiciones I-EVOLUTION +generales, I-EVOLUTION +estaba I-EVOLUTION +hipotenso I-EVOLUTION +y B-TREATMENT +hubo I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +administrarle I-TREATMENT +vasopresores I-TREATMENT +y I-TREATMENT +utilizar I-TREATMENT +catéter I-TREATMENT +de I-TREATMENT +Swan-Ganz I-TREATMENT +; I-TREATMENT +presentó B-EVOLUTION +tres I-EVOLUTION +paros I-EVOLUTION +cardiorrespiratorios I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +(ritmo I-EVOLUTION +de I-EVOLUTION +paro: I-EVOLUTION +actividad I-EVOLUTION +eléctrica I-EVOLUTION +sin I-EVOLUTION +pulso). I-EVOLUTION +Presentaba, B-TREATMENT +además, I-TREATMENT +signos I-TREATMENT +clínicos I-TREATMENT +y I-TREATMENT +paraclínicos I-TREATMENT +de I-TREATMENT +hipoperfusión, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +le I-TREATMENT +administró I-TREATMENT +inotrópico, I-TREATMENT +y I-TREATMENT +nuevamente I-TREATMENT +se I-TREATMENT +intensificó I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibiótico, I-TREATMENT +administrando I-TREATMENT +vancomicina I-TREATMENT +(1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas) I-TREATMENT +y I-TREATMENT +meropenem I-TREATMENT +(1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas). I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +hizo, I-EXPLORATION +igualmente, I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +cerebral I-EXPLORATION +contrastada, I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +focos I-EXPLORATION +isquémicos I-EXPLORATION +en I-EXPLORATION +varios I-EXPLORATION +terri I-EXPLORATION +torios I-EXPLORATION +vasculares I-EXPLORATION +supratentoriales I-EXPLORATION +e I-EXPLORATION +infratentoriales, I-EXPLORATION +los I-EXPLORATION +cuales I-EXPLORATION +se I-EXPLORATION +consideran I-EXPLORATION +indicativos I-EXPLORATION +de I-EXPLORATION +embolia. I-EXPLORATION + I-EXPLORATION +Gradualmente B-EVOLUTION +se I-EVOLUTION +logró I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +neurológica I-EVOLUTION +parcial, I-EVOLUTION +lo B-TREATMENT +que I-TREATMENT +posibilitó I-TREATMENT +retirarle I-TREATMENT +el I-TREATMENT +tubo I-TREATMENT +de I-TREATMENT +tórax I-TREATMENT +y I-TREATMENT +el I-TREATMENT +medicamento I-TREATMENT +vasoactivo, I-TREATMENT +pero I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +del I-TREATMENT +inotrópico I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +persis I-TREATMENT +tencia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +disfunción I-TREATMENT +cardiaca I-TREATMENT +con I-TREATMENT +compromiso I-TREATMENT +grave I-TREATMENT +de I-TREATMENT +la I-TREATMENT +válvula I-TREATMENT +mitral. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Neurología I-EVOLUTION +se I-EVOLUTION +evaluó I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +cinco I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +encontró I-EVOLUTION +que I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +de I-EVOLUTION +conciencia I-EVOLUTION +era I-EVOLUTION +adecuado, I-EVOLUTION +sin I-EVOLUTION +deficiencias I-EVOLUTION +neurológicas I-EVOLUTION +focalizadas; I-EVOLUTION +finalmente, B-TREATMENT +al I-TREATMENT +décimo I-TREATMENT +día I-TREATMENT +de I-TREATMENT +hospitalización, I-TREATMENT +se I-TREATMENT +reemplazó I-TREATMENT +la I-TREATMENT +válvula I-TREATMENT +mitral I-TREATMENT +por I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +mecánica I-TREATMENT +#27. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +inicial I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +fue I-EVOLUTION +estable I-EVOLUTION +y I-EVOLUTION +no I-EVOLUTION +requirió I-EVOLUTION +de I-EVOLUTION +medicamento I-EVOLUTION +vasopresor I-EVOLUTION +o I-EVOLUTION +inotrópico; I-EVOLUTION +la I-EVOLUTION +única I-EVOLUTION +complicación I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +presentó I-EVOLUTION +fue I-EVOLUTION +una I-EVOLUTION +coagulopatía I-EVOLUTION +secundaria I-EVOLUTION +al I-EVOLUTION +uso I-EVOLUTION +de I-EVOLUTION +bomba I-EVOLUTION +extracorpórea, I-EVOLUTION +la B-TREATMENT +cual I-TREATMENT +se I-TREATMENT +corrigió I-TREATMENT +con I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +hemocomponentes. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +mitral I-EXPLORATION +nativa I-EXPLORATION +se I-EXPLORATION +reportó I-EXPLORATION +endocarditis I-EXPLORATION +aguda, I-EXPLORATION +en I-EXPLORATION +tanto I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +bacterias I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +cultivos I-EXPLORATION +definitivos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +siguió I-EVOLUTION +hospitalizado I-EVOLUTION +para I-EVOLUTION +optimizar I-EVOLUTION +la I-EVOLUTION +anticoagulación. I-EVOLUTION +Diez I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +presentó I-EVOLUTION +deterioro I-EVOLUTION +clínico, I-EVOLUTION +con I-EVOLUTION +inestabilidad I-EVOLUTION +hemodinámica I-EVOLUTION +y I-EVOLUTION +falla I-EVOLUTION +respiratoria. I-EVOLUTION +Se B-TREATMENT +documentó I-TREATMENT +bacteriemia I-TREATMENT +por I-TREATMENT +Klebsiella I-TREATMENT +pneumoniae I-TREATMENT +positiva I-TREATMENT +para I-TREATMENT +betalactamasa I-TREATMENT +de I-TREATMENT +espectro I-TREATMENT +extendido I-TREATMENT +(BLEE), I-TREATMENT +ante I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +con I-TREATMENT +meropenem I-TREATMENT +y I-TREATMENT +vancomicina. I-TREATMENT +En B-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +ecocardiograma I-EXPLORATION +transesofágico I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +prótesis I-EXPLORATION +mecánica I-EXPLORATION +en I-EXPLORATION +posición I-EXPLORATION +mitral I-EXPLORATION +funcio I-EXPLORATION +naba I-EXPLORATION +normalmente. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +hacer I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humoral I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +al I-EXPLORATION +haber I-EXPLORATION +presentado I-EXPLORATION +dos I-EXPLORATION +bacteriemias I-EXPLORATION +por I-EXPLORATION +bacterias I-EXPLORATION +encapsuladas, I-EXPLORATION +sin I-EXPLORATION +embargo, I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +estaban I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +rangos I-EXPLORATION +normales. I-EXPLORATION +Al B-TREATMENT +completarse I-TREATMENT +una I-TREATMENT +semana I-TREATMENT +de I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +meropenem I-TREATMENT +se I-TREATMENT +comenzó I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +ceftriaxona I-TREATMENT +con I-TREATMENT +la I-TREATMENT +intención I-TREATMENT +de I-TREATMENT +completar I-TREATMENT +otra I-TREATMENT +semana I-TREATMENT +más, I-TREATMENT +suspender I-TREATMENT +y I-TREATMENT +continuar I-TREATMENT +después I-TREATMENT +solo I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +las I-TREATMENT +seis I-TREATMENT +semanas I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +endocarditis. I-TREATMENT + I-TREATMENT +Finalmente, B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +secuelas I-EVOLUTION +neurológicas I-EVOLUTION +evidentes I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +fracción I-EVOLUTION +de I-EVOLUTION +eyección I-EVOLUTION +preservada I-EVOLUTION +(60-65 I-EVOLUTION +%), I-EVOLUTION +cavidades I-EVOLUTION +izquierda I-EVOLUTION +y I-EVOLUTION +derecha I-EVOLUTION +de I-EVOLUTION +tamaño I-EVOLUTION +y I-EVOLUTION +contractilidad I-EVOLUTION +normales, I-EVOLUTION +prótesis I-EVOLUTION +mecánica I-EVOLUTION +mitral I-EVOLUTION +con I-EVOLUTION +función I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +gradiente I-EVOLUTION +medio I-EVOLUTION +(6 I-EVOLUTION +mm I-EVOLUTION +Hg), I-EVOLUTION +y I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +imágenes I-EVOLUTION +sugestivas I-EVOLUTION +de I-EVOLUTION +vegetaciones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +ni B-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +interés, I-FAMILY_HISTORY +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +externa I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urología I-DERIVED_FROM/TO +ante I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +hallazgo I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +ecografía I-DERIVED_FROM/TO +abdominal, I-DERIVED_FROM/TO +realizada I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +síntomas I-DERIVED_FROM/TO +digestivos I-DERIVED_FROM/TO +inespecíficos, I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +suprarrenal I-DERIVED_FROM/TO +derecha I-DERIVED_FROM/TO +sólida I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +6 I-DERIVED_FROM/TO +cm I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +diámetro. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +La B-EXPLORATION +anamnesis I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +no I-EXPLORATION +revelaron I-EXPLORATION +síntomas I-EXPLORATION +ni I-EXPLORATION +signos I-EXPLORATION +que I-EXPLORATION +orientaran I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +endocrinopatía, I-EXPLORATION +ni I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +primario. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +procedió, I-EXPLORATION +mediante I-EXPLORATION +estudio I-EXPLORATION +endocrinológico, I-EXPLORATION +a I-EXPLORATION +establecer I-EXPLORATION +el I-EXPLORATION +carácter I-EXPLORATION +funcionante I-EXPLORATION +o I-EXPLORATION +no I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +suprarrenal. I-EXPLORATION +Se I-EXPLORATION +determinaron: I-EXPLORATION +cortisol I-EXPLORATION +libre I-EXPLORATION +en I-EXPLORATION +orina; I-EXPLORATION +cortisol I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas; I-EXPLORATION +supresión I-EXPLORATION +con I-EXPLORATION +1 I-EXPLORATION +mgr I-EXPLORATION +de I-EXPLORATION +dexametasona; I-EXPLORATION +cortisol I-EXPLORATION +basal I-EXPLORATION +en I-EXPLORATION +sangre; I-EXPLORATION +ACTH; I-EXPLORATION +aldosterona I-EXPLORATION +en I-EXPLORATION +sangre; I-EXPLORATION +DHEA-sulfato; I-EXPLORATION +catecolaminas I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +(noradrenalina, I-EXPLORATION +adrenalina) I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +orina, I-EXPLORATION +y I-EXPLORATION +sus I-EXPLORATION +metabolitos I-EXPLORATION +(vanilmandélico, I-EXPLORATION +metanefrinas). I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +analíticos I-EXPLORATION +practicados I-EXPLORATION +fueron I-EXPLORATION +todos I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +demuestra I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +suprarrenal I-EXPLORATION +derecha I-EXPLORATION +sólida, I-EXPLORATION +de I-EXPLORATION +contornos I-EXPLORATION +bien I-EXPLORATION +definidos I-EXPLORATION +y I-EXPLORATION +densidad I-EXPLORATION +heterogénea, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +hipodensas I-EXPLORATION +e I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +calcio I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +interior, I-EXPLORATION +que I-EXPLORATION +mide I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +3 I-EXPLORATION +cm. I-EXPLORATION +La I-EXPLORATION +Resonancia I-EXPLORATION +Magnética I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +ovalada I-EXPLORATION +y I-EXPLORATION +bien I-EXPLORATION +definida, I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +mayor, I-EXPLORATION +isointensa I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +bazo I-EXPLORATION +en I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +T2, I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +irregulares I-EXPLORATION +hiperintensas I-EXPLORATION +en I-EXPLORATION +T2. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +concluyó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +suprarrenal I-EXPLORATION +derecha I-EXPLORATION +sólida, I-EXPLORATION +de I-EXPLORATION +6, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +funcionante. I-EXPLORATION +Con B-TREATMENT +este I-TREATMENT +diagnóstico, I-TREATMENT +y I-TREATMENT +apoyados I-TREATMENT +fundamentalmente I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tamaño I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tumoración, I-TREATMENT +así I-TREATMENT +como I-TREATMENT +en I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +calcificaciones I-TREATMENT +irregulares I-TREATMENT +en I-TREATMENT +su I-TREATMENT +interior, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +quirúrgica I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +que I-TREATMENT +se I-TREATMENT +tratara I-TREATMENT +de I-TREATMENT +un I-TREATMENT +carcinoma I-TREATMENT +suprarrenal. I-TREATMENT +Se I-TREATMENT +practicó I-TREATMENT +suprarrenalectomía I-TREATMENT +derecha I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +lumbotomía. I-TREATMENT + I-TREATMENT +Macroscópicamente, I-TREATMENT +la I-TREATMENT +pieza I-TREATMENT +de I-TREATMENT +suprarrenalectomía I-TREATMENT +midió I-TREATMENT +8 I-TREATMENT +x I-TREATMENT +6, I-TREATMENT +5 I-TREATMENT +x I-TREATMENT +3 I-TREATMENT +cm. I-TREATMENT +La B-EXPLORATION +tumoración I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +superficie I-EXPLORATION +multinodular, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +homogéneo, I-EXPLORATION +blanquecino-grisáceo I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +fasciculado. I-EXPLORATION +Microscópicamente, I-EXPLORATION +el I-EXPLORATION +tumor I-EXPLORATION +está I-EXPLORATION +constituido I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Schwann I-EXPLORATION +dispuestas I-EXPLORATION +en I-EXPLORATION +pequeños I-EXPLORATION +fascículos I-EXPLORATION +entrelazados I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +estroma I-EXPLORATION +mixoide I-EXPLORATION +y I-EXPLORATION +grupos I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +ganglionares I-EXPLORATION +maduras. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +para I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +S-100, I-EXPLORATION +observándose I-EXPLORATION +intensa I-EXPLORATION +y I-EXPLORATION +generalizada I-EXPLORATION +inmunoreacción I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +neoplásicas. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +ganglioneuroma I-EXPLORATION +suprarrenal. I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +2 I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencias I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lesión. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +prostático I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +IPSS I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +PSA: I-PRESENT_ILLNESS +0, I-PRESENT_ILLNESS +91. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destaca I-EXPLORATION +un I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +encontrando I-EXPLORATION +un I-EXPLORATION +adenoma I-EXPLORATION +grado I-EXPLORATION +1, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +hemiescroto I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +lisa, I-EXPLORATION +dura, I-EXPLORATION +no I-EXPLORATION +adherida I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +profundos, I-EXPLORATION +blanquecina I-EXPLORATION +e I-EXPLORATION +indolora I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +exploración. I-EXPLORATION +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +demanda I-PRESENT_ILLNESS +cirugía I-PRESENT_ILLNESS +aduciendo I-PRESENT_ILLNESS +problemas I-PRESENT_ILLNESS +estéticos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-TREATMENT +realiza I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +bajo I-TREATMENT +anestesia I-TREATMENT +local I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT +Macroscópicamente B-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +presenta I-EXPLORATION +coloración I-EXPLORATION +blanquecina I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +firme I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +7 I-EXPLORATION +cm, I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +de I-EXPLORATION +corte I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +sólida, I-EXPLORATION +amarillenta I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +arremolinado. I-EXPLORATION + I-EXPLORATION +Microscópicamente I-EXPLORATION +se I-EXPLORATION +describe I-EXPLORATION +una I-EXPLORATION +neoformación I-EXPLORATION +mesenquimal I-EXPLORATION +relativamente I-EXPLORATION +bien I-EXPLORATION +delimitada, I-EXPLORATION +no I-EXPLORATION +encapsulada, I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +haces I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +estirpe I-EXPLORATION +muscular I-EXPLORATION +lisa I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +marcada I-EXPLORATION +positividad I-EXPLORATION +citoplasmática I-EXPLORATION +con I-EXPLORATION +actina, I-EXPLORATION +desmina I-EXPLORATION +y I-EXPLORATION +focal I-EXPLORATION +con I-EXPLORATION +CD I-EXPLORATION +68. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +atipia I-EXPLORATION +citológica. I-EXPLORATION +La I-EXPLORATION +actividad I-EXPLORATION +mitótica I-EXPLORATION +es I-EXPLORATION +muy I-EXPLORATION +baja I-EXPLORATION +(0, I-EXPLORATION +5 I-EXPLORATION +mitosis I-EXPLORATION +por I-EXPLORATION +50 I-EXPLORATION +HPF), I-EXPLORATION +no I-EXPLORATION +observándose I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +ni I-EXPLORATION +necrosis. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +diagnóstico I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +leiomioma I-EVOLUTION +escrotal. I-EVOLUTION +Tras I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +no I-EVOLUTION +hay I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +local. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +69 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que, B-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales, I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +adenocarcinoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +próstata I-PAST_MEDICAL_HISTORY +bien I-PAST_MEDICAL_HISTORY +diferenciado I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +análogos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +LHRH I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mielolipoma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +glándula I-PAST_MEDICAL_HISTORY +suprarrenal I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +cm I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +casualmente I-PAST_MEDICAL_HISTORY +mediante I-PAST_MEDICAL_HISTORY +TAC I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +0º I-PRESENT_ILLNESS +C, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +coincidiendo, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +inicio I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuadro, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +caída I-PRESENT_ILLNESS +accidental I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cama. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +aunque I-EXPLORATION +hemodinámica I-EXPLORATION +estable. I-EXPLORATION +El I-EXPLORATION +abdomen I-EXPLORATION +era I-EXPLORATION +globuloso I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +ligeramente I-EXPLORATION +distendido. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +dolor I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hipocondrio I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +Murphy I-EXPLORATION +positivo. I-EXPLORATION +La I-EXPLORATION +auscultación I-EXPLORATION +cardio I-EXPLORATION +respiratoria I-EXPLORATION +resultó I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +mostraba I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +13.800 I-EXPLORATION +*10e9/L I-EXPLORATION +y I-EXPLORATION +neutrofilia I-EXPLORATION +(83%), I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +110 I-EXPLORATION +g/l I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +indirecta I-EXPLORATION +(0, I-EXPLORATION +9 I-EXPLORATION +mg/dl). I-EXPLORATION + I-EXPLORATION +Fue I-EXPLORATION +realizada I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +de I-EXPLORATION +urgencia I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +heterogénea I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +dependiente I-EXPLORATION +de I-EXPLORATION +glándula I-EXPLORATION +suprarrenal I-EXPLORATION +derecha I-EXPLORATION +con I-EXPLORATION +compresión I-EXPLORATION +de I-EXPLORATION +vena I-EXPLORATION +cava, I-EXPLORATION +sin I-EXPLORATION +poder I-EXPLORATION +discernir I-EXPLORATION +si I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +hematoma I-EXPLORATION +o I-EXPLORATION +absceso. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +confirmó I-EXPLORATION +tal I-EXPLORATION +hallazgo, I-EXPLORATION +informándolo I-EXPLORATION +como I-EXPLORATION +hematoma I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +sangrado I-EXPLORATION +activo, I-EXPLORATION +de I-EXPLORATION +16 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +que I-EXPLORATION +comprimía I-EXPLORATION +y I-EXPLORATION +desplazaba I-EXPLORATION +vena I-EXPLORATION +cava. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +laparotomía I-TREATMENT +urgente I-TREATMENT +en I-TREATMENT +la I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +suprarrenalectomía I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +exéresis I-TREATMENT +del I-TREATMENT +hematoma. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurrió I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +décimo I-EVOLUTION +día. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +excepción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +palpitaciones I-PAST_MEDICAL_HISTORY +ocasionales. I-PAST_MEDICAL_HISTORY +Presentó B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +súbita I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +disnea, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +donde I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +neumonía I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +ingresada I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +iniciar I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +antibiótico. I-PRESENT_ILLNESS +A B-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +se I-EVOLUTION +agravó I-EVOLUTION +el I-EVOLUTION +cuadro I-EVOLUTION +con I-EVOLUTION +fiebre, I-EVOLUTION +hipoxemia I-EVOLUTION +progresiva I-EVOLUTION +y I-EVOLUTION +oliguria, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +trasladada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +unidad I-EVOLUTION +de I-EVOLUTION +cuidados I-EVOLUTION +intensivos I-EVOLUTION +(UCI). I-EVOLUTION + I-EVOLUTION +Al B-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +UCI I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +40, I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +del I-EXPLORATION +85% I-EXPLORATION +con I-EXPLORATION +reservorio, I-EXPLORATION +frecuencia I-EXPLORATION +cardiaca I-EXPLORATION +de I-EXPLORATION +140 I-EXPLORATION +ppm, I-EXPLORATION +tensión I-EXPLORATION +arterial I-EXPLORATION +120/40 I-EXPLORATION +mmHg, I-EXPLORATION +temp-35º I-EXPLORATION +C. I-EXPLORATION +La I-EXPLORATION +auscultación I-EXPLORATION +cardiopulmonar I-EXPLORATION +mostraba I-EXPLORATION +crepitantes I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +hemitorax I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +pulsos I-EXPLORATION +distales I-EXPLORATION +aunque I-EXPLORATION +sin I-EXPLORATION +edemas I-EXPLORATION +en I-EXPLORATION +extremidades. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +realizada I-EXPLORATION +destacaba I-EXPLORATION +leucocitosis I-EXPLORATION +de I-EXPLORATION +36400, I-EXPLORATION +Glucosa: I-EXPLORATION +266 I-EXPLORATION +mg/dL, I-EXPLORATION +Creatinina: I-EXPLORATION +3, I-EXPLORATION +3 I-EXPLORATION +mg/dL, I-EXPLORATION +AST: I-EXPLORATION +3127 I-EXPLORATION +U/L, I-EXPLORATION +ALT: I-EXPLORATION +3139 I-EXPLORATION +U/L, I-EXPLORATION +Gamma I-EXPLORATION +GT: I-EXPLORATION +86 I-EXPLORATION +U/L I-EXPLORATION +y I-EXPLORATION +tiempos I-EXPLORATION +de I-EXPLORATION +coagulación I-EXPLORATION +ligeramente I-EXPLORATION +elevados. I-EXPLORATION +Gasometría: I-EXPLORATION +PH: I-EXPLORATION +7, I-EXPLORATION +11. I-EXPLORATION +PCO2: I-EXPLORATION +41. I-EXPLORATION +PO2: I-EXPLORATION +44. I-EXPLORATION +Saturación I-EXPLORATION +O2: I-EXPLORATION +63. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +infiltrado I-EXPLORATION +alveolo-intersticial I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +derecho. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +intubación I-TREATMENT +inmediata I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +antibióticos I-TREATMENT +de I-TREATMENT +mayor I-TREATMENT +espectro. I-TREATMENT +La B-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +de I-EXPLORATION +fracaso I-EXPLORATION +multiorgánico I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +analítica I-EXPLORATION +llamó I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +la I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +creatinin-fosfoquinasa I-EXPLORATION +y I-EXPLORATION +troponina, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ecocardiograma I-EXPLORATION +transesofágico, I-EXPLORATION +objetivándose I-EXPLORATION +masa I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +cava I-EXPLORATION +superior I-EXPLORATION +que I-EXPLORATION +llegaba I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +que I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +bilateral I-EXPLORATION +sin I-EXPLORATION +tromboembolismo I-EXPLORATION +pulmonar, I-EXPLORATION +dilatación I-EXPLORATION +y I-EXPLORATION +ocupación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior I-EXPLORATION +intrahépatica I-EXPLORATION +que I-EXPLORATION +proximalmente I-EXPLORATION +llega I-EXPLORATION +hasta I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +distalmente I-EXPLORATION +hasta I-EXPLORATION +las I-EXPLORATION +venas I-EXPLORATION +renales. I-EXPLORATION +Hipodensidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +suprahepática I-EXPLORATION +derecha I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +trombosis I-EXPLORATION +secundaria I-EXPLORATION +y I-EXPLORATION +masa I-EXPLORATION +suprarrenal I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm I-EXPLORATION +hipercaptante, I-EXPLORATION +en I-EXPLORATION +íntimo I-EXPLORATION +contacto I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +cava I-EXPLORATION +inferior. I-EXPLORATION + I-EXPLORATION +Habiendo B-DERIVED_FROM/TO +estabilizado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +UCI I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +4 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +ingreso, I-DERIVED_FROM/TO +intubada I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +disfunción I-DERIVED_FROM/TO +multiorgánica, I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +fin I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +planificar I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +quirúrgico. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Se B-EXPLORATION +repite I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +destaca I-EXPLORATION +leucocitosis, I-EXPLORATION +AST: I-EXPLORATION +165 I-EXPLORATION +UI/L, I-EXPLORATION +ALT: I-EXPLORATION +1050 I-EXPLORATION +UI/L I-EXPLORATION +con I-EXPLORATION +ionograma I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +normales. I-EXPLORATION +Tras B-TREATMENT +valorar I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +aportadas, I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +gravedad I-TREATMENT +del I-TREATMENT +cuadro, I-TREATMENT +y I-TREATMENT +puesto I-TREATMENT +que I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +de I-TREATMENT +imagen I-TREATMENT +realizadas I-TREATMENT +no I-TREATMENT +presentan I-TREATMENT +metástasis I-TREATMENT +a I-TREATMENT +distancia, I-TREATMENT +se I-TREATMENT +planteó I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +urgente. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +una I-TREATMENT +laparatomía I-TREATMENT +subcostal I-TREATMENT +bilateral I-TREATMENT +al I-TREATMENT +mismo I-TREATMENT +tiempo I-TREATMENT +que I-TREATMENT +una I-TREATMENT +esternotomía I-TREATMENT +longitudinal. I-TREATMENT +Se I-TREATMENT +aprecia I-TREATMENT +derrame I-TREATMENT +pleural I-TREATMENT +bilateral, I-TREATMENT +ligero I-TREATMENT +derrame I-TREATMENT +pericárdico I-TREATMENT +y I-TREATMENT +corazón I-TREATMENT +con I-TREATMENT +contracción I-TREATMENT +normal I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cavidad I-TREATMENT +torácica, I-TREATMENT +mientras I-TREATMENT +que I-TREATMENT +la I-TREATMENT +laparotomía I-TREATMENT +muestra I-TREATMENT +isquemia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +segmentos I-TREATMENT +6 I-TREATMENT +y I-TREATMENT +7 I-TREATMENT +del I-TREATMENT +hígado I-TREATMENT +y I-TREATMENT +masa I-TREATMENT +suprarrenal I-TREATMENT +derecha. I-TREATMENT + I-TREATMENT +El I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +Cirugía I-TREATMENT +General I-TREATMENT +realiza I-TREATMENT +hepatectomía I-TREATMENT +anterior I-TREATMENT +con I-TREATMENT +maniobra I-TREATMENT +de I-TREATMENT +Pringle I-TREATMENT +intermitente, I-TREATMENT +sin I-TREATMENT +voltear I-TREATMENT +el I-TREATMENT +hígado, I-TREATMENT +seccionando I-TREATMENT +el I-TREATMENT +hígado I-TREATMENT +hasta I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +cara I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Cava I-TREATMENT +retrohepática. I-TREATMENT +Posteriormente, I-TREATMENT +el I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +Urología I-TREATMENT +tras I-TREATMENT +descolgar I-TREATMENT +el I-TREATMENT +colon I-TREATMENT +derecho I-TREATMENT +realiza I-TREATMENT +disección I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +hasta I-TREATMENT +iliacas I-TREATMENT +primitivas, I-TREATMENT +ligadura I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +genital I-TREATMENT +derecha, I-TREATMENT +liberación I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +renal I-TREATMENT +y I-TREATMENT +cara I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +riñón I-TREATMENT +derecho. I-TREATMENT +Se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +liberación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +glándula I-TREATMENT +suprarrenal I-TREATMENT +derecha, I-TREATMENT +a I-TREATMENT +excepción I-TREATMENT +de I-TREATMENT +su I-TREATMENT +borde I-TREATMENT +superior I-TREATMENT +y I-TREATMENT +medial I-TREATMENT +que I-TREATMENT +está I-TREATMENT +íntimamente I-TREATMENT +unido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +pared I-TREATMENT +derecha I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +cava. I-TREATMENT +Queda I-TREATMENT +así I-TREATMENT +expuesto I-TREATMENT +el I-TREATMENT +campo I-TREATMENT +para I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +suprarrenal I-TREATMENT +e I-TREATMENT +hígado I-TREATMENT +derecho I-TREATMENT +a I-TREATMENT +falta I-TREATMENT +de I-TREATMENT +cavotomía.. I-TREATMENT + I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +realizado I-TREATMENT +esto, I-TREATMENT +el I-TREATMENT +equipo I-TREATMENT +de I-TREATMENT +Cirugía I-TREATMENT +Cardiaca I-TREATMENT +comienza I-TREATMENT +la I-TREATMENT +circulación I-TREATMENT +extracorpórea I-TREATMENT +bajando I-TREATMENT +progresivamente I-TREATMENT +la I-TREATMENT +temperatura I-TREATMENT +hasta I-TREATMENT +alcanzar I-TREATMENT +14ºC I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +esofágico I-TREATMENT +y I-TREATMENT +19ºC I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +rectal, I-TREATMENT +tras I-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +exanguinar I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +parar I-TREATMENT +la I-TREATMENT +circulación I-TREATMENT +extracorpórea I-TREATMENT +manteniendo I-TREATMENT +la I-TREATMENT +sangre I-TREATMENT +en I-TREATMENT +un I-TREATMENT +oxigenador. I-TREATMENT +Es I-TREATMENT +entonces I-TREATMENT +cuando I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +cavotomía I-TREATMENT +inferior I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +suprarrenal I-TREATMENT +hasta I-TREATMENT +2 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +diafragma, I-TREATMENT +aurículotomía I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +trombo I-TREATMENT +tumoral I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +incisión I-TREATMENT +realizada I-TREATMENT +en I-TREATMENT +la I-TREATMENT +cava I-TREATMENT +inferior. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +sección I-TREATMENT +de I-TREATMENT +pared I-TREATMENT +lateral I-TREATMENT +derecha I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +(desde I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +suprarrenal I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +suprahepática I-TREATMENT +derecha), I-TREATMENT +extrayendo I-TREATMENT +en I-TREATMENT +bloque I-TREATMENT +hígado I-TREATMENT +derecho I-TREATMENT +con I-TREATMENT +venas I-TREATMENT +suprahepática I-TREATMENT +y I-TREATMENT +suprarrenal I-TREATMENT +derechas I-TREATMENT +incluidas I-TREATMENT +en I-TREATMENT +dicho I-TREATMENT +parche, I-TREATMENT +suprarrenal I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +trombo. I-TREATMENT +Se I-TREATMENT +produce I-TREATMENT +rotura I-TREATMENT +del I-TREATMENT +trombo I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +renal, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +en I-TREATMENT +un I-TREATMENT +segundo I-TREATMENT +tiempo I-TREATMENT +se I-TREATMENT +extrae I-TREATMENT +por I-TREATMENT +tracción I-TREATMENT +el I-TREATMENT +trombo I-TREATMENT +desde I-TREATMENT +vena I-TREATMENT +renal I-TREATMENT +hasta I-TREATMENT +iliacas I-TREATMENT +primitivas. I-TREATMENT +Se I-TREATMENT +realiza I-TREATMENT +irrigación I-TREATMENT +de I-TREATMENT +cava I-TREATMENT +y I-TREATMENT +aurícula I-TREATMENT +derecha I-TREATMENT +y, I-TREATMENT +al I-TREATMENT +no I-TREATMENT +observarse I-TREATMENT +restos I-TREATMENT +de I-TREATMENT +trombo I-TREATMENT +ni I-TREATMENT +infiltración I-TREATMENT +de I-TREATMENT +las I-TREATMENT +paredes I-TREATMENT +de I-TREATMENT +cava I-TREATMENT +o I-TREATMENT +aurícula, I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +al I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +cava I-TREATMENT +y I-TREATMENT +orejuela I-TREATMENT +derecha I-TREATMENT +por I-TREATMENT +separado I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +vez I-TREATMENT +mediante I-TREATMENT +sutura I-TREATMENT +continua I-TREATMENT +con I-TREATMENT +monofilamento. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +realizado I-TREATMENT +dicho I-TREATMENT +cierre I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +reperfundir I-TREATMENT +progresivamente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +volviendo I-TREATMENT +a I-TREATMENT +entrar I-TREATMENT +en I-TREATMENT +circulación I-TREATMENT +extracorpórea, I-TREATMENT +recalentándola I-TREATMENT +y I-TREATMENT +procediendo I-TREATMENT +a I-TREATMENT +desclampar I-TREATMENT +la I-TREATMENT +aorta I-TREATMENT +y I-TREATMENT +perfundir I-TREATMENT +el I-TREATMENT +corazón I-TREATMENT +al I-TREATMENT +alcanzar I-TREATMENT +una I-TREATMENT +temperatura I-TREATMENT +esofágica I-TREATMENT +de I-TREATMENT +34ºC. I-TREATMENT +El I-TREATMENT +inicio I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +cardiaca I-TREATMENT +permite I-TREATMENT +la I-TREATMENT +salida I-TREATMENT +de I-TREATMENT +circulación I-TREATMENT +extracorpórea. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +colocan I-TREATMENT +drenajes I-TREATMENT +retroesternal, I-TREATMENT +mediastínico, I-TREATMENT +subhepático I-TREATMENT +y I-TREATMENT +retroperitoneal I-TREATMENT +en I-TREATMENT +fosa I-TREATMENT +renal I-TREATMENT +derecha. I-TREATMENT +Durante I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +se I-TREATMENT +transfundieron I-TREATMENT +14 I-TREATMENT +concentrados I-TREATMENT +de I-TREATMENT +hematíes, I-TREATMENT +1200 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +plasma I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +unidades I-TREATMENT +de I-TREATMENT +plaquetas. I-TREATMENT +Durante B-EVOLUTION +la I-EVOLUTION +estancia I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +UCI I-EVOLUTION +se I-EVOLUTION +realiza I-EVOLUTION +ecografía I-EVOLUTION +abdominal I-EVOLUTION +que I-EVOLUTION +muestras I-EVOLUTION +buena I-EVOLUTION +permeabilidad I-EVOLUTION +del I-EVOLUTION +sistema I-EVOLUTION +venoso I-EVOLUTION +hepático I-EVOLUTION +izquierdo I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +vena I-EVOLUTION +cava. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +trasladada I-EVOLUTION +a I-EVOLUTION +planta, I-EVOLUTION +encontrándose I-EVOLUTION +consciente, I-EVOLUTION +orientada I-EVOLUTION +y I-EVOLUTION +colaboradora, I-EVOLUTION +aunque I-EVOLUTION +presentando I-EVOLUTION +debilidad I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +cuatro I-EVOLUTION +extremidades. I-EVOLUTION +La B-TREATMENT +paciente I-TREATMENT +permanece I-TREATMENT +ingresada I-TREATMENT +en I-TREATMENT +planta I-TREATMENT +durante I-TREATMENT +20 I-TREATMENT +días I-TREATMENT +recibiendo I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +cinesiterapia I-TREATMENT +generalizada I-TREATMENT +pasiva I-TREATMENT +y I-TREATMENT +asistida. I-TREATMENT +Tras I-TREATMENT +buena I-TREATMENT +evolución I-TREATMENT +en I-TREATMENT +la I-TREATMENT +movilidad I-TREATMENT +es I-TREATMENT +dada I-TREATMENT +de I-TREATMENT +alta, I-TREATMENT +no I-TREATMENT +precisando I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +excepción I-TREATMENT +de I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +feocromocitoma I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +suprarrenal I-EXPLORATION +derecha I-EXPLORATION +cuyo I-EXPLORATION +diámetro I-EXPLORATION +mayor I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +2 I-EXPLORATION +cm. I-EXPLORATION +El I-EXPLORATION +tumor I-EXPLORATION +no I-EXPLORATION +está I-EXPLORATION +encapsulado I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +extiende I-EXPLORATION +fuera I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +suprarrenal, I-EXPLORATION +sin I-EXPLORATION +afectar I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +órganos I-EXPLORATION +adyacentes. I-EXPLORATION +Existe I-EXPLORATION +necrosis I-EXPLORATION +tumoral I-EXPLORATION +extensa. I-EXPLORATION +La I-EXPLORATION +glándula I-EXPLORATION +suprarrenal I-EXPLORATION +no I-EXPLORATION +neoplásica I-EXPLORATION +no I-EXPLORATION +muestra I-EXPLORATION +anomalías. I-EXPLORATION +Los I-EXPLORATION +ganglios I-EXPLORATION +linfáticos I-EXPLORATION +estudiados I-EXPLORATION +no I-EXPLORATION +presentan I-EXPLORATION +tumor. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +hepático I-EXPLORATION +hay I-EXPLORATION +extensas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +hemorragia I-EXPLORATION +centrolobulillar, I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +hepatocitos I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +fragmentos I-EXPLORATION +estudiados I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +hepático. I-EXPLORATION +Trombo I-EXPLORATION +infrarrenal I-EXPLORATION +hemático, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +tumorales. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +la I-EVOLUTION +revisión I-EVOLUTION +realizada I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +asintomática, I-EVOLUTION +realizando I-EVOLUTION +vida I-EVOLUTION +activa I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +TC I-EVOLUTION +no I-EVOLUTION +mostró I-EVOLUTION +lesiones I-EVOLUTION +sugestivas I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +tumoral. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +33 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +médicos I-PAST_MEDICAL_HISTORY +ni I-PAST_MEDICAL_HISTORY +quirúrgicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sala I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +traumatología I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +diagnostico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +lumbalgia I-PRESENT_ILLNESS +rebelde I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +domiciliario. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +abdominopélvico I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +retroperitoneal I-EXPLORATION +(paraaórtica) I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +continua I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +cadena I-EXPLORATION +iliaca I-EXPLORATION +primitiva I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +cadenas I-EXPLORATION +iliacas, I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +la I-EXPLORATION +externa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +abdominopelviana I-EXPLORATION +(9¥28 I-EXPLORATION +cm). I-EXPLORATION +La I-EXPLORATION +tumoración I-EXPLORATION +es I-EXPLORATION +sólida I-EXPLORATION +con I-EXPLORATION +pequeñas I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +cervicotorácico I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +punción I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resultado I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +germinales I-EXPLORATION +tipo I-EXPLORATION +seminoma. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +testicular I-EXPLORATION +bilateral I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +testicular I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +múltiples I-EXPLORATION +imágenes I-EXPLORATION +ecogénicas I-EXPLORATION +puntiformes I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +testículos I-EXPLORATION +(mas I-EXPLORATION +llamativas I-EXPLORATION +y I-EXPLORATION +extensas I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +teste I-EXPLORATION +izquierdo), I-EXPLORATION +pero I-EXPLORATION +sin I-EXPLORATION +masa I-EXPLORATION +clara. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +ecográficos, I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +biopsia I-EXPLORATION +testicular I-EXPLORATION +bilateral. I-EXPLORATION +En I-EXPLORATION +ambos I-EXPLORATION +testes I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +atrofia I-EXPLORATION +testicular I-EXPLORATION +con I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +"solo I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Sertoli", I-EXPLORATION +hialinización I-EXPLORATION +tubular I-EXPLORATION +y I-EXPLORATION +microlitiasis. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +practicada I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +llamaba I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +una I-EXPLORATION +LDH I-EXPLORATION +de I-EXPLORATION +1903 I-EXPLORATION +y I-EXPLORATION +b-HCG I-EXPLORATION +de I-EXPLORATION +23, I-EXPLORATION +8, I-EXPLORATION +con I-EXPLORATION +α-fetoproteína I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +CTEP I-TREATMENT +(Cisplatino I-TREATMENT +y I-TREATMENT +Etopósido). I-TREATMENT +Después B-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +ciclos I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +observándose I-EXPLORATION +la I-EXPLORATION +total I-EXPLORATION +desaparición I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +retroperitoneal, I-EXPLORATION +quedando I-EXPLORATION +tan I-EXPLORATION +solo I-EXPLORATION +dos I-EXPLORATION +adenopatías I-EXPLORATION +paraaórticas I-EXPLORATION +izquierdas I-EXPLORATION +y I-EXPLORATION +otra I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +iliaca I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +cada I-EXPLORATION +una, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +dos I-TREATMENT +ciclos I-TREATMENT +mas I-TREATMENT +de I-TREATMENT +CTEP, I-TREATMENT +sin B-EVOLUTION +conseguirse I-EVOLUTION +reducción I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tamaño I-EVOLUTION +de I-EVOLUTION +dichas I-EVOLUTION +adenopatías. I-EVOLUTION + I-EVOLUTION +Con B-TREATMENT +la I-TREATMENT +intención I-TREATMENT +de I-TREATMENT +extirpar I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +tumoral I-TREATMENT +restante I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +quimioterapia, I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +las I-TREATMENT +adenopatías I-TREATMENT +y I-TREATMENT +orquiectomía I-TREATMENT +bilateral. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +adenopatías I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +fibroso I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +linfoide I-EXPLORATION +disperso I-EXPLORATION +y I-EXPLORATION +necrosis I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +tumor. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +testículos I-EXPLORATION +informo I-EXPLORATION +de I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +solo I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Sertoli, I-EXPLORATION +con I-EXPLORATION +importante I-EXPLORATION +atrofia I-EXPLORATION +tubular, I-EXPLORATION +hialinosis, I-EXPLORATION +calcificaciones I-EXPLORATION +y I-EXPLORATION +microlitiasis I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +tumor. I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +doce I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +clínicamente I-EVOLUTION +asintomático I-EVOLUTION +con B-TREATMENT +tratamiento I-TREATMENT +hormonal I-TREATMENT +sustitutivo I-TREATMENT +y B-EVOLUTION +sin I-EVOLUTION +recidiva I-EVOLUTION +radiológica I-EVOLUTION +ni I-EVOLUTION +analítica. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +26 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipo I-PRESENT_ILLNESS +persistente, I-PRESENT_ILLNESS +dispepsia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sensación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +plenitud I-PRESENT_ILLNESS +postprandrial. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +destaca I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +laparotomía I-PAST_MEDICAL_HISTORY +exploradora I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +14 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +abdominal, I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cual I-PAST_MEDICAL_HISTORY +desconocemos I-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +haberse I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +centro. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +objetivó I-EXPLORATION +una I-EXPLORATION +ocupación I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +hemiabdomen I-EXPLORATION +derecho I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica, I-EXPLORATION +a I-EXPLORATION +tensión, I-EXPLORATION +indolora I-EXPLORATION +y I-EXPLORATION +mate I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +percusión I-EXPLORATION +que I-EXPLORATION +sobrepasaba I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +de I-EXPLORATION +rutina I-EXPLORATION +que I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +un I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +7, I-EXPLORATION +13 I-EXPLORATION +x I-EXPLORATION +106 I-EXPLORATION +hematíes, I-EXPLORATION +20.5 I-EXPLORATION +g/dl I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +y I-EXPLORATION +hematocrito I-EXPLORATION +de I-EXPLORATION +65.9%, I-EXPLORATION +con I-EXPLORATION +cifras I-EXPLORATION +similares I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +preoperatorio I-EXPLORATION +inmediato. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +hidronefrosis I-EXPLORATION +masiva I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +ectasia I-EXPLORATION +pielocalicial I-EXPLORATION +masiva I-EXPLORATION +con I-EXPLORATION +prácticamente I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +cortical, I-EXPLORATION +que I-EXPLORATION +ocupaba I-EXPLORATION +la I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +hemiabdomen I-EXPLORATION +derecho, I-EXPLORATION +sobrepasando I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +hasta I-EXPLORATION +contactar I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo, I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +en I-EXPLORATION +herradura I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +practicó, I-TREATMENT +por I-TREATMENT +lumbotomía, I-TREATMENT +nefrectomía I-TREATMENT +derecha I-TREATMENT +de I-TREATMENT +un I-TREATMENT +gran I-TREATMENT +riñón I-TREATMENT +hidronefrótico I-TREATMENT +secundario I-TREATMENT +a I-TREATMENT +estenosis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +unión I-TREATMENT +pieloureteral, I-TREATMENT +cursando I-TREATMENT +el I-TREATMENT +postoperatorio I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT +El B-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +informó I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +hidronefrótico I-EXPLORATION +con I-EXPLORATION +atrofia I-EXPLORATION +cortical I-EXPLORATION +marcada. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +hemograma I-EXPLORATION +al I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cirugía I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +Hemoglobina I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +g/dl, I-EXPLORATION +4, I-EXPLORATION +6 I-EXPLORATION +millones I-EXPLORATION +de I-EXPLORATION +eritrocitos I-EXPLORATION +y I-EXPLORATION +43, I-EXPLORATION +7% I-EXPLORATION +de I-EXPLORATION +hematocrito. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +otro I-EXPLORATION +hemograma I-EXPLORATION +10 I-EXPLORATION +meses I-EXPLORATION +después I-EXPLORATION +evidenciándose I-EXPLORATION +una I-EXPLORATION +normalización I-EXPLORATION +del I-EXPLORATION +recuento I-EXPLORATION +eritrocitario. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +compatible I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +Pielonefritis I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +nefríticos I-PAST_MEDICAL_HISTORY +izquierdos I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +estudiados I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +juventud. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +puñopercusión I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +positiva I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +con I-EXPLORATION +hipertrofia I-EXPLORATION +prostática I-EXPLORATION +volumen I-EXPLORATION +III/IV, I-EXPLORATION +fibroadenomatosa I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +nódulos. I-EXPLORATION +Analítica I-EXPLORATION +sanguínea I-EXPLORATION +con I-EXPLORATION +bioquímica I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +PSA I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +4 I-EXPLORATION +ng/ml I-EXPLORATION +y I-EXPLORATION +formula I-EXPLORATION +sanguínea I-EXPLORATION +con I-EXPLORATION +leucocitosis I-EXPLORATION +y I-EXPLORATION +desviación I-EXPLORATION +izquierda. I-EXPLORATION +Analítica I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +con I-EXPLORATION +nitritos I-EXPLORATION +positivos I-EXPLORATION +y I-EXPLORATION +leucocituria. I-EXPLORATION +Urocultivos I-EXPLORATION +y I-EXPLORATION +Hemocultivos I-EXPLORATION +positivos I-EXPLORATION +a I-EXPLORATION +E. I-EXPLORATION +Coli. I-EXPLORATION +Rx I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +aparato I-EXPLORATION +urinario I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos I-EXPLORATION +significativos. I-EXPLORATION +Ecografía I-EXPLORATION +con I-EXPLORATION +ectasia I-EXPLORATION +renal I-EXPLORATION +izquierda I-EXPLORATION +grado I-EXPLORATION +II-III. I-EXPLORATION +La I-EXPLORATION +UIV I-EXPLORATION +realizada I-EXPLORATION +muestra I-EXPLORATION +vía I-EXPLORATION +urinaria I-EXPLORATION +alta I-EXPLORATION +derecha I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +y I-EXPLORATION +retraso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +captación I-EXPLORATION +y I-EXPLORATION +eliminación I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +del I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +que I-EXPLORATION +persiste I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +dos I-EXPLORATION +horas. I-EXPLORATION +Se I-EXPLORATION +procede I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +nefrostomía I-EXPLORATION +derivativa I-EXPLORATION +izquierda I-EXPLORATION +y I-EXPLORATION +posterior I-EXPLORATION +pielografía I-EXPLORATION +anterógrada, I-EXPLORATION +la I-EXPLORATION +cual I-EXPLORATION +demuestra I-EXPLORATION +defecto I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +en I-EXPLORATION +uréter I-EXPLORATION +iliaco I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +tumoración I-EXPLORATION +ureteral I-EXPLORATION +de I-EXPLORATION +3-4 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +uréter I-EXPLORATION +en I-EXPLORATION +anzuelo. I-EXPLORATION +Citología I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +nefrostomía I-EXPLORATION +negativa I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +con I-EXPLORATION +TAC I-EXPLORATION +objetivaba I-EXPLORATION +dicha I-EXPLORATION +lesión I-EXPLORATION +como I-EXPLORATION +confinada I-EXPLORATION +al I-EXPLORATION +órgano I-EXPLORATION +origen. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +Nefroureterectomía I-TREATMENT +izquierda I-TREATMENT +previa I-TREATMENT +desinserción I-TREATMENT +endoscópica, I-TREATMENT +siendo I-TREATMENT +el I-TREATMENT +resultado I-TREATMENT +anatomopatológico I-TREATMENT +de I-TREATMENT +Papiloma I-TREATMENT +invertido I-TREATMENT +de I-TREATMENT +uréter I-TREATMENT +y I-TREATMENT +riñón I-TREATMENT +izquierdo I-TREATMENT +con I-TREATMENT +pielonefritis I-TREATMENT +crónica. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +sufre I-EVOLUTION +una I-EVOLUTION +RAO I-EVOLUTION +que I-EVOLUTION +aconseja I-EVOLUTION +la I-EVOLUTION +realización I-EVOLUTION +de I-EVOLUTION +Adenomectomía I-EVOLUTION +Retropúbica I-EVOLUTION +y I-EVOLUTION +posteriormente I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +y I-EVOLUTION +5 I-EVOLUTION +años I-EVOLUTION +presenta I-EVOLUTION +sendas I-EVOLUTION +recidivas I-EVOLUTION +vesicales I-EVOLUTION +de I-EVOLUTION +Carcinoma I-EVOLUTION +transicional I-EVOLUTION +de I-EVOLUTION +vejiga I-EVOLUTION +T1GII. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +vivo I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +urotelial I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +años I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +PI. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +nódulo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +cm. I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +paratesticular I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +Tres B-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +hospital I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +ACVA I-PAST_MEDICAL_HISTORY +parietal I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +presentando I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +fuerza I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +hemicuerpo I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dificultad I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +habla. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +tomografía I-PAST_MEDICAL_HISTORY +axial I-PAST_MEDICAL_HISTORY +computerizada I-PAST_MEDICAL_HISTORY +(TAC) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cráneo I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +apreció I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +zona I-PAST_MEDICAL_HISTORY +hipodensa I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +brazo I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cápsula I-PAST_MEDICAL_HISTORY +blanca I-PAST_MEDICAL_HISTORY +interna I-PAST_MEDICAL_HISTORY +izquierda, I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +otras I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +sutiles I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +región I-PAST_MEDICAL_HISTORY +fronto-parietal I-PAST_MEDICAL_HISTORY +izquierda. I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +administración I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +contraste I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +apreciaron I-PAST_MEDICAL_HISTORY +imágenes I-PAST_MEDICAL_HISTORY +compatibles I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +aneurisma, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +tortuosidad I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +arteria I-PAST_MEDICAL_HISTORY +cerebral I-PAST_MEDICAL_HISTORY +media I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +podría I-PAST_MEDICAL_HISTORY +corresponder I-PAST_MEDICAL_HISTORY +bien I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +trombo I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +efecto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +volumen I-PAST_MEDICAL_HISTORY +parcial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +contexto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +vaso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +morfología I-PAST_MEDICAL_HISTORY +tortuosa. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +angio-resonancia I-PAST_MEDICAL_HISTORY +magnética I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +observó I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +arterias I-PAST_MEDICAL_HISTORY +cerebrales I-PAST_MEDICAL_HISTORY +medias I-PAST_MEDICAL_HISTORY +eran I-PAST_MEDICAL_HISTORY +asimétricas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cuanto I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +señal, I-PAST_MEDICAL_HISTORY +presentando I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +disminución I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +señal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +todo I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +trayecto, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +estenosis. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +electrocardiograma I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +mostró I-PAST_MEDICAL_HISTORY +alteraciones. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +carotídea, I-PAST_MEDICAL_HISTORY +arteriografía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +troncos I-PAST_MEDICAL_HISTORY +cerebrales I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +supraórticos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +ecocardiograma I-PAST_MEDICAL_HISTORY +transesofágico I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +también I-PAST_MEDICAL_HISTORY +normales. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +determinaciones I-PAST_MEDICAL_HISTORY +analíticas I-PAST_MEDICAL_HISTORY +sanguíneas, I-PAST_MEDICAL_HISTORY +todos I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +parámetros I-PAST_MEDICAL_HISTORY +fueron I-PAST_MEDICAL_HISTORY +normales, I-PAST_MEDICAL_HISTORY +incluidos I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +estudios I-PAST_MEDICAL_HISTORY +realizados I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +llegar I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +etiológico I-PAST_MEDICAL_HISTORY +como: I-PAST_MEDICAL_HISTORY +anticoagulante I-PAST_MEDICAL_HISTORY +lúpico, I-PAST_MEDICAL_HISTORY +homocisteína, I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anticardiolipina, I-PAST_MEDICAL_HISTORY +(α2 I-PAST_MEDICAL_HISTORY +antiplasmina, I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anti-proteinasa-3, I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anti-mieloperoxidasa, I-PAST_MEDICAL_HISTORY +proteína I-PAST_MEDICAL_HISTORY +S, I-PAST_MEDICAL_HISTORY +actividad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +proteína I-PAST_MEDICAL_HISTORY +C, I-PAST_MEDICAL_HISTORY +RPR, I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +antinucleares, I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anticitoplasma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +neutrófilos I-PAST_MEDICAL_HISTORY +(ANCA), I-PAST_MEDICAL_HISTORY +anticuerpos I-PAST_MEDICAL_HISTORY +anti I-PAST_MEDICAL_HISTORY +SSA I-PAST_MEDICAL_HISTORY +Ro I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +anti I-PAST_MEDICAL_HISTORY +SSB I-PAST_MEDICAL_HISTORY +LA. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +definitiva, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +trata I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +joven I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ACVA I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +territorio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +cerebral I-PAST_MEDICAL_HISTORY +media I-PAST_MEDICAL_HISTORY +izquierda I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +etiología I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +filiada. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +masa I-PRESENT_ILLNESS +pétrea I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +paratesticular I-PRESENT_ILLNESS +izquierda. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +testicular I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +un I-EXPLORATION +engrosamiento I-EXPLORATION +del I-EXPLORATION +cordón I-EXPLORATION +espermático I-EXPLORATION +izquierdo. I-EXPLORATION +Los I-EXPLORATION +testículos I-EXPLORATION +son I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +morfología I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Resonacia I-EXPLORATION +Magnética I-EXPLORATION +objetivándose I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cordón I-EXPLORATION +espermático I-EXPLORATION +izquierdo I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +comporta I-EXPLORATION +con I-EXPLORATION +alta I-EXPLORATION +señal I-EXPLORATION +en I-EXPLORATION +secuencias I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +T2. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +se I-EXPLORATION +produce I-EXPLORATION +un I-EXPLORATION +realce I-EXPLORATION +periférico I-EXPLORATION +del I-EXPLORATION +mismo I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +hipointensa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +centro I-EXPLORATION +que I-EXPLORATION +representa I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +avascular I-EXPLORATION +de I-EXPLORATION +necrosis. I-EXPLORATION +Las I-EXPLORATION +posibilidades I-EXPLORATION +diagnósticas I-EXPLORATION +fueron I-EXPLORATION +dos: I-EXPLORATION +liposarcoma I-EXPLORATION +del I-EXPLORATION +cordón I-EXPLORATION +espermático I-EXPLORATION +o I-EXPLORATION +vasculitis. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +biopsia I-TREATMENT +de I-TREATMENT +cordón I-TREATMENT +espermático I-TREATMENT +y I-TREATMENT +testículo. I-TREATMENT +Macroscópicamente B-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +nodular, I-EXPLORATION +sólida I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +coloración I-EXPLORATION +blanquecina, I-EXPLORATION +con I-EXPLORATION +zona I-EXPLORATION +irregulares I-EXPLORATION +amarillentas I-EXPLORATION +que I-EXPLORATION +medía I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm. I-EXPLORATION +Histológicamente I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +vasculitis I-EXPLORATION +granulomatosa I-EXPLORATION +necrotizante I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +fundamentalmente I-EXPLORATION +a I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +mediano I-EXPLORATION +tamaño I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +zona I-EXPLORATION +centra I-EXPLORATION +irregular I-EXPLORATION +con I-EXPLORATION +necrosis. I-EXPLORATION +El I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +es I-EXPLORATION +transmural I-EXPLORATION +y I-EXPLORATION +ocasiona I-EXPLORATION +una I-EXPLORATION +obliteración I-EXPLORATION +prácticamente I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +vascular. I-EXPLORATION +Periféricamente I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +adyacentes I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +marcada I-EXPLORATION +fibrosis, I-EXPLORATION +necrosis I-EXPLORATION +grasa I-EXPLORATION +e I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +agudo I-EXPLORATION +y I-EXPLORATION +crónico. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +Ziehl-Neelsen I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +bacilos I-EXPLORATION +alcohol I-EXPLORATION +resistentes. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +anatomo I-EXPLORATION +patológico I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +vasculitis I-EXPLORATION +granulomatosa I-EXPLORATION +necrotizante I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +paratesticular. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +testículo I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +identifican I-EXPLORATION +alteraciones I-EXPLORATION +significativas. I-EXPLORATION + I-EXPLORATION +El B-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presentó I-EVOLUTION +complicaciones I-EVOLUTION +postoperatorias I-EVOLUTION +y B-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +Deflazacort I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +30 I-TREATMENT +mg/día. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +momento I-EVOLUTION +actual I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +16 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +presenta I-EVOLUTION +ninguna I-EVOLUTION +sintomatología I-EVOLUTION +y I-EVOLUTION +sigue I-EVOLUTION +con I-EVOLUTION +dosis I-EVOLUTION +de I-EVOLUTION +mantenimiento I-EVOLUTION +(6 I-EVOLUTION +mg/día). I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +salvo I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +cesáreas, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +remitida I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fosa I-PRESENT_ILLNESS +renal I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +evidencia I-EXPLORATION +una I-EXPLORATION +litiasis I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +urografía I-EXPLORATION +intravenosa I-EXPLORATION +una I-EXPLORATION +acodadura I-EXPLORATION +del I-EXPLORATION +uréter I-EXPLORATION +derecho I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +tercio I-EXPLORATION +superior I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +Asintomática, B-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta. I-EVOLUTION +A B-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +meses, I-EXPLORATION +nuevo I-EXPLORATION +ingreso I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +clínica I-EXPLORATION +y I-EXPLORATION +nueva I-EXPLORATION +batería I-EXPLORATION +de I-EXPLORATION +pruebas: I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +comprueba I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +litiasis I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +uréter I-EXPLORATION +distal I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +pequeñas I-EXPLORATION +calcificaciones I-EXPLORATION +en I-EXPLORATION +riñón I-EXPLORATION +derecho; I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +confirma I-EXPLORATION +lo I-EXPLORATION +hallado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +y I-EXPLORATION +además I-EXPLORATION +descarta I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +uropatía I-EXPLORATION +obstructiva. I-EXPLORATION +En I-EXPLORATION +todo I-EXPLORATION +momento I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +se I-EXPLORATION +encuentran I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +trata I-TREATMENT +la I-TREATMENT +litiasis I-TREATMENT +ureteral I-TREATMENT +mediante I-TREATMENT +ureteroscopia I-TREATMENT +y I-TREATMENT +lasertricia I-TREATMENT +persistiendo I-TREATMENT +la I-TREATMENT +clínica I-TREATMENT +a I-TREATMENT +pesar I-TREATMENT +de I-TREATMENT +la I-TREATMENT +eficacia I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +motiva I-TREATMENT +nuevo I-TREATMENT +ingreso I-TREATMENT +unos I-TREATMENT +meses I-TREATMENT +más I-TREATMENT +tarde. I-TREATMENT +Se B-EXPLORATION +realiza I-EXPLORATION +UIV I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +una I-EXPLORATION +ectasia I-EXPLORATION +ureteropielocalicial I-EXPLORATION +derecha I-EXPLORATION +hasta I-EXPLORATION +cresta I-EXPLORATION +iliaca. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TC I-EXPLORATION +los I-EXPLORATION +riñones I-EXPLORATION +son I-EXPLORATION +normales I-EXPLORATION +pero I-EXPLORATION +el I-EXPLORATION +uréter I-EXPLORATION +derecho I-EXPLORATION +está I-EXPLORATION +discretamente I-EXPLORATION +dilatado I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +distal I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +identifica I-EXPLORATION +un I-EXPLORATION +quiste I-EXPLORATION +ovárico I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +5 I-EXPLORATION +cm, I-EXPLORATION +que I-EXPLORATION +pudiera I-EXPLORATION +estar I-EXPLORATION +comprimiendo I-EXPLORATION +parcialmente I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +distal I-EXPLORATION +del I-EXPLORATION +uréter I-EXPLORATION +(vista I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +ginecología I-EXPLORATION +no I-EXPLORATION +precisa I-EXPLORATION +tratamiento I-EXPLORATION +alguno, I-EXPLORATION +solamente I-EXPLORATION +revisiones I-EXPLORATION +periódicas). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +pielografía I-EXPLORATION +ascendente I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +se I-EXPLORATION +ve I-EXPLORATION +la I-EXPLORATION +ectasia I-EXPLORATION +ureteropielocalicial I-EXPLORATION +sin I-EXPLORATION +observar I-EXPLORATION +claramente I-EXPLORATION +una I-EXPLORATION +estenosis I-EXPLORATION +ureteral; I-EXPLORATION +se B-TREATMENT +coloca I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +doble I-TREATMENT +J I-TREATMENT +que I-TREATMENT +es I-TREATMENT +retirado I-TREATMENT +a I-TREATMENT +las I-TREATMENT +8 I-TREATMENT +semanas I-TREATMENT +sin I-TREATMENT +apreciar I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +mejoría I-TREATMENT +clínica. I-TREATMENT +Se B-EXPLORATION +decide I-EXPLORATION +hacer I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN) I-EXPLORATION +que I-EXPLORATION +nos I-EXPLORATION +pueda I-EXPLORATION +aportar I-EXPLORATION +algún I-EXPLORATION +dato I-EXPLORATION +nuevo I-EXPLORATION +que I-EXPLORATION +justifique I-EXPLORATION +los I-EXPLORATION +síntomas; I-EXPLORATION +dicha I-EXPLORATION +RMN I-EXPLORATION +nos I-EXPLORATION +informa I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +ectasia I-EXPLORATION +ureteral I-EXPLORATION +derecha I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +síndrome I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +ovárica. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +programa I-TREATMENT +para I-TREATMENT +intervención I-TREATMENT +quirúrgica: I-TREATMENT +ligadura I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +ovárica I-TREATMENT +más I-TREATMENT +ureterolisis I-TREATMENT +derecha I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +laparoscópica I-TREATMENT +transabdominal. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +es I-TREATMENT +colocada I-TREATMENT +en I-TREATMENT +ligero I-TREATMENT +decúbito I-TREATMENT +lateral I-TREATMENT +izquierdo. I-TREATMENT +Insuflación I-TREATMENT +abdominal I-TREATMENT +con I-TREATMENT +CO2 I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +una I-TREATMENT +aguja I-TREATMENT +de I-TREATMENT +Veress I-TREATMENT +y I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +cuatro I-TREATMENT +trócares, I-TREATMENT +2 I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +mm I-TREATMENT +- I-TREATMENT +(uno I-TREATMENT +subesternal I-TREATMENT +y I-TREATMENT +otro I-TREATMENT +en I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +lumbar I-TREATMENT +entre I-TREATMENT +la I-TREATMENT +cresta I-TREATMENT +iliaca I-TREATMENT +y I-TREATMENT +la I-TREATMENT +12ª I-TREATMENT +costilla) I-TREATMENT +- I-TREATMENT +y I-TREATMENT +2 I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +mm I-TREATMENT +- I-TREATMENT +(uno I-TREATMENT +en I-TREATMENT +el I-TREATMENT +ombligo, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +coloca I-TREATMENT +la I-TREATMENT +óptica, I-TREATMENT +y I-TREATMENT +el I-TREATMENT +otro I-TREATMENT +suprapúbico) I-TREATMENT +-. I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +incisión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +línea I-TREATMENT +de I-TREATMENT +Toldt I-TREATMENT +y I-TREATMENT +decolación I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +identificación I-TREATMENT +del I-TREATMENT +uréter I-TREATMENT +lumbar I-TREATMENT +y I-TREATMENT +seguimiento I-TREATMENT +del I-TREATMENT +mismo I-TREATMENT +hasta I-TREATMENT +observar I-TREATMENT +su I-TREATMENT +paso I-TREATMENT +entre I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +iliaca I-TREATMENT +y I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +ovárica, I-TREATMENT +ésta I-TREATMENT +última I-TREATMENT +cruza I-TREATMENT +por I-TREATMENT +encima I-TREATMENT +del I-TREATMENT +uréter I-TREATMENT +y I-TREATMENT +se I-TREATMENT +bifurca I-TREATMENT +en I-TREATMENT +2 I-TREATMENT +ramas I-TREATMENT +que I-TREATMENT +actúan I-TREATMENT +a I-TREATMENT +modo I-TREATMENT +de I-TREATMENT +pinza I-TREATMENT +comprimiendo I-TREATMENT +el I-TREATMENT +uréter. I-TREATMENT +Se I-TREATMENT +libera I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +ovárica I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +procede I-TREATMENT +a I-TREATMENT +la I-TREATMENT +ligadura I-TREATMENT +y I-TREATMENT +sección I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT +Para I-TREATMENT +finalizar, I-TREATMENT +colocamos I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +tipo I-TREATMENT +Redon I-TREATMENT +sin I-TREATMENT +aspiración I-TREATMENT +a I-TREATMENT +través I-TREATMENT +del I-TREATMENT +trócar I-TREATMENT +lateral, I-TREATMENT +se I-TREATMENT +confirma I-TREATMENT +la I-TREATMENT +hemostasia, I-TREATMENT +se I-TREATMENT +evacúa I-TREATMENT +el I-TREATMENT +CO2 I-TREATMENT +y I-TREATMENT +se I-TREATMENT +suturan I-TREATMENT +los I-TREATMENT +puertos I-TREATMENT +de I-TREATMENT +entrada. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +cursa I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +es I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +segundo I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +revisiones I-EVOLUTION +posteriores, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +3 I-EVOLUTION +y I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +totalmente I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +UIV I-EVOLUTION +de I-EVOLUTION +control I-EVOLUTION +ha I-EVOLUTION +desaparecido I-EVOLUTION +la I-EVOLUTION +ectasia I-EVOLUTION +y I-EVOLUTION +acodadura I-EVOLUTION +del I-EVOLUTION +uréter I-EVOLUTION +derecho. I-EVOLUTION + I-EVOLUTION + +Hermanos B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +casados B-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +hijos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infertilidad I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sinusitis I-PAST_MEDICAL_HISTORY +frecuentes I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +infecciones I-PAST_MEDICAL_HISTORY +respiratorias I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +repetición I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +muchos I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +aunque I-PAST_MEDICAL_HISTORY +niegan I-PAST_MEDICAL_HISTORY +haberlas I-PAST_MEDICAL_HISTORY +padecido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY +Madre B-FAMILY_HISTORY +y I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +presentan I-FAMILY_HISTORY +broncopatía I-FAMILY_HISTORY +crónica I-FAMILY_HISTORY +no I-FAMILY_HISTORY +filiada. I-FAMILY_HISTORY +Padre I-FAMILY_HISTORY +sano I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +afectación I-FAMILY_HISTORY +pulmonar I-FAMILY_HISTORY +o I-FAMILY_HISTORY +sinusal. I-FAMILY_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +hermanos, I-EXPLORATION +hermana, I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +madre, I-EXPLORATION +sólo I-EXPLORATION +destaca I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +roncus I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +pulmonar. I-EXPLORATION +No B-FAMILY_HISTORY +se I-FAMILY_HISTORY +pudieron I-FAMILY_HISTORY +obtener I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +clínicos I-FAMILY_HISTORY +de I-FAMILY_HISTORY +la I-FAMILY_HISTORY +ascendencia I-FAMILY_HISTORY +tanto I-FAMILY_HISTORY +paterna I-FAMILY_HISTORY +como I-FAMILY_HISTORY +materna. I-FAMILY_HISTORY +Bioquímica B-EXPLORATION +ordinaria I-EXPLORATION +normal, I-EXPLORATION +incluyendo I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +hepática I-EXPLORATION +y I-EXPLORATION +renal. I-EXPLORATION +Alfa-1-anti-tripsina I-EXPLORATION +normal. I-EXPLORATION +Proteinograma I-EXPLORATION +e I-EXPLORATION +inmunoglobulinas I-EXPLORATION +normales. I-EXPLORATION +Hormonas I-EXPLORATION +tiroideas I-EXPLORATION +normales. I-EXPLORATION +Marcadores I-EXPLORATION +del I-EXPLORATION +virus I-EXPLORATION +B I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hepatitis I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana I-EXPLORATION +negativos. I-EXPLORATION +Anticuerpos I-EXPLORATION +antinucleares, I-EXPLORATION +pruebas I-EXPLORATION +reumáticas, I-EXPLORATION +fracción I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +C4 I-EXPLORATION +negativos. I-EXPLORATION +Gasometría I-EXPLORATION +arterial I-EXPLORATION +basal I-EXPLORATION +y I-EXPLORATION +bicarbonato I-EXPLORATION +normal. I-EXPLORATION +Espirometría I-EXPLORATION +normal. I-EXPLORATION +Saturación I-EXPLORATION +Hb I-EXPLORATION +normal. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +normal. I-EXPLORATION +Tanto I-EXPLORATION +los I-EXPLORATION +hermanos I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +hermana I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +madre I-EXPLORATION +rehusaron I-EXPLORATION +hacer I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +respiratoria I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +ultraestructural I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cilios. I-EXPLORATION +El I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +semen I-EXPLORATION +indica I-EXPLORATION +astenozoospermia I-EXPLORATION +total I-EXPLORATION +en I-EXPLORATION +3 I-EXPLORATION +seminogramas I-EXPLORATION +diferentes I-EXPLORATION +realizados I-EXPLORATION +a I-EXPLORATION +ambos I-EXPLORATION +hermanos, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +concentración I-EXPLORATION +espermática I-EXPLORATION +media I-EXPLORATION +de I-EXPLORATION +23 I-EXPLORATION +millones/ml, I-EXPLORATION +un I-EXPLORATION +porcentaje I-EXPLORATION +de I-EXPLORATION +formas I-EXPLORATION +normales I-EXPLORATION +por I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +Kruger I-EXPLORATION +del I-EXPLORATION +6% I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +viabilidad I-EXPLORATION +del I-EXPLORATION +95%. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +ultraestructural I-EXPLORATION +del I-EXPLORATION +flagelo I-EXPLORATION +espermático I-EXPLORATION +por I-EXPLORATION +microscopía I-EXPLORATION +electrónica I-EXPLORATION +indica I-EXPLORATION +que I-EXPLORATION +los I-EXPLORATION +dos I-EXPLORATION +hermanos I-EXPLORATION +tienen I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +anomalía. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +mayoría I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +secciones I-EXPLORATION +transversales I-EXPLORATION +se I-EXPLORATION +encuentra I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +brazos I-EXPLORATION +de I-EXPLORATION +dineína. I-EXPLORATION +El I-EXPLORATION +filamento I-EXPLORATION +de I-EXPLORATION +nexina I-EXPLORATION +está I-EXPLORATION +presente, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +las I-EXPLORATION +fibras I-EXPLORATION +radiales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +par I-EXPLORATION +central. I-EXPLORATION +En I-EXPLORATION +espermatozoides I-EXPLORATION +aislados, I-EXPLORATION +coincidiendo I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +brazos I-EXPLORATION +de I-EXPLORATION +dineína, I-EXPLORATION +hay I-EXPLORATION +también I-EXPLORATION +pérdida I-EXPLORATION +del I-EXPLORATION +par I-EXPLORATION +central. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +anomalía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +vaina I-EXPLORATION +fibrosa, I-EXPLORATION +ni I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +fibras I-EXPLORATION +densas. I-EXPLORATION +La I-EXPLORATION +pieza I-EXPLORATION +intermedia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mitad I-EXPLORATION +aproximadamente I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +casos I-EXPLORATION +tenía I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +número I-EXPLORATION +de I-EXPLORATION +mitocondrias I-EXPLORATION +y I-EXPLORATION +mitocondrias I-EXPLORATION +extras I-EXPLORATION +no I-EXPLORATION +alineadas. I-EXPLORATION +Otros I-EXPLORATION +datos I-EXPLORATION +añadidos I-EXPLORATION +fueron I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +microtúbulos I-EXPLORATION +extra I-EXPLORATION +periféricos I-EXPLORATION +al I-EXPLORATION +axonema. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +25 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vejiga I-PAST_MEDICAL_HISTORY +hiperrefléxica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +sección I-PAST_MEDICAL_HISTORY +medular I-PAST_MEDICAL_HISTORY +traumática I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +disparos I-PRESENT_ILLNESS +miccionales I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +incontinencia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cuadros I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pielonefritis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +repetición. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +cistografía I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +vejiga I-EXPLORATION +de I-EXPLORATION +escasa I-EXPLORATION +capacidad, I-EXPLORATION +sin I-EXPLORATION +reflujo I-EXPLORATION +vesicoureteral. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +urodinámico I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +un I-EXPLORATION +disparo I-EXPLORATION +miccional I-EXPLORATION +desde I-EXPLORATION +los I-EXPLORATION +60cc I-EXPLORATION +de I-EXPLORATION +llenado I-EXPLORATION +con I-EXPLORATION +altas I-EXPLORATION +presiones I-EXPLORATION +vesicales I-EXPLORATION +que I-EXPLORATION +había I-EXPLORATION +resultado I-EXPLORATION +refractario I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +conservador. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +enterocistoplastia I-TREATMENT +de I-TREATMENT +ampliación I-TREATMENT +laparoscópica I-TREATMENT +con I-TREATMENT +un I-TREATMENT +segmento I-TREATMENT +ileal I-TREATMENT +de I-TREATMENT +25 I-TREATMENT +cm I-TREATMENT +plegado I-TREATMENT +en I-TREATMENT +U. I-TREATMENT +La I-TREATMENT +duración I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +4, I-TREATMENT +5 I-TREATMENT +horas I-TREATMENT +con I-TREATMENT +un I-TREATMENT +sangrado I-TREATMENT +mínimo. I-TREATMENT +Durante B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +constipación, I-EVOLUTION +que I-EVOLUTION +ya I-EVOLUTION +presentaba I-EVOLUTION +ocasionalmente I-EVOLUTION +antes I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION +Se I-EVOLUTION +procedió I-EVOLUTION +al I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +al I-EVOLUTION +duodécimo I-EVOLUTION +día I-EVOLUTION +postoperatorio. I-EVOLUTION + I-EVOLUTION +El I-EVOLUTION +seguimiento I-EVOLUTION +ha I-EVOLUTION +sido I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +meses. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +en I-EVOLUTION +programa I-EVOLUTION +de I-EVOLUTION +autocateterismos, I-EVOLUTION +continente I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +nuevos I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +infección I-EVOLUTION +urinaria. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +destacando B-PAST_MEDICAL_HISTORY +entre I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +II I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +insulina, I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miopía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cataratas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nuestra I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +craurosis I-PRESENT_ILLNESS +prepucial I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +impide I-PRESENT_ILLNESS +retracción I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +prepucio. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +debajo I-EXPLORATION +de I-EXPLORATION +prepucio I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +del I-EXPLORATION +glande I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +tres I-EXPLORATION +centímetros I-EXPLORATION +no I-EXPLORATION +doloroso I-EXPLORATION +y I-EXPLORATION +muy I-EXPLORATION +consistente. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +pene, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +con I-EXPLORATION +anestesia I-EXPLORATION +local I-EXPLORATION +incisión I-EXPLORATION +prepucial I-EXPLORATION +encontrándonos I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +cuatro I-EXPLORATION +centímetros I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +de I-EXPLORATION +color I-EXPLORATION +rojo I-EXPLORATION +amarillento, I-EXPLORATION +algo I-EXPLORATION +rugoso, I-EXPLORATION +consistente I-EXPLORATION +al I-EXPLORATION +tacto I-EXPLORATION +y I-EXPLORATION +situado I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +glande. I-EXPLORATION +Se I-EXPLORATION +tomó I-EXPLORATION +una I-EXPLORATION +cuña I-EXPLORATION +profunda I-EXPLORATION +del I-EXPLORATION +nódulo I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +para I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +no I-TREATMENT +realizar I-TREATMENT +circuncisión I-TREATMENT +ni I-TREATMENT +exéresis I-TREATMENT +del I-TREATMENT +nódulo I-TREATMENT +a I-TREATMENT +la I-TREATMENT +espera I-TREATMENT +del I-TREATMENT +resultado. I-TREATMENT +Aunque I-TREATMENT +con I-TREATMENT +la I-TREATMENT +incisión I-TREATMENT +prepucial I-TREATMENT +el I-TREATMENT +glande I-TREATMENT +pudo I-TREATMENT +ser I-TREATMENT +exteriorizado I-TREATMENT +y I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +higiene I-TREATMENT +adecuada. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +histológico I-EXPLORATION +es I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +amiloidosis I-EXPLORATION +nodular. I-EXPLORATION +Es B-EVOLUTION +curioso I-EVOLUTION +señalar I-EVOLUTION +que I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +tiempo I-EVOLUTION +transcurrido I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +espera I-EVOLUTION +del I-EVOLUTION +resultado I-EVOLUTION +histológico, I-EVOLUTION +al I-EVOLUTION +poder I-EVOLUTION +realizar I-EVOLUTION +una I-EVOLUTION +higiene I-EVOLUTION +adecuada, I-EVOLUTION +el I-EVOLUTION +aspecto I-EVOLUTION +del I-EVOLUTION +nódulo I-EVOLUTION +mejoró. I-EVOLUTION + I-EVOLUTION +De B-TREATMENT +forma I-TREATMENT +reglada I-TREATMENT +realizamos I-TREATMENT +circuncisión I-TREATMENT +y I-TREATMENT +exéresis I-TREATMENT +completa I-TREATMENT +del I-TREATMENT +nódulo, I-TREATMENT +confirmando B-EXPLORATION +este I-EXPLORATION +segundo I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +nódulo I-EXPLORATION +amiloidótico. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +permanganato I-EXPLORATION +potásico I-EXPLORATION +que I-EXPLORATION +permitió I-EXPLORATION +diferenciar I-EXPLORATION +el I-EXPLORATION +amiloide I-EXPLORATION +tipo I-EXPLORATION +AA I-EXPLORATION +del I-EXPLORATION +AL, I-EXPLORATION +éste I-EXPLORATION +último I-EXPLORATION +característico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +forma I-EXPLORATION +primaria I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +sensible I-EXPLORATION +al I-EXPLORATION +permanganato. I-EXPLORATION +La I-EXPLORATION +muestra I-EXPLORATION +tisular I-EXPLORATION +se I-EXPLORATION +tiñó I-EXPLORATION +con I-EXPLORATION +Rojo I-EXPLORATION +Congo I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +examinó I-EXPLORATION +con I-EXPLORATION +luz I-EXPLORATION +polarizada I-EXPLORATION +observándose I-EXPLORATION +la I-EXPLORATION +típica I-EXPLORATION +birrefrigencia I-EXPLORATION +verde. I-EXPLORATION +Después I-EXPLORATION +de I-EXPLORATION +haber I-EXPLORATION +identificado I-EXPLORATION +el I-EXPLORATION +amiloide, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +e I-EXPLORATION +inmunohistoquímica. I-EXPLORATION +El I-EXPLORATION +componente I-EXPLORATION +amiloide I-EXPLORATION +lo I-EXPLORATION +constituía I-EXPLORATION +el I-EXPLORATION +tipo I-EXPLORATION +AL, I-EXPLORATION +característico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +amiloidosis I-EXPLORATION +primaria I-EXPLORATION +y I-EXPLORATION +amiloidosis I-EXPLORATION +local. I-EXPLORATION +Este I-EXPLORATION +componente I-EXPLORATION +fibrilar I-EXPLORATION +se I-EXPLORATION +caracteriza I-EXPLORATION +por I-EXPLORATION +tener I-EXPLORATION +un I-EXPLORATION +depósito I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas I-EXPLORATION +Kappa I-EXPLORATION +o I-EXPLORATION +lambda. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +complementario I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +amiloidosis I-EXPLORATION +generalizada I-EXPLORATION +consistente I-EXPLORATION +en I-EXPLORATION +hemograma, I-EXPLORATION +bioquímica, I-EXPLORATION +proteinograma, I-EXPLORATION +PSA, I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +mucosa I-EXPLORATION +rectal. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +síndrome I-EXPLORATION +nefrótico I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +creímos I-EXPLORATION +oportuno I-EXPLORATION +realizar I-EXPLORATION +biopsia I-EXPLORATION +renal. I-EXPLORATION +Tampoco I-EXPLORATION +presentaba I-EXPLORATION +artritis, I-EXPLORATION +insuficiencia I-EXPLORATION +cardíaca, I-EXPLORATION +hipotensión I-EXPLORATION +ni I-EXPLORATION +neuropatía. I-EXPLORATION +Todas I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +presentaron I-EXPLORATION +unos I-EXPLORATION +resultados I-EXPLORATION +normales I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +descartó I-EXPLORATION +amiloidosis I-EXPLORATION +generalizada. I-EXPLORATION + I-EXPLORATION +Dos B-EVOLUTION +años I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +recidivado I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +ha I-EVOLUTION +desarrollado I-EVOLUTION +amiloidosis I-EVOLUTION +generalizada. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +62 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +edemas I-PRESENT_ILLNESS +progresivos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ambas I-PRESENT_ILLNESS +extremidades I-PRESENT_ILLNESS +inferiores, I-PRESENT_ILLNESS +región I-PRESENT_ILLNESS +genital I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inguinal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +ninguna I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +acompañante. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +constaban I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cólicos I-PAST_MEDICAL_HISTORY +nefríticos I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +complicados. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +llamaba I-EXPLORATION +la I-EXPLORATION +atención I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +púbica, I-EXPLORATION +incluyendo I-EXPLORATION +pene, I-EXPLORATION +escroto I-EXPLORATION +y I-EXPLORATION +región I-EXPLORATION +inguinal, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +extendía I-EXPLORATION +por I-EXPLORATION +ambas I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +siendo I-EXPLORATION +más I-EXPLORATION +evidente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +izquierda, I-EXPLORATION +sin I-EXPLORATION +fovea. I-EXPLORATION +No I-EXPLORATION +existían I-EXPLORATION +lesiones I-EXPLORATION +cutáneas, I-EXPLORATION +ni I-EXPLORATION +adenopatías I-EXPLORATION +laterocervicales I-EXPLORATION +o I-EXPLORATION +axilares. I-EXPLORATION +Palpación I-EXPLORATION +de I-EXPLORATION +probables I-EXPLORATION +adenopatías I-EXPLORATION +inguinales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +tacto I-EXPLORATION +rectal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +próstata I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +dura I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +dolorosa. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +incluyendo I-EXPLORATION +bioquímica, I-EXPLORATION +hemograma, I-EXPLORATION +proteinograma, I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +con I-EXPLORATION +proteinuria I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +estrictamente I-EXPLORATION +normal. I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +destacando I-EXPLORATION +un I-EXPLORATION +PSA I-EXPLORATION +de I-EXPLORATION +100 I-EXPLORATION +microgramos/l. I-EXPLORATION + I-EXPLORATION +Tanto I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +como I-EXPLORATION +el I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +objetivaron I-EXPLORATION +múltiples I-EXPLORATION +adenopatías I-EXPLORATION +retroperitoneales I-EXPLORATION +paraaórticas I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +cadenas I-EXPLORATION +ilíacas I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +próstata I-EXPLORATION +aumentada I-EXPLORATION +de I-EXPLORATION +tamaño. I-EXPLORATION +Se I-EXPLORATION +consultó I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Urología I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +llevó I-EXPLORATION +a I-EXPLORATION +cabo I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +prostática I-EXPLORATION +concluyente I-EXPLORATION +para I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +próstata I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +adenopatía I-EXPLORATION +inguinal I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +invasión I-EXPLORATION +por I-EXPLORATION +adenocarcinoma I-EXPLORATION +prostático. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +intensa I-EXPLORATION +positividad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +población I-EXPLORATION +neoplásica I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +prostática, I-EXPLORATION +el I-EXPLORATION +antígeno I-EXPLORATION +prostático I-EXPLORATION +específico I-EXPLORATION +(PSA) I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +los I-EXPLORATION +receptores I-EXPLORATION +de I-EXPLORATION +andrógenos. I-EXPLORATION +La I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +mostró I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +captación I-EXPLORATION +retroauricular I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +apófisis I-EXPLORATION +espinosa I-EXPLORATION +y I-EXPLORATION +carilla I-EXPLORATION +auricular I-EXPLORATION +de I-EXPLORATION +C3. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +hormonal I-TREATMENT +con I-TREATMENT +antiandrógenos I-TREATMENT +y I-TREATMENT +análogos I-TREATMENT +de I-TREATMENT +LHRH. I-TREATMENT +Ante I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +metástasis I-TREATMENT +óseas, I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +ácido I-TREATMENT +zoledrónico. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +nueve I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +hallaba I-EVOLUTION +estable I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +clínico I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +cambios I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +exploración I-EVOLUTION +física. I-EVOLUTION +El I-EVOLUTION +PSA I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +4, I-EVOLUTION +6 I-EVOLUTION +microgramos/l. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +es B-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +completar I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +acudir I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +especialidades I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +tumoración I-DERIVED_FROM/TO +indolora I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +testículo I-DERIVED_FROM/TO +izquierdo I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +mes I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +otra I-DERIVED_FROM/TO +sintomatología. I-DERIVED_FROM/TO +Se B-EXPLORATION +le I-EXPLORATION +detecta I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +centro I-EXPLORATION +de I-EXPLORATION +especialidades I-EXPLORATION +un I-EXPLORATION +testículo I-EXPLORATION +izquierdo I-EXPLORATION +hipogénico I-EXPLORATION +y I-EXPLORATION +disminuido I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +que I-EXPLORATION +dificulta I-EXPLORATION +su I-EXPLORATION +valoración, I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +testículo I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +parénquima I-EXPLORATION +heterogéneo I-EXPLORATION +sospechoso I-EXPLORATION +de I-EXPLORATION +neoplasia. I-EXPLORATION + I-EXPLORATION +No B-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +alergias I-PAST_MEDICAL_HISTORY +medicamentosas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tampoco I-PAST_MEDICAL_HISTORY +tiene I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +palpa I-EXPLORATION +un I-EXPLORATION +teste I-EXPLORATION +izquierdo I-EXPLORATION +hipotrófico. I-EXPLORATION +El I-EXPLORATION +teste I-EXPLORATION +derecho I-EXPLORATION +se I-EXPLORATION +presenta I-EXPLORATION +algo I-EXPLORATION +aumentado I-EXPLORATION +de I-EXPLORATION +tamaño. I-EXPLORATION +Ambos I-EXPLORATION +no I-EXPLORATION +dolorosos, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +regulares. I-EXPLORATION +Epidídimos I-EXPLORATION +y I-EXPLORATION +cordones I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +patológicos. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +solicitan I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +que I-EXPLORATION +resultan I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +alfa-feto I-EXPLORATION +proteína I-EXPLORATION +de I-EXPLORATION +2.7 I-EXPLORATION +ng/ml I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +beta-hCG I-EXPLORATION +de I-EXPLORATION +4.2 I-EXPLORATION +mUI/ml. I-EXPLORATION + I-EXPLORATION +Durante I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +nuevas I-EXPLORATION +exploraciones I-EXPLORATION +complementarias, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +con I-EXPLORATION +flujo I-EXPLORATION +Doppler I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +teste I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +49mm I-EXPLORATION +x I-EXPLORATION +36mm I-EXPLORATION +x I-EXPLORATION +26mm I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +hipoecoica, I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +lobulados, I-EXPLORATION +heterogénea, I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +prácticamente I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +testículo, I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +flujo I-EXPLORATION +Doppler. I-EXPLORATION +Y I-EXPLORATION +un I-EXPLORATION +teste I-EXPLORATION +izquierdo I-EXPLORATION +de I-EXPLORATION +32 I-EXPLORATION +mm I-EXPLORATION +x I-EXPLORATION +22 I-EXPLORATION +mm I-EXPLORATION +x I-EXPLORATION +20 I-EXPLORATION +mm I-EXPLORATION +hetrogéneo I-EXPLORATION +con I-EXPLORATION +lesión I-EXPLORATION +focal I-EXPLORATION +ligeramente I-EXPLORATION +hipoecoica I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +9 I-EXPLORATION +mm I-EXPLORATION +con I-EXPLORATION +sutil I-EXPLORATION +flujo I-EXPLORATION +Doppler. I-EXPLORATION +Además, I-EXPLORATION +microlitiasis I-EXPLORATION +testiculares I-EXPLORATION +bilaterales. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +TAC I-EXPLORATION +toraco-abdomino-pélvico I-EXPLORATION +con I-EXPLORATION +contraste, I-EXPLORATION +donde I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +identificaron I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +metástasis I-EXPLORATION +en I-EXPLORATION +ninguno I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +territorios I-EXPLORATION +visualizados. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +tumor I-TREATMENT +testicular I-TREATMENT +bilateral, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +orquiectomía I-TREATMENT +bilateral I-TREATMENT +vía I-TREATMENT +inguinal. I-TREATMENT +Al I-TREATMENT +mismo I-TREATMENT +tiempo I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +hormonal I-TREATMENT +sustitutivo. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +Anatomía I-EXPLORATION +patológica I-EXPLORATION +informan I-EXPLORATION +de I-EXPLORATION +testículo I-EXPLORATION +izquierdo I-EXPLORATION +atrófico I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +focos I-EXPLORATION +microscópicos I-EXPLORATION +de I-EXPLORATION +Seminoma I-EXPLORATION +clásico I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +amplias I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +Neoplasia I-EXPLORATION +Intratubular I-EXPLORATION +de I-EXPLORATION +Células I-EXPLORATION +Germinales I-EXPLORATION +(NICG) I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +tumoral I-EXPLORATION +en I-EXPLORATION +albugínea, I-EXPLORATION +rete I-EXPLORATION +testis, I-EXPLORATION +epidídimo I-EXPLORATION +o I-EXPLORATION +infiltración I-EXPLORATION +vascular. I-EXPLORATION +El I-EXPLORATION +testículo I-EXPLORATION +derecho I-EXPLORATION +presenta I-EXPLORATION +tumoración I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +de I-EXPLORATION +Seminoma I-EXPLORATION +clásico I-EXPLORATION +que I-EXPLORATION +ocupa I-EXPLORATION +prácticamente I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +parénquima, I-EXPLORATION +asociado I-EXPLORATION +a I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +Neoplasia I-EXPLORATION +Intratubular I-EXPLORATION +de I-EXPLORATION +Células I-EXPLORATION +Germinales I-EXPLORATION +(NICG) I-EXPLORATION +y I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +atrofia I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +testículo I-EXPLORATION +restante. I-EXPLORATION +Túnica I-EXPLORATION +albugínea, I-EXPLORATION +rete I-EXPLORATION +testis, I-EXPLORATION +epidídimo I-EXPLORATION +y I-EXPLORATION +borde I-EXPLORATION +quirúrgico I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +tumor. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +completó I-TREATMENT +con I-TREATMENT +dos I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia I-TREATMENT +con I-TREATMENT +carboplatino. I-TREATMENT + I-TREATMENT +Actualmente B-EVOLUTION +lleva I-EVOLUTION +aproximadamente I-EVOLUTION +3 I-EVOLUTION +años I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumadora B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +cigarrillos/día, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +poliquistosis I-PAST_MEDICAL_HISTORY +hepatorrenal I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +12 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +estadio I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +(con I-PAST_MEDICAL_HISTORY +aclaramiento I-PAST_MEDICAL_HISTORY +creatinina I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +ml/min I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +proteinuria). I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +ningún I-PAST_MEDICAL_HISTORY +otro I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +patológico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +La B-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +lumbar I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +requiere I-PRESENT_ILLNESS +ingreso. I-PRESENT_ILLNESS +Inicialmente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +orienta I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +quística. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Se B-EXPLORATION +realiza I-EXPLORATION +ecografía I-EXPLORATION +reno-vesical I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +poliquistosis I-EXPLORATION +hepatorrenal, I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +una I-EXPLORATION +desestructuración I-EXPLORATION +parenquimatosa I-EXPLORATION +renal I-EXPLORATION +por I-EXPLORATION +quistes, I-EXPLORATION +preferentemente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo, I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +del I-EXPLORATION +tamaño I-EXPLORATION +respecto I-EXPLORATION +al I-EXPLORATION +contralateral, I-EXPLORATION +Existe I-EXPLORATION +una I-EXPLORATION +ecogenicidad I-EXPLORATION +heterogénea I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +preservado I-EXPLORATION +que I-EXPLORATION +sugiere I-EXPLORATION +turgencia I-EXPLORATION +parenquimatosa I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +desdibujamiento I-EXPLORATION +sinusal I-EXPLORATION +izquierdo I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +ecogénico I-EXPLORATION +que I-EXPLORATION +ejerce I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +proyecta I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +pelvis I-EXPLORATION +renal. I-EXPLORATION +Dada I-EXPLORATION +la I-EXPLORATION +poca I-EXPLORATION +especificidad I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +ecográficos I-EXPLORATION +se I-EXPLORATION +completa I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +mediante I-EXPLORATION +TC I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +nuevamente I-EXPLORATION +desestructuración I-EXPLORATION +renal I-EXPLORATION +bilateral I-EXPLORATION +por I-EXPLORATION +poliquistosis, I-EXPLORATION +con I-EXPLORATION +algunos I-EXPLORATION +quistes I-EXPLORATION +hiperdensos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +basal I-EXPLORATION +realizado I-EXPLORATION +sin I-EXPLORATION +contraste I-EXPLORATION +endovenoso. I-EXPLORATION +La I-EXPLORATION +afectación I-EXPLORATION +es I-EXPLORATION +asimétrica, I-EXPLORATION +más I-EXPLORATION +intensa I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo, I-EXPLORATION +siendo I-EXPLORATION +dicho I-EXPLORATION +riñón I-EXPLORATION +de I-EXPLORATION +mayor I-EXPLORATION +tamaño. I-EXPLORATION +La I-EXPLORATION +región I-EXPLORATION +piélica I-EXPLORATION +izquierda I-EXPLORATION +está I-EXPLORATION +ocupada I-EXPLORATION +por I-EXPLORATION +un I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +partes I-EXPLORATION +blandas I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +un I-EXPLORATION +realce I-EXPLORATION +moderado I-EXPLORATION +tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +endovenosa I-EXPLORATION +de I-EXPLORATION +contraste, I-EXPLORATION +sin I-EXPLORATION +definición I-EXPLORATION +clara I-EXPLORATION +de I-EXPLORATION +sus I-EXPLORATION +límites. I-EXPLORATION +Funcionalmente I-EXPLORATION +existe I-EXPLORATION +un I-EXPLORATION +evidente I-EXPLORATION +retraso I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lado I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +eliminación I-EXPLORATION +del I-EXPLORATION +contraste I-EXPLORATION +endovenoso I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +secciones I-EXPLORATION +realizadas I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +retardada. I-EXPLORATION +El I-EXPLORATION +conjunto I-EXPLORATION +de I-EXPLORATION +hallazgos I-EXPLORATION +sugiere I-EXPLORATION +ocupación I-EXPLORATION +tumoral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pelvis I-EXPLORATION +renal I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +poliquistosis I-EXPLORATION +con I-EXPLORATION +alteración I-EXPLORATION +funcional I-EXPLORATION +secundaria. I-EXPLORATION +Se I-EXPLORATION +observan I-EXPLORATION +ganglios I-EXPLORATION +retroperitoneales I-EXPLORATION +no I-EXPLORATION +aumentados I-EXPLORATION +significativamente I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +en I-EXPLORATION +situación I-EXPLORATION +interaortocava I-EXPLORATION +y I-EXPLORATION +retroaórtica. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +clínico I-TREATMENT +de I-TREATMENT +masa I-TREATMENT +renal I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +proceso I-TREATMENT +neoformativo, I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +nefrectomía I-TREATMENT +radical I-TREATMENT +izquierda, I-TREATMENT +con I-TREATMENT +suprarrenalectomía I-TREATMENT +izquierda I-TREATMENT +más I-TREATMENT +linfadenectomía I-TREATMENT +aortocava, I-TREATMENT +sin I-TREATMENT +incidencias I-TREATMENT +ni I-TREATMENT +complicaciones I-TREATMENT +inmediatas. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +no I-EVOLUTION +surgen I-EVOLUTION +complicaciones, I-EVOLUTION +con I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +estable. I-EVOLUTION +Un I-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +nefrectomía, I-EVOLUTION +el I-EVOLUTION +aclaramiento I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +52 I-EVOLUTION +ml/min I-EVOLUTION +y I-EVOLUTION +aparece I-EVOLUTION +proteinuria I-EVOLUTION +de I-EVOLUTION +0, I-EVOLUTION +16 I-EVOLUTION +g/24 I-EVOLUTION +h. I-EVOLUTION + I-EVOLUTION +En B-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +anátomo-patológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza, I-EXPLORATION +macroscópicamente I-EXPLORATION +destaca I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +renal I-EXPLORATION +blanquecina, I-EXPLORATION +firme, I-EXPLORATION +de I-EXPLORATION +9 I-EXPLORATION +x I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +5 I-EXPLORATION +cm., I-EXPLORATION +de I-EXPLORATION +bordes I-EXPLORATION +mal I-EXPLORATION +definidos, I-EXPLORATION +que I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +central I-EXPLORATION +de I-EXPLORATION +necrosis. I-EXPLORATION +Está I-EXPLORATION +situada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +central I-EXPLORATION +renal, I-EXPLORATION +afectando I-EXPLORATION +la I-EXPLORATION +práctica I-EXPLORATION +totalidad I-EXPLORATION +del I-EXPLORATION +parénquima, I-EXPLORATION +alcanzando I-EXPLORATION +el I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +perirrenal I-EXPLORATION +y I-EXPLORATION +rodeando I-EXPLORATION +la I-EXPLORATION +glándula I-EXPLORATION +suprarrenal. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hilio I-EXPLORATION +renal I-EXPLORATION +se I-EXPLORATION +identifican I-EXPLORATION +cuatro I-EXPLORATION +ganglios I-EXPLORATION +linfáticos. I-EXPLORATION +El I-EXPLORATION +parénquima I-EXPLORATION +renal I-EXPLORATION +no I-EXPLORATION +tumoral I-EXPLORATION +está I-EXPLORATION +totalmente I-EXPLORATION +desestructurado I-EXPLORATION +y I-EXPLORATION +sustituido I-EXPLORATION +por I-EXPLORATION +múltiples I-EXPLORATION +quistes I-EXPLORATION +de I-EXPLORATION +hasta I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +afectan I-EXPLORATION +tanto I-EXPLORATION +corteza I-EXPLORATION +como I-EXPLORATION +médula I-EXPLORATION +renal. I-EXPLORATION +Histológicamente, I-EXPLORATION +la I-EXPLORATION +tumoración I-EXPLORATION +está I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +citoplasma I-EXPLORATION +amplio I-EXPLORATION +y I-EXPLORATION +eosinófilo, I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +redondeados I-EXPLORATION +con I-EXPLORATION +marcada I-EXPLORATION +atipia, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +organizan I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +sólido I-EXPLORATION +cohesivo, I-EXPLORATION +característico I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +escamoso I-EXPLORATION +pobremente I-EXPLORATION +diferenciado. I-EXPLORATION +Son I-EXPLORATION +extensas I-EXPLORATION +las I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +tumoral. I-EXPLORATION +El I-EXPLORATION +tumor I-EXPLORATION +afecta I-EXPLORATION +uréter I-EXPLORATION +proximal, I-EXPLORATION +pelvis I-EXPLORATION +renal, I-EXPLORATION +parénquima I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +tanto I-EXPLORATION +perirrenal I-EXPLORATION +como I-EXPLORATION +perihiliar. I-EXPLORATION +Se I-EXPLORATION +objetiva I-EXPLORATION +infiltración I-EXPLORATION +tumoral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vena I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +extensa I-EXPLORATION +infiltración I-EXPLORATION +tumoral I-EXPLORATION +perineural I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +ganglios I-EXPLORATION +simpáticos I-EXPLORATION +del I-EXPLORATION +hilio I-EXPLORATION +renal. I-EXPLORATION +La I-EXPLORATION +masa I-EXPLORATION +tumoral I-EXPLORATION +está I-EXPLORATION +constituida I-EXPLORATION +por I-EXPLORATION +carcinoma I-EXPLORATION +escamoso, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +seno I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cual, I-EXPLORATION +se I-EXPLORATION +aprecia I-EXPLORATION +un I-EXPLORATION +área I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +urotelial I-EXPLORATION +papilar I-EXPLORATION +intraureteral. I-EXPLORATION +Se I-EXPLORATION +identifica I-EXPLORATION +metástasis I-EXPLORATION +del I-EXPLORATION +carcinoma I-EXPLORATION +en I-EXPLORATION +dos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +cuatro I-EXPLORATION +ganglios I-EXPLORATION +linfáticos I-EXPLORATION +hiliares I-EXPLORATION +identificados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pieza. I-EXPLORATION +Los I-EXPLORATION +márgenes I-EXPLORATION +de I-EXPLORATION +resección I-EXPLORATION +quirúrgica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza, I-EXPLORATION +son I-EXPLORATION +negativos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +linfadenectomía I-EXPLORATION +paraórtica I-EXPLORATION +se I-EXPLORATION +identifican I-EXPLORATION +6 I-EXPLORATION +ganglios I-EXPLORATION +linfáticos I-EXPLORATION +libres I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +neoplásica. I-EXPLORATION +En I-EXPLORATION +resumen, I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +anátomo-patológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +escamoso I-EXPLORATION +pobremente I-EXPLORATION +diferenciado I-EXPLORATION +originado I-EXPLORATION +en I-EXPLORATION +pelvis I-EXPLORATION +renal I-EXPLORATION +y I-EXPLORATION +uréter, I-EXPLORATION +categoría I-EXPLORATION +pT4pN2, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +contexto I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +renal I-EXPLORATION +poliquística I-EXPLORATION +autosómico-dominante I-EXPLORATION +(riñón I-EXPLORATION +poliquístico I-EXPLORATION +del I-EXPLORATION +adulto). I-EXPLORATION + B-TREATMENT +En I-TREATMENT +la I-TREATMENT +actualidad, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +sigue I-TREATMENT +tratamiento I-TREATMENT +oncológico. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +reseñables, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +macrohematuria I-PRESENT_ILLNESS +asintomática I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio, I-EXPLORATION +la I-EXPLORATION +citología I-EXPLORATION +urinaria I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cistoscopia I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +urografía I-EXPLORATION +intravenosa I-EXPLORATION +se I-EXPLORATION +evidenciaba I-EXPLORATION +un I-EXPLORATION +efecto I-EXPLORATION +masa I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +riñón I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +desplazamiento I-EXPLORATION +craneal I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +colector. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +renal I-EXPLORATION +derecha I-EXPLORATION +heterogénea I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm, I-EXPLORATION +en I-EXPLORATION +polo I-EXPLORATION +inferior, I-EXPLORATION +con I-EXPLORATION +realce I-EXPLORATION +periférico, I-EXPLORATION +áreas I-EXPLORATION +hipodensas I-EXPLORATION +centrales I-EXPLORATION +y I-EXPLORATION +calcificaciones. I-EXPLORATION +Se I-EXPLORATION +observaban I-EXPLORATION +asimismo I-EXPLORATION +adenopatías I-EXPLORATION +látero-cava, I-EXPLORATION +retrocava I-EXPLORATION +e I-EXPLORATION +interaorto-cava, I-EXPLORATION +siendo I-EXPLORATION +la I-EXPLORATION +mayor I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +cm. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +practicó I-TREATMENT +nefrectomía I-TREATMENT +radical I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +linfadenectomía I-TREATMENT +retroperitoneal, I-TREATMENT +mediante I-TREATMENT +abordaje I-TREATMENT +abdominal I-TREATMENT +anterior. I-TREATMENT +El I-TREATMENT +estudio I-TREATMENT +anatomopatológico I-TREATMENT +reveló I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +un I-TREATMENT +adenocarcinoma I-TREATMENT +renal I-TREATMENT +de I-TREATMENT +células I-TREATMENT +claras I-TREATMENT +de I-TREATMENT +10, I-TREATMENT +5 I-TREATMENT +x I-TREATMENT +9 I-TREATMENT +cm I-TREATMENT +y I-TREATMENT +afectación I-TREATMENT +metastásica I-TREATMENT +de I-TREATMENT +9 I-TREATMENT +de I-TREATMENT +los I-TREATMENT +12 I-TREATMENT +ganglios I-TREATMENT +linfáticos I-TREATMENT +aislados, I-TREATMENT +cuyo I-TREATMENT +tamaño I-TREATMENT +oscilaba I-TREATMENT +entre I-TREATMENT +0, I-TREATMENT +3 I-TREATMENT +y I-TREATMENT +6 I-TREATMENT +cm. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +transcurrió I-EVOLUTION +con I-EVOLUTION +normalidad I-EVOLUTION +hasta I-EVOLUTION +el I-EVOLUTION +4º I-EVOLUTION +día, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +la I-EVOLUTION +salida I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +líquido I-EVOLUTION +lechoso I-EVOLUTION +y I-EVOLUTION +denso I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +catéter I-EVOLUTION +de I-EVOLUTION +drenaje. I-EVOLUTION +El B-EXPLORATION +cultivo I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +era I-EXPLORATION +estéril I-EXPLORATION +y I-EXPLORATION +su I-EXPLORATION +análisis I-EXPLORATION +bioquímico I-EXPLORATION +y I-EXPLORATION +citológico I-EXPLORATION +era I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +quilo: I-EXPLORATION +pH: I-EXPLORATION +7, I-EXPLORATION +581, I-EXPLORATION +7600 I-EXPLORATION +células I-EXPLORATION +nucleadas/mm3 I-EXPLORATION +(82% I-EXPLORATION +mononucleares, I-EXPLORATION +18% I-EXPLORATION +polinucleares), I-EXPLORATION +colesterol: I-EXPLORATION +352 I-EXPLORATION +mg/dl, I-EXPLORATION +triglicéridos: I-EXPLORATION +3920 I-EXPLORATION +mg/dl. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +con I-EXPLORATION +Sudan I-EXPLORATION +III I-EXPLORATION +se I-EXPLORATION +visualizaban I-EXPLORATION +abundantes I-EXPLORATION +gotas I-EXPLORATION +de I-EXPLORATION +grasa I-EXPLORATION +neutra. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +TAC I-EXPLORATION +abdominal, I-EXPLORATION +observando I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +porción I-EXPLORATION +izquierda I-EXPLORATION +del I-EXPLORATION +mesenterio, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +linfocele. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +ascitis I-TREATMENT +quilosa I-TREATMENT +se I-TREATMENT +instauró I-TREATMENT +tratamiento I-TREATMENT +consistente I-TREATMENT +en I-TREATMENT +suspensión I-TREATMENT +de I-TREATMENT +dieta I-TREATMENT +oral I-TREATMENT +y I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +total. I-TREATMENT +Ante I-TREATMENT +el I-TREATMENT +incremento I-TREATMENT +del I-TREATMENT +débito I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +quilosa I-TREATMENT +en I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +horas I-TREATMENT +siguientes I-TREATMENT +al I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +tratamiento, I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +octreótide I-TREATMENT +(0, I-TREATMENT +1 I-TREATMENT +mg/8h, I-TREATMENT +subcutáneo), I-TREATMENT +observándose I-TREATMENT +un I-TREATMENT +descenso I-TREATMENT +manifiesto I-TREATMENT +del I-TREATMENT +drenaje I-TREATMENT +quiloso. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +linfografía I-EXPLORATION +isotópica I-EXPLORATION +(99mTc) I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +12 I-EXPLORATION +y I-EXPLORATION +24 I-EXPLORATION +días I-EXPLORATION +del I-EXPLORATION +inicio I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fístula, I-EXPLORATION +observando I-EXPLORATION +un I-EXPLORATION +acúmulo I-EXPLORATION +de I-EXPLORATION +trazador I-EXPLORATION +medial I-EXPLORATION +a I-EXPLORATION +cadena I-EXPLORATION +ilíaca I-EXPLORATION +derecha, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +linfonodo, I-EXPLORATION +sin I-EXPLORATION +objetivarse I-EXPLORATION +fuga I-EXPLORATION +linfática I-EXPLORATION +alguna. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +control, I-EXPLORATION +tras I-EXPLORATION +9 I-EXPLORATION +días I-EXPLORATION +sin I-EXPLORATION +débito I-EXPLORATION +fistuloso, I-EXPLORATION +se I-EXPLORATION +comprobó I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +del I-EXPLORATION +quilocele I-EXPLORATION +retroperitoneal, I-EXPLORATION +procediendo B-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +drenaje I-TREATMENT +TAC-dirigido I-TREATMENT +del I-TREATMENT +mismo. I-TREATMENT +El I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colección I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +hasta I-TREATMENT +los I-TREATMENT +7 I-TREATMENT +días, I-TREATMENT +tras I-TREATMENT +4 I-TREATMENT +días I-TREATMENT +sin I-TREATMENT +débito. I-TREATMENT + I-TREATMENT +El I-TREATMENT +paciente I-TREATMENT +permaneció I-TREATMENT +en I-TREATMENT +dieta I-TREATMENT +absoluta I-TREATMENT +y I-TREATMENT +con I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +total I-TREATMENT +durante I-TREATMENT +15 I-TREATMENT +días. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +octreótide I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +22 I-TREATMENT +días. I-TREATMENT + I-TREATMENT +Cinco B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +permanece I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +radiológicamente I-EVOLUTION +libre I-EVOLUTION +de I-EVOLUTION +enfermedad I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +fuga I-EVOLUTION +quilosa. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +presentando B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +atraso I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +desarrollo I-PAST_MEDICAL_HISTORY +psico-motor, I-PAST_MEDICAL_HISTORY +trombocitopenia I-PAST_MEDICAL_HISTORY +auto-inmune, I-PAST_MEDICAL_HISTORY +neumonía I-PAST_MEDICAL_HISTORY +linfocítica I-PAST_MEDICAL_HISTORY +granulomatosa I-PAST_MEDICAL_HISTORY +difusa, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +anti-fosfolipídeo, I-PAST_MEDICAL_HISTORY +esplenomegalia, I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +central, I-PAST_MEDICAL_HISTORY +soriasis I-PAST_MEDICAL_HISTORY +inversa I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +psicosis. I-PAST_MEDICAL_HISTORY +Medicado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +alendronato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sodio, I-PAST_MEDICAL_HISTORY +haloperidol, I-PAST_MEDICAL_HISTORY +lorazepam, I-PAST_MEDICAL_HISTORY +trihexifenidilo, I-PAST_MEDICAL_HISTORY +omeprazol, I-PAST_MEDICAL_HISTORY +carbonato I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +calcio I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hierro I-PAST_MEDICAL_HISTORY +oral. I-PAST_MEDICAL_HISTORY +Enviado B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urología I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +volumen I-PRESENT_ILLNESS +progresivo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +genitales I-PRESENT_ILLNESS +externos. I-PRESENT_ILLNESS +Refería I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +generalizada I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +difusa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +piel I-PRESENT_ILLNESS +escrotal, I-PRESENT_ILLNESS +condicionando I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +miccional, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +marcha I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +higiene I-PRESENT_ILLNESS +deficiente. I-PRESENT_ILLNESS +Negaba B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +quirúrgicos I-PAST_MEDICAL_HISTORY +genitales, I-PAST_MEDICAL_HISTORY +inguinales I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +pélvicos. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +radioterapia I-PAST_MEDICAL_HISTORY +inguinal I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +pélvica. I-PAST_MEDICAL_HISTORY +Negaba I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +países I-PAST_MEDICAL_HISTORY +asociados I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +filariosis I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +cuadros I-PAST_MEDICAL_HISTORY +compatibles I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +erisipela I-PAST_MEDICAL_HISTORY +inguinal/genital. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +objetivo I-EXPLORATION +presentaba I-EXPLORATION +marcado I-EXPLORATION +espesamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +túnicas I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +genitales I-EXPLORATION +externos, I-EXPLORATION +endurecido, I-EXPLORATION +indoloro, I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +mal I-EXPLORATION +definidos, I-EXPLORATION +envolviendo I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +circunferencia I-EXPLORATION +y I-EXPLORATION +hasta I-EXPLORATION +peniana, I-EXPLORATION +mimetizando I-EXPLORATION +edema I-EXPLORATION +penoescrotal I-EXPLORATION +masivo. I-EXPLORATION +Aparentemente I-EXPLORATION +las I-EXPLORATION +porciones I-EXPLORATION +dorsales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +escrotal I-EXPLORATION +no I-EXPLORATION +estaban I-EXPLORATION +envueltas I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +proceso. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +las I-EXPLORATION +túnicas I-EXPLORATION +eran I-EXPLORATION +perfectamente I-EXPLORATION +móviles I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +planos I-EXPLORATION +profundos, I-EXPLORATION +tales I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +cuerpos I-EXPLORATION +cavernosos I-EXPLORATION +y I-EXPLORATION +glande, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +alteraciones. I-EXPLORATION +Adicionalmente I-EXPLORATION +presentaba I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +tipo I-EXPLORATION +psoriásico I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +muslos I-EXPLORATION +y I-EXPLORATION +peri-umbilical, I-EXPLORATION +con I-EXPLORATION +aspectos I-EXPLORATION +de I-EXPLORATION +maceración I-EXPLORATION +y I-EXPLORATION +exudado I-EXPLORATION +importantes. I-EXPLORATION +La I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +regiones I-EXPLORATION +inguinales I-EXPLORATION +no I-EXPLORATION +ponía I-EXPLORATION +en I-EXPLORATION +evidencia I-EXPLORATION +adenopatías I-EXPLORATION +sospechosas. I-EXPLORATION +Miembros I-EXPLORATION +inferiores I-EXPLORATION +sin I-EXPLORATION +edemas. I-EXPLORATION +Tacto I-EXPLORATION +rectal I-EXPLORATION +sin I-EXPLORATION +masas I-EXPLORATION +anormales. I-EXPLORATION +Sin I-EXPLORATION +adenopatías I-EXPLORATION +periféricas. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +términos I-EXPLORATION +analíticos I-EXPLORATION +únicamente I-EXPLORATION +era I-EXPLORATION +notoria I-EXPLORATION +una I-EXPLORATION +trombocitopenia I-EXPLORATION +discreta I-EXPLORATION +(123.000/mL), I-EXPLORATION +no I-EXPLORATION +registrándose I-EXPLORATION +cualquier I-EXPLORATION +otra I-EXPLORATION +alteración I-EXPLORATION +como I-EXPLORATION +leucocitosis I-EXPLORATION +o I-EXPLORATION +eosinofília. I-EXPLORATION + I-EXPLORATION +Para I-EXPLORATION +descartar I-EXPLORATION +neoformaciones/adenopatías I-EXPLORATION +pélvicas I-EXPLORATION +o I-EXPLORATION +inguinales, I-EXPLORATION +fue I-EXPLORATION +pedido I-EXPLORATION +TAC I-EXPLORATION +pélvico I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +cualquier I-EXPLORATION +anomalía, I-EXPLORATION +excepto I-EXPLORATION +un I-EXPLORATION +marcadísimo I-EXPLORATION +espesamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +túnicas I-EXPLORATION +genitales. I-EXPLORATION + I-EXPLORATION +Sin I-EXPLORATION +antecedentes I-EXPLORATION +que I-EXPLORATION +permitieran I-EXPLORATION +orientar I-EXPLORATION +para I-EXPLORATION +otro I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +diagnóstico, I-EXPLORATION +fue I-EXPLORATION +adelantado I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +linfedema I-EXPLORATION +idiopático I-EXPLORATION +genital, I-EXPLORATION +en I-EXPLORATION +este I-EXPLORATION +caso I-EXPLORATION +linfedema I-EXPLORATION +praecox, I-EXPLORATION +dada I-EXPLORATION +la I-EXPLORATION +edad I-EXPLORATION +de I-EXPLORATION +presentación. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +la I-TREATMENT +intención I-TREATMENT +de I-TREATMENT +mejorar I-TREATMENT +el I-TREATMENT +trofismo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +circundante I-TREATMENT +y I-TREATMENT +la I-TREATMENT +sintomatología I-TREATMENT +urinaria, I-TREATMENT +fue I-TREATMENT +colocada I-TREATMENT +cistostomía I-TREATMENT +percutánea I-TREATMENT +y I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +terapéutica I-TREATMENT +antibiótica I-TREATMENT +y I-TREATMENT +anti-fúngica I-TREATMENT +durante I-TREATMENT +dos I-TREATMENT +semanas. I-TREATMENT +Se B-EVOLUTION +verificó I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +acentuada I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +cutáneas I-EVOLUTION +exudativas, I-EVOLUTION +sin I-EVOLUTION +modificación I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +áreas I-EVOLUTION +propiamente I-EVOLUTION +afectadas I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION +En B-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +la I-TREATMENT +situación. I-TREATMENT +Este I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +toda I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +macroscópicamente I-TREATMENT +afectada, I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +injertos I-TREATMENT +cutáneos I-TREATMENT +para I-TREATMENT +cobertura I-TREATMENT +de I-TREATMENT +la I-TREATMENT +hasta I-TREATMENT +peniana I-TREATMENT +y I-TREATMENT +confección I-TREATMENT +de I-TREATMENT +neo-escroto I-TREATMENT +con I-TREATMENT +colgajos I-TREATMENT +cutáneos I-TREATMENT +de I-TREATMENT +piel I-TREATMENT +vecina. I-TREATMENT +En I-TREATMENT +primer I-TREATMENT +lugar I-TREATMENT +fue I-TREATMENT +realizada I-TREATMENT +una I-TREATMENT +circuncisión, I-TREATMENT +seguida I-TREATMENT +de I-TREATMENT +incisión I-TREATMENT +peniana I-TREATMENT +dorsal I-TREATMENT +longitudinal I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +y I-TREATMENT +túnicas I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +profundidad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fáscia I-TREATMENT +de I-TREATMENT +Buck, I-TREATMENT +con I-TREATMENT +disección I-TREATMENT +circunferencial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +totalidad I-TREATMENT +del I-TREATMENT +hasta I-TREATMENT +peniana I-TREATMENT +llegando I-TREATMENT +a I-TREATMENT +la I-TREATMENT +base I-TREATMENT +del I-TREATMENT +pene. I-TREATMENT +A I-TREATMENT +continuación I-TREATMENT +fue I-TREATMENT +realizada I-TREATMENT +una I-TREATMENT +incisión I-TREATMENT +arciforme I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +ambas I-TREATMENT +regiones I-TREATMENT +inguinales, I-TREATMENT +teniendo I-TREATMENT +como I-TREATMENT +centro I-TREATMENT +la I-TREATMENT +base I-TREATMENT +del I-TREATMENT +pene. I-TREATMENT +A I-TREATMENT +partir I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma I-TREATMENT +fueron I-TREATMENT +aislados I-TREATMENT +los I-TREATMENT +cordones I-TREATMENT +inguinales, I-TREATMENT +exteriorizados I-TREATMENT +los I-TREATMENT +testículos I-TREATMENT +y I-TREATMENT +realizada I-TREATMENT +inversión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +túnica I-TREATMENT +vaginal. I-TREATMENT +Bajo I-TREATMENT +control I-TREATMENT +de I-TREATMENT +todas I-TREATMENT +las I-TREATMENT +estructuras I-TREATMENT +importantes, I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +exéresis I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +afectada. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +que I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +dorsal I-TREATMENT +de I-TREATMENT +la I-TREATMENT +piel I-TREATMENT +escrotal I-TREATMENT +no I-TREATMENT +se I-TREATMENT +encontraba I-TREATMENT +aparentemente I-TREATMENT +afectada I-TREATMENT +(como I-TREATMENT +de I-TREATMENT +resto I-TREATMENT +es I-TREATMENT +típico I-TREATMENT +en I-TREATMENT +las I-TREATMENT +situaciones I-TREATMENT +de I-TREATMENT +linfedema), I-TREATMENT +esta I-TREATMENT +no I-TREATMENT +fue I-TREATMENT +retirada, I-TREATMENT +permitiendo I-TREATMENT +tener I-TREATMENT +así I-TREATMENT +piel I-TREATMENT +suficiente I-TREATMENT +para I-TREATMENT +confeccionar I-TREATMENT +un I-TREATMENT +neo-escroto I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +rotación I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +misma. I-TREATMENT +Las I-TREATMENT +incisiones I-TREATMENT +inguinales I-TREATMENT +y I-TREATMENT +el I-TREATMENT +escroto I-TREATMENT +fueron I-TREATMENT +cerrados I-TREATMENT +después I-TREATMENT +de I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +drenos I-TREATMENT +aspirativos. I-TREATMENT +Para I-TREATMENT +cobertura I-TREATMENT +del I-TREATMENT +hasta I-TREATMENT +peniana I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +recogida I-TREATMENT +de I-TREATMENT +injertos I-TREATMENT +cutáneos I-TREATMENT +de I-TREATMENT +piel I-TREATMENT +parcial I-TREATMENT +a I-TREATMENT +nivel I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +que I-TREATMENT +fueron I-TREATMENT +colocados I-TREATMENT +directamente I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +fascia I-TREATMENT +de I-TREATMENT +Buck, I-TREATMENT +en I-TREATMENT +disposición I-TREATMENT +helicoidal. I-TREATMENT +Los I-TREATMENT +drenos I-TREATMENT +fueron I-TREATMENT +retirados I-TREATMENT +el I-TREATMENT +segundo I-TREATMENT +día I-TREATMENT +postoperatorio I-TREATMENT +y I-TREATMENT +el I-TREATMENT +apósito I-TREATMENT +compresivo I-TREATMENT +el I-TREATMENT +quinto I-TREATMENT +día I-TREATMENT +verificándose I-TREATMENT +viabilidad I-TREATMENT +total I-TREATMENT +del I-TREATMENT +material I-TREATMENT +injertado. I-TREATMENT + I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +era I-TREATMENT +notoria I-TREATMENT +la I-TREATMENT +consistencia I-TREATMENT +gelatinosa I-TREATMENT +acentuada I-TREATMENT +de I-TREATMENT +las I-TREATMENT +túnicas, I-TREATMENT +con I-TREATMENT +aparente I-TREATMENT +aspecto I-TREATMENT +translúcido I-TREATMENT +y I-TREATMENT +exudación I-TREATMENT +acentuada. I-TREATMENT +La I-TREATMENT +pieza I-TREATMENT +quirúrgica I-TREATMENT +comprendiendo I-TREATMENT +piel I-TREATMENT +peniana I-TREATMENT +y I-TREATMENT +escrotal I-TREATMENT +afectada I-TREATMENT +totalizaba I-TREATMENT +1, I-TREATMENT +05 I-TREATMENT +Kg. I-TREATMENT +El B-EXPLORATION +resultado I-EXPLORATION +anatomo-patológico I-EXPLORATION +puso I-EXPLORATION +en I-EXPLORATION +evidencia I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +mixoide I-EXPLORATION +hipocelular I-EXPLORATION +con I-EXPLORATION +abundante I-EXPLORATION +estroma I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +fusiformes, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +atipia I-EXPLORATION +celular I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +mitosis, I-EXPLORATION +infiltrante I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +componente I-EXPLORATION +prominente I-EXPLORATION +de I-EXPLORATION +vasos I-EXPLORATION +de I-EXPLORATION +calibre I-EXPLORATION +variado I-EXPLORATION +y I-EXPLORATION +ectasiados. I-EXPLORATION +Inmunohistoquímica: I-EXPLORATION +vimentina I-EXPLORATION ++; I-EXPLORATION +CD I-EXPLORATION +34 I-EXPLORATION ++; I-EXPLORATION +desmina I-EXPLORATION +e I-EXPLORATION +actina I-EXPLORATION +negativos. I-EXPLORATION +Conclusión: I-EXPLORATION +aspectos I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +angiomixoma I-EXPLORATION +agresivo. I-EXPLORATION + I-EXPLORATION +Después B-EVOLUTION +de I-EVOLUTION +13 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +bien, I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +clínica I-EVOLUTION +de I-EVOLUTION +recidiva I-EVOLUTION +y I-EVOLUTION +satisfecho I-EVOLUTION +del I-EVOLUTION +punto I-EVOLUTION +de I-EVOLUTION +vista I-EVOLUTION +estético. I-EVOLUTION + I-EVOLUTION + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +34 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +suprapúbico, I-PRESENT_ILLNESS +polaquiuria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +nicturia. I-PRESENT_ILLNESS +Sin B-EXPLORATION +hallazgos I-EXPLORATION +de I-EXPLORATION +laboratorio. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +cistoscopía I-EXPLORATION +se I-EXPLORATION +evidencian I-EXPLORATION +glomerulaciones I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +distención I-EXPLORATION +vesical. I-EXPLORATION +Una I-EXPLORATION +biopsia I-EXPLORATION +vesical I-EXPLORATION +randomizadas I-EXPLORATION +revela I-EXPLORATION +mucosa I-EXPLORATION +vesical I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +perivascular I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +eosinófilos. I-EXPLORATION +Se I-EXPLORATION +diagnóstica I-EXPLORATION +cistitis I-EXPLORATION +eosinofílica. I-EXPLORATION +Inicialmente B-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +instilaciones I-TREATMENT +vesicales I-TREATMENT +de I-TREATMENT +heparina I-TREATMENT +y I-TREATMENT +corticoides, I-TREATMENT +sin I-TREATMENT +embargo I-TREATMENT +persistió I-TREATMENT +con I-TREATMENT +frecuencia I-TREATMENT +miccional I-TREATMENT +de I-TREATMENT +20/6. I-TREATMENT +Posteriormente I-TREATMENT +se I-TREATMENT +uso I-TREATMENT +amitriptilina, I-TREATMENT +oxibutinina I-TREATMENT +y I-TREATMENT +teltoridona I-TREATMENT +sin I-TREATMENT +respuesta. I-TREATMENT +Estudio B-EXPLORATION +urodinamico I-EXPLORATION +revela I-EXPLORATION +vejiga I-EXPLORATION +inestable I-EXPLORATION +sensitiva I-EXPLORATION +durante I-EXPLORATION +fase I-EXPLORATION +de I-EXPLORATION +continencia. I-EXPLORATION +Se I-EXPLORATION +repite I-EXPLORATION +cistoscopía I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +significativos. I-EXPLORATION +Una I-EXPLORATION +nueva I-EXPLORATION +biopsia I-EXPLORATION +revela I-EXPLORATION +inflamación I-EXPLORATION +inespecífica. I-EXPLORATION +Se B-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Hidroxicina I-TREATMENT +20 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +más I-TREATMENT +Diclofenaco I-TREATMENT +sódico I-TREATMENT +50 I-TREATMENT +mg. I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h, I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta. I-TREATMENT +El B-EVOLUTION +dolor I-EVOLUTION +cedió I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +frecuencia I-EVOLUTION +miccional I-EVOLUTION +disminuyó I-EVOLUTION +a I-EVOLUTION +6/0, I-EVOLUTION +con I-EVOLUTION +mayor I-EVOLUTION +volumen I-EVOLUTION +miccional. I-EVOLUTION +Por B-TREATMENT +somnolencia I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +antihistamínico I-TREATMENT +a I-TREATMENT +Cetirizina, I-TREATMENT +con I-TREATMENT +igual I-TREATMENT +respuesta. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +8-10 I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hematuria I-PRESENT_ILLNESS +macroscópica, I-PRESENT_ILLNESS +indolora I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +coágulos. I-PRESENT_ILLNESS +Asimismo I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +frecuencia I-PRESENT_ILLNESS +miccional, I-PRESENT_ILLNESS +escozor I-PRESENT_ILLNESS +miccional I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tenesmo I-PRESENT_ILLNESS +vesical, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +seguido I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +ciprofloxacino I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +Diclofenaco I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +evidenciar I-PRESENT_ILLNESS +mejoría. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +no I-EXPLORATION +evidencia I-EXPLORATION +ningún I-EXPLORATION +signo I-EXPLORATION +de I-EXPLORATION +interés I-EXPLORATION +(trayectos I-EXPLORATION +uretero-renales I-EXPLORATION +no I-EXPLORATION +dolorosos, I-EXPLORATION +puño I-EXPLORATION +percusión I-EXPLORATION +bilateral I-EXPLORATION +negativa). I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +ecografía I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +intravesical I-EXPLORATION +de I-EXPLORATION +35, I-EXPLORATION +7 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo, I-EXPLORATION +con I-EXPLORATION +unos I-EXPLORATION +riñones I-EXPLORATION +ecográficamente I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +cistoscopia I-EXPLORATION +flexible, I-EXPLORATION +que I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +bilobulada I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +infiltrante I-EXPLORATION +con I-EXPLORATION +áreas I-EXPLORATION +parcialmente I-EXPLORATION +necróticas I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +superficie. I-EXPLORATION + I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +Tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +tóraco-abdominal, I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +y I-EXPLORATION +Resección I-EXPLORATION +trans-uretral I-EXPLORATION +(RTU) I-EXPLORATION +biopsia I-EXPLORATION +para I-EXPLORATION +establecer I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +y I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +extensión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +enfermedad. I-EXPLORATION +La I-EXPLORATION +TC I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +vesical I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +cm. I-EXPLORATION +de I-EXPLORATION +diámetro I-EXPLORATION +máximo, I-EXPLORATION +bien I-EXPLORATION +definida I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +perivesical, I-EXPLORATION +ni I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +significativo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +extensión I-EXPLORATION +se I-EXPLORATION +completó I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +gammagrafía I-EXPLORATION +ósea I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +RTU I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +mesenquimal, I-EXPLORATION +fusocelular, I-EXPLORATION +con I-EXPLORATION +haces I-EXPLORATION +largos I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +fusiformes I-EXPLORATION +y I-EXPLORATION +frecuentes I-EXPLORATION +mitosis. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +intensa I-EXPLORATION +inmunorreactividad I-EXPLORATION +con I-EXPLORATION +vimentina I-EXPLORATION +y I-EXPLORATION +actina I-EXPLORATION +muscular I-EXPLORATION +específica. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +leiomiosarcoma I-TREATMENT +vesical I-TREATMENT +clínicamente I-TREATMENT +localizado I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +realizar I-TREATMENT +exenteración I-TREATMENT +pélvica I-TREATMENT +anterior I-TREATMENT +(cistectomía I-TREATMENT +radical, I-TREATMENT +histerectomía I-TREATMENT +más I-TREATMENT +doble I-TREATMENT +anexectomía I-TREATMENT +y I-TREATMENT +derivación I-TREATMENT +urinaria I-TREATMENT +ileal). I-TREATMENT + I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +tumoración I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vejiga I-EXPLORATION +de I-EXPLORATION +crecimiento I-EXPLORATION +exofítico I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +de I-EXPLORATION +8, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +6 I-EXPLORATION +x I-EXPLORATION +4 I-EXPLORATION +cm, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +pedículo I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION + I-EXPLORATION +Era I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +mesenquimal I-EXPLORATION +maligno I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +alargadas, I-EXPLORATION +de I-EXPLORATION +nucleolos I-EXPLORATION +longilíneos I-EXPLORATION +bordes I-EXPLORATION +romos I-EXPLORATION +y I-EXPLORATION +citoplasmas I-EXPLORATION +fibrilares. I-EXPLORATION +En I-EXPLORATION +algunas I-EXPLORATION +zonas I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +figuras I-EXPLORATION +de I-EXPLORATION +mitosis I-EXPLORATION +(20 I-EXPLORATION +mitosis I-EXPLORATION +por I-EXPLORATION +10 I-EXPLORATION +campos I-EXPLORATION +de I-EXPLORATION +gran I-EXPLORATION +aumento). I-EXPLORATION +El I-EXPLORATION +tumor I-EXPLORATION +se I-EXPLORATION +alojaba I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +vesical, I-EXPLORATION +sin I-EXPLORATION +infiltrar I-EXPLORATION +el I-EXPLORATION +urotelio I-EXPLORATION +de I-EXPLORATION +superficie, I-EXPLORATION +ni I-EXPLORATION +la I-EXPLORATION +capa I-EXPLORATION +muscular I-EXPLORATION +propia I-EXPLORATION +vesical, I-EXPLORATION +presentando I-EXPLORATION +su I-EXPLORATION +origen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +capa I-EXPLORATION +muscular I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +submucosa I-EXPLORATION +(Muscularis I-EXPLORATION +Mucosae). I-EXPLORATION + I-EXPLORATION +Tanto I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +ganglios I-EXPLORATION +iliacos I-EXPLORATION +e I-EXPLORATION +ilio-obturatrices, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +perivesical I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +estructuras I-EXPLORATION +estudiadas, I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +ninguna I-EXPLORATION +alteración. I-EXPLORATION + I-EXPLORATION +Tras B-EVOLUTION +un I-EVOLUTION +postoperatorio I-EVOLUTION +sin I-EVOLUTION +incidencias I-EVOLUTION +relevantes, I-EVOLUTION +se B-TREATMENT +decidió I-TREATMENT +completar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +quimioterapia I-TREATMENT +adyuvante I-TREATMENT +que I-TREATMENT +la I-TREATMENT +paciente, I-TREATMENT +con I-TREATMENT +Adriamicina I-TREATMENT +e I-TREATMENT +Ifosfamida I-TREATMENT +realizó I-TREATMENT +en I-TREATMENT +su I-TREATMENT +Centro I-TREATMENT +de I-TREATMENT +referencia, I-TREATMENT +recibiendo I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +ciclos I-TREATMENT +(1 I-TREATMENT +mensual) I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +tolerancia. I-TREATMENT +Se I-TREATMENT +retrasó I-TREATMENT +el I-TREATMENT +inicio I-TREATMENT +del I-TREATMENT +ciclo I-TREATMENT +en I-TREATMENT +una I-TREATMENT +ocasión I-TREATMENT +por I-TREATMENT +fiebre. I-TREATMENT + I-TREATMENT +Al B-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +finalizar I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +complementario I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +recidiva I-EVOLUTION +locorregional I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +T.C. I-EVOLUTION +realizada I-EVOLUTION +durante I-EVOLUTION +una I-EVOLUTION +revisión. I-EVOLUTION +Por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +la I-TREATMENT +extirpación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +lesión, I-TREATMENT +con I-TREATMENT +informe I-TREATMENT +anatomopatológico I-TREATMENT +de I-TREATMENT +leiomiosarcoma I-TREATMENT +de I-TREATMENT +6, I-TREATMENT +5 I-TREATMENT +cms. I-TREATMENT +de I-TREATMENT +diámetro I-TREATMENT +con I-TREATMENT +un I-TREATMENT +borde I-TREATMENT +afecto. I-TREATMENT +Se I-TREATMENT +decidió I-TREATMENT +completar I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +quicio-radioterapia I-TREATMENT +adyuvante, I-TREATMENT +con I-TREATMENT +régimen I-TREATMENT +quimioterápico I-TREATMENT +basado I-TREATMENT +en I-TREATMENT +Ifosfamida I-TREATMENT +a I-TREATMENT +altas I-TREATMENT +dosis I-TREATMENT +(3.520 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +por I-TREATMENT +5 I-TREATMENT +días), I-TREATMENT +de I-TREATMENT +los I-TREATMENT +cuales I-TREATMENT +se I-TREATMENT +ha I-TREATMENT +administrado I-TREATMENT +6 I-TREATMENT +ciclos, I-TREATMENT +uno I-TREATMENT +mensual. I-TREATMENT +Una I-TREATMENT +vez I-TREATMENT +completados I-TREATMENT +los I-TREATMENT +2 I-TREATMENT +primeros I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +quimioterapia, I-TREATMENT +recibió I-TREATMENT +radioterapia I-TREATMENT +externa, I-TREATMENT +a I-TREATMENT +razón I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +8 I-TREATMENT +Gy/día, I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +total I-TREATMENT +de I-TREATMENT +45 I-TREATMENT +Gy I-TREATMENT +sobre I-TREATMENT +lecho I-TREATMENT +tumoral I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +una I-TREATMENT +sobreimpresión I-TREATMENT +pélvica I-TREATMENT +con I-TREATMENT +16 I-TREATMENT +Gy I-TREATMENT +hasta I-TREATMENT +completar I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +pélvica I-TREATMENT +de I-TREATMENT +61 I-TREATMENT +Gy. I-TREATMENT +Posteriormente B-EVOLUTION +pasó I-EVOLUTION +a I-EVOLUTION +revisiones I-EVOLUTION +periódicas. I-EVOLUTION + I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +ocho I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +haber I-EVOLUTION +finalizado I-EVOLUTION +el I-EVOLUTION +segundo I-EVOLUTION +tratamiento I-EVOLUTION +adyuvante, I-EVOLUTION +32 I-EVOLUTION +meses I-EVOLUTION +desde I-EVOLUTION +el I-EVOLUTION +diagnóstico, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +vuelve I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +una I-EVOLUTION +recidiva I-EVOLUTION +pélvica I-EVOLUTION +de I-EVOLUTION +5 I-EVOLUTION +x I-EVOLUTION +5, I-EVOLUTION +8 I-EVOLUTION +cm., I-EVOLUTION +con I-EVOLUTION +probable I-EVOLUTION +infiltración I-EVOLUTION +de I-EVOLUTION +recto-sigma I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +vejiga I-EVOLUTION +ileal. I-EVOLUTION +Se B-TREATMENT +realiza I-TREATMENT +rectosigmoidoscopia I-TREATMENT +con I-TREATMENT +punción I-TREATMENT +aspiración I-TREATMENT +con I-TREATMENT +aguja I-TREATMENT +fina, I-TREATMENT +con I-TREATMENT +resultado I-TREATMENT +anatomopatológico I-TREATMENT +de I-TREATMENT +citología I-TREATMENT +maligna, I-TREATMENT +sarcoma I-TREATMENT +fusocelular I-TREATMENT +compatible I-TREATMENT +con I-TREATMENT +leiomiosarcoma. I-TREATMENT +Se B-EXPLORATION +ha I-EXPLORATION +realizado I-EXPLORATION +estudio I-EXPLORATION +inmunohistoquímico I-EXPLORATION +con I-EXPLORATION +anticuerpos I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +Caldesmón I-EXPLORATION +y I-EXPLORATION +Miosina I-EXPLORATION +de I-EXPLORATION +músculo I-EXPLORATION +liso, I-EXPLORATION +observándose I-EXPLORATION +inmunorreactividad I-EXPLORATION +intensa I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +tumorales I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +ambos I-EXPLORATION +anticuerpos. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +segunda I-TREATMENT +recidiva I-TREATMENT +se I-TREATMENT +recomendó I-TREATMENT +realizar I-TREATMENT +resección I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +consolidación I-TREATMENT +con I-TREATMENT +braquiterapia. I-TREATMENT +La I-TREATMENT +paciente I-TREATMENT +desestimó I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +cirugía I-TREATMENT +con I-TREATMENT +braquiterapia I-TREATMENT +por I-TREATMENT +miedo I-TREATMENT +a I-TREATMENT +las I-TREATMENT +complicaciones I-TREATMENT +de I-TREATMENT +la I-TREATMENT +braquiterapia, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +fue I-TREATMENT +intervenida I-TREATMENT +en I-TREATMENT +otro I-TREATMENT +centro, I-TREATMENT +realizando I-TREATMENT +exenteración I-TREATMENT +pélvica I-TREATMENT +posterior. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +control I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +presentar I-EVOLUTION +una I-EVOLUTION +nueva I-EVOLUTION +recidiva, I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +incisión, I-EVOLUTION +realizándose B-TREATMENT +resección I-TREATMENT +del I-TREATMENT +mismo. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +y I-EVOLUTION +41 I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +inicial, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática, I-EVOLUTION +en I-EVOLUTION +controles I-EVOLUTION +periódicos I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +enfermedad. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +68 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal I-EXPLORATION +(IMC) I-EXPLORATION +de I-EXPLORATION +31, I-EXPLORATION +2, I-EXPLORATION +que B-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cáncer I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +próstata I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +estadio I-PRESENT_ILLNESS +T2a I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +examen I-PRESENT_ILLNESS +(antígeno I-PRESENT_ILLNESS +prostático I-PRESENT_ILLNESS +específico I-PRESENT_ILLNESS +[PSA], I-PRESENT_ILLNESS +3, I-PRESENT_ILLNESS +18 I-PRESENT_ILLNESS +ng/ml). I-PRESENT_ILLNESS +Tenía B-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +clínica I-PAST_MEDICAL_HISTORY +anterior I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión, I-PAST_MEDICAL_HISTORY +diabetes, I-PAST_MEDICAL_HISTORY +hiperlipemia, I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cirrosis. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Antes B-TREATMENT +de I-TREATMENT +la I-TREATMENT +cirugía, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +tenía I-TREATMENT +vendaje I-TREATMENT +espiral I-TREATMENT +y I-TREATMENT +dispositivos I-TREATMENT +de I-TREATMENT +compresión I-TREATMENT +intermitente I-TREATMENT +en I-TREATMENT +ambas I-TREATMENT +extremidades I-TREATMENT +inferiores I-TREATMENT +para I-TREATMENT +prevenir I-TREATMENT +trombosis I-TREATMENT +venosa I-TREATMENT +profunda I-TREATMENT +(TVP). I-TREATMENT +Tras I-TREATMENT +administrar I-TREATMENT +anestesia I-TREATMENT +combinada I-TREATMENT +general-espinal, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +colocado I-TREATMENT +en I-TREATMENT +posición I-TREATMENT +de I-TREATMENT +Trendelenburg I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +PRL I-TREATMENT +extraperitoneal, I-TREATMENT +con I-TREATMENT +preservación I-TREATMENT +nerviosa I-TREATMENT +bilateral. I-TREATMENT +Su I-TREATMENT +presión I-TREATMENT +sanguínea I-TREATMENT +en I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +de I-TREATMENT +administrar I-TREATMENT +la I-TREATMENT +anestesia I-TREATMENT +era I-TREATMENT +de I-TREATMENT +150/80 I-TREATMENT +mmHg I-TREATMENT +y I-TREATMENT +permaneció I-TREATMENT +por I-TREATMENT +debajo I-TREATMENT +de I-TREATMENT +este I-TREATMENT +nivel I-TREATMENT +durante I-TREATMENT +todo I-TREATMENT +el I-TREATMENT +procedimiento. I-TREATMENT +La I-TREATMENT +operación I-TREATMENT +duró I-TREATMENT +360 I-TREATMENT +min I-TREATMENT +y I-TREATMENT +la I-TREATMENT +pérdida I-TREATMENT +de I-TREATMENT +sangre I-TREATMENT +fue I-TREATMENT +de I-TREATMENT +1.000 I-TREATMENT +ml. I-TREATMENT +El I-TREATMENT +sangrado I-TREATMENT +ocurrió I-TREATMENT +durante I-TREATMENT +el I-TREATMENT +control I-TREATMENT +de I-TREATMENT +pedículos I-TREATMENT +vasculares I-TREATMENT +y I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +del I-TREATMENT +paquete I-TREATMENT +neurovascular. I-TREATMENT +La B-EXPLORATION +patología I-EXPLORATION +quirúrgica I-EXPLORATION +reveló I-EXPLORATION +una I-EXPLORATION +próstata I-EXPLORATION +de I-EXPLORATION +55 I-EXPLORATION +g, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +adenocarcinoma I-EXPLORATION +en I-EXPLORATION +estadio I-EXPLORATION +T2a I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +puntuación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +escala I-EXPLORATION +de I-EXPLORATION +Gleason I-EXPLORATION +6 I-EXPLORATION +con I-EXPLORATION +márgenes I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +el I-EVOLUTION +primer I-EVOLUTION +día I-EVOLUTION +posquirúrgico, I-EVOLUTION +comenzó I-EVOLUTION +a I-EVOLUTION +quejarse I-EVOLUTION +de I-EVOLUTION +entumecimiento I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +pierna I-EVOLUTION +derecha, I-EVOLUTION +que I-EVOLUTION +estaba I-EVOLUTION +inflamada I-EVOLUTION +y I-EVOLUTION +blanda I-EVOLUTION +al I-EVOLUTION +tacto. I-EVOLUTION +Los B-EXPLORATION +pulsos I-EXPLORATION +pedios I-EXPLORATION +estaban I-EXPLORATION +presentes I-EXPLORATION +de I-EXPLORATION +forma I-EXPLORATION +bilateral. I-EXPLORATION +Sospechamos I-EXPLORATION +una I-EXPLORATION +TVP I-EXPLORATION +y I-EXPLORATION +pedimos I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +Doppler, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +permeabilidad I-EXPLORATION +del I-EXPLORATION +sistema I-EXPLORATION +venoso I-EXPLORATION +profundo. I-EXPLORATION +Su I-EXPLORATION +creatinina I-EXPLORATION +sérica I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +creatina I-EXPLORATION +fosfocinasa I-EXPLORATION +llegó I-EXPLORATION +hasta I-EXPLORATION +23.000 I-EXPLORATION +U/l. I-EXPLORATION +Aunque B-TREATMENT +el I-TREATMENT +Doppler I-TREATMENT +fue I-TREATMENT +normal, I-TREATMENT +se I-TREATMENT +diagnosticó I-TREATMENT +una I-TREATMENT +TVP I-TREATMENT +con I-TREATMENT +rabdomiólisis I-TREATMENT +secundaria I-TREATMENT +y I-TREATMENT +fallo I-TREATMENT +renal I-TREATMENT +sobre I-TREATMENT +la I-TREATMENT +base I-TREATMENT +de I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +clínicos, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +comenzó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +heparina. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +los I-EVOLUTION +días I-EVOLUTION +posquirúrgicos I-EVOLUTION +siguientes, I-EVOLUTION +aunque I-EVOLUTION +los I-EVOLUTION +pulsos I-EVOLUTION +pedios I-EVOLUTION +seguían I-EVOLUTION +siendo I-EVOLUTION +palpables I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +valores I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +sérica I-EVOLUTION +y I-EVOLUTION +creatina I-EVOLUTION +fosfocinasa I-EVOLUTION +mejoraban, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentaba I-EVOLUTION +un I-EVOLUTION +empeoramiento I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +dolor I-EVOLUTION +intermitente. I-EVOLUTION +Se B-EXPLORATION +repitieron I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +Doppler, I-EXPLORATION +que I-EXPLORATION +excluyeron I-EXPLORATION +TVP I-EXPLORATION +y I-EXPLORATION +mostraron I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +de I-EXPLORATION +alta I-EXPLORATION +resistencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +arterias I-EXPLORATION +tibiales I-EXPLORATION +derechas. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +sometido I-TREATMENT +a I-TREATMENT +una I-TREATMENT +fasciotomía I-TREATMENT +de I-TREATMENT +cuatro I-TREATMENT +compartimentos I-TREATMENT +por I-TREATMENT +el I-TREATMENT +SC I-TREATMENT +de I-TREATMENT +la I-TREATMENT +pierna. I-TREATMENT +Los I-TREATMENT +músculos I-TREATMENT +sobresalían I-TREATMENT +fácilmente I-TREATMENT +a I-TREATMENT +medida I-TREATMENT +que I-TREATMENT +se I-TREATMENT +seccionaba I-TREATMENT +la I-TREATMENT +fascia I-TREATMENT +suprayacente. I-TREATMENT +Había I-TREATMENT +áreas I-TREATMENT +de I-TREATMENT +necrosis I-TREATMENT +focal I-TREATMENT +que I-TREATMENT +fueron I-TREATMENT +eliminadas. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +postoperatorio, I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +fue I-EVOLUTION +remitiendo I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +capaz I-EVOLUTION +de I-EVOLUTION +caminar I-EVOLUTION +con I-EVOLUTION +ayuda. I-EVOLUTION +Las I-EVOLUTION +heridas I-EVOLUTION +se I-EVOLUTION +cerraron I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +14 I-EVOLUTION +días I-EVOLUTION +posteriores I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +fasciotomía. I-EVOLUTION + I-EVOLUTION +Seis I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +PRL, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +recuperó I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +capaz I-EVOLUTION +de I-EVOLUTION +caminar I-EVOLUTION +sin I-EVOLUTION +ayuda, I-EVOLUTION +pero I-EVOLUTION +aún I-EVOLUTION +presenta I-EVOLUTION +dolor I-EVOLUTION +neuropático I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +empeine I-EVOLUTION +del I-EVOLUTION +pie I-EVOLUTION +derecho. I-EVOLUTION +Su I-EVOLUTION +PSA I-EVOLUTION +estaba I-EVOLUTION +por I-EVOLUTION +debajo I-EVOLUTION +de I-EVOLUTION +0, I-EVOLUTION +04 I-EVOLUTION +ng/ml, I-EVOLUTION +usaba I-EVOLUTION +pañal I-EVOLUTION +diario I-EVOLUTION +por I-EVOLUTION +una I-EVOLUTION +leve I-EVOLUTION +incontinencia I-EVOLUTION +por I-EVOLUTION +esfuerzo I-EVOLUTION +y I-EVOLUTION +aún I-EVOLUTION +no I-EVOLUTION +había I-EVOLUTION +recuperado I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +sexual. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +derivado B-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +plástica I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +reconstrucción I-DERIVED_FROM/TO +escrotal I-DERIVED_FROM/TO +después I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +inicial I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urología I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +desbridamiento I-DERIVED_FROM/TO +quirúrgico I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +soporte I-DERIVED_FROM/TO +médico I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +2 I-DERIVED_FROM/TO +semanas. I-DERIVED_FROM/TO +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes: I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +mal I-PAST_MEDICAL_HISTORY +controlada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +16 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +necesidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hemodiálisis I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +veces I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +semana. I-PAST_MEDICAL_HISTORY +Había B-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +sometido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +amputación I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +isquemia. I-PRESENT_ILLNESS +El B-TREATMENT +colgajo I-TREATMENT +pediculado I-TREATMENT +fasciocutáneo I-TREATMENT +del I-TREATMENT +muslo I-TREATMENT +fue I-TREATMENT +usado I-TREATMENT +con I-TREATMENT +buenos I-TREATMENT +resultados I-TREATMENT +para I-TREATMENT +la I-TREATMENT +reconstrucción I-TREATMENT +del I-TREATMENT +escroto. I-TREATMENT +En I-TREATMENT +el I-TREATMENT +posoperatorio I-TREATMENT +(al I-TREATMENT +4.o I-TREATMENT +día), I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +desarrolló I-TREATMENT +un I-TREATMENT +edema I-TREATMENT +agudo I-TREATMENT +de I-TREATMENT +pulmón, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +resolvió I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +médico. I-TREATMENT +No B-EVOLUTION +hubo I-EVOLUTION +necrosis I-EVOLUTION +del I-EVOLUTION +colgajo I-EVOLUTION +ni I-EVOLUTION +se I-EVOLUTION +produjeron I-EVOLUTION +infecciones. I-EVOLUTION +Fue B-TREATMENT +necesario I-TREATMENT +proceder I-TREATMENT +a I-TREATMENT +la I-TREATMENT +remodelación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +porción I-TREATMENT +inferomedial I-TREATMENT +del I-TREATMENT +colgajo I-TREATMENT +por I-TREATMENT +dehiscencia I-TREATMENT +parcial I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sutura. I-TREATMENT +Se B-EVOLUTION +dio I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +del I-EVOLUTION +servicio I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +2 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +internamiento. I-EVOLUTION + I-EVOLUTION + +Masculino B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sentado I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +cinturón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seguridad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +parte I-PRESENT_ILLNESS +trasera I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +automóvil, I-PRESENT_ILLNESS +participó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +automovilístico. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +mantuvo I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +asiento I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +evento I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +conocimiento I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +arribo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +paramédicos. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +ocurrió I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +área I-PRESENT_ILLNESS +rural I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +traslado I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +DUP I-PRESENT_ILLNESS +duró I-PRESENT_ILLNESS +aprox. I-PRESENT_ILLNESS +90min. I-PRESENT_ILLNESS +Fue I-PRESENT_ILLNESS +transportado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +collarín I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inmovilizado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +decúbito I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tabla I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +protección. I-PRESENT_ILLNESS +Los B-EXPLORATION +signos I-EXPLORATION +vitales I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +llegada: I-EXPLORATION +temperatura, I-EXPLORATION +36, I-EXPLORATION +5oC; I-EXPLORATION +pulso, I-EXPLORATION +84/min; I-EXPLORATION +PA, I-EXPLORATION +110/63mm I-EXPLORATION +Hg I-EXPLORATION +y I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +14. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +(EF) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +DUP I-EXPLORATION +presentó I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +leve, I-EXPLORATION +escoriaciones I-EXPLORATION +en I-EXPLORATION +diferentes I-EXPLORATION +partes I-EXPLORATION +del I-EXPLORATION +cuerpo, I-EXPLORATION +sin I-EXPLORATION +embargo I-EXPLORATION +el I-EXPLORATION +ultrasonido I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +rayos I-EXPLORATION +X I-EXPLORATION +solo I-EXPLORATION +evidenciaron I-EXPLORATION +rectificación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +columna I-EXPLORATION +cervical. I-EXPLORATION +Estudios I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +hemoglobina I-EXPLORATION +y I-EXPLORATION +creatinina I-EXPLORATION +normales; I-EXPLORATION +examen I-EXPLORATION +de I-EXPLORATION +orina: I-EXPLORATION +microhematuria. I-EXPLORATION +Después B-EVOLUTION +de I-EVOLUTION +algunas I-EVOLUTION +horas, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +hemotórax I-EVOLUTION +y I-EVOLUTION +continúo I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +abdominal. I-EVOLUTION +Se B-TREATMENT +le I-TREATMENT +colocó I-TREATMENT +sonda I-TREATMENT +en I-TREATMENT +tórax I-TREATMENT +en I-TREATMENT +el I-TREATMENT +hemitórax I-TREATMENT +izquierdo I-TREATMENT +y B-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +contrastada. I-EXPLORATION +Al I-EXPLORATION +valorar I-EXPLORATION +la I-EXPLORATION +TAC, I-EXPLORATION +el I-EXPLORATION +caso I-EXPLORATION +fue I-EXPLORATION +comentado I-EXPLORATION +con I-EXPLORATION +nuestro I-EXPLORATION +departamento. I-EXPLORATION +En I-EXPLORATION +este I-EXPLORATION +momento I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +contaba I-EXPLORATION +con I-EXPLORATION +8hrs I-EXPLORATION +en I-EXPLORATION +observación. I-EXPLORATION +En I-EXPLORATION +nuestra I-EXPLORATION +evaluación, I-EXPLORATION +observamos I-EXPLORATION +equimosis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +flanco I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +drenaje I-EXPLORATION +escaso I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +sonda I-EXPLORATION +en I-EXPLORATION +tórax. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +izquierdo I-EXPLORATION +sin I-EXPLORATION +captación I-EXPLORATION +de I-EXPLORATION +medio I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +pequeño I-EXPLORATION +hematoma I-EXPLORATION +esplénico. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +manejar I-TREATMENT +conservadoramente. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +egresado I-EVOLUTION +6 I-EVOLUTION +días I-EVOLUTION +después. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +58 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución, I-PAST_MEDICAL_HISTORY +tratado I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +controlado. I-PAST_MEDICAL_HISTORY +Como I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +patológico I-PAST_MEDICAL_HISTORY +relevante I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +habia I-PAST_MEDICAL_HISTORY +advertido I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +masa I-PAST_MEDICAL_HISTORY +abdominal I-PAST_MEDICAL_HISTORY +palpable I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pulsátil I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +mes. I-PAST_MEDICAL_HISTORY +Diez B-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +intenso. I-PRESENT_ILLNESS +La B-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +abdominal I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +aneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +infrarrenal, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +que I-EXPLORATION +involucra I-EXPLORATION +y I-EXPLORATION +lo I-EXPLORATION +adhiere I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +tercera I-EXPLORATION +porción I-EXPLORATION +del I-EXPLORATION +duodeno. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +solicitó I-TREATMENT +el I-TREATMENT +alta I-TREATMENT +voluntaria I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +propuesta I-TREATMENT +quirúrgica. I-TREATMENT +Cinco B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +reingresó I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Terapia I-EVOLUTION +Intensiva I-EVOLUTION +por I-EVOLUTION +presentar I-EVOLUTION +hemorragia I-EVOLUTION +digestiva I-EVOLUTION +alta I-EVOLUTION +manifestada I-EVOLUTION +por I-EVOLUTION +hematemesis I-EVOLUTION +y I-EVOLUTION +melena I-EVOLUTION +de I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +shock I-EVOLUTION +hipovolémico, I-EVOLUTION +tensión I-EVOLUTION +arterial I-EVOLUTION +media I-EVOLUTION +(TAM) I-EVOLUTION +30 I-EVOLUTION +mmHg, I-EVOLUTION +frecuencia I-EVOLUTION +cardíaca I-EVOLUTION +(FC): I-EVOLUTION +140 I-EVOLUTION +lpm I-EVOLUTION +y I-EVOLUTION +hematocrito I-EVOLUTION +del I-EVOLUTION +18%. I-EVOLUTION +Una B-EXPLORATION +vez I-EXPLORATION +compensado I-EXPLORATION +el I-EXPLORATION +trastorno I-EXPLORATION +hemodinámico, I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +fibroendoscopia I-EXPLORATION +digestiva I-EXPLORATION +alta, I-EXPLORATION +constatándose I-EXPLORATION +sangrado I-EXPLORATION +activo I-EXPLORATION +en I-EXPLORATION +cara I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +tercera I-EXPLORATION +porción I-EXPLORATION +duodenal. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +entonces I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +por I-TREATMENT +resangrado I-TREATMENT +masivo, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +hallazgo I-TREATMENT +intraoperatorio I-TREATMENT +de I-TREATMENT +aneurisma I-TREATMENT +de I-TREATMENT +aorta I-TREATMENT +abdominal I-TREATMENT +infrarrenal I-TREATMENT +sacular I-TREATMENT +adherido I-TREATMENT +a I-TREATMENT +la I-TREATMENT +cara I-TREATMENT +posterior I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tercera I-TREATMENT +porción I-TREATMENT +duodenal I-TREATMENT +con I-TREATMENT +comunicación I-TREATMENT +a I-TREATMENT +la I-TREATMENT +luz I-TREATMENT +de I-TREATMENT +dicho I-TREATMENT +órgano I-TREATMENT +por I-TREATMENT +un I-TREATMENT +orificio I-TREATMENT +de I-TREATMENT +unos I-TREATMENT +4 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +diámetro. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +un I-TREATMENT +by-pass I-TREATMENT +aorto-bifemoral. I-TREATMENT +Debido B-EVOLUTION +al I-EVOLUTION +grave I-EVOLUTION +compromiso I-EVOLUTION +hemodinámico I-EVOLUTION +presentó I-EVOLUTION +paro I-EVOLUTION +cardiorrespiratorio I-EVOLUTION +en I-EVOLUTION +quirófano, I-EVOLUTION +falleciendo I-EVOLUTION +pocas I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Terapia I-EVOLUTION +Intensiva. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +51 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cirugía I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +disección I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +aorta I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +clasificación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Stanford, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +colocación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +prótesis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +teflón, I-PAST_MEDICAL_HISTORY +cuatro I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +consulta. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Una B-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +previa I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Terapia I-PRESENT_ILLNESS +Intensiva I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +melena I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lipotimia. I-PRESENT_ILLNESS +Ingresó I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hematemesis I-PRESENT_ILLNESS +abundante I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +melena I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +shock I-PRESENT_ILLNESS +hipovolémico, I-PRESENT_ILLNESS +siendo B-TREATMENT +estabilizado I-TREATMENT +con I-TREATMENT +fluidos. I-TREATMENT +Un B-EVOLUTION +nuevo I-EVOLUTION +episodio I-EVOLUTION +de I-EVOLUTION +hematemesis I-EVOLUTION +masiva I-EVOLUTION +lo I-EVOLUTION +lleva I-EVOLUTION +al I-EVOLUTION +paro I-EVOLUTION +cardiorrespiratorio I-EVOLUTION +y B-TREATMENT +tras I-TREATMENT +una I-TREATMENT +adecuada I-TREATMENT +resucitación I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +intervención I-TREATMENT +quirúrgica, I-TREATMENT +con I-TREATMENT +el I-TREATMENT +hallazgo I-TREATMENT +quirúrgico I-TREATMENT +de I-TREATMENT +FAE I-TREATMENT +al I-TREATMENT +nivel I-TREATMENT +de I-TREATMENT +la I-TREATMENT +tercera I-TREATMENT +porción I-TREATMENT +duodenal, I-TREATMENT +y I-TREATMENT +un I-TREATMENT +orificio I-TREATMENT +de I-TREATMENT +2 I-TREATMENT +x I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +diámetro. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +cierre I-TREATMENT +simple, I-TREATMENT +gastroyeyuno I-TREATMENT +anastomosis I-TREATMENT +y I-TREATMENT +anastomosis I-TREATMENT +coledocoduodenal. I-TREATMENT +Falleció B-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +inmediato. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +13 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +sugerente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +viriasis, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +edemas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +superiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +oligoanuria I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +presenta I-EXPLORATION +mal I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +obnubilación, I-EXPLORATION +hipotensión, I-EXPLORATION +taquicardia I-EXPLORATION +y I-EXPLORATION +taquipnea, I-EXPLORATION +junto I-EXPLORATION +a I-EXPLORATION +lesiones I-EXPLORATION +petequiales I-EXPLORATION +en I-EXPLORATION +hombros, I-EXPLORATION +espalda I-EXPLORATION +y I-EXPLORATION +miembros I-EXPLORATION +superiores. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacan: I-EXPLORATION +plaquetopenia I-EXPLORATION +(13.000/mm3); I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +28 I-EXPLORATION +mg/dl; I-EXPLORATION +coagulopatía I-EXPLORATION +con I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +tromboplastina I-EXPLORATION +parcial I-EXPLORATION +activado: I-EXPLORATION +47 I-EXPLORATION +seg I-EXPLORATION +(control: I-EXPLORATION +30 I-EXPLORATION +seg), I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina: I-EXPLORATION +20 I-EXPLORATION +seg I-EXPLORATION +(control: I-EXPLORATION +11 I-EXPLORATION +seg), I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +Quick: I-EXPLORATION +60%, I-EXPLORATION +fibrinógeno: I-EXPLORATION +332 I-EXPLORATION +mg/dl; I-EXPLORATION +actividad I-EXPLORATION +de I-EXPLORATION +antitrombina-III: I-EXPLORATION +38%, I-EXPLORATION +Na+: I-EXPLORATION +117mEq/l, I-EXPLORATION +K+: I-EXPLORATION +6, I-EXPLORATION +7 I-EXPLORATION +mEq/l, I-EXPLORATION +creatinina I-EXPLORATION +0, I-EXPLORATION +7 I-EXPLORATION +mg/dl; I-EXPLORATION +urea I-EXPLORATION +69 I-EXPLORATION +mg/dl, I-EXPLORATION +y I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +con I-EXPLORATION +30 I-EXPLORATION +leucocitos/mm3 I-EXPLORATION +y I-EXPLORATION +proteínas I-EXPLORATION +de I-EXPLORATION +95 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +con I-TREATMENT +expansión, I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +noradrenalina I-TREATMENT +a I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +µg/kg/min, I-TREATMENT +y I-TREATMENT +cefotaxima. I-TREATMENT +Se I-TREATMENT +inicia I-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +y I-TREATMENT +diálisis I-TREATMENT +peritoneal I-TREATMENT +por I-TREATMENT +insuficiencia I-TREATMENT +renal I-TREATMENT +y I-TREATMENT +alteraciones I-TREATMENT +iónicas. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +5 I-EVOLUTION +horas I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +presenta I-EVOLUTION +parada I-EVOLUTION +cardiorrespiratoria I-EVOLUTION +por I-EVOLUTION +fibrilación I-EVOLUTION +ventricular I-EVOLUTION +refractaria I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +medidas I-EVOLUTION +de I-EVOLUTION +reanimación. I-EVOLUTION + I-EVOLUTION +Los B-EXPLORATION +cultivos I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +salvo I-EXPLORATION +el I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +de I-EXPLORATION +petequia I-EXPLORATION +cutánea I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +aisló I-EXPLORATION +S. I-EXPLORATION +pyogenes I-EXPLORATION +serotipo I-EXPLORATION +M1T1. I-EXPLORATION + I-EXPLORATION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +hombre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +54 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que B-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +asma I-PAST_MEDICAL_HISTORY +bronquial I-PAST_MEDICAL_HISTORY +extrínseco I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +eco-transtorácico I-PAST_MEDICAL_HISTORY +(ETT) I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +hipertrófica I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +obstructiva, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +mitral I-PAST_MEDICAL_HISTORY +leve-moderada. I-PAST_MEDICAL_HISTORY +Realizaba I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +activa I-PAST_MEDICAL_HISTORY +encontrándose I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +funcional I-PAST_MEDICAL_HISTORY +I. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acudió B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +precordial I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +realizar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +esfuerzo I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +posterior I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +palpitaciones. I-PRESENT_ILLNESS +En B-EXPLORATION +un I-EXPLORATION +primer I-EXPLORATION +electrocardiograma I-EXPLORATION +(ECG) I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +taquicardia I-EXPLORATION +regular I-EXPLORATION +con I-EXPLORATION +QRS I-EXPLORATION +ancho I-EXPLORATION +a I-EXPLORATION +210 I-EXPLORATION +lpm, I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +respondió I-EXPLORATION +al I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +adenosina I-EXPLORATION +ni I-EXPLORATION +a I-EXPLORATION +maniobras I-EXPLORATION +vagales. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +realizar I-TREATMENT +una I-TREATMENT +cardioversión I-TREATMENT +eléctrica I-TREATMENT +con I-TREATMENT +100 I-TREATMENT +J I-TREATMENT +que I-TREATMENT +derivó I-TREATMENT +en I-TREATMENT +fibrilación I-TREATMENT +ventricular I-TREATMENT +(FV) I-TREATMENT +revertida I-TREATMENT +con I-TREATMENT +dos I-TREATMENT +choques I-TREATMENT +de I-TREATMENT +360 I-TREATMENT +J. I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +amiodarona I-TREATMENT +intravenosa, I-TREATMENT +pero I-TREATMENT +fue I-TREATMENT +preciso I-TREATMENT +suspenderla I-TREATMENT +poco I-TREATMENT +después I-TREATMENT +por I-TREATMENT +la I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +disfunción I-TREATMENT +sinusal, I-TREATMENT +con I-TREATMENT +ritmo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +unión I-TREATMENT +a I-TREATMENT +40 I-TREATMENT +latidos/ I-TREATMENT +minuto. I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +administró I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +empírica I-TREATMENT +sulfato I-TREATMENT +de I-TREATMENT +magnesio I-TREATMENT +y I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +ingresó I-TREATMENT +en I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +Coronaria. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +sistémica I-EXPLORATION +de I-EXPLORATION +130/70 I-EXPLORATION +mmHg. I-EXPLORATION +Se I-EXPLORATION +auscultaba I-EXPLORATION +un I-EXPLORATION +soplo I-EXPLORATION +sistólico, I-EXPLORATION +en I-EXPLORATION +ápex I-EXPLORATION +y I-EXPLORATION +borde I-EXPLORATION +esternal I-EXPLORATION +izquierdo, I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +congestión I-EXPLORATION +pulmonar. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +ECG I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +disfunción I-EXPLORATION +sinusal, I-EXPLORATION +QRS I-EXPLORATION +ancho I-EXPLORATION +con I-EXPLORATION +morfología I-EXPLORATION +de I-EXPLORATION +bloqueo I-EXPLORATION +completo I-EXPLORATION +de I-EXPLORATION +rama I-EXPLORATION +izquierda I-EXPLORATION +e I-EXPLORATION +intervalo I-EXPLORATION +QT I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +30 I-EXPLORATION +horas I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +síntomas I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +CPK I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +2.657 I-EXPLORATION +U/l I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +troponina I-EXPLORATION +I I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +21 I-EXPLORATION +ng/ml. I-EXPLORATION +Los I-EXPLORATION +iones I-EXPLORATION +séricos I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +ecocardiograma I-EXPLORATION +realizado I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +equipo I-EXPLORATION +portátil I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +un I-EXPLORATION +ventrículo I-EXPLORATION +izquierdo I-EXPLORATION +(VI) I-EXPLORATION +muy I-EXPLORATION +dilatado I-EXPLORATION +y I-EXPLORATION +globalmente I-EXPLORATION +hipoquinético, I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +miocardio I-EXPLORATION +muy I-EXPLORATION +hipertrófico, I-EXPLORATION +con I-EXPLORATION +trabeculaciones. I-EXPLORATION + I-EXPLORATION +Como I-EXPLORATION +parte I-EXPLORATION +del I-EXPLORATION +protocolo I-EXPLORATION +de I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +taquicardias I-EXPLORATION +ventriculares I-EXPLORATION +(TV), I-EXPLORATION +con I-EXPLORATION +sospecha I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +miocardiopatía I-EXPLORATION +dilatada, I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +hemodinámico. I-EXPLORATION +La I-EXPLORATION +ventriculografía I-EXPLORATION +izquierda I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +ventrículo I-EXPLORATION +con I-EXPLORATION +fracción I-EXPLORATION +de I-EXPLORATION +eyección I-EXPLORATION +(FE) I-EXPLORATION +del I-EXPLORATION +20%, I-EXPLORATION +con I-EXPLORATION +defectos I-EXPLORATION +generalizados I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +contractilidad I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +importante I-EXPLORATION +trabeculación I-EXPLORATION +que I-EXPLORATION +sugirió I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +miocardiopatía I-EXPLORATION +no I-EXPLORATION +compactada I-EXPLORATION +(MNC) I-EXPLORATION +o I-EXPLORATION +miocardiopatía I-EXPLORATION +espongiforme I-EXPLORATION +(ME). I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +angiográficamente I-EXPLORATION +significativa. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +cateterismo I-EXPLORATION +derecho I-EXPLORATION +las I-EXPLORATION +presiones I-EXPLORATION +fueron: I-EXPLORATION +aurícula I-EXPLORATION +derecha I-EXPLORATION +(AD) I-EXPLORATION +10 I-EXPLORATION +mmHg, I-EXPLORATION +ventrículo I-EXPLORATION +derecho I-EXPLORATION +(VD) I-EXPLORATION +70/4 I-EXPLORATION +mmHg, I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +(AP) I-EXPLORATION +70/15 I-EXPLORATION +mmHg, I-EXPLORATION +enclavamiento I-EXPLORATION +capilar I-EXPLORATION +pulmonar I-EXPLORATION +(PECP) I-EXPLORATION +15 I-EXPLORATION +mmHg. I-EXPLORATION +Índice I-EXPLORATION +cardíaco I-EXPLORATION +2 I-EXPLORATION +litros/minuto/m2; I-EXPLORATION +presión I-EXPLORATION +telediastólica I-EXPLORATION +VI I-EXPLORATION +(PTDVI) I-EXPLORATION +30 I-EXPLORATION +mmHg; I-EXPLORATION +gradiente I-EXPLORATION +mitral I-EXPLORATION +invertido I-EXPLORATION +(PTDVI I-EXPLORATION +> I-EXPLORATION +PECP). I-EXPLORATION +La I-EXPLORATION +coronariografía I-EXPLORATION +mostró I-EXPLORATION +unas I-EXPLORATION +arterias I-EXPLORATION +epicárdicas I-EXPLORATION +angiográficamente I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +diagnóstica I-EXPLORATION +de I-EXPLORATION +MNC I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +ecocardiografía I-EXPLORATION +por I-EXPLORATION +personal I-EXPLORATION +especializado. I-EXPLORATION +La I-EXPLORATION +ecocardiografía-2D I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +marcada I-EXPLORATION +trabeculación I-EXPLORATION +del I-EXPLORATION +VI, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +ápex I-EXPLORATION +y I-EXPLORATION +segmentos I-EXPLORATION +medios I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +lateral I-EXPLORATION +e I-EXPLORATION +inferior, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +relación I-EXPLORATION +telesistólica I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +entre I-EXPLORATION +la I-EXPLORATION +gruesa I-EXPLORATION +capa I-EXPLORATION +interna I-EXPLORATION +de I-EXPLORATION +miocardio I-EXPLORATION +no I-EXPLORATION +compactado I-EXPLORATION +(NC) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +fina I-EXPLORATION +capa I-EXPLORATION +externa I-EXPLORATION +de I-EXPLORATION +miocardio I-EXPLORATION +compactado I-EXPLORATION +(NC/C I-EXPLORATION +> I-EXPLORATION +2). I-EXPLORATION +Con I-EXPLORATION +doppler I-EXPLORATION +color I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +el I-EXPLORATION +flujo I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +en I-EXPLORATION +comunicación I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +profundos I-EXPLORATION +recesos I-EXPLORATION +intertrabeculares I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +cavidad I-EXPLORATION +ventricular. I-EXPLORATION +El I-EXPLORATION +flujo I-EXPLORATION +diastólico I-EXPLORATION +mitral I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +patrón I-EXPLORATION +restrictivo. I-EXPLORATION +El I-EXPLORATION +VI I-EXPLORATION +tenía I-EXPLORATION +morfología I-EXPLORATION +esferoidal I-EXPLORATION +y I-EXPLORATION +medía I-EXPLORATION +en I-EXPLORATION +telediástole I-EXPLORATION +70 I-EXPLORATION +mm, I-EXPLORATION +la I-EXPLORATION +aurícula I-EXPLORATION +izquierda I-EXPLORATION +47 I-EXPLORATION +mm I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +VD I-EXPLORATION +30 I-EXPLORATION +mm. I-EXPLORATION +Un I-EXPLORATION +flujo I-EXPLORATION +de I-EXPLORATION +regurgitación I-EXPLORATION +mitral I-EXPLORATION +fue I-EXPLORATION +valorado I-EXPLORATION +como I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +moderada, I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +insuficiencia I-EXPLORATION +tricuspídea I-EXPLORATION +permitió I-EXPLORATION +calcular I-EXPLORATION +un I-EXPLORATION +gradiente I-EXPLORATION +AD-VD I-EXPLORATION +de I-EXPLORATION +55 I-EXPLORATION +mmHg, I-EXPLORATION +estimándose I-EXPLORATION +una I-EXPLORATION +presión I-EXPLORATION +de I-EXPLORATION +AP I-EXPLORATION +de I-EXPLORATION +65 I-EXPLORATION +mmHg. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +detectaron I-EXPLORATION +anomalías I-EXPLORATION +valvulares I-EXPLORATION +estructurales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +consideró I-EXPLORATION +necesario I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +ecocardiografía I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +dada I-EXPLORATION +la I-EXPLORATION +buena I-EXPLORATION +calidad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +imágenes I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bidimensional1. I-EXPLORATION + I-EXPLORATION +Con B-EVOLUTION +estos I-EVOLUTION +hallazgos I-EVOLUTION +ecocardiográficos I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +MNC I-EVOLUTION +según I-EVOLUTION +los I-EVOLUTION +criterios I-EVOLUTION +de I-EVOLUTION +Jenni, I-EVOLUTION +por I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +compactación I-EVOLUTION +del I-EVOLUTION +miocardio I-EVOLUTION +ventricular I-EVOLUTION +izquierdo I-EVOLUTION +sin I-EVOLUTION +otras I-EVOLUTION +anomalías I-EVOLUTION +cardíacas I-EVOLUTION +asociadas2, I-EVOLUTION +3. I-EVOLUTION +Aunque I-EVOLUTION +hubiera I-EVOLUTION +sido I-EVOLUTION +interesante I-EVOLUTION +una I-EVOLUTION +cardiorresonancia, I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +pudo I-EVOLUTION +realizar I-EVOLUTION +por I-EVOLUTION +no I-EVOLUTION +disponer I-EVOLUTION +de I-EVOLUTION +esta I-EVOLUTION +técnica I-EVOLUTION +en I-EVOLUTION +nuestro I-EVOLUTION +hospital4, I-EVOLUTION +5. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +sufrió I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +accidente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +coche. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +valoración I-EXPLORATION +inicial I-EXPLORATION +estaba I-EXPLORATION +estable I-EXPLORATION +hemodinámicamente. I-EXPLORATION +La I-EXPLORATION +TACHT I-EXPLORATION +corporal I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +mostraba: I-EXPLORATION +seudoaneurisma I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +aorta I-EXPLORATION +torácica I-EXPLORATION +distal I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +subclavia I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +sangrado I-EXPLORATION +periaórtico. I-EXPLORATION +Ingresó B-TREATMENT +en I-TREATMENT +la I-TREATMENT +UCI, I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +médico. I-TREATMENT +A I-TREATMENT +las I-TREATMENT +36 I-TREATMENT +horas I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +reparación I-TREATMENT +quirúrgica I-TREATMENT +con I-TREATMENT +endoprótesis I-TREATMENT +en I-TREATMENT +la I-TREATMENT +aorta I-TREATMENT +torácica I-TREATMENT +descendente I-TREATMENT +por I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +femoral I-TREATMENT +izquierda. I-TREATMENT +Hubo I-TREATMENT +una I-TREATMENT +oclusión I-TREATMENT +asintomática I-TREATMENT +de I-TREATMENT +la I-TREATMENT +arteria I-TREATMENT +subclavia I-TREATMENT +izquierda. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +TACHT I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +6 I-EXPLORATION +días I-EXPLORATION +mostraba I-EXPLORATION +una I-EXPLORATION +correcta I-EXPLORATION +localización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +endoprótesis. I-EXPLORATION +Al B-EVOLUTION +décimo I-EVOLUTION +día I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +pericarditis I-EVOLUTION +aguda I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +decimosexto I-EVOLUTION +día, I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +76 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Crohn I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +prednisona I-PAST_MEDICAL_HISTORY +(30mg I-PAST_MEDICAL_HISTORY +diarios) I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mesazalina, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +otro I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +artralgias I-PRESENT_ILLNESS +generalizadas. I-PRESENT_ILLNESS +Ante B-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +hipotensión I-TREATMENT +con I-TREATMENT +una I-TREATMENT +presión I-TREATMENT +arterial I-TREATMENT +media I-TREATMENT +(PAM) I-TREATMENT +<55mmHg I-TREATMENT +e I-TREATMENT +hiponatremia I-TREATMENT +(129mEq/l) I-TREATMENT +se I-TREATMENT +sospecha I-TREATMENT +insuficiencia I-TREATMENT +suprarrenal I-TREATMENT +por I-TREATMENT +deprivación I-TREATMENT +(abandono I-TREATMENT +de I-TREATMENT +la I-TREATMENT +prednisona I-TREATMENT +48h I-TREATMENT +antes) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +administran I-TREATMENT +60mg I-TREATMENT +de I-TREATMENT +metilprednisolona, I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +hemodinámica. I-TREATMENT +Las B-EXPLORATION +artralgias I-EXPLORATION +se I-EXPLORATION +atribuyen I-EXPLORATION +también I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +brote I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +enfermedad I-EXPLORATION +inflamatoria I-EXPLORATION +intestinal I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +cese I-EXPLORATION +brusco I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +medicación. I-EXPLORATION + I-EXPLORATION +En B-EVOLUTION +las I-EVOLUTION +siguientes I-EVOLUTION +24h I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refiere I-EVOLUTION +disnea I-EVOLUTION +con I-EVOLUTION +desaturación I-EVOLUTION +progresiva I-EVOLUTION +(hasta I-EVOLUTION +el I-EVOLUTION +76%) I-EVOLUTION +sin I-EVOLUTION +oxigenoterapia. I-EVOLUTION +Se B-EXPLORATION +realiza I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +torácica, I-EXPLORATION +que I-EXPLORATION +observa I-EXPLORATION +patrón I-EXPLORATION +en I-EXPLORATION +vidrio I-EXPLORATION +deslustrado I-EXPLORATION +inespecífico I-EXPLORATION +bilateral. I-EXPLORATION +La B-TREATMENT +sospecha I-TREATMENT +diagnóstica I-TREATMENT +en I-TREATMENT +ese I-TREATMENT +momento I-TREATMENT +corresponde I-TREATMENT +a I-TREATMENT +enfermedad I-TREATMENT +pulmonar I-TREATMENT +intersticial I-TREATMENT +versus I-TREATMENT +neumonía I-TREATMENT +adquirida I-TREATMENT +en I-TREATMENT +la I-TREATMENT +comunidad, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +oxigenoterapia, I-TREATMENT +levofloxacino I-TREATMENT +y I-TREATMENT +metilprednisolona. I-TREATMENT + I-TREATMENT +El B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +trasladó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +principal I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +insuficiencia I-DERIVED_FROM/TO +respiratoria I-DERIVED_FROM/TO +hipoxémica I-DERIVED_FROM/TO +aguda. I-DERIVED_FROM/TO +Al B-TREATMENT +presentar I-TREATMENT +4 I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +gravedad I-TREATMENT +de I-TREATMENT +la I-TREATMENT +British I-TREATMENT +Thoracic I-TREATMENT +Society4 I-TREATMENT +para I-TREATMENT +neumonía I-TREATMENT +adquirida I-TREATMENT +en I-TREATMENT +la I-TREATMENT +comunidad I-TREATMENT +ingresó I-TREATMENT +en I-TREATMENT +nuestra I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Cuidados I-TREATMENT +Críticos: I-TREATMENT +taquipnea I-TREATMENT +>30 I-TREATMENT +respiraciones I-TREATMENT +por I-TREATMENT +minuto, I-TREATMENT +urea I-TREATMENT +>42mg/dl, I-TREATMENT +enfermedad I-TREATMENT +preexistente, I-TREATMENT +edad I-TREATMENT +superior I-TREATMENT +a I-TREATMENT +50 I-TREATMENT +años I-TREATMENT +y I-TREATMENT +afectación I-TREATMENT +pulmonar I-TREATMENT +bilateral I-TREATMENT +en I-TREATMENT +la I-TREATMENT +radiografía I-TREATMENT +de I-TREATMENT +tórax. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +presentó I-EXPLORATION +cuadro I-EXPLORATION +indicativo I-EXPLORATION +de I-EXPLORATION +neumonía I-EXPLORATION +intersticial I-EXPLORATION +bilateral I-EXPLORATION +difusa, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +acompañó I-EXPLORATION +de I-EXPLORATION +extensas I-EXPLORATION +manifestaciones I-EXPLORATION +de I-EXPLORATION +alveolitis I-EXPLORATION +exudativa I-EXPLORATION +con I-EXPLORATION +ensanchamiento I-EXPLORATION +mediastínico I-EXPLORATION +superior, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +adenopatías I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +cadenas I-EXPLORATION +paratraqueales I-EXPLORATION +derecha I-EXPLORATION +e I-EXPLORATION +izquierda. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +eosinofilia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +fórmula I-EXPLORATION +leucocitaria I-EXPLORATION +ni I-EXPLORATION +leucocitosis, I-EXPLORATION +esperable I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +parasitaria; I-EXPLORATION +además, I-EXPLORATION +el I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +leucocitos I-EXPLORATION +tampoco I-EXPLORATION +fue I-EXPLORATION +llamativo. I-EXPLORATION +Se I-EXPLORATION +observó I-EXPLORATION +antígeno I-EXPLORATION +para I-EXPLORATION +neumococo I-EXPLORATION +positivo I-EXPLORATION +en I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +linezolid, I-TREATMENT +cefotaxima I-TREATMENT +y I-TREATMENT +fluconazol, I-TREATMENT +ventilación I-TREATMENT +no I-TREATMENT +invasiva I-TREATMENT +con I-TREATMENT +ventilación I-TREATMENT +con I-TREATMENT +presión I-TREATMENT +positiva I-TREATMENT +continua I-TREATMENT +de I-TREATMENT ++7 I-TREATMENT +cmH2O I-TREATMENT +y I-TREATMENT +asistencia I-TREATMENT +inspiratoria I-TREATMENT +de I-TREATMENT ++15cm I-TREATMENT +H2O I-TREATMENT +y I-TREATMENT +FiO2 I-TREATMENT +al I-TREATMENT +60%, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +alternó I-TREATMENT +con I-TREATMENT +períodos I-TREATMENT +de I-TREATMENT +oxigenoterapia I-TREATMENT +con I-TREATMENT +Ventimask. I-TREATMENT +Progresivamente, B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +deterioro I-EVOLUTION +general I-EVOLUTION +con I-EVOLUTION +sepsis I-EVOLUTION +grave I-EVOLUTION +y I-EVOLUTION +disfunción I-EVOLUTION +multiorgánica, I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +shock, I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +inotropos I-EVOLUTION +y I-EVOLUTION +vasopresores I-EVOLUTION +para I-EVOLUTION +conseguir I-EVOLUTION +una I-EVOLUTION +PAM I-EVOLUTION +>60mmHg, I-EVOLUTION +insuficiencia I-EVOLUTION +renal I-EVOLUTION +aguda I-EVOLUTION +que B-TREATMENT +requirió I-TREATMENT +hemodiafiltración I-TREATMENT +venovenosa I-TREATMENT +continua I-TREATMENT +e I-TREATMENT +insuficiencia I-TREATMENT +respiratoria I-TREATMENT +con I-TREATMENT +necesidad I-TREATMENT +de I-TREATMENT +intubación I-TREATMENT +orotraqueal I-TREATMENT +y I-TREATMENT +ventilación I-TREATMENT +mecánica. I-TREATMENT +Ante I-TREATMENT +este I-TREATMENT +deterioro, I-TREATMENT +se I-TREATMENT +sospechó I-TREATMENT +de I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +una I-TREATMENT +sobreinfección I-TREATMENT +bacteriana I-TREATMENT +o I-TREATMENT +por I-TREATMENT +hongos I-TREATMENT +concomitantes, I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +llevó I-TREATMENT +al I-TREATMENT +cambio I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +(imipenem, I-TREATMENT +linezolid I-TREATMENT +y I-TREATMENT +anidulofungina) I-TREATMENT +y I-TREATMENT +extracción I-TREATMENT +de I-TREATMENT +nuevas I-TREATMENT +muestras I-TREATMENT +microbiológicas: I-TREATMENT +broncoaspirado I-TREATMENT +(BAS), I-TREATMENT +hemocultivo I-TREATMENT +y I-TREATMENT +urinocultivo. I-TREATMENT +Fue I-TREATMENT +en I-TREATMENT +este I-TREATMENT +último I-TREATMENT +BAS I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +observaron I-TREATMENT +larvas I-TREATMENT +de I-TREATMENT +Ss, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +ivermectina I-TREATMENT +(16,5mg/24h) I-TREATMENT +por I-TREATMENT +sonda I-TREATMENT +nasogástrica I-TREATMENT +(SNG). I-TREATMENT +Tras I-TREATMENT +repetir I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48h I-TREATMENT +los I-TREATMENT +cultivos I-TREATMENT +biológicos I-TREATMENT +y I-TREATMENT +mostrar I-TREATMENT +la I-TREATMENT +presencia I-TREATMENT +de I-TREATMENT +larvas I-TREATMENT +de I-TREATMENT +Ss I-TREATMENT +aún I-TREATMENT +activas I-TREATMENT +en I-TREATMENT +BAS, I-TREATMENT +jugo I-TREATMENT +gástrico I-TREATMENT +y I-TREATMENT +heces, I-TREATMENT +se I-TREATMENT +asoció I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +albendazol I-TREATMENT +(400mg/24h) I-TREATMENT +por I-TREATMENT +SNG. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +posterior I-EXPLORATION +control I-EXPLORATION +microbiológico I-EXPLORATION +tras I-EXPLORATION +48h I-EXPLORATION +del I-EXPLORATION +tratamiento I-EXPLORATION +combinado, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +en I-EXPLORATION +BAS I-EXPLORATION +Ss I-EXPLORATION +inactivos. I-EXPLORATION +Sin B-EVOLUTION +embargo, I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +fue I-EVOLUTION +de I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +distrés I-EVOLUTION +respiratorio I-EVOLUTION +agudo I-EVOLUTION +(SDRA) I-EVOLUTION +con I-EVOLUTION +hipoxemia I-EVOLUTION +grave I-EVOLUTION +y I-EVOLUTION +shock I-EVOLUTION +séptico I-EVOLUTION +refractario I-EVOLUTION +al I-EVOLUTION +soporte I-EVOLUTION +vasoconstrictor I-EVOLUTION +e I-EVOLUTION +inotropo. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +falleció I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +17 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +ingreso I-EVOLUTION +en I-EVOLUTION +nuestra I-EVOLUTION +unidad. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +describe I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Valme I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ideación I-PRESENT_ILLNESS +autolítica I-PRESENT_ILLNESS +persistente I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +alucinaciones I-PRESENT_ILLNESS +auditivas. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +psiquiátricos, I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +Unidad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Agudos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Salud I-PAST_MEDICAL_HISTORY +Mental I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +diversas I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2007, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +orientación I-PAST_MEDICAL_HISTORY +diagnóstica, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +último I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +depresivo I-PAST_MEDICAL_HISTORY +moderado I-PAST_MEDICAL_HISTORY +(F32.1 I-PAST_MEDICAL_HISTORY +CIE-10). I-PAST_MEDICAL_HISTORY +Estaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +risperidona I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +mg/24h, I-PAST_MEDICAL_HISTORY +ac. I-PAST_MEDICAL_HISTORY +valproico I-PAST_MEDICAL_HISTORY +1500 I-PAST_MEDICAL_HISTORY +mg/24h, I-PAST_MEDICAL_HISTORY +citalopram I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +mg/24h I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +flunitrazepam I-PAST_MEDICAL_HISTORY +1mg/24h. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +contexto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +duelo I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +fallecimiento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hija, I-PRESENT_ILLNESS +relataba I-PRESENT_ILLNESS +incremento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ansiedad, I-PRESENT_ILLNESS +tristeza, I-PRESENT_ILLNESS +anhedonia, I-PRESENT_ILLNESS +apatía, I-PRESENT_ILLNESS +abandono I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +actividades, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +alucinaciones I-PRESENT_ILLNESS +auditivas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +espacio I-PRESENT_ILLNESS +externo. I-PRESENT_ILLNESS +Eran I-PRESENT_ILLNESS +voces I-PRESENT_ILLNESS +imperativas I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +insultantes I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tenían I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +él I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +repercusión I-PRESENT_ILLNESS +conductual I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +afectiva: I-PRESENT_ILLNESS +"Empezó I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +rumor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +ahora I-PRESENT_ILLNESS +son I-PRESENT_ILLNESS +claras, I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +si I-PRESENT_ILLNESS +alguien I-PRESENT_ILLNESS +me I-PRESENT_ILLNESS +hablara. I-PRESENT_ILLNESS +Se I-PRESENT_ILLNESS +hacen I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +fuertes I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +puedo I-PRESENT_ILLNESS +controlarlas, I-PRESENT_ILLNESS +me I-PRESENT_ILLNESS +dicen I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +me I-PRESENT_ILLNESS +haga I-PRESENT_ILLNESS +daño, I-PRESENT_ILLNESS +también I-PRESENT_ILLNESS +me I-PRESENT_ILLNESS +insultan.". I-PRESENT_ILLNESS +Estaba B-EXPLORATION +consciente, I-EXPLORATION +orientado I-EXPLORATION +auto I-EXPLORATION +y I-EXPLORATION +alopsíquicamente, I-EXPLORATION +euproséxico. I-EXPLORATION +Su I-EXPLORATION +actitud I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +colaboración I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +alteraciones I-EXPLORATION +groseras I-EXPLORATION +en I-EXPLORATION +funciones I-EXPLORATION +superiores. I-EXPLORATION +El I-EXPLORATION +lenguaje I-EXPLORATION +era I-EXPLORATION +fluido, I-EXPLORATION +espontáneo I-EXPLORATION +y I-EXPLORATION +coherente. I-EXPLORATION +Refería I-EXPLORATION +sentimientos I-EXPLORATION +de I-EXPLORATION +culpa I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +reciente I-EXPLORATION +muerte I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +hija, I-EXPLORATION +desconfianza I-EXPLORATION +de I-EXPLORATION +todos I-EXPLORATION +aquellos I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +rodeaban, I-EXPLORATION +y I-EXPLORATION +desamparo I-EXPLORATION +y I-EXPLORATION +soledad I-EXPLORATION +en I-EXPLORATION +relación I-EXPLORATION +a I-EXPLORATION +su I-EXPLORATION +situación I-EXPLORATION +vital. I-EXPLORATION +Tenía I-EXPLORATION +ideas I-EXPLORATION +de I-EXPLORATION +muerte I-EXPLORATION +y I-EXPLORATION +autolisis. I-EXPLORATION +Se I-EXPLORATION +quejaba I-EXPLORATION +de I-EXPLORATION +insomnio I-EXPLORATION +con I-EXPLORATION +despertares I-EXPLORATION +intermitentes I-EXPLORATION +y I-EXPLORATION +frecuentes I-EXPLORATION +pesadillas. I-EXPLORATION +Disponía I-EXPLORATION +de I-EXPLORATION +nulo I-EXPLORATION +soporte I-EXPLORATION +familiar I-EXPLORATION +y I-EXPLORATION +social I-EXPLORATION +y I-EXPLORATION +había I-EXPLORATION +abandonado I-EXPLORATION +progresivamente I-EXPLORATION +su I-EXPLORATION +trabajo. I-EXPLORATION + I-EXPLORATION +Datos B-PAST_MEDICAL_HISTORY +biográficos I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Niñez I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +adolescencia I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Siendo I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +pequeño I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +padres I-PAST_MEDICAL_HISTORY +emigraron I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +él, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +hermanos, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +quedó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +España, I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +cuidado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +abuelos I-PAST_MEDICAL_HISTORY +paternos. I-PAST_MEDICAL_HISTORY +Recuerda I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +feliz, I-PAST_MEDICAL_HISTORY +protegido I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +arropado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ellos, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +llegó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +considerar I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +padres. I-PAST_MEDICAL_HISTORY +Definía I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +abuelo I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +persona, I-PAST_MEDICAL_HISTORY +responsable I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +trabajador. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +abuela, I-PAST_MEDICAL_HISTORY +"Una I-PAST_MEDICAL_HISTORY +santa, I-PAST_MEDICAL_HISTORY +volcada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mi I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +todos.". I-PAST_MEDICAL_HISTORY +Con I-PAST_MEDICAL_HISTORY +ellos I-PAST_MEDICAL_HISTORY +vivía I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +tía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ésta, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +compartió I-PAST_MEDICAL_HISTORY +juegos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +afecto. I-PAST_MEDICAL_HISTORY +Paso I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +adolescencia I-PAST_MEDICAL_HISTORY +separado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +padres. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +pesar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +estos I-PAST_MEDICAL_HISTORY +regresaron I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +país I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +emigraron, I-PAST_MEDICAL_HISTORY +nunca I-PAST_MEDICAL_HISTORY +consiguió I-PAST_MEDICAL_HISTORY +integrarse I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +nuclear. I-PAST_MEDICAL_HISTORY +Sin I-PAST_MEDICAL_HISTORY +entender I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +qué, I-PAST_MEDICAL_HISTORY +comentaba I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +sentido I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +culpa I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +ello. I-PAST_MEDICAL_HISTORY +Describía I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +distante I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +egoísta; I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +padre I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +afectuoso, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +ambos, I-PAST_MEDICAL_HISTORY +"Incapaces I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hacer I-PAST_MEDICAL_HISTORY +nada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +mí". I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +crió I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +económico I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +hermanos, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +despertó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +éstos I-PAST_MEDICAL_HISTORY +recelos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +críticas I-PAST_MEDICAL_HISTORY +constantes I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +él, I-PAST_MEDICAL_HISTORY +clara I-PAST_MEDICAL_HISTORY +desconfianza I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +relación. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +colegio I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +instituto I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +ejemplar, I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +buenas I-PAST_MEDICAL_HISTORY +notas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +nunca I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +compañeros I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +profesores. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +aquella I-PAST_MEDICAL_HISTORY +época, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +describía I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +sí I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +"Trabajador, I-PAST_MEDICAL_HISTORY +guasón, I-PAST_MEDICAL_HISTORY +amable I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +entregado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +todos...". I-PAST_MEDICAL_HISTORY +Cursó I-PAST_MEDICAL_HISTORY +estudios I-PAST_MEDICAL_HISTORY +superiores, I-PAST_MEDICAL_HISTORY +ejerciendo I-PAST_MEDICAL_HISTORY +posteriormente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +profesión I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +éxito I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +años. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Vida I-PAST_MEDICAL_HISTORY +adulta I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Después I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +noviazgo I-PAST_MEDICAL_HISTORY +normalizado I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +casó I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +hijos: I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +niña I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +niño, I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +menor. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +matrimonio I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +bien, I-PAST_MEDICAL_HISTORY +sentía I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +esposa I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +aliada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +escasas I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +podía I-PAST_MEDICAL_HISTORY +imponer I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +criterio. I-PAST_MEDICAL_HISTORY +Su I-PAST_MEDICAL_HISTORY +hija, I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +él, I-PAST_MEDICAL_HISTORY +"La I-PAST_MEDICAL_HISTORY +única I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mundo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +me I-PAST_MEDICAL_HISTORY +defendía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +apoyaba I-PAST_MEDICAL_HISTORY +ante I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +críticas". I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +conflicto I-PAST_MEDICAL_HISTORY +relevante I-PAST_MEDICAL_HISTORY +surgió I-PAST_MEDICAL_HISTORY +quince I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +morir I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +abuelos. I-PAST_MEDICAL_HISTORY +Por I-PAST_MEDICAL_HISTORY +cuestiones I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +herencia, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +sintió I-PAST_MEDICAL_HISTORY +duramente I-PAST_MEDICAL_HISTORY +criticado I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +padres I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hermanos, I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +llamaron I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +"Niño I-PAST_MEDICAL_HISTORY +rico I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +aprovechado.". I-PAST_MEDICAL_HISTORY +Dos I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +después I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +comentado, I-PAST_MEDICAL_HISTORY +tuvo I-PAST_MEDICAL_HISTORY +importantes I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +laboral; I-PAST_MEDICAL_HISTORY +tema I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +generó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +él I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +profundo I-PAST_MEDICAL_HISTORY +malestar; I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +sentirse I-PAST_MEDICAL_HISTORY +intensamente I-PAST_MEDICAL_HISTORY +inseguro I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +desconfiado, I-PAST_MEDICAL_HISTORY +reduciendo I-PAST_MEDICAL_HISTORY +progresivamente I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +labor I-PAST_MEDICAL_HISTORY +profesional. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +hizo I-PAST_MEDICAL_HISTORY +entonces I-PAST_MEDICAL_HISTORY +patente I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +conflictiva I-PAST_MEDICAL_HISTORY +conyugal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +separación I-PAST_MEDICAL_HISTORY +matrimonial, I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +hija I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +enfermó I-PAST_MEDICAL_HISTORY +gravemente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +falleció I-PAST_MEDICAL_HISTORY +seis I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +después. I-PAST_MEDICAL_HISTORY +Ahora I-PAST_MEDICAL_HISTORY +vivía I-PAST_MEDICAL_HISTORY +sólo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mantenía I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +vecinos I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +barrio I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +residía. I-PAST_MEDICAL_HISTORY +Disfrutaba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pequeñas I-PAST_MEDICAL_HISTORY +tertulias I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +bares I-PAST_MEDICAL_HISTORY +cercanos I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +abandonando I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +irritabilidad I-PAST_MEDICAL_HISTORY +creciente, I-PAST_MEDICAL_HISTORY +facilitada I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +abusivo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alcohol. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Psicoterapia B-TREATMENT +breve I-TREATMENT + I-TREATMENT +Se I-TREATMENT +propuso I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +una I-TREATMENT +psicoterapia I-TREATMENT +dinámica I-TREATMENT +breve I-TREATMENT +durante I-TREATMENT +su I-TREATMENT +ingreso I-TREATMENT +en I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Agudos. I-TREATMENT +El I-TREATMENT +número I-TREATMENT +de I-TREATMENT +sesiones I-TREATMENT +no I-TREATMENT +se I-TREATMENT +concretó I-TREATMENT +al I-TREATMENT +inicio, I-TREATMENT +quedando I-TREATMENT +esto I-TREATMENT +a I-TREATMENT +expensas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +y I-TREATMENT +tiempo I-TREATMENT +del I-TREATMENT +ingreso. I-TREATMENT +Se I-TREATMENT +realizaron I-TREATMENT +doce I-TREATMENT +sesiones I-TREATMENT +de I-TREATMENT +cuarenta I-TREATMENT +minutos I-TREATMENT +de I-TREATMENT +duración. I-TREATMENT +Como I-TREATMENT +criterios I-TREATMENT +de I-TREATMENT +inclusión I-TREATMENT +se I-TREATMENT +tuvieron I-TREATMENT +en I-TREATMENT +cuenta: I-TREATMENT +la I-TREATMENT +capacidad I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +pensar I-TREATMENT +sobre I-TREATMENT +sus I-TREATMENT +sentimientos, I-TREATMENT +la I-TREATMENT +existencia I-TREATMENT +de I-TREATMENT +varias I-TREATMENT +relaciones I-TREATMENT +significativas I-TREATMENT +en I-TREATMENT +el I-TREATMENT +pasado I-TREATMENT +y I-TREATMENT +la I-TREATMENT +buena I-TREATMENT +capacidad I-TREATMENT +de I-TREATMENT +vinculación I-TREATMENT +con I-TREATMENT +el I-TREATMENT +terapeuta. I-TREATMENT + I-TREATMENT +Hipótesis B-EXPLORATION +Psicodinámica I-EXPLORATION +Inicial I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +mecanismos I-EXPLORATION +adaptativos I-EXPLORATION +del I-EXPLORATION +yo I-EXPLORATION +desplegados I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +infancia I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +constancia, I-EXPLORATION +capacidad I-EXPLORATION +de I-EXPLORATION +trabajo, I-EXPLORATION +responsabilidad, I-EXPLORATION +entrega I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +demás I-EXPLORATION +y I-EXPLORATION +calidez I-EXPLORATION +afectiva I-EXPLORATION +proporcionaron I-EXPLORATION +al I-EXPLORATION +paciente I-EXPLORATION +una I-EXPLORATION +adecuada I-EXPLORATION +imagen I-EXPLORATION +del I-EXPLORATION +sí I-EXPLORATION +durante I-EXPLORATION +años. I-EXPLORATION +Ninguna I-EXPLORATION +de I-EXPLORATION +estas I-EXPLORATION +cualidades I-EXPLORATION +habían I-EXPLORATION +logrado I-EXPLORATION +mantenerse I-EXPLORATION +tras I-EXPLORATION +el I-EXPLORATION +duro I-EXPLORATION +golpe I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +muerte I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +hija I-EXPLORATION +(factor I-EXPLORATION +desencadenante). I-EXPLORATION +Debilitado I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +emocional I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +fracaso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +relación I-EXPLORATION +conyugal, I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +profesional I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +conflicto I-EXPLORATION +laboral I-EXPLORATION +y I-EXPLORATION +aislado I-EXPLORATION +socialmente I-EXPLORATION +por I-EXPLORATION +las I-EXPLORATION +consecuencias I-EXPLORATION +del I-EXPLORATION +consumo I-EXPLORATION +excesivo I-EXPLORATION +de I-EXPLORATION +alcohol, I-EXPLORATION +fue I-EXPLORATION +invadido I-EXPLORATION +por I-EXPLORATION +sentimientos I-EXPLORATION +reactivados I-EXPLORATION +desde I-EXPLORATION +el I-EXPLORATION +pasado, I-EXPLORATION +surgidos I-EXPLORATION +en I-EXPLORATION +etapas I-EXPLORATION +no I-EXPLORATION +resueltas I-EXPLORATION +del I-EXPLORATION +desarrollo I-EXPLORATION +infantil, I-EXPLORATION +cuando I-EXPLORATION +fue I-EXPLORATION +excluido I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +familia I-EXPLORATION +nuclear I-EXPLORATION +(conflicto I-EXPLORATION +nuclear). I-EXPLORATION +Sentimientos I-EXPLORATION +de I-EXPLORATION +culpa, I-EXPLORATION +desconfianza, I-EXPLORATION +desamparo I-EXPLORATION +y I-EXPLORATION +soledad, I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +presente I-EXPLORATION +provocaron I-EXPLORATION +una I-EXPLORATION +importante I-EXPLORATION +quiebra I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +sí, I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +del I-EXPLORATION +yo I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +sentido I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +realidad. I-EXPLORATION +Vencido I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +puesta I-EXPLORATION +en I-EXPLORATION +marcha I-EXPLORATION +de I-EXPLORATION +mecanismos I-EXPLORATION +defensivos I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +introyección, I-EXPLORATION +interiorizando I-EXPLORATION +el I-EXPLORATION +objeto I-EXPLORATION +persecutorio, I-EXPLORATION +las I-EXPLORATION +voces I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +identificación I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +objeto I-EXPLORATION +idealizado, I-EXPLORATION +las I-EXPLORATION +figuras I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +abuela I-EXPLORATION +e I-EXPLORATION +hija, I-EXPLORATION +deseando I-EXPLORATION +morir I-EXPLORATION +como I-EXPLORATION +ellas, I-EXPLORATION +se I-EXPLORATION +mostraba I-EXPLORATION +incapaz I-EXPLORATION +de I-EXPLORATION +enfrentar I-EXPLORATION +su I-EXPLORATION +propio I-EXPLORATION +sustento I-EXPLORATION +y I-EXPLORATION +destino. I-EXPLORATION + I-EXPLORATION +Trabajo B-TREATMENT +en I-TREATMENT +el I-TREATMENT +Foco I-TREATMENT + I-TREATMENT +Teniendo I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +la I-TREATMENT +hipótesis I-TREATMENT +psicodinámica I-TREATMENT +inicial, I-TREATMENT +se I-TREATMENT +seleccionaron I-TREATMENT +los I-TREATMENT +sentimientos I-TREATMENT +de I-TREATMENT +culpa, I-TREATMENT +desconfianza, I-TREATMENT +desamparo I-TREATMENT +y I-TREATMENT +soledad I-TREATMENT +como I-TREATMENT +foco I-TREATMENT +terapéutico. I-TREATMENT +Estos I-TREATMENT +sentimientos I-TREATMENT +se I-TREATMENT +abordaron I-TREATMENT +desde I-TREATMENT +una I-TREATMENT +perspectiva I-TREATMENT +cognitiva, I-TREATMENT +emocional I-TREATMENT +y I-TREATMENT +conductual, I-TREATMENT +intentando I-TREATMENT +facilitar I-TREATMENT +al I-TREATMENT +paciente I-TREATMENT +su I-TREATMENT +identificación, I-TREATMENT +expresión, I-TREATMENT +regulación I-TREATMENT +y I-TREATMENT +transformación: I-TREATMENT + I-TREATMENT +Sentimiento I-TREATMENT +de I-TREATMENT +culpa: I-TREATMENT +se I-TREATMENT +sentía I-TREATMENT +terriblemente I-TREATMENT +culpable I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +y I-TREATMENT +posterior I-TREATMENT +fallecimiento I-TREATMENT +de I-TREATMENT +su I-TREATMENT +hija. I-TREATMENT +Se I-TREATMENT +facilitó I-TREATMENT +la I-TREATMENT +expresión I-TREATMENT +de I-TREATMENT +este I-TREATMENT +sentimiento, I-TREATMENT +aumentando I-TREATMENT +la I-TREATMENT +conciencia I-TREATMENT +de I-TREATMENT +su I-TREATMENT +presencia I-TREATMENT +en I-TREATMENT +el I-TREATMENT +pasado. I-TREATMENT +Se I-TREATMENT +abordaron I-TREATMENT +las I-TREATMENT +fantasías I-TREATMENT +de I-TREATMENT +omnipotencia I-TREATMENT +y I-TREATMENT +creencias I-TREATMENT +mágicas, I-TREATMENT +la I-TREATMENT +aceptación I-TREATMENT +de I-TREATMENT +los I-TREATMENT +límites I-TREATMENT +propios I-TREATMENT +y I-TREATMENT +el I-TREATMENT +reconocimiento I-TREATMENT +de I-TREATMENT +los I-TREATMENT +límites I-TREATMENT +de I-TREATMENT +la I-TREATMENT +naturaleza I-TREATMENT +humana. I-TREATMENT +Para I-TREATMENT +favorecer I-TREATMENT +la I-TREATMENT +reparación I-TREATMENT +del I-TREATMENT +daño I-TREATMENT +y I-TREATMENT +la I-TREATMENT +transformación I-TREATMENT +del I-TREATMENT +sentimiento, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +animó I-TREATMENT +a I-TREATMENT +la I-TREATMENT +conducta I-TREATMENT +de I-TREATMENT +ayuda I-TREATMENT +y I-TREATMENT +entrega I-TREATMENT +a I-TREATMENT +los I-TREATMENT +demás I-TREATMENT +pacientes, I-TREATMENT +personas I-TREATMENT +necesitadas I-TREATMENT +como I-TREATMENT +él. I-TREATMENT + I-TREATMENT +Sentimiento I-TREATMENT +de I-TREATMENT +desconfianza: I-TREATMENT +sentimiento I-TREATMENT +que I-TREATMENT +emergió I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +conflictiva I-TREATMENT +familiar I-TREATMENT +y I-TREATMENT +laboral. I-TREATMENT +Con I-TREATMENT +la I-TREATMENT +intención I-TREATMENT +de I-TREATMENT +trabajar I-TREATMENT +la I-TREATMENT +confianza I-TREATMENT +en I-TREATMENT +sí I-TREATMENT +mismo, I-TREATMENT +base I-TREATMENT +de I-TREATMENT +la I-TREATMENT +posibilidad I-TREATMENT +de I-TREATMENT +confiar I-TREATMENT +en I-TREATMENT +los I-TREATMENT +demás, I-TREATMENT +se I-TREATMENT +hizo I-TREATMENT +un I-TREATMENT +intento I-TREATMENT +de I-TREATMENT +reestructurar I-TREATMENT +la I-TREATMENT +imagen I-TREATMENT +de I-TREATMENT +sí I-TREATMENT +y I-TREATMENT +la I-TREATMENT +autoestima I-TREATMENT +perdida, I-TREATMENT +ofreciéndole I-TREATMENT +una I-TREATMENT +experiencia I-TREATMENT +emocional I-TREATMENT +correctiva, I-TREATMENT +en I-TREATMENT +el I-TREATMENT +contexto I-TREATMENT +de I-TREATMENT +la I-TREATMENT +relación I-TREATMENT +terapéutica, I-TREATMENT +al I-TREATMENT +valorarle I-TREATMENT +y I-TREATMENT +reforzar I-TREATMENT +con I-TREATMENT +frecuencia I-TREATMENT +sus I-TREATMENT +cualidades, I-TREATMENT +entre I-TREATMENT +ellas, I-TREATMENT +su I-TREATMENT +generosidad, I-TREATMENT +entrega I-TREATMENT +y I-TREATMENT +capacidad I-TREATMENT +de I-TREATMENT +apego. I-TREATMENT +Además I-TREATMENT +se I-TREATMENT +le I-TREATMENT +instó I-TREATMENT +a I-TREATMENT +contactar I-TREATMENT +con I-TREATMENT +su I-TREATMENT +tía I-TREATMENT +y I-TREATMENT +primo I-TREATMENT +que I-TREATMENT +residían I-TREATMENT +ahora I-TREATMENT +en I-TREATMENT +otra I-TREATMENT +ciudad, I-TREATMENT +con I-TREATMENT +los I-TREATMENT +que I-TREATMENT +había I-TREATMENT +mantenido I-TREATMENT +una I-TREATMENT +relación I-TREATMENT +de I-TREATMENT +confianza I-TREATMENT +y I-TREATMENT +apego. I-TREATMENT + I-TREATMENT +Sentimiento I-TREATMENT +de I-TREATMENT +desamparo I-TREATMENT +y I-TREATMENT +soledad: I-TREATMENT +La I-TREATMENT +muerte I-TREATMENT +de I-TREATMENT +sus I-TREATMENT +abuelos I-TREATMENT +y I-TREATMENT +su I-TREATMENT +hija, I-TREATMENT +el I-TREATMENT +divorcio I-TREATMENT +y I-TREATMENT +el I-TREATMENT +aislamiento I-TREATMENT +social I-TREATMENT +favorecieron I-TREATMENT +ambos I-TREATMENT +sentimientos. I-TREATMENT +Se I-TREATMENT +trabajó I-TREATMENT +la I-TREATMENT +resolución I-TREATMENT +del I-TREATMENT +duelo, I-TREATMENT +facilitando I-TREATMENT +la I-TREATMENT +identificación I-TREATMENT +y I-TREATMENT +expresión I-TREATMENT +de I-TREATMENT +la I-TREATMENT +rabia I-TREATMENT +por I-TREATMENT +la I-TREATMENT +muerte I-TREATMENT +de I-TREATMENT +sus I-TREATMENT +seres I-TREATMENT +más I-TREATMENT +queridos I-TREATMENT +y I-TREATMENT +señalando I-TREATMENT +la I-TREATMENT +permanencia I-TREATMENT +de I-TREATMENT +las I-TREATMENT +relaciones I-TREATMENT +de I-TREATMENT +objeto I-TREATMENT +en I-TREATMENT +el I-TREATMENT +interior. I-TREATMENT +Además, I-TREATMENT +se I-TREATMENT +destacó I-TREATMENT +la I-TREATMENT +importancia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +ayuda I-TREATMENT +recibida I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +exterior, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +institución I-TREATMENT +sanitaria. I-TREATMENT +Tomó I-TREATMENT +en I-TREATMENT +aquel I-TREATMENT +momento I-TREATMENT +conciencia I-TREATMENT +del I-TREATMENT +miedo I-TREATMENT +a I-TREATMENT +enfrentar I-TREATMENT +su I-TREATMENT +situación, I-TREATMENT +a I-TREATMENT +vivir I-TREATMENT +en I-TREATMENT +soledad I-TREATMENT +y I-TREATMENT +se I-TREATMENT +le I-TREATMENT +propuso I-TREATMENT +entonces I-TREATMENT +reiniciar I-TREATMENT +el I-TREATMENT +contacto I-TREATMENT +telefónico I-TREATMENT +con I-TREATMENT +amigos I-TREATMENT +y I-TREATMENT +compañeros. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urgencias I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +psiquiatra I-DERIVED_FROM/TO +habitual I-DERIVED_FROM/TO +debido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +alteraciones I-DERIVED_FROM/TO +conductuales I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +entorno I-DERIVED_FROM/TO +familiar. I-DERIVED_FROM/TO +Ha B-PRESENT_ILLNESS +venido I-PRESENT_ILLNESS +desarrollando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +hábitos I-PRESENT_ILLNESS +alimentarios I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +han I-PRESENT_ILLNESS +puesto I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +peligro I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +salud, I-PRESENT_ILLNESS +rechazando I-PRESENT_ILLNESS +algunos I-PRESENT_ILLNESS +alimentos I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +considerar I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +estaban I-PRESENT_ILLNESS +"contaminados". I-PRESENT_ILLNESS +Cuando I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +tratado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +modificar I-PRESENT_ILLNESS +estas I-PRESENT_ILLNESS +conductas, I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +ha I-PRESENT_ILLNESS +mostrado I-PRESENT_ILLNESS +irritado I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +agresividad I-PRESENT_ILLNESS +hacia I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +madre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +hermano I-PRESENT_ILLNESS +menor. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +entrevista I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mostró I-PRESENT_ILLNESS +colaborador, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +aspecto I-PRESENT_ILLNESS +descuidado I-PRESENT_ILLNESS +debido I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +falta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +higiene. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +contacto I-PRESENT_ILLNESS +era I-PRESENT_ILLNESS +peculiar, I-PRESENT_ILLNESS +mostrando I-PRESENT_ILLNESS +sonrisas I-PRESENT_ILLNESS +inapropiadas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +alta I-PRESENT_ILLNESS +latencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +discurso. I-PRESENT_ILLNESS +Negaba I-PRESENT_ILLNESS +alteraciones I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +sensopercepción I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pensamiento. I-PRESENT_ILLNESS +Refirió B-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +crisis I-PAST_MEDICAL_HISTORY +epilépticas I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +18 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +acudió I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +psiquiatría I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +problemas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +conducta; I-PAST_MEDICAL_HISTORY +allí I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Asperger. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +pesar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +sintomatología I-PAST_MEDICAL_HISTORY +psicótica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +aquella I-PAST_MEDICAL_HISTORY +ocasión, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +pautó I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +neuroléptico I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +abandonó I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +reacción I-PAST_MEDICAL_HISTORY +adversa. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +valoración I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +bajo I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +psiquiátrico. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ingreso, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +mostraba I-PRESENT_ILLNESS +tranquilo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +colaborador. I-PRESENT_ILLNESS +En B-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +consulta, I-EVOLUTION +solicitó I-EVOLUTION +un I-EVOLUTION +tiempo I-EVOLUTION +previo I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +entrevista I-EVOLUTION +para I-EVOLUTION +poder I-EVOLUTION +realizar I-EVOLUTION +un I-EVOLUTION +paseo I-EVOLUTION +por I-EVOLUTION +los I-EVOLUTION +pasillos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +planta, I-EVOLUTION +ya I-EVOLUTION +que I-EVOLUTION +esto I-EVOLUTION +le I-EVOLUTION +ayudaba I-EVOLUTION +a I-EVOLUTION +calmarse. I-EVOLUTION +Cuando I-EVOLUTION +se I-EVOLUTION +exploró I-EVOLUTION +el I-EVOLUTION +motivo I-EVOLUTION +del I-EVOLUTION +ingreso, I-EVOLUTION +mostró I-EVOLUTION +escasa I-EVOLUTION +conciencia I-EVOLUTION +de I-EVOLUTION +enfermedad, I-EVOLUTION +refiriendo I-EVOLUTION +encontrarse I-EVOLUTION +en I-EVOLUTION +desacuerdo I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +necesidad I-EVOLUTION +del I-EVOLUTION +mismo. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +no I-EVOLUTION +mostraba I-EVOLUTION +signos I-EVOLUTION +de I-EVOLUTION +desconfianza, I-EVOLUTION +presentando I-EVOLUTION +buena I-EVOLUTION +disposición I-EVOLUTION +a I-EVOLUTION +recibir I-EVOLUTION +tratamiento. I-EVOLUTION +Su B-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +primera I-PAST_MEDICAL_HISTORY +infancia I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +notado I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +algo I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +diferente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +paciente, I-PAST_MEDICAL_HISTORY +si I-PAST_MEDICAL_HISTORY +bien I-PAST_MEDICAL_HISTORY +reconocía I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +información I-PAST_MEDICAL_HISTORY +sobre I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Asperger I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +comentaba I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +compañeros I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colegio I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +reían I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +él I-PAST_MEDICAL_HISTORY +porque I-PAST_MEDICAL_HISTORY +utilizaba I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +vocabulario I-PAST_MEDICAL_HISTORY +muy I-PAST_MEDICAL_HISTORY +formal. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +rendimiento I-PAST_MEDICAL_HISTORY +académico I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +excelente I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +bachillerato, I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +comenzó I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +suspender I-PAST_MEDICAL_HISTORY +asignaturas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +pesar I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +contar I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +capacidad I-PAST_MEDICAL_HISTORY +intelectual I-PAST_MEDICAL_HISTORY +superior I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +media. I-PAST_MEDICAL_HISTORY +Hasta I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +pasaba I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +mayor I-PAST_MEDICAL_HISTORY +parte I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tiempo I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +casa, I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +convivía I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +hermano I-PAST_MEDICAL_HISTORY +menor. I-PAST_MEDICAL_HISTORY +Comentaba I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +menudo I-PAST_MEDICAL_HISTORY +solía I-PAST_MEDICAL_HISTORY +dar I-PAST_MEDICAL_HISTORY +largos I-PAST_MEDICAL_HISTORY +paseos I-PAST_MEDICAL_HISTORY +o I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +desplazaba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +autobús, I-PAST_MEDICAL_HISTORY +actividades I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +realizaba I-PAST_MEDICAL_HISTORY +siempre I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +solitario. I-PAST_MEDICAL_HISTORY +Refería I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +fuerte I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +ciencias I-PAST_MEDICAL_HISTORY +naturales. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Al B-EVOLUTION +avanzar I-EVOLUTION +el I-EVOLUTION +ingreso, I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +observaba I-EVOLUTION +más I-EVOLUTION +distendido, I-EVOLUTION +con I-EVOLUTION +menor I-EVOLUTION +rigidez I-EVOLUTION +postural I-EVOLUTION +y I-EVOLUTION +menor I-EVOLUTION +latencia I-EVOLUTION +de I-EVOLUTION +respuesta I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +discurso. I-EVOLUTION +También I-EVOLUTION +se I-EVOLUTION +redujeron I-EVOLUTION +las I-EVOLUTION +sonrisas I-EVOLUTION +inmotivadas, I-EVOLUTION +las I-EVOLUTION +cuales I-EVOLUTION +reaparecían I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +contexto I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +interacción I-EVOLUTION +con I-EVOLUTION +personas I-EVOLUTION +desconocidas. I-EVOLUTION +El B-TREATMENT +tratamiento I-TREATMENT +antipsicótico I-TREATMENT +se I-TREATMENT +mostró I-TREATMENT +eficaz I-TREATMENT +en I-TREATMENT +la I-TREATMENT +reducción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +irritabilidad I-TREATMENT +del I-TREATMENT +paciente. I-TREATMENT +La B-EVOLUTION +rigidez I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +ideas I-EVOLUTION +sobre I-EVOLUTION +la I-EVOLUTION +alimentación I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +hábitos I-EVOLUTION +de I-EVOLUTION +higiene I-EVOLUTION +y I-EVOLUTION +sueño I-EVOLUTION +continuaron I-EVOLUTION +al I-EVOLUTION +alta. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que B-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +urgencias I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +alteraciones I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +conducta I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +vía I-DERIVED_FROM/TO +pública. I-DERIVED_FROM/TO +Sus B-PRESENT_ILLNESS +padres I-PRESENT_ILLNESS +referían I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +ido I-PRESENT_ILLNESS +disminuyendo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +progresiva I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sueño, I-PRESENT_ILLNESS +así I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +verbalizado I-PRESENT_ILLNESS +ideas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +carácter I-PRESENT_ILLNESS +mesiánico. I-PRESENT_ILLNESS +Parecía I-PRESENT_ILLNESS +llevar I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +desorganizada I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +descuido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +tareas I-PRESENT_ILLNESS +básicas, I-PRESENT_ILLNESS +dedicación I-PRESENT_ILLNESS +excesiva I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +videojuegos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deficiente I-PRESENT_ILLNESS +alimentación. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +entrevista I-EXPLORATION +se I-EXPLORATION +mostró I-EXPLORATION +hostil, I-EXPLORATION +suspicaz, I-EXPLORATION +e I-EXPLORATION +interpretativo I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +entorno, I-EXPLORATION +especialmente I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +colores, I-EXPLORATION +llegando I-EXPLORATION +a I-EXPLORATION +referir I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +"sentía" I-EXPLORATION +azul. I-EXPLORATION +Negó I-EXPLORATION +alteraciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +esfera I-EXPLORATION +sensoperceptiva. I-EXPLORATION +Desde B-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +tres I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +psiquiatría I-PAST_MEDICAL_HISTORY +debido I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +varios I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +psicóticos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +afectivos, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +psicofarmacológico, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +abandonado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +meses. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Ya B-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +unidad, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +mostró I-EVOLUTION +tranquilo, I-EVOLUTION +pero I-EVOLUTION +muy I-EVOLUTION +desconfiado. I-EVOLUTION +Explicó I-EVOLUTION +lo I-EVOLUTION +sucedido I-EVOLUTION +como I-EVOLUTION +resultado I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +"pistas I-EVOLUTION +falsas" I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +llevaron I-EVOLUTION +a I-EVOLUTION +alertar I-EVOLUTION +a I-EVOLUTION +determinadas I-EVOLUTION +personas I-EVOLUTION +de I-EVOLUTION +que I-EVOLUTION +estaban I-EVOLUTION +en I-EVOLUTION +peligro. I-EVOLUTION +Su B-FAMILY_HISTORY +madre I-FAMILY_HISTORY +refirió I-FAMILY_HISTORY +llevar I-FAMILY_HISTORY +varios I-FAMILY_HISTORY +años I-FAMILY_HISTORY +en I-FAMILY_HISTORY +tratamiento I-FAMILY_HISTORY +psiquiátrico I-FAMILY_HISTORY +por I-FAMILY_HISTORY +distimia, I-FAMILY_HISTORY +mientras I-FAMILY_HISTORY +que I-FAMILY_HISTORY +el I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +había I-FAMILY_HISTORY +recibido I-FAMILY_HISTORY +un I-FAMILY_HISTORY +diagnóstico I-FAMILY_HISTORY +de I-FAMILY_HISTORY +trastorno I-FAMILY_HISTORY +obsesivo I-FAMILY_HISTORY +compulsivo I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +pasado. I-FAMILY_HISTORY +Los B-EXPLORATION +familiares I-EXPLORATION +no I-EXPLORATION +refirieron I-EXPLORATION +ninguna I-EXPLORATION +alteración I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +desarrollo I-EXPLORATION +del I-EXPLORATION +paciente, I-EXPLORATION +si I-EXPLORATION +bien I-EXPLORATION +él I-EXPLORATION +mismo I-EXPLORATION +reconoció I-EXPLORATION +que I-EXPLORATION +siempre I-EXPLORATION +se I-EXPLORATION +había I-EXPLORATION +sentido I-EXPLORATION +un I-EXPLORATION +"bicho I-EXPLORATION +raro". I-EXPLORATION +Recordaba I-EXPLORATION +la I-EXPLORATION +etapa I-EXPLORATION +escolar I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +"infierno", I-EXPLORATION +presentando I-EXPLORATION +un I-EXPLORATION +mal I-EXPLORATION +manejo I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +relaciones I-EXPLORATION +interpersonales, I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +punto I-EXPLORATION +de I-EXPLORATION +reconocer I-EXPLORATION +que I-EXPLORATION +le I-EXPLORATION +daba I-EXPLORATION +"fobia" I-EXPLORATION +la I-EXPLORATION +cara I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +personas. I-EXPLORATION +Es I-EXPLORATION +por I-EXPLORATION +esta I-EXPLORATION +razón I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +desde I-EXPLORATION +la I-EXPLORATION +adolescencia I-EXPLORATION +mantenía I-EXPLORATION +contacto I-EXPLORATION +interpersonal I-EXPLORATION +casi I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +exclusiva I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +juegos I-EXPLORATION +de I-EXPLORATION +ordenador I-EXPLORATION +en I-EXPLORATION +línea. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +medida I-EVOLUTION +que I-EVOLUTION +avanzó I-EVOLUTION +el I-EVOLUTION +ingreso I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +observaba I-EVOLUTION +más I-EVOLUTION +distendido, I-EVOLUTION +si I-EVOLUTION +bien I-EVOLUTION +refería I-EVOLUTION +sentirse I-EVOLUTION +incómodo I-EVOLUTION +rodeado I-EVOLUTION +de I-EVOLUTION +gente. I-EVOLUTION +También I-EVOLUTION +comentó I-EVOLUTION +que I-EVOLUTION +le I-EVOLUTION +molestaba I-EVOLUTION +el I-EVOLUTION +sonido I-EVOLUTION +del I-EVOLUTION +tubo I-EVOLUTION +del I-EVOLUTION +televisor I-EVOLUTION +situado I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +salas I-EVOLUTION +comunes I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +unidad, I-EVOLUTION +el I-EVOLUTION +cual I-EVOLUTION +percibía I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +nítida. I-EVOLUTION +Como I-EVOLUTION +estrategia I-EVOLUTION +de I-EVOLUTION +afrontamiento I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +momentos I-EVOLUTION +de I-EVOLUTION +estrés, I-EVOLUTION +deambulaba I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +pasillo I-EVOLUTION +siguiendo I-EVOLUTION +una I-EVOLUTION +secuencia I-EVOLUTION +rutinaria I-EVOLUTION +que I-EVOLUTION +podía I-EVOLUTION +durar I-EVOLUTION +varias I-EVOLUTION +horas I-EVOLUTION +y I-EVOLUTION +que, I-EVOLUTION +según I-EVOLUTION +decía, I-EVOLUTION +le I-EVOLUTION +ayudaba I-EVOLUTION +a I-EVOLUTION +relajarse. I-EVOLUTION +Mencionó B-EXPLORATION +tener I-EXPLORATION +habitualmente I-EXPLORATION +"paranoias" I-EXPLORATION +que I-EXPLORATION +asociaba I-EXPLORATION +con I-EXPLORATION +su I-EXPLORATION +comportamiento I-EXPLORATION +anterior I-EXPLORATION +al I-EXPLORATION +ingreso. I-EXPLORATION +Relacionó I-EXPLORATION +el I-EXPLORATION +episodio I-EXPLORATION +conductual I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +sentimiento I-EXPLORATION +profundo I-EXPLORATION +de I-EXPLORATION +soledad I-EXPLORATION +y I-EXPLORATION +frustración I-EXPLORATION +por I-EXPLORATION +su I-EXPLORATION +incapacidad I-EXPLORATION +para I-EXPLORATION +mantener I-EXPLORATION +relaciones I-EXPLORATION +interpersonales I-EXPLORATION +estables. I-EXPLORATION +Al I-EXPLORATION +ser I-EXPLORATION +preguntado I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +relación I-EXPLORATION +entre I-EXPLORATION +percepción I-EXPLORATION +y I-EXPLORATION +color I-EXPLORATION +manifestada I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +servicio I-EXPLORATION +de I-EXPLORATION +urgencias, I-EXPLORATION +respondió I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +letra I-EXPLORATION +traducida I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +canción I-EXPLORATION +(en I-EXPLORATION +inglés I-EXPLORATION +la I-EXPLORATION +palabra I-EXPLORATION +"blue" I-EXPLORATION +presenta I-EXPLORATION +dos I-EXPLORATION +significados: I-EXPLORATION +azul I-EXPLORATION +y I-EXPLORATION +triste. I-EXPLORATION +Al I-EXPLORATION +decir I-EXPLORATION +sentirse I-EXPLORATION +azul I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +realmente I-EXPLORATION +expresaba I-EXPLORATION +un I-EXPLORATION +sentimiento I-EXPLORATION +de I-EXPLORATION +tristeza). I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +presentó I-TREATMENT +buena I-TREATMENT +respuesta I-TREATMENT +al I-TREATMENT +tratamiento I-TREATMENT +antipsicótico, I-TREATMENT +si B-EVOLUTION +bien I-EVOLUTION +tanto I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +afectivos I-EVOLUTION +como I-EVOLUTION +la I-EVOLUTION +rigidez I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +pensamiento I-EVOLUTION +nunca I-EVOLUTION +desaparecieron. I-EVOLUTION + I-EVOLUTION +La B-EXPLORATION +tabla I-EXPLORATION +1 I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +comparación I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +Escala I-EXPLORATION +de I-EXPLORATION +Inteligencia I-EXPLORATION +Wechsler I-EXPLORATION +para I-EXPLORATION +Adultos I-EXPLORATION +(WAIS) I-EXPLORATION +(30), I-EXPLORATION +la I-EXPLORATION +Escala I-EXPLORATION +de I-EXPLORATION +Síndromes I-EXPLORATION +Positivos I-EXPLORATION +y I-EXPLORATION +Negativos I-EXPLORATION +(PANSS) I-EXPLORATION +(32) I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +Cociente I-EXPLORATION +de I-EXPLORATION +Espectro I-EXPLORATION +Autista I-EXPLORATION +(AQ) I-EXPLORATION +(31) I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +pacientes. I-EXPLORATION +La I-EXPLORATION +tabla I-EXPLORATION +2 I-EXPLORATION +muestra I-EXPLORATION +una I-EXPLORATION +comparación I-EXPLORATION +entre I-EXPLORATION +los I-EXPLORATION +criterios I-EXPLORATION +de I-EXPLORATION +esquizofrenia I-EXPLORATION +y I-EXPLORATION +autismo I-EXPLORATION +compartidos I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +tres I-EXPLORATION +casos I-EXPLORATION +descritos. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +41 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +(HTA) I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +difícil I-PAST_MEDICAL_HISTORY +control I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +mala I-PAST_MEDICAL_HISTORY +cumplimiento I-PAST_MEDICAL_HISTORY +terapéutico. I-PAST_MEDICAL_HISTORY +Había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2008 I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +probable I-PAST_MEDICAL_HISTORY +nefroangiosclerosis. I-PAST_MEDICAL_HISTORY +Se I-PAST_MEDICAL_HISTORY +implanta I-PAST_MEDICAL_HISTORY +catéter I-PAST_MEDICAL_HISTORY +peritoneal I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +diciembre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2009, I-PAST_MEDICAL_HISTORY +iniciando I-PAST_MEDICAL_HISTORY +DP I-PAST_MEDICAL_HISTORY +continua I-PAST_MEDICAL_HISTORY +ambulatoria I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +tarde I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +incidencias I-PAST_MEDICAL_HISTORY +destacables. I-PAST_MEDICAL_HISTORY +Un B-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disfunción I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +catéter I-PRESENT_ILLNESS +peritoneal, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +importante I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +drenaje. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +hipoventilación I-EXPLORATION +hasta I-EXPLORATION +el I-EXPLORATION +campo I-EXPLORATION +medio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +pulmón I-EXPLORATION +derecho. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +refiere I-EXPLORATION +disnea, I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +buena I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno, I-EXPLORATION +con I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +importante I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +hidrotórax I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +DP I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +toracocentesis I-EXPLORATION +diagnóstica, I-EXPLORATION +obteniendo I-EXPLORATION +un I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +datos: I-EXPLORATION +leucocitos I-EXPLORATION +200. I-EXPLORATION +Glucosa I-EXPLORATION +418. I-EXPLORATION +Proteínas I-EXPLORATION +<1, I-EXPLORATION +LDH I-EXPLORATION +42. I-EXPLORATION + I-EXPLORATION +Dado B-TREATMENT +que I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +negaba I-TREATMENT +a I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +hemodiálisis, I-TREATMENT +tras I-TREATMENT +unos I-TREATMENT +días I-TREATMENT +de I-TREATMENT +reposo I-TREATMENT +peritoneal I-TREATMENT +con I-TREATMENT +los I-TREATMENT +que I-TREATMENT +se I-TREATMENT +consiguió I-TREATMENT +la I-TREATMENT +normalización I-TREATMENT +de I-TREATMENT +la I-TREATMENT +radiografía I-TREATMENT +de I-TREATMENT +tórax, I-TREATMENT +se I-TREATMENT +intenta I-TREATMENT +realizar I-TREATMENT +DP I-TREATMENT +automática I-TREATMENT +con I-TREATMENT +bajo I-TREATMENT +volumen I-TREATMENT +y I-TREATMENT +cabecera I-TREATMENT +a I-TREATMENT +45o, I-TREATMENT +sin I-TREATMENT +conseguir I-TREATMENT +un I-TREATMENT +buen I-TREATMENT +funcionamiento I-TREATMENT +del I-TREATMENT +catéter I-TREATMENT +por I-TREATMENT +importante I-TREATMENT +dificultad I-TREATMENT +para I-TREATMENT +el I-TREATMENT +drenaje I-TREATMENT +y I-TREATMENT +con I-TREATMENT +nueva I-TREATMENT +aparición I-TREATMENT +de I-TREATMENT +hidrotórax. I-TREATMENT +Finalmente, I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +aceptó I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +HD I-TREATMENT +que I-TREATMENT +en I-TREATMENT +el I-TREATMENT +momento I-TREATMENT +actual I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +sin I-TREATMENT +incidencias I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +FAV I-TREATMENT +radiocefálica I-TREATMENT +izquierda. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +77 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Nefrología I-DERIVED_FROM/TO +por B-PRESENT_ILLNESS +creatinina I-PRESENT_ILLNESS +plasmática I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2, I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +mg/dl. I-PRESENT_ILLNESS +Entre B-PAST_MEDICAL_HISTORY +sus I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +diversas I-PAST_MEDICAL_HISTORY +intervenciones I-PAST_MEDICAL_HISTORY +quirúrgicas I-PAST_MEDICAL_HISTORY +(menisco I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1985; I-PAST_MEDICAL_HISTORY +timoma I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anatomía I-PAST_MEDICAL_HISTORY +patológica I-PAST_MEDICAL_HISTORY +benigna I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1999; I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +nasosinusales I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +más I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2008; I-PAST_MEDICAL_HISTORY +varices I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2006; I-PAST_MEDICAL_HISTORY +cistocele I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +2008; I-PAST_MEDICAL_HISTORY +fractura I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cadera I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +julio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2010); I-PAST_MEDICAL_HISTORY +colangitis I-PAST_MEDICAL_HISTORY +esclerosante I-PAST_MEDICAL_HISTORY +primaria I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +2003, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +ursodesoxicólico. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +cateterismo I-PAST_MEDICAL_HISTORY +biliar I-PAST_MEDICAL_HISTORY +retrógado I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +esfinterectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +dilatación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +zonas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estenosis. I-PAST_MEDICAL_HISTORY +También I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +inflamatoria I-PAST_MEDICAL_HISTORY +intestinal I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +misma I-PAST_MEDICAL_HISTORY +época; I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +practicaron I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +colonoscopias I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +unas I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +eran I-PAST_MEDICAL_HISTORY +normales I-PAST_MEDICAL_HISTORY +y, I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +otras, I-PAST_MEDICAL_HISTORY +mostraban I-PAST_MEDICAL_HISTORY +mínimas I-PAST_MEDICAL_HISTORY +ulceraciones I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nivel I-PAST_MEDICAL_HISTORY +iliocecal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +colon. I-PAST_MEDICAL_HISTORY +Pericarditis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +etiología I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +filiada I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +enero I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2010. I-PAST_MEDICAL_HISTORY +Gonartrosis I-PAST_MEDICAL_HISTORY +bilateral. I-PAST_MEDICAL_HISTORY +Intolerancia I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +hierro I-PAST_MEDICAL_HISTORY +oral. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +primer I-PAST_MEDICAL_HISTORY +momento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +vista I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +externa I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encontraba I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +zolpidem, I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +mg/día; I-PAST_MEDICAL_HISTORY +ácido I-PAST_MEDICAL_HISTORY +ursodesoxicólico, I-PAST_MEDICAL_HISTORY +1250 I-PAST_MEDICAL_HISTORY +mg/día; I-PAST_MEDICAL_HISTORY +pantoprazol, I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +mg/día; I-PAST_MEDICAL_HISTORY +mirtazapina, I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +mg/día; I-PAST_MEDICAL_HISTORY +dextropropoxífeno, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +paracetamol I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +ocasional. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +interrogatorio I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +cansancio, I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +medianos I-PRESENT_ILLNESS +esfuerzos; I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +apetito; I-PRESENT_ILLNESS +náuseas I-PRESENT_ILLNESS +ocasionales I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tos; I-PRESENT_ILLNESS +estreñimiento I-PRESENT_ILLNESS +habitual I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +unas I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +alternaba I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +deposiciones I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +día, I-PRESENT_ILLNESS +pero I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +presencia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos; I-PRESENT_ILLNESS +nicturia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +veces I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +meses; I-PRESENT_ILLNESS +micciones I-PRESENT_ILLNESS +diurnas I-PRESENT_ILLNESS +cada I-PRESENT_ILLNESS +3-4 I-PRESENT_ILLNESS +horas; I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +relataba I-PRESENT_ILLNESS +antecedentes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +renoureterales I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +haber I-PRESENT_ILLNESS +tenido I-PRESENT_ILLNESS +hematuria. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En B-FAMILY_HISTORY +cuanto I-FAMILY_HISTORY +a I-FAMILY_HISTORY +sus I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares, I-FAMILY_HISTORY +padres I-FAMILY_HISTORY +fallecidos I-FAMILY_HISTORY +en I-FAMILY_HISTORY +edad I-FAMILY_HISTORY +avanzada I-FAMILY_HISTORY +y I-FAMILY_HISTORY +tres I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +fallecidos I-FAMILY_HISTORY +por I-FAMILY_HISTORY +tumores. I-FAMILY_HISTORY + I-FAMILY_HISTORY +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física: I-EXPLORATION +talla: I-EXPLORATION +159 I-EXPLORATION +cm; I-EXPLORATION +peso: I-EXPLORATION +53 I-EXPLORATION +kg. I-EXPLORATION +Presión I-EXPLORATION +arterial: I-EXPLORATION +137/72 I-EXPLORATION +mmHg; I-EXPLORATION +frecuencia I-EXPLORATION +cardíaca: I-EXPLORATION +95 I-EXPLORATION +lpm. I-EXPLORATION +Sin I-EXPLORATION +ingurgitación I-EXPLORATION +yugular; I-EXPLORATION +carótidas I-EXPLORATION +rítmicas I-EXPLORATION +y I-EXPLORATION +simétricas; I-EXPLORATION +auscultación I-EXPLORATION +cardiopulmonar I-EXPLORATION +normal; I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +abdomen I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +hepatomegalia I-EXPLORATION +de I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +4 I-EXPLORATION +traveses I-EXPLORATION +de I-EXPLORATION +dedo I-EXPLORATION +más I-EXPLORATION +evidente I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +derecho, I-EXPLORATION +no I-EXPLORATION +dolorosa I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +soplos I-EXPLORATION +abdominales. I-EXPLORATION +Extremidades: I-EXPLORATION +sin I-EXPLORATION +edemas I-EXPLORATION +y I-EXPLORATION +pulsos I-EXPLORATION +distales I-EXPLORATION +presentes. I-EXPLORATION + I-EXPLORATION +Revisada I-EXPLORATION +la I-EXPLORATION +historia I-EXPLORATION +analítica, I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +noviembre I-EXPLORATION +de I-EXPLORATION +2010 I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +plasmática I-EXPLORATION +osciló I-EXPLORATION +entre I-EXPLORATION +2, I-EXPLORATION +4-2, I-EXPLORATION +5 I-EXPLORATION +mg/dl; I-EXPLORATION +en I-EXPLORATION +diciembre I-EXPLORATION +de I-EXPLORATION +2010 I-EXPLORATION +la I-EXPLORATION +creatinina I-EXPLORATION +plasmática I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +9 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +enero I-EXPLORATION +de I-EXPLORATION +2011, I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +7 I-EXPLORATION +mg/dl. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +en I-EXPLORATION +enero I-EXPLORATION +y I-EXPLORATION +febrero I-EXPLORATION +de I-EXPLORATION +2011, I-EXPLORATION +cabe I-EXPLORATION +destacar: I-EXPLORATION +colesterol: I-EXPLORATION +204 I-EXPLORATION +mg/dl; I-EXPLORATION +GOT I-EXPLORATION +(glutamato-oxalacetato-transaminasa): I-EXPLORATION +37 I-EXPLORATION +U/l; I-EXPLORATION +GPT I-EXPLORATION +(glutamato-piruvato-transaminasa): I-EXPLORATION +23 I-EXPLORATION +U/l; I-EXPLORATION +GGT I-EXPLORATION +(gammaglutamil I-EXPLORATION +transferasa): I-EXPLORATION +431 I-EXPLORATION +U/l; I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina: I-EXPLORATION +483 I-EXPLORATION +U/l; I-EXPLORATION +LDH I-EXPLORATION +(lactatodeshidrogenasa): I-EXPLORATION +646 I-EXPLORATION +U/l; I-EXPLORATION +ferritina: I-EXPLORATION +399 I-EXPLORATION +ng/ml; I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +transferrina, I-EXPLORATION +11%. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +ordinaria I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemograma: I-EXPLORATION +hematocrito: I-EXPLORATION +35, I-EXPLORATION +1%; I-EXPLORATION +hemoglobina: I-EXPLORATION +11, I-EXPLORATION +3 I-EXPLORATION +g/dl; I-EXPLORATION +resto I-EXPLORATION +normal. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +coagulación: I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +tromboplastina I-EXPLORATION +parcial I-EXPLORATION +activado: I-EXPLORATION +45 I-EXPLORATION +segundos. I-EXPLORATION +Anticardiolipina I-EXPLORATION +IgM I-EXPLORATION +positiva: I-EXPLORATION +21, I-EXPLORATION +80 I-EXPLORATION +U I-EXPLORATION +MPL/ml I-EXPLORATION +(normal: I-EXPLORATION +0, I-EXPLORATION +5-11). I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +recogida I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas: I-EXPLORATION +proteinuria: I-EXPLORATION +0, I-EXPLORATION +53 I-EXPLORATION +g/24 I-EXPLORATION +horas; I-EXPLORATION +aclaramiento I-EXPLORATION +de I-EXPLORATION +creatinina: I-EXPLORATION +17 I-EXPLORATION +ml/min. I-EXPLORATION +El I-EXPLORATION +sistemático I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +fue I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +inmunológico I-EXPLORATION +mostró I-EXPLORATION +positividad I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +anticitoplasma I-EXPLORATION +de I-EXPLORATION +neutrófilos I-EXPLORATION +(ANCA) I-EXPLORATION +(anti-MPO I-EXPLORATION +y I-EXPLORATION +Anti-PR3 I-EXPLORATION +negativos); I-EXPLORATION +los I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +(ANA), I-EXPLORATION +anti-DNA, I-EXPLORATION +anticuerpos I-EXPLORATION +antimúsculo I-EXPLORATION +liso, I-EXPLORATION +anticuerpos I-EXPLORATION +antimitocondriales I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas: I-EXPLORATION +IgG: I-EXPLORATION +253 I-EXPLORATION +mg/dl I-EXPLORATION +(normal: I-EXPLORATION +751-1560); I-EXPLORATION +IgM: I-EXPLORATION +10 I-EXPLORATION +mg/dl I-EXPLORATION +(normal: I-EXPLORATION +46-304); I-EXPLORATION +IgA I-EXPLORATION +81 I-EXPLORATION +mg/dl I-EXPLORATION +(normal: I-EXPLORATION +82-453). I-EXPLORATION +El I-EXPLORATION +complemento, I-EXPLORATION +factor I-EXPLORATION +reumatoide, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +y I-EXPLORATION +ceruloplasmina I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +en I-EXPLORATION +rango I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +de I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana, I-EXPLORATION +fue I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +hormonas I-EXPLORATION +tiroideas I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antitiroideos I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +paratohormona I-EXPLORATION +intacta I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +149 I-EXPLORATION +pg/ml. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +electroforesis I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +inmunoglobulinas, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +orina, I-EXPLORATION +proteinuria I-EXPLORATION +no I-EXPLORATION +selectiva. I-EXPLORATION +La I-EXPLORATION +proteinuria I-EXPLORATION +de I-EXPLORATION +Bence-Jones I-EXPLORATION +resultó I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +(ecografía I-EXPLORATION +renal): I-EXPLORATION +riñones I-EXPLORATION +de I-EXPLORATION +tamaño, I-EXPLORATION +morfología I-EXPLORATION +y I-EXPLORATION +ecogenicidad I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +litiasis I-EXPLORATION +ni I-EXPLORATION +dilatación. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +deterioro I-EXPLORATION +de I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +de I-EXPLORATION +causa I-EXPLORATION +no I-EXPLORATION +clara I-EXPLORATION +(se I-EXPLORATION +desconocían I-EXPLORATION +valores I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +previa), I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +biopsia I-EXPLORATION +renal I-EXPLORATION +percutánea I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +siguientes I-EXPLORATION +hallazgos: I-EXPLORATION +4 I-EXPLORATION +glomérulos, I-EXPLORATION +2 I-EXPLORATION +de I-EXPLORATION +ellos I-EXPLORATION +completamente I-EXPLORATION +esclerosados I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +otros I-EXPLORATION +2 I-EXPLORATION +en I-EXPLORATION +vías I-EXPLORATION +de I-EXPLORATION +esclerosis. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +inmunofluorescencia I-EXPLORATION +fue I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +IgG, I-EXPLORATION +IgA, I-EXPLORATION +IgM I-EXPLORATION +y I-EXPLORATION +C3. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +intersticio I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +un I-EXPLORATION +denso I-EXPLORATION +infiltrado I-EXPLORATION +linfocitario I-EXPLORATION +que I-EXPLORATION +expandía I-EXPLORATION +y I-EXPLORATION +ocupaba I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +tejido, I-EXPLORATION +destruyendo I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +habitual I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +renal. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +valoraba I-EXPLORATION +bien I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +fibrosis I-EXPLORATION +debido I-EXPLORATION +al I-EXPLORATION +infiltrado I-EXPLORATION +existente. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +figura I-EXPLORATION +2 I-EXPLORATION +A I-EXPLORATION +se I-EXPLORATION +muestra I-EXPLORATION +la I-EXPLORATION +inmunohistoquímica I-EXPLORATION +con I-EXPLORATION +CD3 I-EXPLORATION +(anticuerpo I-EXPLORATION +monoclonal I-EXPLORATION +que I-EXPLORATION +marca I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +en I-EXPLORATION +general) I-EXPLORATION +y I-EXPLORATION +demuestra I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +mayoría I-EXPLORATION +del I-EXPLORATION +infiltrado I-EXPLORATION +es I-EXPLORATION +a I-EXPLORATION +expensas I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +T, I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +figura I-EXPLORATION +2 I-EXPLORATION +B, I-EXPLORATION +la I-EXPLORATION +inmunohistoquímica I-EXPLORATION +con I-EXPLORATION +CD4. I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +final I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +nefropatía I-EXPLORATION +tubulointersticial I-EXPLORATION +severa I-EXPLORATION +(infiltrado I-EXPLORATION +intersticial I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +linfocitario I-EXPLORATION +T I-EXPLORATION +CD4 I-EXPLORATION +positivos). I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +los I-TREATMENT +hallazgos I-TREATMENT +de I-TREATMENT +la I-TREATMENT +biopsia I-TREATMENT +se I-TREATMENT +indicó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona, I-TREATMENT +50 I-TREATMENT +mg/día, I-TREATMENT +en I-TREATMENT +pauta I-TREATMENT +descendente. I-TREATMENT + I-TREATMENT +Ocho B-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +mantiene I-EVOLUTION +una I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +estabilizada I-EVOLUTION +(creatinina I-EVOLUTION +plasmática I-EVOLUTION +de I-EVOLUTION +2, I-EVOLUTION +2 I-EVOLUTION +mg/dl, I-EVOLUTION +aclaramiento I-EVOLUTION +de I-EVOLUTION +20 I-EVOLUTION +ml/min I-EVOLUTION +y I-EVOLUTION +proteinuria I-EVOLUTION +de I-EVOLUTION +0, I-EVOLUTION +49 I-EVOLUTION +g/24 I-EVOLUTION +h). I-EVOLUTION +Respecto I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +hepática: I-EVOLUTION +GOT: I-EVOLUTION +24 I-EVOLUTION +U/l; I-EVOLUTION +GPT: I-EVOLUTION +18 I-EVOLUTION +U/l; I-EVOLUTION +GGT: I-EVOLUTION +172 I-EVOLUTION +U/l; I-EVOLUTION +fosfatasa I-EVOLUTION +alcalina: I-EVOLUTION +342 I-EVOLUTION +U/l. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +ingresado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +fosas I-PRESENT_ILLNESS +lumbares, I-PRESENT_ILLNESS +fatiga I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +diuresis I-PRESENT_ILLNESS +conservada. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +presentaba I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cocaína I-PAST_MEDICAL_HISTORY +intranasal I-PAST_MEDICAL_HISTORY +(1 I-PAST_MEDICAL_HISTORY +g) I-PAST_MEDICAL_HISTORY +cinco I-PAST_MEDICAL_HISTORY +días I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +admisión. I-PAST_MEDICAL_HISTORY +Negó B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +todo I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +ingesta I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +antiinflamatorios I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +esteroideos I-PRESENT_ILLNESS +u I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +medicamentos. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +presión I-EXPLORATION +arterial I-EXPLORATION +ligeramente I-EXPLORATION +elevada I-EXPLORATION +de I-EXPLORATION +147/97 I-EXPLORATION +mmHg, I-EXPLORATION +sin I-EXPLORATION +fiebre, I-EXPLORATION +erupción I-EXPLORATION +cutánea I-EXPLORATION +o I-EXPLORATION +artralgias. I-EXPLORATION + I-EXPLORATION +Las I-EXPLORATION +exploraciones I-EXPLORATION +cardiovascular I-EXPLORATION +y I-EXPLORATION +respiratoria I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +abdomen I-EXPLORATION +era I-EXPLORATION +blando, I-EXPLORATION +depresible I-EXPLORATION +e I-EXPLORATION +indoloro, I-EXPLORATION +el I-EXPLORATION +hígado I-EXPLORATION +era I-EXPLORATION +palpable I-EXPLORATION +a I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +por I-EXPLORATION +debajo I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +costal I-EXPLORATION +y I-EXPLORATION +presentaba I-EXPLORATION +discreto I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +lumbar I-EXPLORATION +bilateral. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +inicial I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +anodino I-EXPLORATION +(sin I-EXPLORATION +eosinofilia), I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +funci��n I-EXPLORATION +hepática I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +albúmina I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +rango I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad; I-EXPLORATION +creatinina I-EXPLORATION +sérica: I-EXPLORATION +160 I-EXPLORATION +μmol/l; I-EXPLORATION +urea: I-EXPLORATION +7, I-EXPLORATION +5 I-EXPLORATION +mmol/l; I-EXPLORATION +potasio: I-EXPLORATION +3, I-EXPLORATION +9 I-EXPLORATION +mmol/l; I-EXPLORATION +sodio: I-EXPLORATION +139 I-EXPLORATION +mmol/l; I-EXPLORATION +cloruro: I-EXPLORATION +101 I-EXPLORATION +mmol/l. I-EXPLORATION +La I-EXPLORATION +creatina I-EXPLORATION +cinasa I-EXPLORATION +total I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +(3, I-EXPLORATION +3 I-EXPLORATION +μkat/l), I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +fracción I-EXPLORATION +MB I-EXPLORATION +normal. I-EXPLORATION +El I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +mostró I-EXPLORATION +2 I-EXPLORATION +leucocitos I-EXPLORATION +y I-EXPLORATION +3 I-EXPLORATION +hematíes I-EXPLORATION +por I-EXPLORATION +campo I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +hematíes I-EXPLORATION +dismórficos I-EXPLORATION +ni I-EXPLORATION +eosinófilos. I-EXPLORATION +Bioquímica I-EXPLORATION +orina: I-EXPLORATION +sodio: I-EXPLORATION +46 I-EXPLORATION +mmol/l, I-EXPLORATION +potasio: I-EXPLORATION +33 I-EXPLORATION +mmol/l I-EXPLORATION +y I-EXPLORATION +cloruro: I-EXPLORATION +63 I-EXPLORATION +mmol/l, I-EXPLORATION +cociente I-EXPLORATION +proteína: I-EXPLORATION +creatinina I-EXPLORATION +en I-EXPLORATION +5 I-EXPLORATION +g/mol; I-EXPLORATION +urocultivo I-EXPLORATION +negativo. I-EXPLORATION + I-EXPLORATION +Proteinograma I-EXPLORATION +electroforético, I-EXPLORATION +inmunoglobulinas, I-EXPLORATION +complemento, I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +enzima I-EXPLORATION +convertidora I-EXPLORATION +de I-EXPLORATION +angiotensina I-EXPLORATION +y I-EXPLORATION +títulos I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +inmunodeficiencia I-EXPLORATION +humana, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr, I-EXPLORATION +citomegalovirus, I-EXPLORATION +hepatitis I-EXPLORATION +A, I-EXPLORATION +B, I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +y I-EXPLORATION +micoplasma I-EXPLORATION +no I-EXPLORATION +detectó I-EXPLORATION +infección I-EXPLORATION +activa. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +demostró I-EXPLORATION +unos I-EXPLORATION +riñones I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +normal, I-EXPLORATION +difusamente I-EXPLORATION +ecogénicos I-EXPLORATION +con I-EXPLORATION +flujo I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +venoso I-EXPLORATION +apropiado. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +electrocardiograma I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +índice I-EXPLORATION +cardiotorácico I-EXPLORATION +< I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +y I-EXPLORATION +unos I-EXPLORATION +campos I-EXPLORATION +pulmonares I-EXPLORATION +sin I-EXPLORATION +infiltrados. I-EXPLORATION + I-EXPLORATION +Después B-EVOLUTION +de I-EVOLUTION +su I-EVOLUTION +admisión, I-EVOLUTION +el I-EVOLUTION +débito I-EVOLUTION +urinario I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +en I-EVOLUTION +50 I-EVOLUTION +a I-EVOLUTION +75 I-EVOLUTION +ml/h I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +creatinina I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +sin I-EVOLUTION +cambios. I-EVOLUTION +El B-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +sometió I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +renal. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +histológicos I-EXPLORATION +son I-EXPLORATION +los I-EXPLORATION +siguientes: I-EXPLORATION +la I-EXPLORATION +microscopía I-EXPLORATION +óptica I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +13 I-EXPLORATION +glomérulos, I-EXPLORATION +todos I-EXPLORATION +ellos I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +esclerosis, I-EXPLORATION +proliferación I-EXPLORATION +o I-EXPLORATION +lesiones I-EXPLORATION +necróticas. I-EXPLORATION +Las I-EXPLORATION +membranas I-EXPLORATION +basales I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +mesangio I-EXPLORATION +glomerular I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +intersticio I-EXPLORATION +mostraba I-EXPLORATION +moderado I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +mononuclear I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +eosinófilos, I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +tubulitis I-EXPLORATION +focal I-EXPLORATION +y I-EXPLORATION +atrofia. I-EXPLORATION +Las I-EXPLORATION +arteriolas I-EXPLORATION +no I-EXPLORATION +presentaban I-EXPLORATION +lesiones I-EXPLORATION +destacables I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +existían I-EXPLORATION +depósitos I-EXPLORATION +inmunes I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +inmunofluorescencia. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +fueron I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +patológico I-EXPLORATION +de I-EXPLORATION +nefritis I-EXPLORATION +tubulointersticial I-EXPLORATION +aguda I-EXPLORATION +(NIA). I-EXPLORATION + I-EXPLORATION +Este I-EXPLORATION +hecho, I-EXPLORATION +junto I-EXPLORATION +con I-EXPLORATION +las I-EXPLORATION +características I-EXPLORATION +clínicas I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +consumo I-EXPLORATION +reciente I-EXPLORATION +de I-EXPLORATION +cocaína, I-EXPLORATION +nos I-EXPLORATION +llevó I-EXPLORATION +a I-EXPLORATION +definir I-EXPLORATION +este I-EXPLORATION +caso I-EXPLORATION +como I-EXPLORATION +NIA I-EXPLORATION +inducida I-EXPLORATION +por I-EXPLORATION +cocaína. I-EXPLORATION + I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +obviamente I-TREATMENT +interrumpió I-TREATMENT +el I-TREATMENT +consumo I-TREATMENT +de I-TREATMENT +la I-TREATMENT +droga I-TREATMENT +y I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +oral I-TREATMENT +(1 I-TREATMENT +mg/kg/día I-TREATMENT +dosis I-TREATMENT +inicial), I-TREATMENT +que I-TREATMENT +se I-TREATMENT +disminuyó I-TREATMENT +progresivamente I-TREATMENT +y I-TREATMENT +se I-TREATMENT +interrumpió I-TREATMENT +después I-TREATMENT +de I-TREATMENT +12 I-TREATMENT +semanas. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +posterior I-EVOLUTION +ha I-EVOLUTION +presentado I-EVOLUTION +una I-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +progresiva I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +recuperación I-EVOLUTION +completa I-EVOLUTION +ya I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +del I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +obesidad I-PAST_MEDICAL_HISTORY +mórbida I-PAST_MEDICAL_HISTORY +(IMC I-PAST_MEDICAL_HISTORY +47 I-PAST_MEDICAL_HISTORY +kg/m2), I-PAST_MEDICAL_HISTORY +HTA, I-PAST_MEDICAL_HISTORY +DM I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +apnea I-PAST_MEDICAL_HISTORY +obstructiva I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +sueño I-PAST_MEDICAL_HISTORY +(SAOS), I-PAST_MEDICAL_HISTORY +hipercolesterolemia I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +infarto I-PAST_MEDICAL_HISTORY +agudo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miocardio I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +stent I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +angioplastia I-PAST_MEDICAL_HISTORY +coronaria I-PAST_MEDICAL_HISTORY +transluminal I-PAST_MEDICAL_HISTORY +percutánea-stent. I-PAST_MEDICAL_HISTORY +Se B-DERIVED_FROM/TO +derivó I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +realización I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +cirugía I-DERIVED_FROM/TO +bariátrica, I-DERIVED_FROM/TO +técnica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +gastrectomía I-DERIVED_FROM/TO +tubular I-DERIVED_FROM/TO +laparoscópica. I-DERIVED_FROM/TO +Al B-TREATMENT +alta, I-TREATMENT +su I-TREATMENT +tratamiento I-TREATMENT +incluyó I-TREATMENT +ramipril I-TREATMENT +10 I-TREATMENT +mg/24 I-TREATMENT +horas, I-TREATMENT +bisoprolol/hidroclorotiazida I-TREATMENT +10/25 I-TREATMENT +mg/24 I-TREATMENT +horas, I-TREATMENT +atorvastatina I-TREATMENT +10 I-TREATMENT +mg/24 I-TREATMENT +horas, I-TREATMENT +barnidipino I-TREATMENT +20 I-TREATMENT +mg/24 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +metformina I-TREATMENT +1/8 I-TREATMENT +horas. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +refirió I-EVOLUTION +escasa I-EVOLUTION +ingesta I-EVOLUTION +hidroalimentaria, I-EVOLUTION +episodios I-EVOLUTION +ocasionales I-EVOLUTION +de I-EVOLUTION +mareo I-EVOLUTION +y I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +20 I-EVOLUTION +kg I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +en I-EVOLUTION +un I-EVOLUTION +mes. I-EVOLUTION +Ante I-EVOLUTION +el I-EVOLUTION +empeoramiento I-EVOLUTION +clínico I-EVOLUTION +progresivo I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +asociación I-EVOLUTION +de I-EVOLUTION +síndrome I-EVOLUTION +diarreico, I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +Urgencias, I-EVOLUTION +donde I-EVOLUTION +se I-EVOLUTION +constató I-EVOLUTION +mal I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +bradipsiquia, I-EVOLUTION +sequedad I-EVOLUTION +de I-EVOLUTION +piel I-EVOLUTION +y I-EVOLUTION +mucosas, I-EVOLUTION +y I-EVOLUTION +presión I-EVOLUTION +arterial I-EVOLUTION +(PA) I-EVOLUTION +92/65 I-EVOLUTION +mmHg. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +analítica: I-EXPLORATION +glucosa I-EXPLORATION +214 I-EXPLORATION +mg/dl, I-EXPLORATION +urea I-EXPLORATION +403 I-EXPLORATION +mg/dl, I-EXPLORATION +creatinina I-EXPLORATION +(Cr) I-EXPLORATION +9, I-EXPLORATION +2 I-EXPLORATION +mg/dl, I-EXPLORATION +Na I-EXPLORATION +151 I-EXPLORATION +mmol/l, I-EXPLORATION +Cl I-EXPLORATION +113 I-EXPLORATION +mmol/l, I-EXPLORATION +K I-EXPLORATION +4 I-EXPLORATION +mmol/l; I-EXPLORATION +hemograma: I-EXPLORATION +hemoglobina I-EXPLORATION +(Hb) I-EXPLORATION +15, I-EXPLORATION +4 I-EXPLORATION +g/dl, I-EXPLORATION +VH I-EXPLORATION +44, I-EXPLORATION +5%; I-EXPLORATION +leucocitos I-EXPLORATION +18800/uL; I-EXPLORATION +plaquetas I-EXPLORATION +287000/uL; I-EXPLORATION +función I-EXPLORATION +renal I-EXPLORATION +en I-EXPLORATION +orina: I-EXPLORATION +urea I-EXPLORATION +239 I-EXPLORATION +mg/dl, I-EXPLORATION +Cr I-EXPLORATION +339 I-EXPLORATION +mg/dl, I-EXPLORATION +Na I-EXPLORATION +52 I-EXPLORATION +mmol/l, I-EXPLORATION +K I-EXPLORATION +9, I-EXPLORATION +1 I-EXPLORATION +mmol/l, I-EXPLORATION +excreción I-EXPLORATION +fraccional I-EXPLORATION +de I-EXPLORATION +sodio I-EXPLORATION +(EF I-EXPLORATION +Na) I-EXPLORATION +0, I-EXPLORATION +9%; I-EXPLORATION +gasometría I-EXPLORATION +venosa: I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +33, I-EXPLORATION +bicarbonato I-EXPLORATION +11, I-EXPLORATION +1 I-EXPLORATION +mmol/l, I-EXPLORATION +pCO2 I-EXPLORATION +21 I-EXPLORATION +mmHg. I-EXPLORATION +Se B-TREATMENT +ingresó I-TREATMENT +en I-TREATMENT +Nefrología I-TREATMENT +con I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +IRA I-TREATMENT +prerrenal, I-TREATMENT +hipernatremia I-TREATMENT +e I-TREATMENT +infección I-TREATMENT +urinaria, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +y I-TREATMENT +reposición I-TREATMENT +hidroelectrolítica I-TREATMENT +controlada I-TREATMENT +con I-TREATMENT +buena I-TREATMENT +respuesta, I-TREATMENT +siendo I-TREATMENT +la I-TREATMENT +creatinina I-TREATMENT +al I-TREATMENT +alta I-TREATMENT +de I-TREATMENT +0, I-TREATMENT +86 I-TREATMENT +mg/dl. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +IRC B-PAST_MEDICAL_HISTORY +terminal I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nefropatía I-PAST_MEDICAL_HISTORY +diabética I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +sustitutivo I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +hemodiálisis, I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +crónica, I-PAST_MEDICAL_HISTORY +miocardiopatía I-PAST_MEDICAL_HISTORY +dilatada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +isquémico, I-PAST_MEDICAL_HISTORY +retinopatía I-PAST_MEDICAL_HISTORY +diabética, I-PAST_MEDICAL_HISTORY +accidente I-PAST_MEDICAL_HISTORY +vascular I-PAST_MEDICAL_HISTORY +cerebral I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +años; I-PAST_MEDICAL_HISTORY +ingresa B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +medicina I-PRESENT_ILLNESS +interna I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cetoacidosis I-PRESENT_ILLNESS +diabética. I-PRESENT_ILLNESS +Durante B-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +detectan I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +maculopapulosas, I-EXPLORATION +eritematosas, I-EXPLORATION +con I-EXPLORATION +zona I-EXPLORATION +descamativa I-EXPLORATION +hiperqueratósica I-EXPLORATION +central, I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +universal. I-EXPLORATION +Se B-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +dermatología, I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +realiza I-DERIVED_FROM/TO +biopsia I-DERIVED_FROM/TO +cutánea I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +las I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +diagnostica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +enfermedad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Kyrle. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +59 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +en B-PAST_MEDICAL_HISTORY +DP I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +octubre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2012 I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +renal I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +secundaria I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +nefropatía I-PAST_MEDICAL_HISTORY +diabética. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +líquido I-PRESENT_ILLNESS +peritoneal I-PRESENT_ILLNESS +turbio, I-PRESENT_ILLNESS +refiriendo I-PRESENT_ILLNESS +descenso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +ultrafiltración. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +sido I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +neoformación I-PAST_MEDICAL_HISTORY +nasal. I-PAST_MEDICAL_HISTORY +Los B-EXPLORATION +resultados I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +eran: I-EXPLORATION +aspecto I-EXPLORATION +turbio, I-EXPLORATION +700 I-EXPLORATION +leucocitos/μl I-EXPLORATION +(mononucleares I-EXPLORATION +80% I-EXPLORATION +y I-EXPLORATION +polimorfonucleares I-EXPLORATION +20%), I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +del I-EXPLORATION +predominio I-EXPLORATION +de I-EXPLORATION +mononucleares I-EXPLORATION +se I-EXPLORATION +inició I-EXPLORATION +terapia I-EXPLORATION +antibiótica I-EXPLORATION +empírica I-EXPLORATION +con I-EXPLORATION +vancomicina I-EXPLORATION +y I-EXPLORATION +ceftazidima I-EXPLORATION +intraperitoneal. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +ni I-EXPLORATION +masas; I-EXPLORATION +el I-EXPLORATION +orificio I-EXPLORATION +de I-EXPLORATION +salida I-EXPLORATION +del I-EXPLORATION +catéter I-EXPLORATION +peritoneal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +túnel I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +analíticos I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +destacaban: I-EXPLORATION +leucocitos I-EXPLORATION +37000/mm3, I-EXPLORATION +plaquetas I-EXPLORATION +640000/mm3, I-EXPLORATION +hemoglobina I-EXPLORATION +10, I-EXPLORATION +3g/dl, I-EXPLORATION +creatinina I-EXPLORATION +5, I-EXPLORATION +4mg/dl, I-EXPLORATION +urea I-EXPLORATION +180mg/dl, I-EXPLORATION +Na I-EXPLORATION +138mEq/l, I-EXPLORATION +K I-EXPLORATION +4mEq/l, I-EXPLORATION +calcio I-EXPLORATION +9, I-EXPLORATION +5mg/dl, I-EXPLORATION +fósforo I-EXPLORATION +4, I-EXPLORATION +8mg/dl, I-EXPLORATION +albúmina I-EXPLORATION +3, I-EXPLORATION +9mg/dl. I-EXPLORATION +Los I-EXPLORATION +cultivos I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +resultaron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computarizada I-EXPLORATION +de I-EXPLORATION +cráneo, I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +abdomen I-EXPLORATION +para I-EXPLORATION +completar I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +nasal I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +días I-EXPLORATION +siguientes, I-EXPLORATION +siendo I-EXPLORATION +informado I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +mediastínicas I-EXPLORATION +y I-EXPLORATION +retroperitoneales I-EXPLORATION +diseminadas. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +nasal I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +como I-EXPLORATION +linfoma I-EXPLORATION +no-Hodgkin I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +B I-EXPLORATION +grandes I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +citología I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +demostró I-EXPLORATION +linfocitos I-EXPLORATION +atípicos. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +inició I-TREATMENT +su I-TREATMENT +tratamiento I-TREATMENT +quimioterápico I-TREATMENT +y I-TREATMENT +permaneció I-TREATMENT +en I-TREATMENT +la I-TREATMENT +técnica I-TREATMENT +de I-TREATMENT +DP I-TREATMENT +sin I-TREATMENT +más I-TREATMENT +incidencias I-TREATMENT +dialíticas. I-TREATMENT + I-TREATMENT +La B-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +turbio I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +DP I-EXPLORATION +generalmente I-EXPLORATION +se I-EXPLORATION +asocia I-EXPLORATION +a I-EXPLORATION +una I-EXPLORATION +peritonitis. I-EXPLORATION +Para I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +peritonitis I-EXPLORATION +bacteriana I-EXPLORATION +se I-EXPLORATION +requieren I-EXPLORATION +al I-EXPLORATION +menos I-EXPLORATION +dos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +tres I-EXPLORATION +condiciones: I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +solo I-EXPLORATION +o I-EXPLORATION +acompañado I-EXPLORATION +de I-EXPLORATION +otros I-EXPLORATION +síntomas I-EXPLORATION +abdominales, I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +con I-EXPLORATION +más I-EXPLORATION +de I-EXPLORATION +100 I-EXPLORATION +leucocitos/μl, I-EXPLORATION +siendo I-EXPLORATION +más I-EXPLORATION +del I-EXPLORATION +50% I-EXPLORATION +polimorfonucleares, I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +o I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +que I-EXPLORATION +demuestre I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +microorganismos1. I-EXPLORATION + I-EXPLORATION +Es I-EXPLORATION +difícil I-EXPLORATION +diferenciar I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +peritoneal I-EXPLORATION +con I-EXPLORATION +cultivo I-EXPLORATION +negativo I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +inflamación I-EXPLORATION +peritoneal I-EXPLORATION +no I-EXPLORATION +infecciosa I-EXPLORATION +(peritonitis I-EXPLORATION +estéril). I-EXPLORATION +Un I-EXPLORATION +cultivo I-EXPLORATION +peritoneal I-EXPLORATION +negativo I-EXPLORATION +generalmente I-EXPLORATION +se I-EXPLORATION +debe I-EXPLORATION +a I-EXPLORATION +fallos I-EXPLORATION +técnicos I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +procesamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +muestras, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +manejo I-EXPLORATION +resulta I-EXPLORATION +complicado, I-EXPLORATION +dado I-EXPLORATION +que I-EXPLORATION +existen I-EXPLORATION +peritonitis I-EXPLORATION +infecciosas I-EXPLORATION +sin I-EXPLORATION +crecimiento I-EXPLORATION +bacteriano I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +cultivo. I-EXPLORATION +Se I-EXPLORATION +aconseja I-EXPLORATION +revisar I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +cultivo I-EXPLORATION +cuando I-EXPLORATION +estos I-EXPLORATION +sean I-EXPLORATION +negativos I-EXPLORATION +en I-EXPLORATION +más I-EXPLORATION +del I-EXPLORATION +20% I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +ocasiones I-EXPLORATION +e I-EXPLORATION +interrogar I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +uso I-EXPLORATION +de I-EXPLORATION +antibióticos I-EXPLORATION +previos I-EXPLORATION +al I-EXPLORATION +paciente2. I-EXPLORATION +Para I-EXPLORATION +lograr I-EXPLORATION +una I-EXPLORATION +rapidez I-EXPLORATION +diagnóstica I-EXPLORATION +en I-EXPLORATION +casos I-EXPLORATION +de I-EXPLORATION +peritonitis I-EXPLORATION +estéril, I-EXPLORATION +las I-EXPLORATION +guías I-EXPLORATION +de I-EXPLORATION +DP I-EXPLORATION +españolas I-EXPLORATION +esquematizan I-EXPLORATION +teniendo I-EXPLORATION +en I-EXPLORATION +cuenta I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +o I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +tipo I-EXPLORATION +de I-EXPLORATION +células. I-EXPLORATION +Un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +polimorfornucleares I-EXPLORATION +puede I-EXPLORATION +ser I-EXPLORATION +por I-EXPLORATION +inflamación I-EXPLORATION +de I-EXPLORATION +víscera I-EXPLORATION +intraperitoneal I-EXPLORATION +o I-EXPLORATION +yuxtaperitoneal, I-EXPLORATION +medicamentos I-EXPLORATION +o I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +contaminado I-EXPLORATION +por I-EXPLORATION +endotoxinas. I-EXPLORATION +Si I-EXPLORATION +están I-EXPLORATION +aumentados I-EXPLORATION +los I-EXPLORATION +eosinófilos, I-EXPLORATION +se I-EXPLORATION +sospechará I-EXPLORATION +reacción I-EXPLORATION +alérgica I-EXPLORATION +al I-EXPLORATION +material I-EXPLORATION +de I-EXPLORATION +diálisis, I-EXPLORATION +medicamentos, I-EXPLORATION +irritación I-EXPLORATION +peritoneal I-EXPLORATION +por I-EXPLORATION +sangre I-EXPLORATION +retrógrada I-EXPLORATION +o I-EXPLORATION +tras I-EXPLORATION +peritonitis I-EXPLORATION +por I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +parásitos. I-EXPLORATION +El I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +mononucleares I-EXPLORATION +puede I-EXPLORATION +asociarse I-EXPLORATION +a I-EXPLORATION +icodextrina, I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +micobacterias, I-EXPLORATION +hongos. I-EXPLORATION +Si I-EXPLORATION +además I-EXPLORATION +hay I-EXPLORATION +hematíes, I-EXPLORATION +se I-EXPLORATION +ha I-EXPLORATION +de I-EXPLORATION +considerar: I-EXPLORATION +ovulación, I-EXPLORATION +menstruación I-EXPLORATION +retrógrada, I-EXPLORATION +rotura I-EXPLORATION +de I-EXPLORATION +quiste I-EXPLORATION +ovárico, I-EXPLORATION +líquido I-EXPLORATION +hipertónico, I-EXPLORATION +adherencias I-EXPLORATION +peritoneales, I-EXPLORATION +ejercicio I-EXPLORATION +físico I-EXPLORATION +y I-EXPLORATION +trauma I-EXPLORATION +por I-EXPLORATION +catéter. I-EXPLORATION +Con I-EXPLORATION +elevados I-EXPLORATION +mononucleares I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +malignas, I-EXPLORATION +hay I-EXPLORATION +que I-EXPLORATION +pensar I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +o I-EXPLORATION +metástasis I-EXPLORATION +peritoneales. I-EXPLORATION +Por I-EXPLORATION +otra I-EXPLORATION +parte, I-EXPLORATION +en I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +puede I-EXPLORATION +ser I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +incremento I-EXPLORATION +de I-EXPLORATION +fibrina I-EXPLORATION +o I-EXPLORATION +de I-EXPLORATION +triglicéridos3, I-EXPLORATION +4. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +literatura I-EXPLORATION +se I-EXPLORATION +describen I-EXPLORATION +algunos I-EXPLORATION +casos I-EXPLORATION +de I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +peritonitis I-EXPLORATION +en I-EXPLORATION +DP I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +procesos I-EXPLORATION +tumorales, I-EXPLORATION +entre I-EXPLORATION +ellos, I-EXPLORATION +un I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +renales I-EXPLORATION +recurrente I-EXPLORATION +diagnosticado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +citología I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +peritoneal5. I-EXPLORATION +Otro I-EXPLORATION +paciente I-EXPLORATION +presentó I-EXPLORATION +una I-EXPLORATION +peritonitis I-EXPLORATION +estéril I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +antecedente I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +diagnosticado I-EXPLORATION +diez I-EXPLORATION +años I-EXPLORATION +antes. I-EXPLORATION +La I-EXPLORATION +citología I-EXPLORATION +del I-EXPLORATION +líquido I-EXPLORATION +peritoneal I-EXPLORATION +permitió I-EXPLORATION +observar I-EXPLORATION +los I-EXPLORATION +linfocitos I-EXPLORATION +atípicos I-EXPLORATION +y, I-EXPLORATION +al I-EXPLORATION +igual I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +caso, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +invasión I-EXPLORATION +peritoneal, I-EXPLORATION +continuó I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +DP6. I-EXPLORATION + I-EXPLORATION +Como I-EXPLORATION +conclusión I-EXPLORATION +del I-EXPLORATION +caso, I-EXPLORATION +debemos I-EXPLORATION +señalar I-EXPLORATION +que I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +peritonitis I-EXPLORATION +estériles I-EXPLORATION +no I-EXPLORATION +debemos I-EXPLORATION +olvidar I-EXPLORATION +la I-EXPLORATION +posible I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +proceso I-EXPLORATION +neoplásico. I-EXPLORATION + I-EXPLORATION + +Paciente B-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +48 I-DERIVED_FROM/TO +años I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +tras I-DERIVED_FROM/TO +detectarse I-DERIVED_FROM/TO +ambulatoriamente I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +creatinina I-DERIVED_FROM/TO +sérica I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +7, I-DERIVED_FROM/TO +56mg/dl. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaba: I-EXPLORATION +tensión I-EXPLORATION +arterial: I-EXPLORATION +163/111mmHg, I-EXPLORATION +peso: I-EXPLORATION +105kg, I-EXPLORATION +talla: I-EXPLORATION +190cm, I-EXPLORATION +índice I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +corporal: I-EXPLORATION +29kg/m2. I-EXPLORATION +Leve I-EXPLORATION +déficit I-EXPLORATION +cognitivo. I-EXPLORATION +Fenotipo I-EXPLORATION +corporal I-EXPLORATION +corpulento. I-EXPLORATION +Facies I-EXPLORATION +con I-EXPLORATION +prognatismo I-EXPLORATION +y I-EXPLORATION +macroglosia. I-EXPLORATION +Labios I-EXPLORATION +gruesos, I-EXPLORATION +arcos I-EXPLORATION +superciliares I-EXPLORATION +prominentes, I-EXPLORATION +voz I-EXPLORATION +grave. I-EXPLORATION +Auscultación I-EXPLORATION +normal. I-EXPLORATION +Fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +normal. I-EXPLORATION +El I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +refería I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +morfología I-EXPLORATION +corporal. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +mostraba I-EXPLORATION +riñones I-EXPLORATION +de I-EXPLORATION +dimensiones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +límite I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +con I-EXPLORATION +espesor I-EXPLORATION +del I-EXPLORATION +parénquima I-EXPLORATION +renal I-EXPLORATION +bilateral I-EXPLORATION +marcadamente I-EXPLORATION +adelgazado, I-EXPLORATION +prácticamente I-EXPLORATION +inexistente. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +presentaba I-EXPLORATION +parámetros I-EXPLORATION +bioquímicos I-EXPLORATION +propios I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +uremia I-EXPLORATION +con I-EXPLORATION +serologías I-EXPLORATION +víricas I-EXPLORATION +negativas I-EXPLORATION +y I-EXPLORATION +pruebas I-EXPLORATION +inmunológicas I-EXPLORATION +normales. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +practicaron I-EXPLORATION +determinaciones I-EXPLORATION +hormonales: I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Cortisol: I-EXPLORATION +23mcg/dl I-EXPLORATION +(6-28), I-EXPLORATION +TSH: I-EXPLORATION +1, I-EXPLORATION +01mcUI/ml I-EXPLORATION +(0,27-4,2). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Renina: I-EXPLORATION +29, I-EXPLORATION +7microUI/ml I-EXPLORATION +(2,8-39,9). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Aldosterona: I-EXPLORATION +152, I-EXPLORATION +8pg/ml I-EXPLORATION +(10-160). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +FSH: I-EXPLORATION +12, I-EXPLORATION +4mUI/ml I-EXPLORATION +(1,5-12,4), I-EXPLORATION +LH: I-EXPLORATION +8, I-EXPLORATION +4mUI/ml I-EXPLORATION +(1,7-8,6). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Prolactina: I-EXPLORATION +553mUI/l I-EXPLORATION +(86-324), I-EXPLORATION +testosterona I-EXPLORATION +total: I-EXPLORATION +1, I-EXPLORATION +99ng/ml I-EXPLORATION +(2,5-8,4). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +GH: I-EXPLORATION +4, I-EXPLORATION +24ng/ml I-EXPLORATION +(0-1). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +Somatomedina I-EXPLORATION +C I-EXPLORATION +(IGF1): I-EXPLORATION +670ng/ml I-EXPLORATION +(100-358). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +IGF1-BP3: I-EXPLORATION +7, I-EXPLORATION +59micro/ml I-EXPLORATION +(3,3-6,7). I-EXPLORATION + I-EXPLORATION +- I-EXPLORATION +ACTH: I-EXPLORATION +39pg/ml I-EXPLORATION +(8-46). I-EXPLORATION + I-EXPLORATION +La B-TREATMENT +hipertensión I-TREATMENT +se I-TREATMENT +controló I-TREATMENT +con I-TREATMENT +tratamiento I-TREATMENT +médico. I-TREATMENT +Ante I-TREATMENT +el I-TREATMENT +deterioro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +función I-TREATMENT +renal, I-TREATMENT +cuya I-TREATMENT +etiología I-TREATMENT +no I-TREATMENT +se I-TREATMENT +pudo I-TREATMENT +filiar, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +mediante I-TREATMENT +hemodiálisis I-TREATMENT +crónica. I-TREATMENT + I-TREATMENT +Se B-EXPLORATION +practicó I-EXPLORATION +un I-EXPLORATION +primer I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +sobrecarga I-EXPLORATION +oral I-EXPLORATION +a I-EXPLORATION +glucosa I-EXPLORATION +(TSOG). I-EXPLORATION + I-EXPLORATION +Llegados I-EXPLORATION +a I-EXPLORATION +este I-EXPLORATION +punto, I-EXPLORATION +los I-EXPLORATION +clínicos I-EXPLORATION +sospechábamos, I-EXPLORATION +en I-EXPLORATION +función I-EXPLORATION +del I-EXPLORATION +fenotipo I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +perfil I-EXPLORATION +hormonal I-EXPLORATION +(aumento I-EXPLORATION +de I-EXPLORATION +GH, I-EXPLORATION +IGF-1 I-EXPLORATION +y I-EXPLORATION +IGF1-BP3; I-EXPLORATION +TSOG I-EXPLORATION +sin I-EXPLORATION +supresión I-EXPLORATION +clara I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +GH), I-EXPLORATION +una I-EXPLORATION +acromegalia. I-EXPLORATION +No B-TREATMENT +pudo I-TREATMENT +practicarse I-TREATMENT +una I-TREATMENT +resonancia I-TREATMENT +magnética I-TREATMENT +nuclear I-TREATMENT +(RMN) I-TREATMENT +hipofisaria I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +negativa I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +y I-TREATMENT +su I-TREATMENT +familia. I-TREATMENT + I-TREATMENT +Cuatro I-TREATMENT +meses I-TREATMENT +después I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +finalmente I-TREATMENT +la I-TREATMENT +RMN I-TREATMENT +sin I-TREATMENT +contraste I-TREATMENT +paramagnético. I-TREATMENT +La B-EXPLORATION +hipófisis I-EXPLORATION +presentaba I-EXPLORATION +un I-EXPLORATION +tamaño I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +tallo I-EXPLORATION +hipofisario I-EXPLORATION +centrado. I-EXPLORATION +Se B-TREATMENT +practicó I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +TSOG, I-TREATMENT +mostrando I-TREATMENT +una I-TREATMENT +GH I-TREATMENT +basal I-TREATMENT +normal, I-TREATMENT +con I-TREATMENT +aumento I-TREATMENT +paradójico I-TREATMENT +a I-TREATMENT +los I-TREATMENT +30 I-TREATMENT +minutos, I-TREATMENT +pero I-TREATMENT +con I-TREATMENT +adecuada I-TREATMENT +supresión I-TREATMENT +a I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +horas. I-TREATMENT + I-TREATMENT +En B-EXPLORATION +esa I-EXPLORATION +fecha I-EXPLORATION +los I-EXPLORATION +niveles I-EXPLORATION +de I-EXPLORATION +IGF-1 I-EXPLORATION +(340 I-EXPLORATION +ng/ml) I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +IGF1-BP3 I-EXPLORATION +(6, I-EXPLORATION +3 I-EXPLORATION +µg/ml) I-EXPLORATION +se I-EXPLORATION +habían I-EXPLORATION +normalizado I-EXPLORATION +también. I-EXPLORATION +La I-EXPLORATION +prolactina I-EXPLORATION +continuaba I-EXPLORATION +elevada I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +testosterona I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +Actualmente B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +controles I-EVOLUTION +periódicos I-EVOLUTION +en I-EVOLUTION +endocrinología I-EVOLUTION +y I-EVOLUTION +continúa I-EVOLUTION +en I-EVOLUTION +hemodiálisis. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +hialinosis I-PRESENT_ILLNESS +segmentaria I-PRESENT_ILLNESS +focal I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +respuesta I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +esteroides, I-PRESENT_ILLNESS +ciclofosfamida I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +vincristina. I-PRESENT_ILLNESS +Comenzó I-PRESENT_ILLNESS +DP I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +1990. I-PRESENT_ILLNESS +Durante B-TREATMENT +los I-TREATMENT +siguientes I-TREATMENT +11 I-TREATMENT +años I-TREATMENT +recibió I-TREATMENT +3 I-TREATMENT +trasplantes I-TREATMENT +renales, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +tiempo I-TREATMENT +total I-TREATMENT +fuera I-TREATMENT +de I-TREATMENT +diálisis I-TREATMENT +de I-TREATMENT +5 I-TREATMENT +años. I-TREATMENT +Fue I-TREATMENT +paratiroidectomizado I-TREATMENT +por I-TREATMENT +hiperparatiroidismo I-TREATMENT +grave. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +transporte I-EVOLUTION +peritoneal I-EVOLUTION +se I-EVOLUTION +mantuvo I-EVOLUTION +como I-EVOLUTION +medio-alto I-EVOLUTION +con I-EVOLUTION +tendencia I-EVOLUTION +al I-EVOLUTION +alza. I-EVOLUTION +Con B-TREATMENT +el I-TREATMENT +tiempo I-TREATMENT +se I-TREATMENT +redujo I-TREATMENT +la I-TREATMENT +ultrafiltración I-TREATMENT +y I-TREATMENT +aumentaron I-TREATMENT +las I-TREATMENT +necesidades I-TREATMENT +osmóticas I-TREATMENT +de I-TREATMENT +las I-TREATMENT +soluciones. I-TREATMENT +Medimos B-EXPLORATION +CA-125 I-EXPLORATION +en I-EXPLORATION +efluente I-EXPLORATION +en I-EXPLORATION +diferentes I-EXPLORATION +momentos, I-EXPLORATION +encontrándose I-EXPLORATION +un I-EXPLORATION +progresivo I-EXPLORATION +descenso. I-EXPLORATION +Sufrió B-EVOLUTION +12 I-EVOLUTION +peritonitis, I-EVOLUTION +todas I-EVOLUTION +por I-EVOLUTION +gérmenes I-EVOLUTION +Gram I-EVOLUTION +positivos. I-EVOLUTION +Se I-EVOLUTION +insistió I-EVOLUTION +al I-EVOLUTION +paciente I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +ser I-EVOLUTION +transferido I-EVOLUTION +a I-EVOLUTION +HD, I-EVOLUTION +circunstancia I-EVOLUTION +que I-EVOLUTION +trataba I-EVOLUTION +de I-EVOLUTION +evitar; I-EVOLUTION +finalmente I-EVOLUTION +inició I-EVOLUTION +HD I-EVOLUTION +en I-EVOLUTION +2011. I-EVOLUTION + I-EVOLUTION +Seis I-EVOLUTION +meses I-EVOLUTION +después, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +ingresó I-EVOLUTION +por I-EVOLUTION +dolor I-EVOLUTION +y I-EVOLUTION +distensión I-EVOLUTION +abdominal. I-EVOLUTION +Una B-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +evidenció I-EXPLORATION +dilatación I-EXPLORATION +gástrica I-EXPLORATION +y I-EXPLORATION +duodenal I-EXPLORATION +con I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +loculado, I-EXPLORATION +y I-EXPLORATION +asas I-EXPLORATION +edematosas. I-EXPLORATION +Se I-EXPLORATION +obtuvo I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +del I-EXPLORATION +peritoneo: I-EXPLORATION +proliferación I-EXPLORATION +de I-EXPLORATION +pequeños I-EXPLORATION +vasos, I-EXPLORATION +celularidad I-EXPLORATION +inflamatoria I-EXPLORATION +y I-EXPLORATION +fibrosis. I-EXPLORATION +Se B-TREATMENT +diagnosticó I-TREATMENT +de I-TREATMENT +EPE, I-TREATMENT +comenzando I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +y I-TREATMENT +tamoxifeno. I-TREATMENT +Tras B-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +la I-EVOLUTION +colección I-EVOLUTION +había I-EVOLUTION +disminuido I-EVOLUTION +de I-EVOLUTION +tamaño, I-EVOLUTION +no I-EVOLUTION +observándose I-EVOLUTION +dilatación I-EVOLUTION +de I-EVOLUTION +asas. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +no I-EVOLUTION +sufrió I-EVOLUTION +más I-EVOLUTION +complicaciones. I-EVOLUTION +Se B-TREATMENT +encuentra I-TREATMENT +en I-TREATMENT +HD I-TREATMENT +y I-TREATMENT +continúa I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tamoxifeno. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +40 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +ansioso-depresivo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +infancia, I-PAST_MEDICAL_HISTORY +remitida B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +aumento I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +tamaño I-DERIVED_FROM/TO +tiroideo I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +adenopatías I-DERIVED_FROM/TO +laterocervicales. I-DERIVED_FROM/TO +La B-EXPLORATION +punción- I-EXPLORATION +aspiración I-EXPLORATION +con I-EXPLORATION +aguja I-EXPLORATION +fina I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +fue I-EXPLORATION +sospechosa I-EXPLORATION +de I-EXPLORATION +carcinoma I-EXPLORATION +papilar I-EXPLORATION +de I-EXPLORATION +tiroides I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +remitida I-EXPLORATION +al I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Cirugía I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +tratamiento. I-EXPLORATION +Fue B-TREATMENT +intervenida I-TREATMENT +realizándose I-TREATMENT +tiroidectomía I-TREATMENT +total I-TREATMENT +con I-TREATMENT +vaciamiento I-TREATMENT +cervical I-TREATMENT +funcional I-TREATMENT +bilateral I-TREATMENT +(niveles I-TREATMENT +II, I-TREATMENT +III, I-TREATMENT +IV I-TREATMENT +y I-TREATMENT +V) I-TREATMENT +y I-TREATMENT +del I-TREATMENT +compartimento I-TREATMENT +central I-TREATMENT +del I-TREATMENT +cuello. I-TREATMENT +Se I-TREATMENT +conservaron I-TREATMENT +ambos I-TREATMENT +nervios I-TREATMENT +recurrentes, I-TREATMENT +se I-TREATMENT +reimplantaron I-TREATMENT +las I-TREATMENT +dos I-TREATMENT +paratiroides I-TREATMENT +inferiores I-TREATMENT +y I-TREATMENT +se I-TREATMENT +ligo I-TREATMENT +el I-TREATMENT +conducto I-TREATMENT +torácico. I-TREATMENT +Como B-EVOLUTION +complicación I-EVOLUTION +postquirúrgica I-EVOLUTION +inmediata I-EVOLUTION +presentó I-EVOLUTION +hipocalcemia I-EVOLUTION +transitoria. I-EVOLUTION +Fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +5 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención. I-EVOLUTION + B-EXPLORATION +El I-EXPLORATION +resultado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +confirmó I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +carcinoma I-EXPLORATION +papilar I-EXPLORATION +multifocal I-EXPLORATION +con I-EXPLORATION +metástasis I-EXPLORATION +de I-EXPLORATION +ganglios I-EXPLORATION +linfáticos I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +regiones I-EXPLORATION +cervicales I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +cadena I-EXPLORATION +recurrencial. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +diez I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +intervención, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presentó, I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +brusca, I-EVOLUTION +tumefacción I-EVOLUTION +en I-EVOLUTION +región I-EVOLUTION +cervical I-EVOLUTION +izquierda I-EVOLUTION +con I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +hacia I-EVOLUTION +la I-EVOLUTION +región I-EVOLUTION +anterior I-EVOLUTION +y I-EVOLUTION +cervical I-EVOLUTION +derecha. I-EVOLUTION +No I-EVOLUTION +presentaba I-EVOLUTION +signos I-EVOLUTION +inflamatorios. I-EVOLUTION +Fue B-TREATMENT +valorada I-TREATMENT +por I-TREATMENT +el I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Cirugía I-TREATMENT +decidiéndose I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +un I-TREATMENT +drenaje I-TREATMENT +aspirativo I-TREATMENT +de I-TREATMENT +baja I-TREATMENT +presión I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +de I-TREATMENT +fístula I-TREATMENT +de I-TREATMENT +conducto I-TREATMENT +torácico. I-TREATMENT +La B-EXPLORATION +salida I-EXPLORATION +de I-EXPLORATION +líquido I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +lechoso I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +triglicéridos I-EXPLORATION +de I-EXPLORATION +1410 I-EXPLORATION +mg/dl I-EXPLORATION +confirmo I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +clínica I-EXPLORATION +siendo I-EXPLORATION +remitido I-EXPLORATION +a I-EXPLORATION +nuestras I-EXPLORATION +consultas I-EXPLORATION +para I-EXPLORATION +tratamiento I-EXPLORATION +dietético. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +consulta I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +valoración I-EXPLORATION +antropométrica I-EXPLORATION +básica I-EXPLORATION +y I-EXPLORATION +analítica, I-EXPLORATION +objetivándose I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +estaba I-EXPLORATION +normonutrida I-EXPLORATION +y I-EXPLORATION +sin I-EXPLORATION +complicaciones I-EXPLORATION +metabólicas I-EXPLORATION +derivadas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fístula. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +prescripción I-TREATMENT +yeducación I-TREATMENT +de I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +de I-TREATMENT +una I-TREATMENT +dieta I-TREATMENT +baja I-TREATMENT +en I-TREATMENT +LCT. I-TREATMENT +Se I-TREATMENT +le I-TREATMENT +dieron I-TREATMENT +instrucciones I-TREATMENT +dietéticas I-TREATMENT +escritas I-TREATMENT +(tabla I-TREATMENT +I) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +suplementó I-TREATMENT +con I-TREATMENT +aceite I-TREATMENT +MCT I-TREATMENT +en I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +cc/día. I-TREATMENT + I-TREATMENT +Entre B-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +y I-EXPLORATION +antropometría I-EXPLORATION +pretratamiento I-EXPLORATION +dietético I-EXPLORATION +y I-EXPLORATION +las I-EXPLORATION +realizadas I-EXPLORATION +dos I-EXPLORATION +semanas I-EXPLORATION +después I-EXPLORATION +no I-EXPLORATION +hubo I-EXPLORATION +diferencias I-EXPLORATION +significativas I-EXPLORATION +sin I-EXPLORATION +objetivarse I-EXPLORATION +complicaciones I-EXPLORATION +metabólicas I-EXPLORATION +características I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +patolología. I-EXPLORATION + I-EXPLORATION +Antes I-EXPLORATION +de I-EXPLORATION +iniciar I-EXPLORATION +el I-EXPLORATION +tratamiento I-EXPLORATION +dietético I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +drenaje I-EXPLORATION +diario I-EXPLORATION +máximo I-EXPLORATION +de I-EXPLORATION +400 I-EXPLORATION +cc I-EXPLORATION +de I-EXPLORATION +linfa. I-EXPLORATION +Al I-EXPLORATION +segundo I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +tratamiento I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +obtenido I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +drenaje I-EXPLORATION +disminuyó I-EXPLORATION +a I-EXPLORATION +100-200 I-EXPLORATION +cc I-EXPLORATION +diario I-EXPLORATION +y I-EXPLORATION +fue I-EXPLORATION +variando I-EXPLORATION +sus I-EXPLORATION +características I-EXPLORATION +macroscópicas I-EXPLORATION +haciéndose I-EXPLORATION +más I-EXPLORATION +claro, I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +más I-EXPLORATION +serohemático I-EXPLORATION +y I-EXPLORATION +menos I-EXPLORATION +quiloso. I-EXPLORATION +Se B-TREATMENT +mantuvo I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +dietético I-TREATMENT +y I-TREATMENT +el I-TREATMENT +drenaje I-TREATMENT +percutáneo I-TREATMENT +hasta I-TREATMENT +el I-TREATMENT +día I-TREATMENT +14 I-TREATMENT +tras I-TREATMENT +lo I-TREATMENT +cual, I-TREATMENT +al I-TREATMENT +observarse I-TREATMENT +mínima I-TREATMENT +salida I-TREATMENT +de I-TREATMENT +fluido I-TREATMENT +y I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +características I-TREATMENT +quilosas I-TREATMENT +se I-TREATMENT +retiró I-TREATMENT +el I-TREATMENT +acceso I-TREATMENT +percutáneo. I-TREATMENT +El I-TREATMENT +tratamiento I-TREATMENT +dietético I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +4 I-TREATMENT +días I-TREATMENT +más I-TREATMENT +para I-TREATMENT +observar I-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +retirada I-TREATMENT +del I-TREATMENT +drenaje I-TREATMENT +y B-EVOLUTION +ante I-EVOLUTION +la I-EVOLUTION +ausencia I-EVOLUTION +de I-EVOLUTION +signos I-EVOLUTION +que I-EVOLUTION +sugirieran I-EVOLUTION +recidiva I-EVOLUTION +se I-EVOLUTION +liberalizó I-EVOLUTION +la I-EVOLUTION +dieta, I-EVOLUTION +encontrándose I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +dieta I-EVOLUTION +libre. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +50 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +sangrado I-PRESENT_ILLNESS +postmenopáusico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +diagnosticada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +legrado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +adenocarcinoma I-PRESENT_ILLNESS +velloglandular I-PRESENT_ILLNESS +bien I-PRESENT_ILLNESS +diferenciado I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +extensa I-PRESENT_ILLNESS +diferenciación I-PRESENT_ILLNESS +escamosa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +carcinoma I-PRESENT_ILLNESS +epidermoide. I-PRESENT_ILLNESS +Se B-TREATMENT +intervino I-TREATMENT +quirúrgicamente I-TREATMENT +realizando I-TREATMENT +histerectomía I-TREATMENT +y I-TREATMENT +doble I-TREATMENT +anexectomía, I-TREATMENT +linfadenectomía I-TREATMENT +pélvica I-TREATMENT +y I-TREATMENT +lavado I-TREATMENT +peritoneal. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +quirúrgica I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +espesor I-EXPLORATION +miometrial, I-EXPLORATION +la I-EXPLORATION +serosa I-EXPLORATION +uterina, I-EXPLORATION +el I-EXPLORATION +epitelio I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estroma I-EXPLORATION +cervical, I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Trompa I-EXPLORATION +de I-EXPLORATION +Falopio I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +linfáticos I-EXPLORATION +del I-EXPLORATION +cuerpo I-EXPLORATION +uterino I-EXPLORATION +(estadio I-EXPLORATION +IIIa I-EXPLORATION +GIII). I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +tratar I-TREATMENT +con I-TREATMENT +radioquimioterapia I-TREATMENT +concurrente. I-TREATMENT +Se I-TREATMENT +administraron I-TREATMENT +46 I-TREATMENT +Gy I-TREATMENT +con I-TREATMENT +fraccionamiento I-TREATMENT +clásico I-TREATMENT +(5 I-TREATMENT +x I-TREATMENT +200 I-TREATMENT +cGy) I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +cinco I-TREATMENT +ciclos I-TREATMENT +de I-TREATMENT +Cisplatino I-TREATMENT +(40 I-TREATMENT +mg/semanales). I-TREATMENT +Tras I-TREATMENT +finalizar I-TREATMENT +ambos I-TREATMENT +tratamiento I-TREATMENT +la I-TREATMENT +enferma I-TREATMENT +recibió I-TREATMENT +radioterapia I-TREATMENT +endocavitaria I-TREATMENT +mediante I-TREATMENT +la I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +molde I-TREATMENT +de I-TREATMENT +Chassagne I-TREATMENT +con I-TREATMENT +tres I-TREATMENT +fuentes I-TREATMENT +radioactivas I-TREATMENT +de I-TREATMENT +Cesio-137 I-TREATMENT +de I-TREATMENT +baja I-TREATMENT +tasa I-TREATMENT +de I-TREATMENT +dosis. I-TREATMENT +Recibió I-TREATMENT +además I-TREATMENT +tratamiento I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +Tegafur. I-TREATMENT + I-TREATMENT +Tres B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +terminado I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +ingresó I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +suboclusión I-EVOLUTION +intestinal I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +manejó I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +conservadora. I-EVOLUTION +Presentó I-EVOLUTION +varios I-EVOLUTION +episodios I-EVOLUTION +similares I-EVOLUTION +con I-EVOLUTION +posterioridad I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +pérdida I-EVOLUTION +de I-EVOLUTION +aproximadamente I-EVOLUTION +30 I-EVOLUTION +kg I-EVOLUTION +de I-EVOLUTION +peso. I-EVOLUTION +Fue B-TREATMENT +valorada I-TREATMENT +por I-TREATMENT +la I-TREATMENT +Unidad I-TREATMENT +de I-TREATMENT +Nutrición I-TREATMENT +Clínica I-TREATMENT +que I-TREATMENT +recomendó I-TREATMENT +una I-TREATMENT +dieta I-TREATMENT +pobre I-TREATMENT +en I-TREATMENT +grasas I-TREATMENT +y I-TREATMENT +residuos I-TREATMENT +y I-TREATMENT +suplementos I-TREATMENT +hipercalóricos I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +sin I-TREATMENT +respuesta. I-TREATMENT +Ingresó B-EVOLUTION +para I-EVOLUTION +rehabilitación I-EVOLUTION +intestinal I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +peso I-EVOLUTION +de I-EVOLUTION +26 I-EVOLUTION +kg I-EVOLUTION +y I-EVOLUTION +una I-EVOLUTION +talla I-EVOLUTION +de I-EVOLUTION +148 I-EVOLUTION +cm. I-EVOLUTION +IMC: I-EVOLUTION +11, I-EVOLUTION +9 I-EVOLUTION +kg/m2. I-EVOLUTION +El B-EXPLORATION +estudio I-EXPLORATION +realizado I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +permitió I-EXPLORATION +descartar I-EXPLORATION +recidiva I-EXPLORATION +tumoral I-EXPLORATION +encontrando I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tránsito I-EXPLORATION +digestivo I-EXPLORATION +superior I-EXPLORATION +una I-EXPLORATION +marcada I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +duodeno I-EXPLORATION +y I-EXPLORATION +porción I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +yeyuno I-EXPLORATION +que I-EXPLORATION +llega I-EXPLORATION +a I-EXPLORATION +medir I-EXPLORATION +como I-EXPLORATION +diámetro I-EXPLORATION +máximo I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +yeyuno I-EXPLORATION +proximal. I-EXPLORATION +Tránsito I-EXPLORATION +intestinal I-EXPLORATION +muy I-EXPLORATION +prolongado I-EXPLORATION +que I-EXPLORATION +llega I-EXPLORATION +a I-EXPLORATION +demorarse I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +48 I-EXPLORATION +horas I-EXPLORATION +desde I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +administró I-EXPLORATION +el I-EXPLORATION +contraste I-EXPLORATION +hasta I-EXPLORATION +que I-EXPLORATION +alcanzó I-EXPLORATION +ciego I-EXPLORATION +y I-EXPLORATION +colon I-EXPLORATION +ascendente. I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +dilatación I-EXPLORATION +masiva I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +de I-EXPLORATION +intestino I-EXPLORATION +delgado I-EXPLORATION +que I-EXPLORATION +ocupan I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +abdomen. I-EXPLORATION +Discreto I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +asas. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +hidrógeno I-EXPLORATION +espirado I-EXPLORATION +con I-EXPLORATION +lactosa I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +malabsorción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +Una I-EXPLORATION +colonoscopia I-EXPLORATION +realizada I-EXPLORATION +en I-EXPLORATION +ese I-EXPLORATION +momento I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +colitis I-EXPLORATION +distal I-EXPLORATION +que I-EXPLORATION +histológicamente I-EXPLORATION +correspondían I-EXPLORATION +a I-EXPLORATION +colitis I-EXPLORATION +crónica I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +postradioterapia. I-EXPLORATION +Se B-TREATMENT +colocó I-TREATMENT +una I-TREATMENT +sonda I-TREATMENT +nasogástrica I-TREATMENT +para I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +continua I-TREATMENT +con I-TREATMENT +incapacidad I-TREATMENT +para I-TREATMENT +progresar I-TREATMENT +por I-TREATMENT +encima I-TREATMENT +de I-TREATMENT +30 I-TREATMENT +ml/hora I-TREATMENT +de I-TREATMENT +una I-TREATMENT +fórmula I-TREATMENT +polimérica I-TREATMENT +normocalórica, I-TREATMENT +y I-TREATMENT +sin I-TREATMENT +respuesta I-TREATMENT +a I-TREATMENT +la I-TREATMENT +adición I-TREATMENT +de I-TREATMENT +procinéticos. I-TREATMENT +Por I-TREATMENT +este I-TREATMENT +motivo I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +catéter I-TREATMENT +venoso I-TREATMENT +central I-TREATMENT +tunelizado I-TREATMENT +y I-TREATMENT +se I-TREATMENT +incluyó I-TREATMENT +en I-TREATMENT +el I-TREATMENT +programa I-TREATMENT +de I-TREATMENT +NPD I-TREATMENT +de I-TREATMENT +nuestro I-TREATMENT +centro. I-TREATMENT +Su I-TREATMENT +NP I-TREATMENT +inicial I-TREATMENT +consistía I-TREATMENT +en I-TREATMENT +1.250 I-TREATMENT +ml I-TREATMENT +de I-TREATMENT +volumen I-TREATMENT +y I-TREATMENT +1.440 I-TREATMENT +kcal, I-TREATMENT +infundida I-TREATMENT +a I-TREATMENT +lo I-TREATMENT +largo I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +horas, I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +a I-TREATMENT +la I-TREATMENT +semana. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +inicial I-EVOLUTION +fue I-EVOLUTION +buena I-EVOLUTION +con I-EVOLUTION +progresiva I-EVOLUTION +recuperación I-EVOLUTION +del I-EVOLUTION +peso I-EVOLUTION +y I-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +NPD. I-EVOLUTION +Sin I-EVOLUTION +embargo, I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +primer I-EVOLUTION +ingreso I-EVOLUTION +por I-EVOLUTION +una I-EVOLUTION +bacteriemia I-EVOLUTION +asociada I-EVOLUTION +a I-EVOLUTION +catéter. I-EVOLUTION +En I-EVOLUTION +los I-EVOLUTION +siguientes I-EVOLUTION +14 I-EVOLUTION +meses I-EVOLUTION +fue I-EVOLUTION +ingresada I-EVOLUTION +en I-EVOLUTION +2 I-EVOLUTION +ocasiones I-EVOLUTION +por I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +deshidratación I-EVOLUTION +con I-EVOLUTION +afectación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +(insuficiencia I-EVOLUTION +renal I-EVOLUTION +prerrenal) I-EVOLUTION +secundarias I-EVOLUTION +a I-EVOLUTION +pérdidas I-EVOLUTION +aumentadas I-EVOLUTION +por I-EVOLUTION +vómitos I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +9 I-EVOLUTION +por I-EVOLUTION +infecciones I-EVOLUTION +por I-EVOLUTION +diversos I-EVOLUTION +gérmenes I-EVOLUTION +Gram I-EVOLUTION +positivos, I-EVOLUTION +Gram I-EVOLUTION +negativos I-EVOLUTION +y I-EVOLUTION +hongos I-EVOLUTION +que I-EVOLUTION +obligaron I-EVOLUTION +a I-EVOLUTION +recambiar I-EVOLUTION +el I-EVOLUTION +catéter I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +ocasiones. I-EVOLUTION +En I-EVOLUTION +todos I-EVOLUTION +los I-EVOLUTION +ingresos I-EVOLUTION +se I-EVOLUTION +hizo I-EVOLUTION +revisión I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pautas I-EVOLUTION +de I-EVOLUTION +manejo I-EVOLUTION +del I-EVOLUTION +catéter I-EVOLUTION +venoso I-EVOLUTION +central I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +NPD I-EVOLUTION +sin I-EVOLUTION +poder I-EVOLUTION +constatar I-EVOLUTION +que I-EVOLUTION +hubiera I-EVOLUTION +quebrantamiento I-EVOLUTION +del I-EVOLUTION +protocolo. I-EVOLUTION +A B-TREATMENT +la I-TREATMENT +vista I-TREATMENT +de I-TREATMENT +la I-TREATMENT +mala I-TREATMENT +evolución I-TREATMENT +clínica I-TREATMENT +y I-TREATMENT +a I-TREATMENT +la I-TREATMENT +remisión I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +la I-TREATMENT +enfermedad I-TREATMENT +tumoral I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +plantear I-TREATMENT +una I-TREATMENT +solución I-TREATMENT +quirúrgica I-TREATMENT +alternativa. I-TREATMENT +Se B-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +nuevo I-EXPLORATION +tránsito I-EXPLORATION +digestivo I-EXPLORATION +con I-EXPLORATION +hallazgos I-EXPLORATION +similares I-EXPLORATION +al I-EXPLORATION +realizado I-EXPLORATION +dos I-EXPLORATION +años I-EXPLORATION +antes I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +calibre I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +porción I-EXPLORATION +más I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +sigma, I-EXPLORATION +aunque I-EXPLORATION +permite I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +de I-EXPLORATION +papilla I-EXPLORATION +sin I-EXPLORATION +ninguna I-EXPLORATION +dificultad: I-EXPLORATION +no I-EXPLORATION +hay I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +estenosis. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +laparotomía I-EXPLORATION +media I-EXPLORATION +supra I-EXPLORATION +e I-EXPLORATION +infraumbilical I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +dilatación I-EXPLORATION +de I-EXPLORATION +duodeno I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +delgado I-EXPLORATION +hasta I-EXPLORATION +llegar I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +grupo I-EXPLORATION +de I-EXPLORATION +asas I-EXPLORATION +yeyunoileales I-EXPLORATION +adheridas I-EXPLORATION +entre I-EXPLORATION +sí I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +pelvis I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +colon I-EXPLORATION +de I-EXPLORATION +calibre I-EXPLORATION +normal. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +a I-TREATMENT +liberar I-TREATMENT +las I-TREATMENT +asas I-TREATMENT +afectadas I-TREATMENT +y I-TREATMENT +resecar I-TREATMENT +20 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +yeyunoíleon I-TREATMENT +incluyendo I-TREATMENT +el I-TREATMENT +segmento I-TREATMENT +patológico, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +anastomosis I-TREATMENT +laterolateral. I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza: I-EXPLORATION +"intestino I-EXPLORATION +con I-EXPLORATION +atrofia I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +vellosidades I-EXPLORATION +y I-EXPLORATION +fibrosis I-EXPLORATION +subserosa I-EXPLORATION +con I-EXPLORATION +adherencias, I-EXPLORATION +propio I-EXPLORATION +de I-EXPLORATION +cambios I-EXPLORATION +postradioterapia". I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +una I-EVOLUTION +excelente I-EVOLUTION +recuperación, I-EVOLUTION +con I-EVOLUTION +tolerancia I-EVOLUTION +alimentaria I-EVOLUTION +y I-EVOLUTION +tránsito I-EVOLUTION +intestinal I-EVOLUTION +normal. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +lleva I-EVOLUTION +una I-EVOLUTION +vida I-EVOLUTION +normal, I-EVOLUTION +es I-EVOLUTION +capaz I-EVOLUTION +de I-EVOLUTION +tolerar I-EVOLUTION +una I-EVOLUTION +dieta I-EVOLUTION +variada I-EVOLUTION +con I-EVOLUTION +restricción I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +lactosa I-EVOLUTION +y I-EVOLUTION +había I-EVOLUTION +recuperado I-EVOLUTION +el I-EVOLUTION +peso I-EVOLUTION +anterior I-EVOLUTION +al I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +radioterapia. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +42 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +primer B-PAST_MEDICAL_HISTORY +hijo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +padres I-PAST_MEDICAL_HISTORY +sanos I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +consanguíneos, I-PAST_MEDICAL_HISTORY +diagnosticado B-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +ecografía I-PRESENT_ILLNESS +prenatal I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ureterohidronefrosis I-PRESENT_ILLNESS +bilateral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dilatación I-PRESENT_ILLNESS +gástrica. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +período I-EXPLORATION +neonatal I-EXPLORATION +precoz I-EXPLORATION +únicamente I-EXPLORATION +llamó I-EXPLORATION +la I-EXPLORATION +atención, I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +globuloso I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +deposición I-EXPLORATION +meconial I-EXPLORATION +al I-EXPLORATION +4º I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +vida, I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +absoluta I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +deposiciones. I-EXPLORATION +Un I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +evidenció I-EXPLORATION +microcolon I-EXPLORATION +y I-EXPLORATION +malrotación I-EXPLORATION +intestinal, I-EXPLORATION +corrigiéndose I-EXPLORATION +éstaúltima I-EXPLORATION +quirúrgicamente. I-EXPLORATION +Una I-EXPLORATION +biopsia I-EXPLORATION +rectal I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +enolasa I-EXPLORATION +neuronal I-EXPLORATION +y I-EXPLORATION +descartó I-EXPLORATION +aganglionismo. I-EXPLORATION +Se B-TREATMENT +mantuvo I-TREATMENT +en I-TREATMENT +todo I-TREATMENT +momento I-TREATMENT +con I-TREATMENT +nutrición I-TREATMENT +parenteral, I-TREATMENT +con I-TREATMENT +intentos I-TREATMENT +de I-TREATMENT +ingesta I-TREATMENT +oral I-TREATMENT +que I-TREATMENT +toleró I-TREATMENT +finalmente I-TREATMENT +a I-TREATMENT +los I-TREATMENT +2 I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +con I-TREATMENT +un I-TREATMENT +volumen I-TREATMENT +máximo I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +ml/h. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +siempre I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +diuresis I-EVOLUTION +adecuada, I-EVOLUTION +aunque I-EVOLUTION +mantenía I-EVOLUTION +las I-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +creatinina I-EVOLUTION +en I-EVOLUTION +límites I-EVOLUTION +altos I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad. I-EVOLUTION +Posteriormente B-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +pieloureterostomía I-TREATMENT +bilateral I-TREATMENT +mejorando I-TREATMENT +su I-TREATMENT +función I-TREATMENT +renal. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +20 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +sepsis I-EVOLUTION +nosocomial I-EVOLUTION +relacionada I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +catéter I-EVOLUTION +por I-EVOLUTION +Staphylococcus I-EVOLUTION +epidermidis, I-EVOLUTION +tratada B-TREATMENT +con I-TREATMENT +teicoplanina I-TREATMENT +y I-TREATMENT +cefotaxima I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +respuesta9. I-EVOLUTION +Estos I-EVOLUTION +datos I-EVOLUTION +amplían I-EVOLUTION +lo I-EVOLUTION +ya I-EVOLUTION +publicado I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +año I-EVOLUTION +2004 I-EVOLUTION +por I-EVOLUTION +parte I-EVOLUTION +del I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Neonatología I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Cirugía I-EVOLUTION +Pediátrica I-EVOLUTION +del I-EVOLUTION +Hospital I-EVOLUTION +Universitario I-EVOLUTION +Central I-EVOLUTION +de I-EVOLUTION +Asturias10. I-EVOLUTION + I-EVOLUTION +Actualmente I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +ureterostomía I-EVOLUTION +cutánea I-EVOLUTION +bilateral, I-EVOLUTION +peristaltismo I-EVOLUTION +y I-EVOLUTION +hábito I-EVOLUTION +intestinal I-EVOLUTION +conservados, I-EVOLUTION +relativamente I-EVOLUTION +bien I-EVOLUTION +nutrido I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +aceptable I-EVOLUTION +y I-EVOLUTION +progresivo I-EVOLUTION +desarrollo I-EVOLUTION +ponderal: I-EVOLUTION +percentil I-EVOLUTION +10 I-EVOLUTION +de I-EVOLUTION +peso I-EVOLUTION +y I-EVOLUTION +talla, I-EVOLUTION +índice I-EVOLUTION +de I-EVOLUTION +Waterlow I-EVOLUTION +del I-EVOLUTION +96%. I-EVOLUTION +Recibe B-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +(NP) I-TREATMENT +desde I-TREATMENT +el I-TREATMENT +tercer I-TREATMENT +día I-TREATMENT +de I-TREATMENT +vida I-TREATMENT +y I-TREATMENT +actualmente I-TREATMENT +en I-TREATMENT +régimen I-TREATMENT +ambulatorio, I-TREATMENT +suplementada I-TREATMENT +con I-TREATMENT +aportes I-TREATMENT +orales I-TREATMENT +a I-TREATMENT +débito I-TREATMENT +continuo, I-TREATMENT +desde I-TREATMENT +que I-TREATMENT +inició I-TREATMENT +tolerancia I-TREATMENT +a I-TREATMENT +los I-TREATMENT +mismos. I-TREATMENT +La I-TREATMENT +composición I-TREATMENT +de I-TREATMENT +la I-TREATMENT +NP I-TREATMENT +por I-TREATMENT +kg I-TREATMENT +de I-TREATMENT +peso I-TREATMENT +y I-TREATMENT +día I-TREATMENT +es I-TREATMENT +de I-TREATMENT +1, I-TREATMENT +8 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +aminoácidos, I-TREATMENT +8, I-TREATMENT +6 I-TREATMENT +g I-TREATMENT +de I-TREATMENT +glucosa, I-TREATMENT +1, I-TREATMENT +4 I-TREATMENT +g I-TREATMENT +lípidos, I-TREATMENT +Na I-TREATMENT +3, I-TREATMENT +7 I-TREATMENT +mEq, I-TREATMENT +k I-TREATMENT +1, I-TREATMENT +4 I-TREATMENT +mEq, I-TREATMENT +Ca I-TREATMENT +0, I-TREATMENT +7 I-TREATMENT +mEq, I-TREATMENT +Cl I-TREATMENT +4, I-TREATMENT +4 I-TREATMENT +mEq, I-TREATMENT +P I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +mEq, I-TREATMENT +Mg I-TREATMENT +0, I-TREATMENT +3 I-TREATMENT +mEq, I-TREATMENT +contiene I-TREATMENT +55, I-TREATMENT +7 I-TREATMENT +kcal I-TREATMENT +totales I-TREATMENT +y I-TREATMENT +un I-TREATMENT +volumen I-TREATMENT +total I-TREATMENT +de I-TREATMENT +1.295 I-TREATMENT +ml. I-TREATMENT +La I-TREATMENT +NP I-TREATMENT +es I-TREATMENT +perfundida I-TREATMENT +durante I-TREATMENT +17 I-TREATMENT +horas, I-TREATMENT +en I-TREATMENT +pases I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +ml/hora, I-TREATMENT +con I-TREATMENT +ascenso I-TREATMENT +y I-TREATMENT +descenso I-TREATMENT +en I-TREATMENT +una I-TREATMENT +hora, I-TREATMENT +siendo I-TREATMENT +el I-TREATMENT +tiempo I-TREATMENT +de I-TREATMENT +reposo I-TREATMENT +sin I-TREATMENT +NPD I-TREATMENT +de I-TREATMENT +7 I-TREATMENT +horas. I-TREATMENT +Recibe I-TREATMENT +tratamiento I-TREATMENT +profiláctico I-TREATMENT +frente I-TREATMENT +al I-TREATMENT +sobrecrecimiento I-TREATMENT +bacteriano I-TREATMENT +intestinal I-TREATMENT +con I-TREATMENT +metronidazol, I-TREATMENT +además I-TREATMENT +de I-TREATMENT +trimetropim, I-TREATMENT +fenobarbital, I-TREATMENT +hierro, I-TREATMENT +ácido I-TREATMENT +ursodesoxicólico, I-TREATMENT +ranitidina, I-TREATMENT +eritromicina, I-TREATMENT +vitamina I-TREATMENT +E, I-TREATMENT +vitamina I-TREATMENT +D3 I-TREATMENT +y I-TREATMENT +darbepoetina. I-TREATMENT +Mensualmente, B-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +control I-EXPLORATION +clínico, I-EXPLORATION +analítico I-EXPLORATION +(bioquímica I-EXPLORATION +completa, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda) I-EXPLORATION +y I-EXPLORATION +control I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +de I-EXPLORATION +ostomías I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +catéter I-EXPLORATION +Hickman. I-EXPLORATION +Ha B-EVOLUTION +presentado I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +obstrucción I-EVOLUTION +abdominal, I-EVOLUTION +uno B-TREATMENT +de I-TREATMENT +los I-TREATMENT +cuales, I-TREATMENT +secundario I-TREATMENT +a I-TREATMENT +bridas I-TREATMENT +intestinales, I-TREATMENT +requirió I-TREATMENT +intervención I-TREATMENT +quirúrgica. I-TREATMENT +Las B-EVOLUTION +complicaciones I-EVOLUTION +relacionadas I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +NP I-EVOLUTION +han I-EVOLUTION +sido I-EVOLUTION +dos: I-EVOLUTION +citolisis I-EVOLUTION +hepática I-EVOLUTION +transitoria, I-EVOLUTION +que B-TREATMENT +remitió I-TREATMENT +tras I-TREATMENT +normalizar I-TREATMENT +la I-TREATMENT +relación I-TREATMENT +de I-TREATMENT +calorías I-TREATMENT +procedentes I-TREATMENT +de I-TREATMENT +hidratos I-TREATMENT +de I-TREATMENT +carbono I-TREATMENT +frente I-TREATMENT +a I-TREATMENT +grasas I-TREATMENT +(60/40) I-TREATMENT +(durante I-TREATMENT +este I-TREATMENT +período I-TREATMENT +tenía I-TREATMENT +niveles I-TREATMENT +elevados I-TREATMENT +de I-TREATMENT +GOT, I-TREATMENT +GPT, I-TREATMENT +fosfatasa I-TREATMENT +alcalina I-TREATMENT +y I-TREATMENT +bilirrubina, I-TREATMENT +que I-TREATMENT +se I-TREATMENT +normalizaron) I-TREATMENT +y B-EVOLUTION +una I-EVOLUTION +sepsis I-EVOLUTION +nosocomial I-EVOLUTION +relacionada I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +catéter I-EVOLUTION +por I-EVOLUTION +Staphylococcus I-EVOLUTION +epidermidis, I-EVOLUTION +que B-TREATMENT +respondió I-TREATMENT +adecuadamente I-TREATMENT +a I-TREATMENT +tratamiento I-TREATMENT +antibiótico. I-TREATMENT + I-TREATMENT + +Hombre B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +86 I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +enero I-PRESENT_ILLNESS +2008 I-PRESENT_ILLNESS +ingresa I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hipoglucemia I-PRESENT_ILLNESS +secundaria I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +antidiabéticos I-PRESENT_ILLNESS +orales, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +demencia I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +baja I-PRESENT_ILLNESS +ingesta, I-PRESENT_ILLNESS +se B-TREATMENT +decide I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +sonda I-TREATMENT +nasogástrica I-TREATMENT +(SNG) I-TREATMENT +para I-TREATMENT +alimentación I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +enteral, I-TREATMENT +tras I-TREATMENT +presentar I-TREATMENT +varios I-TREATMENT +episodios I-TREATMENT +de I-TREATMENT +arrancamiento I-TREATMENT +de I-TREATMENT +sonda, I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +gastrostomía I-TREATMENT +radiológica I-TREATMENT +percutánea I-TREATMENT +(GRP). I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +2 I-EVOLUTION +meses I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +acude I-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +urgencias I-EVOLUTION +por I-EVOLUTION +arrancamiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +sonda I-EVOLUTION +de I-EVOLUTION +gastrostomía, I-EVOLUTION +ante B-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +sondas I-TREATMENT +de I-TREATMENT +recambio, I-TREATMENT +se I-TREATMENT +decide I-TREATMENT +colocación I-TREATMENT +de I-TREATMENT +sonda I-TREATMENT +Foley I-TREATMENT +de I-TREATMENT +14 I-TREATMENT +french, I-TREATMENT +desde B-EVOLUTION +entonces I-EVOLUTION +son I-EVOLUTION +múltiples I-EVOLUTION +las I-EVOLUTION +visitas I-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +urgencias I-EVOLUTION +con I-EVOLUTION +problemas I-EVOLUTION +en I-EVOLUTION +relación I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +sonda. I-EVOLUTION +Es I-EVOLUTION +ingresado I-EVOLUTION +por I-EVOLUTION +vómitos I-EVOLUTION +e I-EVOLUTION +intolerancia I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +nutrición I-EVOLUTION +enteral. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +abundante I-EVOLUTION +residuo I-EVOLUTION +bilioso I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +sonda I-EVOLUTION +Foley. I-EVOLUTION +Se B-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +radiológico I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +radiológico I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sonda, I-EXPLORATION +ante I-EXPLORATION +la I-EXPLORATION +mala I-EXPLORATION +tolerancia I-EXPLORATION +enteral I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +alteraciones I-EXPLORATION +radiológicas I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +intestinal, I-EXPLORATION +observándose I-EXPLORATION +como I-EXPLORATION +se I-EXPLORATION +puede I-EXPLORATION +ver I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +figura I-EXPLORATION +1 I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +directo I-EXPLORATION +del I-EXPLORATION +contraste I-EXPLORATION +directamente I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +luz I-EXPLORATION +intestinal. I-EXPLORATION +Se B-TREATMENT +extrajo I-TREATMENT +la I-TREATMENT +sonda I-TREATMENT +Foley I-TREATMENT +por I-TREATMENT +el I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +cirugía I-TREATMENT +sin I-TREATMENT +presentar I-TREATMENT +complicaciones I-TREATMENT +y I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +sonda I-TREATMENT +de I-TREATMENT +gastrostomía I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +del I-TREATMENT +servicio I-TREATMENT +de I-TREATMENT +radiología I-TREATMENT +intervencionista, I-TREATMENT +siendo B-EVOLUTION +dado I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +en I-TREATMENT +bolos. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +81 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +remitido B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Nutrición I-DERIVED_FROM/TO +desde I-DERIVED_FROM/TO +Medicina I-DERIVED_FROM/TO +Interna I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +hipoproteinemia. I-DERIVED_FROM/TO +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +destacan I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial, I-PAST_MEDICAL_HISTORY +arritmia I-PAST_MEDICAL_HISTORY +cardíaca I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +respuesta I-PAST_MEDICAL_HISTORY +ventricular I-PAST_MEDICAL_HISTORY +adecuada. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +ecocardiograma I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +insuficiencia I-EXPLORATION +mitral I-EXPLORATION +moderada, I-EXPLORATION +insuficiencia I-EXPLORATION +aórtica I-EXPLORATION +moderada I-EXPLORATION +por I-EXPLORATION +anuloectasia I-EXPLORATION +valvular I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +auricular I-EXPLORATION +sin I-EXPLORATION +hipertensión I-EXPLORATION +pulmonar. I-EXPLORATION +También B-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Paget I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +hueso, I-PAST_MEDICAL_HISTORY +actualmente I-PAST_MEDICAL_HISTORY +inactiva. I-PAST_MEDICAL_HISTORY +Monorreno I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +hipoplasia I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +riñón I-PAST_MEDICAL_HISTORY +contralateral. I-PAST_MEDICAL_HISTORY +Intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ulcus I-PAST_MEDICAL_HISTORY +gástrico I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +50 I-PAST_MEDICAL_HISTORY +años, I-PAST_MEDICAL_HISTORY +realizándose I-PAST_MEDICAL_HISTORY +gastrectomía I-PAST_MEDICAL_HISTORY +subtotal I-PAST_MEDICAL_HISTORY +Billroth I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +I I-PAST_MEDICAL_HISTORY +(última I-PAST_MEDICAL_HISTORY +endoscopia I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +6 I-PAST_MEDICAL_HISTORY +meses, I-PAST_MEDICAL_HISTORY +donde I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +objetiva I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +quirúrgica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +gastritis I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +atrófica I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +muñón I-PAST_MEDICAL_HISTORY +gástrico). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +revisión I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Servicio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Nefrología I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +patología I-PAST_MEDICAL_HISTORY +renal, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +proteinuria I-PAST_MEDICAL_HISTORY +significativa. I-PAST_MEDICAL_HISTORY +Perfil I-PAST_MEDICAL_HISTORY +hepático I-PAST_MEDICAL_HISTORY +correcto. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis, I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refiere I-PRESENT_ILLNESS +buen I-PRESENT_ILLNESS +apetito I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +adecuada I-PRESENT_ILLNESS +ingesta, I-PRESENT_ILLNESS +realizando I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +dieta I-PRESENT_ILLNESS +equilibrada. I-PRESENT_ILLNESS +Hábito I-PRESENT_ILLNESS +deposicional I-PRESENT_ILLNESS +conservado. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física, I-EXPLORATION +edemas I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +extremidades I-EXPLORATION +inferiores I-EXPLORATION +e I-EXPLORATION +IMC I-EXPLORATION +contaminado I-EXPLORATION +de I-EXPLORATION +21, I-EXPLORATION +7 I-EXPLORATION +kg/m2. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica, I-EXPLORATION +hipoalbuminemia I-EXPLORATION +de I-EXPLORATION +2.002 I-EXPLORATION +mg/dl. I-EXPLORATION +Se I-EXPLORATION +inicia I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +nutrición I-EXPLORATION +enteral I-EXPLORATION +domiciliaria I-EXPLORATION +hiperproteica. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +siguiente I-EXPLORATION +control, I-EXPLORATION +la I-EXPLORATION +albúmina I-EXPLORATION +ha I-EXPLORATION +disminuido I-EXPLORATION +a I-EXPLORATION +1.930 I-EXPLORATION +mg/dl I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +piensa I-EXPLORATION +en I-EXPLORATION +una I-EXPLORATION +enfermedad I-EXPLORATION +malabsortiva I-EXPLORATION +pese I-EXPLORATION +a I-EXPLORATION +no I-EXPLORATION +referir I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +diarrea. I-EXPLORATION +Se I-EXPLORATION +realizan I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +D-xilosa I-EXPLORATION +y I-EXPLORATION +Van I-EXPLORATION +de I-EXPLORATION +Kammer, I-EXPLORATION +siendo I-EXPLORATION +ambos I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +descarta I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +celiaquía I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +gastroduodenal I-EXPLORATION +que I-EXPLORATION +resulta I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +grasa I-EXPLORATION +subcutánea I-EXPLORATION +no I-EXPLORATION +refleja I-EXPLORATION +amiloidosis. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +enfermedad I-EXPLORATION +pierde I-EXPLORATION +proteínas, I-EXPLORATION +se I-EXPLORATION +realiza I-EXPLORATION +aclaramiento I-EXPLORATION +de I-EXPLORATION +A1AT I-EXPLORATION +en I-EXPLORATION +heces I-EXPLORATION +con I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +218 I-EXPLORATION +ml/día I-EXPLORATION +(> I-EXPLORATION +24ml/día) I-EXPLORATION +[A1AT I-EXPLORATION +en I-EXPLORATION +sangre: I-EXPLORATION +156 I-EXPLORATION +mg/dL; I-EXPLORATION +A1AT I-EXPLORATION +en I-EXPLORATION +heces: I-EXPLORATION +1, I-EXPLORATION +53 I-EXPLORATION +mg/g; I-EXPLORATION +peso I-EXPLORATION +heces I-EXPLORATION +en I-EXPLORATION +24 I-EXPLORATION +h: I-EXPLORATION +222, I-EXPLORATION +57 I-EXPLORATION +g] I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +diagnosticado I-EXPLORATION +de I-EXPLORATION +esta I-EXPLORATION +patología. I-EXPLORATION +Pese I-EXPLORATION +a I-EXPLORATION +no I-EXPLORATION +observar I-EXPLORATION +otra I-EXPLORATION +causa I-EXPLORATION +subyacente, I-EXPLORATION +no I-EXPLORATION +es I-EXPLORATION +posible I-EXPLORATION +asegurar I-EXPLORATION +que I-EXPLORATION +su I-EXPLORATION +alteración I-EXPLORATION +cardiológica I-EXPLORATION +sea I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +PLE. I-EXPLORATION +En B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +domiciliaria, I-TREATMENT +mantiene B-EVOLUTION +cifras I-EVOLUTION +de I-EVOLUTION +albúmina I-EVOLUTION +estables. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +55 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +15 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +II. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +mayo I-EXPLORATION +de I-EXPLORATION +2012 I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +tomografía I-EXPLORATION +computerizada I-EXPLORATION +(TC) I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +de I-EXPLORATION +27 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +superior I-EXPLORATION +derecho, I-EXPLORATION +con I-EXPLORATION +probable I-EXPLORATION +infiltración I-EXPLORATION +de I-EXPLORATION +primera I-EXPLORATION +costilla. I-EXPLORATION +Fue I-EXPLORATION +diagnosticada I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +tumor I-EXPLORATION +de I-EXPLORATION +Pancoast I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +estadiaje I-EXPLORATION +inicial I-EXPLORATION +T4N0M0. I-EXPLORATION +En B-TREATMENT +julio I-TREATMENT +de I-TREATMENT +2012 I-TREATMENT +recibió I-TREATMENT +quimioterapia I-TREATMENT +y I-TREATMENT +radioterapia I-TREATMENT +concomitante. I-TREATMENT +Presentó B-EVOLUTION +una I-EVOLUTION +respuesta I-EVOLUTION +completa I-EVOLUTION +y, B-TREATMENT +en I-TREATMENT +octubre I-TREATMENT +de I-TREATMENT +2012, I-TREATMENT +se I-TREATMENT +le I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +lobectomía I-TREATMENT +superior I-TREATMENT +derecha I-TREATMENT +videotoracoscópica I-TREATMENT +y I-TREATMENT +linfadenectomía. I-TREATMENT +El B-EVOLUTION +postoperatorio I-EVOLUTION +fue I-EVOLUTION +tórpido, I-EVOLUTION +con I-EVOLUTION +shock I-EVOLUTION +séptico I-EVOLUTION +de I-EVOLUTION +origen I-EVOLUTION +respiratorio, I-EVOLUTION +insuficiencia I-EVOLUTION +cardiaca, I-EVOLUTION +fracaso I-EVOLUTION +renal I-EVOLUTION +agudo I-EVOLUTION +y B-TREATMENT +requirió I-TREATMENT +ingreso I-TREATMENT +en I-TREATMENT +UVI I-TREATMENT +por I-TREATMENT +insuficiencia I-TREATMENT +respiratoria, I-TREATMENT +precisando I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +total I-TREATMENT +(NPT). I-TREATMENT +Allí B-EVOLUTION +permaneció I-EVOLUTION +ingresada I-EVOLUTION +2 I-EVOLUTION +meses, I-EVOLUTION +hasta I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +trasladada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +planta, I-EVOLUTION +donde I-EVOLUTION +presentó I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +abdomen I-EVOLUTION +agudo, I-EVOLUTION +practicándose I-EVOLUTION +una I-EVOLUTION +laparotomía I-EVOLUTION +exploradora. I-EVOLUTION +Tras B-TREATMENT +observarse I-TREATMENT +una I-TREATMENT +ileítis I-TREATMENT +con I-TREATMENT +componente I-TREATMENT +infeccioso I-TREATMENT +y I-TREATMENT +necrótico I-TREATMENT +junto I-TREATMENT +con I-TREATMENT +asas I-TREATMENT +isquémicas I-TREATMENT +y I-TREATMENT +abundante I-TREATMENT +líquido I-TREATMENT +libre I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +hemático I-TREATMENT +antiguo I-TREATMENT +y I-TREATMENT +fecaloideo, I-TREATMENT +se I-TREATMENT +practicó I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +aproximadamente I-TREATMENT +60 I-TREATMENT +cm I-TREATMENT +de I-TREATMENT +íleon I-TREATMENT +terminal I-TREATMENT +hasta I-TREATMENT +válvula I-TREATMENT +cecal I-TREATMENT +y I-TREATMENT +se I-TREATMENT +dejó I-TREATMENT +ileostomía I-TREATMENT +terminal I-TREATMENT +en I-TREATMENT +fosa I-TREATMENT +ilíaca I-TREATMENT +derecha. I-TREATMENT +Los B-EXPLORATION +cultivos I-EXPLORATION +fueron I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +estafilococos I-EXPLORATION +y I-EXPLORATION +bacilos I-EXPLORATION +gram I-EXPLORATION +positivos, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +intravenoso I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +piperacilina-tazobactam I-TREATMENT +4 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +vancomicina I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +durante I-TREATMENT +14 I-TREATMENT +días. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +evolucionó I-EVOLUTION +favorablemente I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +dieta I-TREATMENT +oral, I-TREATMENT +suplementos I-TREATMENT +hiperproteicos I-TREATMENT +de I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +y I-TREATMENT +complejo I-TREATMENT +polivitamínico I-TREATMENT +con I-TREATMENT +minerales. I-TREATMENT + I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +alta, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +volvió I-EVOLUTION +a I-EVOLUTION +acudir I-EVOLUTION +al I-EVOLUTION +hospital I-EVOLUTION +por I-EVOLUTION +disnea, I-EVOLUTION +fiebre, I-EVOLUTION +náuseas, I-EVOLUTION +vómitos I-EVOLUTION +alimentarios, I-EVOLUTION +febrícula, I-EVOLUTION +astenia, I-EVOLUTION +hiporexia I-EVOLUTION +y I-EVOLUTION +decaimiento I-EVOLUTION +importantes, I-EVOLUTION +acompañados I-EVOLUTION +de I-EVOLUTION +débito I-EVOLUTION +elevado I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +ileostomia I-EVOLUTION +(1.500-2.000 I-EVOLUTION +mL/día). I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +TC, I-EXPLORATION +observándose I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +postquirúrgica I-EXPLORATION +abundante I-EXPLORATION +en I-EXPLORATION +hemitórax I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +probable I-EXPLORATION +fístula I-EXPLORATION +broncopleural, I-EXPLORATION +ingresando I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Cirugía I-EXPLORATION +Torácica. I-EXPLORATION +Se B-TREATMENT +sospechó I-TREATMENT +empiema I-TREATMENT +y I-TREATMENT +se I-TREATMENT +colocaron I-TREATMENT +dos I-TREATMENT +drenajes I-TREATMENT +"pigtail". I-TREATMENT +Se I-TREATMENT +inició I-TREATMENT +antibioterapia I-TREATMENT +con I-TREATMENT +piperacilina-tazobactam I-TREATMENT +4 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +vancomicina I-TREATMENT +1 I-TREATMENT +g I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +horas I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +catéter I-TREATMENT +central I-TREATMENT +de I-TREATMENT +inserción I-TREATMENT +periférica I-TREATMENT +(PICC) I-TREATMENT +en I-TREATMENT +miembro I-TREATMENT +superior I-TREATMENT +izquierdo. I-TREATMENT +No I-TREATMENT +era I-TREATMENT +posible I-TREATMENT +otro I-TREATMENT +acceso I-TREATMENT +central, I-TREATMENT +ya I-TREATMENT +que I-TREATMENT +presentaba I-TREATMENT +trombosis I-TREATMENT +completa I-TREATMENT +de I-TREATMENT +vena I-TREATMENT +yugular I-TREATMENT +derecha I-TREATMENT +por I-TREATMENT +su I-TREATMENT +larga I-TREATMENT +estancia I-TREATMENT +en I-TREATMENT +la I-TREATMENT +UVI. I-TREATMENT +En B-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +general I-EXPLORATION +destacaba I-EXPLORATION +hipocalcemia I-EXPLORATION +(pese I-EXPLORATION +a I-EXPLORATION +tratamiento I-EXPLORATION +con I-EXPLORATION +Natecal® I-EXPLORATION +2 I-EXPLORATION +comprimidos I-EXPLORATION +al I-EXPLORATION +día), I-EXPLORATION +hipopotasemia I-EXPLORATION +e I-EXPLORATION +hipomagnesemia I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +presentaba I-EXPLORATION +previamente. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +intravenoso I-TREATMENT +con I-TREATMENT +gluconato I-TREATMENT +cálcico I-TREATMENT +1 I-TREATMENT +ampolla I-TREATMENT +de I-TREATMENT +10 I-TREATMENT +mL I-TREATMENT +al I-TREATMENT +10% I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +horas, I-TREATMENT +sulfato I-TREATMENT +de I-TREATMENT +magnesio I-TREATMENT +2 I-TREATMENT +gramos I-TREATMENT +cada I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +y I-TREATMENT +suplementos I-TREATMENT +orales I-TREATMENT +de I-TREATMENT +potasio I-TREATMENT +(1 I-TREATMENT +Boi-K® I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas), I-TREATMENT +calcio I-TREATMENT +(Natecal® I-TREATMENT +2 I-TREATMENT +comprimidos I-TREATMENT +al I-TREATMENT +día) I-TREATMENT +y I-TREATMENT +magnesio I-TREATMENT +(2 I-TREATMENT +comprimidos I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas), I-TREATMENT +solicitándose I-TREATMENT +consulta I-TREATMENT +al I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Nutrición. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +continuaba I-EVOLUTION +con I-EVOLUTION +diarrea I-EVOLUTION +líquida I-EVOLUTION +abundante I-EVOLUTION +por I-EVOLUTION +la I-EVOLUTION +ileostomía I-EVOLUTION +(más I-EVOLUTION +de I-EVOLUTION +1500 I-EVOLUTION +mL/día), I-EVOLUTION +refería I-EVOLUTION +anorexia, I-EVOLUTION +astenia, I-EVOLUTION +decaimiento I-EVOLUTION +y I-EVOLUTION +calambres. I-EVOLUTION +Pese I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +suplementacion I-EVOLUTION +oral, I-EVOLUTION +continuaba I-EVOLUTION +con I-EVOLUTION +niveles I-EVOLUTION +indectables I-EVOLUTION +de I-EVOLUTION +magnesio I-EVOLUTION +(< I-EVOLUTION +0, I-EVOLUTION +6 I-EVOLUTION +mg/dL). I-EVOLUTION +Dada B-TREATMENT +la I-TREATMENT +baja I-TREATMENT +ingesta I-TREATMENT +y I-TREATMENT +la I-TREATMENT +mala I-TREATMENT +tolerancia I-TREATMENT +oral I-TREATMENT +a I-TREATMENT +los I-TREATMENT +suplementos I-TREATMENT +de I-TREATMENT +magnesio, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +nutrición I-TREATMENT +parenteral I-TREATMENT +central I-TREATMENT +por I-TREATMENT +el I-TREATMENT +PICC. I-TREATMENT + I-TREATMENT +Tras I-TREATMENT +la I-TREATMENT +normalización I-TREATMENT +hidroelectrolítica I-TREATMENT +y I-TREATMENT +un I-TREATMENT +correcto I-TREATMENT +aporte I-TREATMENT +nutricional, I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +intervenida I-TREATMENT +para I-TREATMENT +el I-TREATMENT +cierre I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fístula I-TREATMENT +broncopleural. I-TREATMENT +Una B-EVOLUTION +semana I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +cirugía, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tomaba I-EVOLUTION +suplementos I-EVOLUTION +nutricionales I-EVOLUTION +y I-EVOLUTION +dieta I-EVOLUTION +por I-EVOLUTION +vía I-EVOLUTION +oral, I-EVOLUTION +mejorando I-EVOLUTION +los I-EVOLUTION +calambres I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +anímico, I-EVOLUTION +sin I-EVOLUTION +necesidad I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antidepresivo. I-EVOLUTION +La I-EVOLUTION +hipomagnesemia I-EVOLUTION +aislada I-EVOLUTION +tardó I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +en I-EVOLUTION +recuperarse, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +con B-TREATMENT +suplementos I-TREATMENT +nutricionales I-TREATMENT +orales I-TREATMENT +y I-TREATMENT +magnesio I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +comprimido I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas. I-TREATMENT +Al I-TREATMENT +no I-TREATMENT +normalizarse I-TREATMENT +completamente I-TREATMENT +las I-TREATMENT +cifras I-TREATMENT +de I-TREATMENT +magnesio I-TREATMENT +y I-TREATMENT +dada I-TREATMENT +la I-TREATMENT +buena I-TREATMENT +tolerancia, I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +a I-TREATMENT +2 I-TREATMENT +comprimidos I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas, I-TREATMENT +consiguiendo B-EVOLUTION +remontar I-EVOLUTION +los I-EVOLUTION +niveles I-EVOLUTION +hasta I-EVOLUTION +límites I-EVOLUTION +dentro I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +normalidad. I-EVOLUTION +Quedaron I-EVOLUTION +descartadas I-EVOLUTION +las I-EVOLUTION +pérdidas I-EVOLUTION +urinarias, I-EVOLUTION +con I-EVOLUTION +unos I-EVOLUTION +niveles I-EVOLUTION +magnesio I-EVOLUTION +en I-EVOLUTION +orina I-EVOLUTION +indetectables I-EVOLUTION +(< I-EVOLUTION +1, I-EVOLUTION +81 I-EVOLUTION +mg/dL), I-EVOLUTION +confirmando I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +malabsorción I-EVOLUTION +intestinal. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +44 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +diagnosticado I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Enfermedad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Huntington, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +deterioro I-PRESENT_ILLNESS +cognitivo I-PRESENT_ILLNESS +severo, I-PRESENT_ILLNESS +disfagia I-PRESENT_ILLNESS +neurogénica, I-PRESENT_ILLNESS +broncoaspiraciones I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +desnutrición, I-PRESENT_ILLNESS +motivo B-TREATMENT +por I-TREATMENT +el I-TREATMENT +que I-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +GEP I-TREATMENT +para I-TREATMENT +nutrición I-TREATMENT +enteral I-TREATMENT +domiciliaria. I-TREATMENT +Durante I-TREATMENT +el I-TREATMENT +procedimiento, I-TREATMENT +por I-TREATMENT +imposibilidad I-TREATMENT +de I-TREATMENT +obtener I-TREATMENT +un I-TREATMENT +punto I-TREATMENT +de I-TREATMENT +contacto I-TREATMENT +entre I-TREATMENT +estómago I-TREATMENT +y I-TREATMENT +pared I-TREATMENT +abdominal I-TREATMENT +por I-TREATMENT +transiluminación I-TREATMENT +y I-TREATMENT +digitopresión, I-TREATMENT +se I-TREATMENT +añadió I-TREATMENT +la I-TREATMENT +asistencia I-TREATMENT +de I-TREATMENT +laparoscópia I-TREATMENT +para I-TREATMENT +concluir I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +de I-TREATMENT +inserción I-TREATMENT +de I-TREATMENT +la I-TREATMENT +sonda I-TREATMENT +de I-TREATMENT +gastrostomía. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +44 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +hábito I-PAST_MEDICAL_HISTORY +tabáquico, I-PAST_MEDICAL_HISTORY +hipercolesterolemia I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +irregular I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +dieta I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipocolesterolemiantes, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +(con I-PAST_MEDICAL_HISTORY +infarto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +miocardio I-PAST_MEDICAL_HISTORY +diafragmático I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +1985). I-PAST_MEDICAL_HISTORY +Ingresa B-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +angiográfico I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +aparición I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +angor, I-PRESENT_ILLNESS +tanto I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +esfuerzo I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +reposo, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +último I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +pesar I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +B-bloqueantes, I-PRESENT_ILLNESS +nitratos, I-PRESENT_ILLNESS +antiagregantes I-PRESENT_ILLNESS +plaquetarios, I-PRESENT_ILLNESS +calcioantagonistas, I-PRESENT_ILLNESS +etc. I-PRESENT_ILLNESS +Tras B-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +del I-EXPLORATION +cateterismo I-EXPLORATION +arterial I-EXPLORATION +y I-EXPLORATION +coronariografía I-EXPLORATION +sin I-EXPLORATION +incidencias I-EXPLORATION +(se I-EXPLORATION +constató I-EXPLORATION +Enfermedad I-EXPLORATION +de I-EXPLORATION +Tres I-EXPLORATION +Vasos) I-EXPLORATION +fue B-EVOLUTION +remitido I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +domicilio I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +y I-EVOLUTION +12 I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +inicia I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +disestesias I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +a I-EVOLUTION +nivel I-EVOLUTION +de I-EVOLUTION +ambas I-EVOLUTION +pantorrillas I-EVOLUTION +que I-EVOLUTION +fue I-EVOLUTION +incrementando I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +dos I-EVOLUTION +días I-EVOLUTION +siguientes I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +acudió I-EVOLUTION +al I-EVOLUTION +servicio I-EVOLUTION +de I-EVOLUTION +urgencias I-EVOLUTION +del I-EVOLUTION +hospital I-EVOLUTION +y I-EVOLUTION +fue I-EVOLUTION +remitido I-EVOLUTION +a I-EVOLUTION +su I-EVOLUTION +domicilio I-EVOLUTION +con B-TREATMENT +medicación I-TREATMENT +analgésica. I-TREATMENT +Acude B-EVOLUTION +nuevamente I-EVOLUTION +a I-EVOLUTION +dicho I-EVOLUTION +servicio I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +después I-EVOLUTION +por I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +múltiples I-EVOLUTION +lesiones I-EVOLUTION +eritematosas I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +piel I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +mitad I-EVOLUTION +inferior I-EVOLUTION +del I-EVOLUTION +abdomen I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +extremidades I-EVOLUTION +inferiores. I-EVOLUTION +Ingresa I-EVOLUTION +para I-EVOLUTION +estudio. I-EVOLUTION +Exploración B-EXPLORATION +física: I-EXPLORATION +Varón, I-EXPLORATION +44 I-EXPLORATION +años, I-EXPLORATION +normolineo; I-EXPLORATION +afebril; I-EXPLORATION +buena I-EXPLORATION +coloración I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas; I-EXPLORATION +xantelasma I-EXPLORATION +bilateral. I-EXPLORATION +PA: I-EXPLORATION +105/65. I-EXPLORATION +ACP: I-EXPLORATION +Frecuencia I-EXPLORATION +central I-EXPLORATION +rítmica I-EXPLORATION +a I-EXPLORATION +62 I-EXPLORATION +ppm. I-EXPLORATION +Abdomen: I-EXPLORATION +Blando, I-EXPLORATION +indoloro I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +sin I-EXPLORATION +visceromegalias I-EXPLORATION +ni I-EXPLORATION +masas. I-EXPLORATION +Extremidades I-EXPLORATION +sin I-EXPLORATION +edemas, I-EXPLORATION +con I-EXPLORATION +masas I-EXPLORATION +gemelares I-EXPLORATION +dolorosas I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación. I-EXPLORATION +Pulsos I-EXPLORATION +femoral, I-EXPLORATION +tibial I-EXPLORATION +posterior I-EXPLORATION +y I-EXPLORATION +pedio I-EXPLORATION +palpables I-EXPLORATION +y I-EXPLORATION +siméticos. I-EXPLORATION +A I-EXPLORATION +nivel I-EXPLORATION +cutáneo I-EXPLORATION +(en I-EXPLORATION +mitad I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +extremidades I-EXPLORATION +inferiores) I-EXPLORATION +se I-EXPLORATION +aprecian I-EXPLORATION +lesiones I-EXPLORATION +eritematosas I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +livedo I-EXPLORATION +reticularis I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +dedos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +pies I-EXPLORATION +coloración I-EXPLORATION +púrpura I-EXPLORATION +con I-EXPLORATION +temperatura I-EXPLORATION +local I-EXPLORATION +normal. I-EXPLORATION +Pruebas I-EXPLORATION +complementarias. I-EXPLORATION +Hemograma: I-EXPLORATION +Leucocitos I-EXPLORATION +10800 I-EXPLORATION +(Seg I-EXPLORATION +43%, I-EXPLORATION +L I-EXPLORATION +36%, I-EXPLORATION +M I-EXPLORATION +6, I-EXPLORATION +1%, I-EXPLORATION +Eosinófilos I-EXPLORATION +13%) I-EXPLORATION +Hgb: I-EXPLORATION +13, I-EXPLORATION +9 I-EXPLORATION +g/dl, I-EXPLORATION +Hct: I-EXPLORATION +42, I-EXPLORATION +7%, I-EXPLORATION +Plaquetas I-EXPLORATION +203.000. I-EXPLORATION +VSG: I-EXPLORATION +16. I-EXPLORATION +Bioquímica: I-EXPLORATION +Glu I-EXPLORATION +129 I-EXPLORATION +mg/dl, I-EXPLORATION +Urea I-EXPLORATION +30 I-EXPLORATION +mg/dl, I-EXPLORATION +Cre I-EXPLORATION +1, I-EXPLORATION +1 I-EXPLORATION +mg/dl, I-EXPLORATION +Na I-EXPLORATION +138 I-EXPLORATION +mEq/l, I-EXPLORATION +K I-EXPLORATION +4, I-EXPLORATION +4 I-EXPLORATION +mEq/l, I-EXPLORATION +GOT I-EXPLORATION +25, I-EXPLORATION +GPT I-EXPLORATION +31, I-EXPLORATION +CK I-EXPLORATION +50, I-EXPLORATION +LDH I-EXPLORATION +337, I-EXPLORATION +Aldolasa I-EXPLORATION +<8 I-EXPLORATION +U/l, I-EXPLORATION +Colesterol I-EXPLORATION +total I-EXPLORATION +232, I-EXPLORATION +HDL I-EXPLORATION +28, I-EXPLORATION +LDL I-EXPLORATION +168, I-EXPLORATION +TG I-EXPLORATION +179, I-EXPLORATION +APO I-EXPLORATION +B/ I-EXPLORATION +APO I-EXPLORATION +A1: I-EXPLORATION +>1.51. I-EXPLORATION +Hemostasia: I-EXPLORATION +Quick I-EXPLORATION +100%, I-EXPLORATION +Fibrinógeno I-EXPLORATION +335. I-EXPLORATION +Orina: I-EXPLORATION +25 I-EXPLORATION +leucos/ I-EXPLORATION +campo. I-EXPLORATION +PTG: I-EXPLORATION +Prot I-EXPLORATION +total I-EXPLORATION +6, I-EXPLORATION +3 I-EXPLORATION +g/l, I-EXPLORATION +Alb I-EXPLORATION +64%, I-EXPLORATION +Alfa I-EXPLORATION +1-G I-EXPLORATION +3, I-EXPLORATION +5%, I-EXPLORATION +Alfa I-EXPLORATION +2-G I-EXPLORATION +9, I-EXPLORATION +8%, I-EXPLORATION +Beta-G I-EXPLORATION +11, I-EXPLORATION +2%, I-EXPLORATION +Gamma-G I-EXPLORATION +12, I-EXPLORATION +8%. I-EXPLORATION +Complemento: I-EXPLORATION +C3 I-EXPLORATION +111 I-EXPLORATION +(83-177 I-EXPLORATION +mg/dl), I-EXPLORATION +C4 I-EXPLORATION +27 I-EXPLORATION +(15-45). I-EXPLORATION +Detección I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +antitejido: I-EXPLORATION +Negativa. I-EXPLORATION +Complejos I-EXPLORATION +inmunocirculantes: I-EXPLORATION +Positivos I-EXPLORATION +para I-EXPLORATION +Ig I-EXPLORATION +M. I-EXPLORATION +Radiografía I-EXPLORATION +tórax/abdomen: I-EXPLORATION +Sin I-EXPLORATION +hallazgos. I-EXPLORATION +Eco-Doppler I-EXPLORATION +MMII: I-EXPLORATION +Venas I-EXPLORATION +ilíacas, I-EXPLORATION +femorales I-EXPLORATION +y I-EXPLORATION +poplíteas I-EXPLORATION +permeables, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +flujo I-EXPLORATION +normal. I-EXPLORATION +ECG: I-EXPLORATION +RS I-EXPLORATION +a I-EXPLORATION +62 I-EXPLORATION +ppm, I-EXPLORATION +BCRDHH, I-EXPLORATION +necrosis I-EXPLORATION +de I-EXPLORATION +cara I-EXPLORATION +inferior I-EXPLORATION +residual. I-EXPLORATION +Examen I-EXPLORATION +oftalmológico: I-EXPLORATION +Normal. I-EXPLORATION +EMG I-EXPLORATION +(realizado I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +21 I-EXPLORATION +días): I-EXPLORATION +Se I-EXPLORATION +apreció I-EXPLORATION +lesión I-EXPLORATION +radicular I-EXPLORATION +irritativa I-EXPLORATION +en I-EXPLORATION +evolución I-EXPLORATION +S1 I-EXPLORATION +derecha I-EXPLORATION +leve. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +cutánea I-EXPLORATION +de I-EXPLORATION +cara I-EXPLORATION +lateral I-EXPLORATION +de I-EXPLORATION +pie I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +reveló I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +pequeñas I-EXPLORATION +arteriolas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +dermis I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +profunda I-EXPLORATION +de I-EXPLORATION +cristales I-EXPLORATION +de I-EXPLORATION +colesterol I-EXPLORATION +enclavado I-EXPLORATION +intraluminalmente I-EXPLORATION +con I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +ocasionales I-EXPLORATION +células I-EXPLORATION +gigantes I-EXPLORATION +fagocitando I-EXPLORATION +en I-EXPLORATION +parte I-EXPLORATION +estos I-EXPLORATION +cristales. I-EXPLORATION +La B-EVOLUTION +evolución I-EVOLUTION +del I-EVOLUTION +enfermo I-EVOLUTION +fue I-EVOLUTION +satisfactoria, I-EVOLUTION +sin I-EVOLUTION +afectación I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +función I-EVOLUTION +renal I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +desaparición I-EVOLUTION +del I-EVOLUTION +livedo I-EVOLUTION +reticularis I-EVOLUTION +y I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +coloración I-EVOLUTION +violácea I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +dedos. I-EVOLUTION +Se B-TREATMENT +siguió I-TREATMENT +un I-TREATMENT +tratamiento I-TREATMENT +sintomático I-TREATMENT +(con I-TREATMENT +analgesia I-TREATMENT +y I-TREATMENT +su I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +la I-TREATMENT +cardiopatía I-TREATMENT +isquémica) I-TREATMENT +y I-TREATMENT +fue I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta I-TREATMENT +siguiéndose I-TREATMENT +su I-TREATMENT +evolución I-TREATMENT +en I-TREATMENT +consultas I-TREATMENT +externas. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +64 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +consulta I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Dermatología I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +unos I-DERIVED_FROM/TO +45 I-DERIVED_FROM/TO +días I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +nódulos I-DERIVED_FROM/TO +cutáneos I-DERIVED_FROM/TO +recidivantes, I-DERIVED_FROM/TO +indoloros I-DERIVED_FROM/TO +e I-DERIVED_FROM/TO +indurados I-DERIVED_FROM/TO +localizados I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +miembros I-DERIVED_FROM/TO +inferiores. I-DERIVED_FROM/TO +No B-EXPLORATION +impresionaba I-EXPLORATION +de I-EXPLORATION +enfermedad, I-EXPLORATION +ni I-EXPLORATION +refería I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +fiebre, I-EXPLORATION +ni I-EXPLORATION +síndrome I-EXPLORATION +constitucional. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destacaban I-EXPLORATION +varias I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +de I-EXPLORATION +placas I-EXPLORATION +nodulares I-EXPLORATION +subcutáneas I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +a I-EXPLORATION +3 I-EXPLORATION +cm. I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +eritemato-violáceas, I-EXPLORATION +simétricas, I-EXPLORATION +duras I-EXPLORATION +e I-EXPLORATION +indoloras, I-EXPLORATION +localizadas I-EXPLORATION +en I-EXPLORATION +ambas I-EXPLORATION +caras I-EXPLORATION +internas I-EXPLORATION +de I-EXPLORATION +muslos, I-EXPLORATION +pantorrilla, I-EXPLORATION +abdomen I-EXPLORATION +y I-EXPLORATION +hombro I-EXPLORATION +izquierdo. I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +visceromegalias I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +tromboflebitis I-EXPLORATION +superficial I-EXPLORATION +en I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +derecho. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +se I-EXPLORATION +objetivó: I-EXPLORATION +leucocitos I-EXPLORATION +12, I-EXPLORATION +3 I-EXPLORATION +x I-EXPLORATION +109/L I-EXPLORATION +(neutrófilos I-EXPLORATION +6, I-EXPLORATION +8, I-EXPLORATION +linfocitos I-EXPLORATION +1, I-EXPLORATION +1, I-EXPLORATION +monocitos I-EXPLORATION +4.3, I-EXPLORATION +eosinófilos I-EXPLORATION +0, I-EXPLORATION +1), I-EXPLORATION +Hb I-EXPLORATION +120 I-EXPLORATION +g/L, I-EXPLORATION +VCM I-EXPLORATION +109, I-EXPLORATION +8 I-EXPLORATION +fL; I-EXPLORATION +Hto. I-EXPLORATION +32%; I-EXPLORATION +plaquetas I-EXPLORATION +133 I-EXPLORATION +x I-EXPLORATION +109/L. I-EXPLORATION +Se I-EXPLORATION +observaban I-EXPLORATION +algunos I-EXPLORATION +granulocitos I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +pelgueroide I-EXPLORATION +(núcleo I-EXPLORATION +no I-EXPLORATION +segmentado I-EXPLORATION +o I-EXPLORATION +hiposegmentado) I-EXPLORATION +y I-EXPLORATION +anisocitosis I-EXPLORATION +discreta. I-EXPLORATION +Reticulocitos: I-EXPLORATION +2, I-EXPLORATION +4% I-EXPLORATION +(totales I-EXPLORATION +86, I-EXPLORATION +4 I-EXPLORATION +x I-EXPLORATION +109/L), I-EXPLORATION +VSG I-EXPLORATION +60 I-EXPLORATION +mm/h; I-EXPLORATION +inmunoglobulinas, I-EXPLORATION +proteinograma, I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +hemostasia, I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +sedimento, I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +hierro, I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +y I-EXPLORATION +ácido I-EXPLORATION +fólico, I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +Eco-doppler I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +demostrándose I-EXPLORATION +una I-EXPLORATION +tromboflebitis I-EXPLORATION +superficial I-EXPLORATION +de I-EXPLORATION +safena I-EXPLORATION +interna I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +trombosis I-EXPLORATION +de I-EXPLORATION +dicha I-EXPLORATION +vena I-EXPLORATION +e I-EXPLORATION +importante I-EXPLORATION +componente I-EXPLORATION +edematoso I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +graso I-EXPLORATION +circundante, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +profunda. I-EXPLORATION +En I-EXPLORATION +varios I-EXPLORATION +hemogramas I-EXPLORATION +posteriores I-EXPLORATION +se I-EXPLORATION +mantuvo I-EXPLORATION +significativamente I-EXPLORATION +elevada I-EXPLORATION +la I-EXPLORATION +cifra I-EXPLORATION +de I-EXPLORATION +monocitos I-EXPLORATION +en I-EXPLORATION +sangre. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +cutánea I-EXPLORATION +que I-EXPLORATION +demostró I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +en I-EXPLORATION +tejido I-EXPLORATION +celular I-EXPLORATION +subcutáneo I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +paniculitis I-EXPLORATION +granulomatosa I-EXPLORATION +panlobular I-EXPLORATION +con I-EXPLORATION +necrosis I-EXPLORATION +lobulillar I-EXPLORATION +tipo I-EXPLORATION +eritema I-EXPLORATION +indurado I-EXPLORATION +de I-EXPLORATION +Bazin I-EXPLORATION +o I-EXPLORATION +vasculitis I-EXPLORATION +nodular, I-EXPLORATION +asociada I-EXPLORATION +a I-EXPLORATION +trombosis I-EXPLORATION +venosa I-EXPLORATION +organizada. I-EXPLORATION +Se I-EXPLORATION +practicó I-EXPLORATION +una I-EXPLORATION +batería I-EXPLORATION +de I-EXPLORATION +pruebas I-EXPLORATION +diagnósticas I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +causas I-EXPLORATION +Infecciosas I-EXPLORATION +(BK, I-EXPLORATION +cultivo I-EXPLORATION +y I-EXPLORATION +análisis I-EXPLORATION +por I-EXPLORATION +PCR I-EXPLORATION +para I-EXPLORATION +Mycobacterium I-EXPLORATION +tuberculosis: I-EXPLORATION +negativos; I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +infección I-EXPLORATION +reciente I-EXPLORATION +por I-EXPLORATION +Toxoplasma, I-EXPLORATION +Legionela, I-EXPLORATION +Mycoplasma I-EXPLORATION +pneumoniae I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +fiebre I-EXPLORATION +Q: I-EXPLORATION +negativas; I-EXPLORATION +ASLO, I-EXPLORATION +negativo; I-EXPLORATION +Singer I-EXPLORATION +Plotz I-EXPLORATION +y I-EXPLORATION +VDRL, I-EXPLORATION +negativos), I-EXPLORATION +causas I-EXPLORATION +neoplásicas I-EXPLORATION +(alfa-feto-proteína, I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario, I-EXPLORATION +b2-microglobulina, I-EXPLORATION +Ca-19.9, I-EXPLORATION +PSA: I-EXPLORATION +normales; I-EXPLORATION +TAC I-EXPLORATION +abdominopélvico: I-EXPLORATION +moderado I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +densidad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +grasa I-EXPLORATION +del I-EXPLORATION +mesenterio I-EXPLORATION +en I-EXPLORATION +flanco I-EXPLORATION +derecho I-EXPLORATION +que I-EXPLORATION +impronta I-EXPLORATION +asas I-EXPLORATION +intestinales, I-EXPLORATION +en I-EXPLORATION +probable I-EXPLORATION +relación I-EXPLORATION +con I-EXPLORATION +paniculitis) I-EXPLORATION +y I-EXPLORATION +enfermedades I-EXPLORATION +sistémicas I-EXPLORATION +(factor I-EXPLORATION +reumatoideo I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antinúcleo I-EXPLORATION +negativos; I-EXPLORATION +niveles I-EXPLORATION +normales I-EXPLORATION +de I-EXPLORATION +C3 I-EXPLORATION +y I-EXPLORATION +C4, I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva, I-EXPLORATION +enzima I-EXPLORATION +convertidor I-EXPLORATION +de I-EXPLORATION +angiotensina I-EXPLORATION +y I-EXPLORATION +alfa-1 I-EXPLORATION +antitripsina). I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Ziehl-Neelsen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +de I-EXPLORATION +biopsia I-EXPLORATION +cutánea I-EXPLORATION +(pues I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +diferencial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lesión I-EXPLORATION +microscópica I-EXPLORATION +observada I-EXPLORATION +debe I-EXPLORATION +establecerse I-EXPLORATION +principalmente I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +infección I-EXPLORATION +cutánea I-EXPLORATION +por I-EXPLORATION +micobacterias) I-EXPLORATION +fue I-EXPLORATION +así I-EXPLORATION +mismo I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +La B-DERIVED_FROM/TO +presencia I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +sangre I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +formas I-DERIVED_FROM/TO +granulocíticas I-DERIVED_FROM/TO +displásicas I-DERIVED_FROM/TO +motivó I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fuera I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +Servicio, I-DERIVED_FROM/TO +en B-EXPLORATION +el I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +aspirado I-EXPLORATION +medular, I-EXPLORATION +observándose I-EXPLORATION +una I-EXPLORATION +médula I-EXPLORATION +ósea I-EXPLORATION +hipercelular I-EXPLORATION +con I-EXPLORATION +megacariocitos I-EXPLORATION +conservados I-EXPLORATION +y I-EXPLORATION +algún I-EXPLORATION +micromegacariocito I-EXPLORATION +ocasionalmente, I-EXPLORATION +destacando I-EXPLORATION +una I-EXPLORATION +hiperplasia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +serie I-EXPLORATION +monocítica I-EXPLORATION +(21% I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +celularidad I-EXPLORATION +medular I-EXPLORATION +global, I-EXPLORATION +entre I-EXPLORATION +promonocitos I-EXPLORATION +y I-EXPLORATION +monocitos) I-EXPLORATION +e I-EXPLORATION +hipoplasia I-EXPLORATION +moderada I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +serie I-EXPLORATION +roja I-EXPLORATION +(13%) I-EXPLORATION +con I-EXPLORATION +displasia I-EXPLORATION +leve I-EXPLORATION +(puentes I-EXPLORATION +intercitoplasmáticos I-EXPLORATION +y I-EXPLORATION +algunas I-EXPLORATION +formas I-EXPLORATION +gigantes), I-EXPLORATION +y I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +una I-EXPLORATION +disgranulopoyesis I-EXPLORATION +significativa I-EXPLORATION +(citoplasmas I-EXPLORATION +francamente I-EXPLORATION +agranulares, I-EXPLORATION +frecuentes I-EXPLORATION +elementos I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +pelgueroide, I-EXPLORATION +asincronismo I-EXPLORATION +madurativo I-EXPLORATION +núcleo-citoplasmático I-EXPLORATION +y I-EXPLORATION +predominio I-EXPLORATION +de I-EXPLORATION +formas I-EXPLORATION +madurativas I-EXPLORATION +intermedias); I-EXPLORATION +la I-EXPLORATION +blastosis I-EXPLORATION +constituía I-EXPLORATION +sólo I-EXPLORATION +un I-EXPLORATION +3%. I-EXPLORATION +El I-EXPLORATION +cariotipo I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +46XY. I-EXPLORATION +Con I-EXPLORATION +todo I-EXPLORATION +ello I-EXPLORATION +el I-EXPLORATION +enfermo I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +de I-EXPLORATION +LMMC I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +cutánea I-EXPLORATION +inespecífica I-EXPLORATION +tipo I-EXPLORATION +paniculitis I-EXPLORATION +lobulillar. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratado I-TREATMENT +con I-TREATMENT +corticoides I-TREATMENT +orales I-TREATMENT +(prednisona I-TREATMENT +30 I-TREATMENT +mg/día, I-TREATMENT +con I-TREATMENT +pauta I-TREATMENT +de I-TREATMENT +descenso I-TREATMENT +semanal), I-TREATMENT +resolviéndose I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +cutáneas I-TREATMENT +pocos I-TREATMENT +días I-TREATMENT +después I-TREATMENT +de I-TREATMENT +comenzar I-TREATMENT +este I-TREATMENT +tratamiento. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad, I-EVOLUTION +tres I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +diagnóstico I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +tratamiento I-EVOLUTION +desde I-EVOLUTION +entonces, I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático, I-EVOLUTION +con I-EVOLUTION +anemia I-EVOLUTION +leve, I-EVOLUTION +VCM I-EVOLUTION +110.9 I-EVOLUTION +fL, I-EVOLUTION +plaquetas I-EVOLUTION +143 I-EVOLUTION +x I-EVOLUTION +109/L, I-EVOLUTION +y I-EVOLUTION +monocitosis I-EVOLUTION +de I-EVOLUTION +2, I-EVOLUTION +3 I-EVOLUTION +x I-EVOLUTION +109/L I-EVOLUTION +en I-EVOLUTION +sangre, I-EVOLUTION +haciéndose I-EVOLUTION +controles I-EVOLUTION +trimestrales; I-EVOLUTION +en I-EVOLUTION +médula I-EVOLUTION +ósea I-EVOLUTION +persiste I-EVOLUTION +la I-EVOLUTION +displasia I-EVOLUTION +trilineal I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +blastosis I-EVOLUTION +del I-EVOLUTION +6% I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +componente I-EVOLUTION +monocítico I-EVOLUTION +del I-EVOLUTION +25%. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +57 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +colecistectomía I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +artrosis I-PAST_MEDICAL_HISTORY +poliarticular I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +ibuprofeno. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +acuosa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +tiempo. I-PRESENT_ILLNESS +Exploración B-EXPLORATION +física: I-EXPLORATION +anodina. I-EXPLORATION +Pruebas I-EXPLORATION +complementarias: I-EXPLORATION +hematimetría, I-EXPLORATION +coagulación, I-EXPLORATION +bioquímica I-EXPLORATION +completa I-EXPLORATION +con I-EXPLORATION +ionograma, I-EXPLORATION +transaminasas I-EXPLORATION +hepáticas, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +total: I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +TSH I-EXPLORATION +y I-EXPLORATION +hormonas I-EXPLORATION +tiroideas: I-EXPLORATION +valores I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +Niveles I-EXPLORATION +plasmáticos I-EXPLORATION +de I-EXPLORATION +péptido I-EXPLORATION +intestinal I-EXPLORATION +vasoactivo I-EXPLORATION +(VIP): I-EXPLORATION +5 I-EXPLORATION +pg/ml I-EXPLORATION +(valores I-EXPLORATION +normales: I-EXPLORATION +0-70 I-EXPLORATION +pg/ml). I-EXPLORATION +Niveles I-EXPLORATION +de I-EXPLORATION +ácido I-EXPLORATION +5-hidroxindol-acético I-EXPLORATION +(5HIAA) I-EXPLORATION +en I-EXPLORATION +orina I-EXPLORATION +de I-EXPLORATION +24 I-EXPLORATION +horas: I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +mg/24 I-EXPLORATION +horas I-EXPLORATION +(las I-EXPLORATION +cifras I-EXPLORATION +normales I-EXPLORATION +son I-EXPLORATION +inferiores I-EXPLORATION +a I-EXPLORATION +10 I-EXPLORATION +mg/24 I-EXPLORATION +horas). I-EXPLORATION +PCR: I-EXPLORATION +1, I-EXPLORATION +2 I-EXPLORATION +mg/dl I-EXPLORATION +(cifras I-EXPLORATION +normales I-EXPLORATION +en I-EXPLORATION +nuestro I-EXPLORATION +laboratorio I-EXPLORATION +hasta I-EXPLORATION +0, I-EXPLORATION +8 I-EXPLORATION +mg/dl), I-EXPLORATION +VSG: I-EXPLORATION +46 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +1ª I-EXPLORATION +hora. I-EXPLORATION +Anticuerpos I-EXPLORATION +antiendomisio I-EXPLORATION +y I-EXPLORATION +antigliadina I-EXPLORATION +negativos I-EXPLORATION +Leucocitos I-EXPLORATION +en I-EXPLORATION +heces: I-EXPLORATION +negativos. I-EXPLORATION +Coprocultivos, I-EXPLORATION +e I-EXPLORATION +investigación I-EXPLORATION +de I-EXPLORATION +Cl I-EXPLORATION +difficile, I-EXPLORATION +de I-EXPLORATION +parásitos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +huevos I-EXPLORATION +de I-EXPLORATION +estos I-EXPLORATION +en I-EXPLORATION +heces: I-EXPLORATION +negativos. I-EXPLORATION +Tránsito I-EXPLORATION +esófago-gastro-duodenal I-EXPLORATION +(TEGD): I-EXPLORATION +normal. I-EXPLORATION +Ecografía I-EXPLORATION +abdominal: I-EXPLORATION +normal I-EXPLORATION +salvo I-EXPLORATION +aerobilia I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +vesícula I-EXPLORATION +biliar. I-EXPLORATION +Colonoscopia I-EXPLORATION +e I-EXPLORATION +ileoscopia: I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +macroscópicas. I-EXPLORATION +Se I-EXPLORATION +toman I-EXPLORATION +6 I-EXPLORATION +biopsias I-EXPLORATION +a I-EXPLORATION +lo I-EXPLORATION +largo I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +(incluido I-EXPLORATION +sigma I-EXPLORATION +y I-EXPLORATION +recto), I-EXPLORATION +observándose I-EXPLORATION +en I-EXPLORATION +todas I-EXPLORATION +ellas I-EXPLORATION +un I-EXPLORATION +importante I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +con I-EXPLORATION +gran I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +intraepiteliales. I-EXPLORATION + I-EXPLORATION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +historia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pérdida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +kg I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +así I-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +artralgias I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hombros I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +rodillas. I-PAST_MEDICAL_HISTORY +Había B-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +brotes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diarrea I-PRESENT_ILLNESS +episódica I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +productos I-PRESENT_ILLNESS +patológicos I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +febrícula. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +advirtió I-EXPLORATION +una I-EXPLORATION +hiperpigmentación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +desnutrición I-EXPLORATION +importante. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +básica I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +anemia I-EXPLORATION +microcítica, I-EXPLORATION +eosinofilia I-EXPLORATION +en I-EXPLORATION +sangre, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +(VSG) I-EXPLORATION +57 I-EXPLORATION +seg, I-EXPLORATION +albúmina I-EXPLORATION +2, I-EXPLORATION +46 I-EXPLORATION +g/dl, I-EXPLORATION +colesterol I-EXPLORATION +82mg/dl, I-EXPLORATION +sideremia I-EXPLORATION +12 I-EXPLORATION +mcg/dl, I-EXPLORATION +ferritina I-EXPLORATION +12 I-EXPLORATION +ng/ml, I-EXPLORATION +Van I-EXPLORATION +de I-EXPLORATION +Kamer I-EXPLORATION +9, I-EXPLORATION +2 I-EXPLORATION +g I-EXPLORATION +de I-EXPLORATION +grasa/día. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computerizada I-EXPLORATION +(TAC) I-EXPLORATION +mostró I-EXPLORATION +gran I-EXPLORATION +cantidad I-EXPLORATION +de I-EXPLORATION +adenopatías I-EXPLORATION +retroperitoneales I-EXPLORATION +y I-EXPLORATION +mesentéricas I-EXPLORATION +de I-EXPLORATION +tamaño I-EXPLORATION +significativo. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +endoscopia I-EXPLORATION +oral I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +gastritis I-EXPLORATION +crónica I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +punteado I-EXPLORATION +blanquecino I-EXPLORATION +en I-EXPLORATION +segunda I-EXPLORATION +porción I-EXPLORATION +duodenal. I-EXPLORATION +La I-EXPLORATION +biopsia I-EXPLORATION +duodenal I-EXPLORATION +demostró I-EXPLORATION +macrófagos I-EXPLORATION +positivos I-EXPLORATION +al I-EXPLORATION +ácido I-EXPLORATION +peryódico I-EXPLORATION +de I-EXPLORATION +Schiff I-EXPLORATION +(PAS) I-EXPLORATION +y I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Ziehl I-EXPLORATION +negativa, I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Whipple. I-EXPLORATION +El B-TREATMENT +paciente I-TREATMENT +se I-TREATMENT +empezó I-TREATMENT +a I-TREATMENT +tratar I-TREATMENT +con I-TREATMENT +penicilina I-TREATMENT +y I-TREATMENT +estreptomicina I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +y I-TREATMENT +luego I-TREATMENT +trimetroprim-sulfametoxazol I-TREATMENT +(TM-SF) I-TREATMENT +pero I-TREATMENT +presentó I-TREATMENT +una I-TREATMENT +reacción I-TREATMENT +urticarial, I-TREATMENT +por I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +hubo I-TREATMENT +que I-TREATMENT +suspender I-TREATMENT +este I-TREATMENT +último, I-TREATMENT +pasando I-TREATMENT +a I-TREATMENT +doxiciclina. I-TREATMENT +Tuvo B-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +aumentó I-EVOLUTION +de I-EVOLUTION +peso, I-EVOLUTION +pero I-EVOLUTION +al I-EVOLUTION +persistir I-EVOLUTION +los I-EVOLUTION +macrófagos I-EVOLUTION +PAS I-EVOLUTION +positivos I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +biopsia, I-EVOLUTION +se I-EVOLUTION +repiten I-EVOLUTION +hasta I-EVOLUTION +dos I-EVOLUTION +ciclos I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +15 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +penicilina I-EVOLUTION +y I-EVOLUTION +estreptomicina. I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +tuvo I-EVOLUTION +un I-EVOLUTION +cuadro I-EVOLUTION +de I-EVOLUTION +inestabilidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +marcha I-EVOLUTION +y I-EVOLUTION +sensación I-EVOLUTION +de I-EVOLUTION +mareo I-EVOLUTION +secundarios I-EVOLUTION +a I-EVOLUTION +toxicidad I-EVOLUTION +laberíntica I-EVOLUTION +por I-EVOLUTION +estreptomicina, I-EVOLUTION +que I-EVOLUTION +inicialmente I-EVOLUTION +planteó I-EVOLUTION +diagnóstico I-EVOLUTION +diferencial I-EVOLUTION +con I-EVOLUTION +afectación I-EVOLUTION +neurológica I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad. I-EVOLUTION +Se B-TREATMENT +retiró I-TREATMENT +entonces I-TREATMENT +la I-TREATMENT +doxiciclina, I-TREATMENT +por I-TREATMENT +asociarse I-TREATMENT +a I-TREATMENT +mayor I-TREATMENT +número I-TREATMENT +de I-TREATMENT +recidivas, I-TREATMENT +y I-TREATMENT +se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +cefixima. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +cumplió I-EVOLUTION +dos I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +antibiótico I-EVOLUTION +estando I-EVOLUTION +asintomático I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +hábitos I-PAST_MEDICAL_HISTORY +tóxicos, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +torácico. I-PRESENT_ILLNESS +El I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +recurrentes I-PRESENT_ILLNESS +similares I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +cinco I-PRESENT_ILLNESS +años. I-PRESENT_ILLNESS +En B-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +ocasión I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +diagnosticó I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +probable I-PAST_MEDICAL_HISTORY +abdomen I-PAST_MEDICAL_HISTORY +agudo, I-PAST_MEDICAL_HISTORY +habiendo I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +punto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +laparotomizado. I-PAST_MEDICAL_HISTORY +El B-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +actual I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39, I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +ºC, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +pleurítico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemitórax I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +abdomen I-EXPLORATION +doloroso, I-EXPLORATION +sobre I-EXPLORATION +todo I-EXPLORATION +en I-EXPLORATION +fosa I-EXPLORATION +iliaca I-EXPLORATION +derecha, I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +irritación I-EXPLORATION +peritoneal. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacaba I-EXPLORATION +PCR I-EXPLORATION +25 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +leucocitos I-EXPLORATION +18.109/ml I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +datos I-EXPLORATION +sugestivos I-EXPLORATION +de I-EXPLORATION +apendicitis I-EXPLORATION +aguda. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +analgésico I-TREATMENT +con I-TREATMENT +remisión I-TREATMENT +del I-TREATMENT +cuadro I-TREATMENT +en I-TREATMENT +24 I-TREATMENT +horas, I-TREATMENT +siendo I-TREATMENT +dado I-TREATMENT +de I-TREATMENT +alta. I-TREATMENT +Posteriormente B-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +estudio I-EXPLORATION +ambulatorio I-EXPLORATION +con I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +fibrocolonoscopia I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +remisión I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +clínica, I-EXPLORATION +los I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +episodios I-EXPLORATION +recurrentes I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +negatividad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +practicadas I-EXPLORATION +se I-EXPLORATION +orientó I-EXPLORATION +como I-EXPLORATION +una I-EXPLORATION +posible I-EXPLORATION +FMF, I-EXPLORATION +procediéndose I-EXPLORATION +a I-EXPLORATION +estudio I-EXPLORATION +genético. I-EXPLORATION +Este I-EXPLORATION +mostró I-EXPLORATION +dos I-EXPLORATION +mutaciones I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +gen I-EXPLORATION +MEFV: I-EXPLORATION +una I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +exón I-EXPLORATION +2, I-EXPLORATION +detectándose I-EXPLORATION +la I-EXPLORATION +sustitución I-EXPLORATION +del I-EXPLORATION +nucleótido I-EXPLORATION +guanina I-EXPLORATION +por I-EXPLORATION +citosina I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +posición I-EXPLORATION +del I-EXPLORATION +triplete I-EXPLORATION +148, I-EXPLORATION +dando I-EXPLORATION +lugar I-EXPLORATION +al I-EXPLORATION +cambio I-EXPLORATION +de I-EXPLORATION +aminoácido I-EXPLORATION +glutámico I-EXPLORATION +por I-EXPLORATION +glutamina. I-EXPLORATION +Dicha I-EXPLORATION +mutuación I-EXPLORATION +recibe I-EXPLORATION +el I-EXPLORATION +nombre I-EXPLORATION +de I-EXPLORATION +E148Q, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +solo I-EXPLORATION +alelo, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +heterozigoto I-EXPLORATION +para I-EXPLORATION +esta I-EXPLORATION +mutuación. I-EXPLORATION +Se I-EXPLORATION +detectó I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +mutuación I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +exón I-EXPLORATION +10, I-EXPLORATION +que I-EXPLORATION +consistía I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +sustitución I-EXPLORATION +del I-EXPLORATION +nucleótido I-EXPLORATION +guanina I-EXPLORATION +por I-EXPLORATION +adenina I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tercera I-EXPLORATION +posición I-EXPLORATION +del I-EXPLORATION +triplete I-EXPLORATION +694, I-EXPLORATION +dando I-EXPLORATION +lugar I-EXPLORATION +al I-EXPLORATION +cambio I-EXPLORATION +de I-EXPLORATION +aminoácido I-EXPLORATION +metionina I-EXPLORATION +por I-EXPLORATION +isoleucina. I-EXPLORATION +Dicha I-EXPLORATION +mutuación I-EXPLORATION +recibe I-EXPLORATION +el I-EXPLORATION +nombre I-EXPLORATION +de I-EXPLORATION +M694I I-EXPLORATION +y I-EXPLORATION +también I-EXPLORATION +se I-EXPLORATION +detectó I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +solo I-EXPLORATION +alelo, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +es I-EXPLORATION +también I-EXPLORATION +heterozigoto I-EXPLORATION +para I-EXPLORATION +esta I-EXPLORATION +mutuación. I-EXPLORATION +Ambas I-EXPLORATION +mutaciones I-EXPLORATION +están I-EXPLORATION +descritas I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +FMF. I-EXPLORATION +Asimismo I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +del I-EXPLORATION +exón I-EXPLORATION +3 I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +proteina I-EXPLORATION +sérica I-EXPLORATION +del I-EXPLORATION +amiloide I-EXPLORATION +SAA-1, I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +genotipo I-EXPLORATION +alfa/beta, I-EXPLORATION +considerado I-EXPLORATION +de I-EXPLORATION +bajo I-EXPLORATION +riesgo I-EXPLORATION +para I-EXPLORATION +el I-EXPLORATION +desarrollo I-EXPLORATION +de I-EXPLORATION +amiloidosis. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +colchicina I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg/día I-TREATMENT +con B-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +y I-EVOLUTION +desaparición I-EVOLUTION +paulatina I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +crisis. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +39 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +mestiza, B-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +ingresó I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +primera I-PAST_MEDICAL_HISTORY +vez I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +febrero I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +1999 I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +nuestro I-PAST_MEDICAL_HISTORY +hospital. I-PAST_MEDICAL_HISTORY +Desde I-PAST_MEDICAL_HISTORY +hacía I-PAST_MEDICAL_HISTORY +diez I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +comenzado I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +dolor I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +rodillas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tobillos, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +aparentes I-PAST_MEDICAL_HISTORY +signos I-PAST_MEDICAL_HISTORY +inflamatorios, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +aliviaban I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Indometacina I-PAST_MEDICAL_HISTORY +y, I-PAST_MEDICAL_HISTORY +además I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +acompañaba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +astenia. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +provincia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +origen I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +ingresado I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +varias I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +llegara I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +etiológico. I-PAST_MEDICAL_HISTORY +Este B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +articular I-PRESENT_ILLNESS +evolucionaba I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +forma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +episodios, I-PRESENT_ILLNESS +acompañándose I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +anemia I-PRESENT_ILLNESS +comprobada. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +sólo I-EXPLORATION +mostró I-EXPLORATION +palidez I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +mucosas, I-EXPLORATION +ligero I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +ambos I-EXPLORATION +tobillos, I-EXPLORATION +adenopatía I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm, I-EXPLORATION +movible I-EXPLORATION +y I-EXPLORATION +elástica I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +inguinal I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +ingreso I-EXPLORATION +fueron I-EXPLORATION +los I-EXPLORATION +siguientes: I-EXPLORATION +hemoglobina I-EXPLORATION +98 I-EXPLORATION +g/l, I-EXPLORATION +hematocrito I-EXPLORATION +30 I-EXPLORATION +vol%, I-EXPLORATION +leucograma I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +normales, I-EXPLORATION +reticolocitos, I-EXPLORATION +glucemias, I-EXPLORATION +creatinina, I-EXPLORATION +TGO I-EXPLORATION +y I-EXPLORATION +TGP, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina, I-EXPLORATION +TP I-EXPLORATION +y I-EXPLORATION +TPT, I-EXPLORATION +todos I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION +La I-EXPLORATION +electroforesis I-EXPLORATION +de I-EXPLORATION +proteínas I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +hipergammaglobulinemia I-EXPLORATION +32, I-EXPLORATION +85 I-EXPLORATION +g/l, I-EXPLORATION +eritrosedimentación I-EXPLORATION +115 I-EXPLORATION +mm/h I-EXPLORATION +y I-EXPLORATION +106 I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +segunda I-EXPLORATION +oportunidad. I-EXPLORATION +El I-EXPLORATION +ultrasonido I-EXPLORATION +de I-EXPLORATION +hemiabdomen I-EXPLORATION +superior I-EXPLORATION +no I-EXPLORATION +demostró I-EXPLORATION +ninguna I-EXPLORATION +alteración. I-EXPLORATION + I-EXPLORATION +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +diagnóstico I-EVOLUTION +preciso. I-EVOLUTION +Reingresa I-EVOLUTION +en I-EVOLUTION +enero I-EVOLUTION +del I-EVOLUTION +2004 I-EVOLUTION +por I-EVOLUTION +astenia I-EVOLUTION +y I-EVOLUTION +fiebre I-EVOLUTION +de I-EVOLUTION +38 I-EVOLUTION +a I-EVOLUTION +39 I-EVOLUTION +ºC I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +periódica I-EVOLUTION +de I-EVOLUTION +una I-EVOLUTION +semana I-EVOLUTION +de I-EVOLUTION +duración I-EVOLUTION +con I-EVOLUTION +intervalos I-EVOLUTION +de I-EVOLUTION +remisiones I-EVOLUTION +espontáneas I-EVOLUTION +cada I-EVOLUTION +dos I-EVOLUTION +o I-EVOLUTION +tres I-EVOLUTION +meses. I-EVOLUTION +Mantenía I-EVOLUTION +dolores I-EVOLUTION +articulares I-EVOLUTION +en I-EVOLUTION +rodillas I-EVOLUTION +y I-EVOLUTION +tobillos I-EVOLUTION +que I-EVOLUTION +mejoraban I-EVOLUTION +con I-EVOLUTION +medicamentos I-EVOLUTION +antinflamatorios I-EVOLUTION +no I-EVOLUTION +esteroideos. I-EVOLUTION + I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +adenopatía I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +supraclavicular I-EXPLORATION +derecha I-EXPLORATION +de I-EXPLORATION +unos I-EXPLORATION +2 I-EXPLORATION +cm, I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +elástica I-EXPLORATION +y I-EXPLORATION +fija I-EXPLORATION +a I-EXPLORATION +planos I-EXPLORATION +profundos. I-EXPLORATION + I-EXPLORATION +Exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio: I-EXPLORATION +hemoglobina I-EXPLORATION +110 I-EXPLORATION +g/l, I-EXPLORATION +eritrosedimentación I-EXPLORATION +130 I-EXPLORATION +mm/h, I-EXPLORATION +hipergammaglobulinemia I-EXPLORATION +policlonal I-EXPLORATION +de I-EXPLORATION +36 I-EXPLORATION +g/l; I-EXPLORATION +medulograma: I-EXPLORATION +médula I-EXPLORATION +reactiva I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +plasmocitos. I-EXPLORATION +Ultrasonido I-EXPLORATION +de I-EXPLORATION +abdomen: I-EXPLORATION +ligera I-EXPLORATION +hepatomegalia I-EXPLORATION +difusa I-EXPLORATION +con I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +ecorrefringencia; I-EXPLORATION +placa I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +ensanchamiento I-EXPLORATION +del I-EXPLORATION +contorno I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +del I-EXPLORATION +mediastino; I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +mediastino: I-EXPLORATION +adenomegalia I-EXPLORATION +en I-EXPLORATION +mediastino I-EXPLORATION +superior I-EXPLORATION +derecho, I-EXPLORATION +de I-EXPLORATION +3 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +sin I-EXPLORATION +alteraciones I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +campos I-EXPLORATION +pulmonares. I-EXPLORATION + I-EXPLORATION +Biopsia I-EXPLORATION +de I-EXPLORATION +ganglio I-EXPLORATION +linfático I-EXPLORATION +cervical: I-EXPLORATION +pérdida I-EXPLORATION +parcial I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arquitectura I-EXPLORATION +con I-EXPLORATION +hiperplasia I-EXPLORATION +linfoide I-EXPLORATION +focal I-EXPLORATION +marcada I-EXPLORATION +y I-EXPLORATION +expansión I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +interfolicular, I-EXPLORATION +ocupada I-EXPLORATION +por I-EXPLORATION +abundantes I-EXPLORATION +plasmocitos I-EXPLORATION +y I-EXPLORATION +cuerpos I-EXPLORATION +de I-EXPLORATION +Russel. I-EXPLORATION + I-EXPLORATION +Inmunohistoquímica: I-EXPLORATION +CD20 I-EXPLORATION +positivo I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +células I-EXPLORATION +linfoides I-EXPLORATION +T, I-EXPLORATION +kappa I-EXPLORATION +y I-EXPLORATION +lambda I-EXPLORATION +positivo I-EXPLORATION +en I-EXPLORATION +plasmocitos. I-EXPLORATION + I-EXPLORATION +Conclusiones: I-EXPLORATION +EC I-EXPLORATION +plasmocelular. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +consistió I-TREATMENT +en I-TREATMENT +un I-TREATMENT +esquema I-TREATMENT +de I-TREATMENT +poliquimioterapia I-TREATMENT +con I-TREATMENT +adriamicina, I-TREATMENT +vincristina, I-TREATMENT +bleomicina I-TREATMENT +y I-TREATMENT +prednisona I-TREATMENT +y B-EVOLUTION +fue I-EVOLUTION +egresada I-EVOLUTION +para I-EVOLUTION +seguimiento I-EVOLUTION +ambulatorio. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +35 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +usuaria B-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +drogas I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +parenteral, I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +VIH I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +VHC I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +seguía I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +antirretroviral I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +resolución. I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +dos I-PAST_MEDICAL_HISTORY +ocasiones I-PAST_MEDICAL_HISTORY +(hacía I-PAST_MEDICAL_HISTORY +4 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +mes), I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +relación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +consumo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +droga I-PAST_MEDICAL_HISTORY +(heroína), I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +episodios I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +foliculitis I-PAST_MEDICAL_HISTORY +candidiásica I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +costocondritis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +2º I-PAST_MEDICAL_HISTORY +arco I-PAST_MEDICAL_HISTORY +costal I-PAST_MEDICAL_HISTORY +derecho I-PAST_MEDICAL_HISTORY +respectivamente. I-PAST_MEDICAL_HISTORY +Fue I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fluconazol I-PAST_MEDICAL_HISTORY +400 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +precisando, I-PAST_MEDICAL_HISTORY +además, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +resección I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cartílago I-PAST_MEDICAL_HISTORY +costal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +trayecto I-PAST_MEDICAL_HISTORY +fistuloso. I-PAST_MEDICAL_HISTORY +A B-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +ingreso, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +anamnesis, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +explicaba I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +semana I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +productiva I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +purulenta, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +torácico I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +características I-PRESENT_ILLNESS +pleuríticas, I-PRESENT_ILLNESS +adelgazamiento I-PRESENT_ILLNESS +no I-PRESENT_ILLNESS +cuantificado I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +localizado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +dorsal I-PRESENT_ILLNESS +bajo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +característica I-PRESENT_ILLNESS +mecánicas. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración, I-EXPLORATION +no I-EXPLORATION +impresionaba I-EXPLORATION +de I-EXPLORATION +afectada, I-EXPLORATION +destacando I-EXPLORATION +semiología I-EXPLORATION +de I-EXPLORATION +neumonía I-EXPLORATION +en I-EXPLORATION +1/3 I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +hemotórax I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +dolor I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +en I-EXPLORATION +apófisis I-EXPLORATION +espinosas I-EXPLORATION +de I-EXPLORATION +última I-EXPLORATION +vértebra I-EXPLORATION +dorsal I-EXPLORATION +y I-EXPLORATION +primeras I-EXPLORATION +lumbares. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +datos I-EXPLORATION +complementarios: I-EXPLORATION +leucocitos I-EXPLORATION +11.800 I-EXPLORATION +(67%N), I-EXPLORATION +hemoglobina I-EXPLORATION +10, I-EXPLORATION +6, I-EXPLORATION +hematocrito I-EXPLORATION +34, I-EXPLORATION +VCM I-EXPLORATION +123 I-EXPLORATION +y I-EXPLORATION +plaquetas I-EXPLORATION +normales. I-EXPLORATION +VSG I-EXPLORATION +de I-EXPLORATION +117 I-EXPLORATION +mm I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +hora. I-EXPLORATION +Los I-EXPLORATION +parámetros I-EXPLORATION +bioquímicos I-EXPLORATION +de I-EXPLORATION +rutina, I-EXPLORATION +coagulación I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +elemental I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +no I-EXPLORATION +mostraron I-EXPLORATION +alteraciones. I-EXPLORATION +Las I-EXPLORATION +determinaciones I-EXPLORATION +de I-EXPLORATION +subpoblaciones I-EXPLORATION +linfocitarias I-EXPLORATION +CD4 I-EXPLORATION +fueron I-EXPLORATION +de I-EXPLORATION +944/mm3 I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +carga I-EXPLORATION +viral I-EXPLORATION +de I-EXPLORATION +VIH I-EXPLORATION +indetectable. I-EXPLORATION +En I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +microbiológicos, I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +serología I-EXPLORATION +de I-EXPLORATION +brucella I-EXPLORATION +fueron I-EXPLORATION +negativas. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +constataron I-EXPLORATION +vegetaciones I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +ecocardiográfica. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +una I-EXPLORATION +imagen I-EXPLORATION +de I-EXPLORATION +radioopacidad I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +inferior I-EXPLORATION +izquierdo I-EXPLORATION +con I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +asociado. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +microbiológicos I-EXPLORATION +de I-EXPLORATION +esputo I-EXPLORATION +resultaron I-EXPLORATION +estériles I-EXPLORATION +con I-EXPLORATION +negatividad I-EXPLORATION +para I-EXPLORATION +BAAR I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +(exudado I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +mononuclear) I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +fue I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +candida I-EXPLORATION +albicans. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +Tac I-EXPLORATION +de I-EXPLORATION +columna I-EXPLORATION +dorso-lumbar I-EXPLORATION +se I-EXPLORATION +hallaron I-EXPLORATION +signos I-EXPLORATION +radiológicos I-EXPLORATION +de I-EXPLORATION +espondilodiscitis I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +tanto I-EXPLORATION +de I-EXPLORATION +cuerpos I-EXPLORATION +vertebrales I-EXPLORATION +D-11, I-EXPLORATION +D-12 I-EXPLORATION +y I-EXPLORATION +L-1, I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +espacios I-EXPLORATION +intervertebrales I-EXPLORATION +D10-D11, I-EXPLORATION +D11-D12 I-EXPLORATION +y I-EXPLORATION +D12-L1, I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +de I-EXPLORATION +tejidos I-EXPLORATION +blandos I-EXPLORATION +paravertebral I-EXPLORATION +y I-EXPLORATION +afectación I-EXPLORATION +intrarraquídea I-EXPLORATION +de I-EXPLORATION +localización I-EXPLORATION +epidural I-EXPLORATION +anterior. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +punción I-EXPLORATION +directa I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +paravertebral. I-EXPLORATION +Se I-EXPLORATION +obtuvo I-EXPLORATION +material I-EXPLORATION +purulento I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +la I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +BAAR I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +cultivo I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Candida I-EXPLORATION +albicans. I-EXPLORATION +Se B-TREATMENT +establecieron I-TREATMENT +medidas I-TREATMENT +ortésicas I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +secuencial I-TREATMENT +con I-TREATMENT +anfotericina I-TREATMENT +B I-TREATMENT +liposomal I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +150 I-TREATMENT +mg/día I-TREATMENT +durante I-TREATMENT +20 I-TREATMENT +días, I-TREATMENT +seguido I-TREATMENT +de I-TREATMENT +fluconazol I-TREATMENT +400 I-TREATMENT +mg/día I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +total I-TREATMENT +de I-TREATMENT +6 I-TREATMENT +meses, I-TREATMENT +evolucionando B-EVOLUTION +con I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +radiológica I-EVOLUTION +(tanto I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +neumonía I-EVOLUTION +como I-EVOLUTION +del I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +y I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +de I-EVOLUTION +espondilodiscitis I-EVOLUTION +con I-EVOLUTION +afectación I-EVOLUTION +de I-EVOLUTION +cuerpos I-EVOLUTION +vertebrales). I-EVOLUTION + I-EVOLUTION +En I-EVOLUTION +la I-EVOLUTION +Tabla I-EVOLUTION +I I-EVOLUTION +se I-EVOLUTION +exponen I-EVOLUTION +diversas I-EVOLUTION +características I-EVOLUTION +de I-EVOLUTION +ambos I-EVOLUTION +casos. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +fumadora B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +paquetes/año, I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +anticonceptivos I-PAST_MEDICAL_HISTORY +orales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +intermitente I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +últimos I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +año I-PAST_MEDICAL_HISTORY +antes, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +octubre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1997 I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +progresiva, I-PRESENT_ILLNESS +náuseas, I-PRESENT_ILLNESS +orinas I-PRESENT_ILLNESS +colúricas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +heces I-PRESENT_ILLNESS +acólicas. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +evidenció I-EXPLORATION +eritema I-EXPLORATION +palmar I-EXPLORATION +bilateral, I-EXPLORATION +ictericia I-EXPLORATION +y I-EXPLORATION +hepatomegalia. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +(ecografía I-EXPLORATION +y I-EXPLORATION +TAC I-EXPLORATION +abdominal) I-EXPLORATION +se I-EXPLORATION +puso I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +una I-EXPLORATION +hepatomegalia I-EXPLORATION +homogénea. I-EXPLORATION +Los I-EXPLORATION +análisis I-EXPLORATION +practicados I-EXPLORATION +demostraron: I-EXPLORATION +GOT I-EXPLORATION +384 I-EXPLORATION +UI/L, I-EXPLORATION +GPT I-EXPLORATION +496 I-EXPLORATION +UI/L, I-EXPLORATION +GGT I-EXPLORATION +78 I-EXPLORATION +UI/L, I-EXPLORATION +FA I-EXPLORATION +553 I-EXPLORATION +UI/L I-EXPLORATION +y I-EXPLORATION +bilirrubina I-EXPLORATION +11, I-EXPLORATION +5 I-EXPLORATION +mg/dl I-EXPLORATION +(directa I-EXPLORATION +4, I-EXPLORATION +8 I-EXPLORATION +mg/dl), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +hipergammaglobulinemia I-EXPLORATION +policlonal, I-EXPLORATION +con I-EXPLORATION +3030 I-EXPLORATION +mg/dl I-EXPLORATION +de I-EXPLORATION +IgG. I-EXPLORATION +Las I-EXPLORATION +serologías I-EXPLORATION +a I-EXPLORATION +VHA, I-EXPLORATION +VHB I-EXPLORATION +y I-EXPLORATION +VHC I-EXPLORATION +resultaron I-EXPLORATION +negativas. I-EXPLORATION +Los I-EXPLORATION +ANA I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Los I-EXPLORATION +AMA I-EXPLORATION +resultaron I-EXPLORATION +positivos I-EXPLORATION +(1/1280), I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +ASMA I-EXPLORATION +(1/320), I-EXPLORATION +Anti-LKM1 I-EXPLORATION +(1/640) I-EXPLORATION +y I-EXPLORATION +ANCA I-EXPLORATION +(1/40). I-EXPLORATION +Se I-EXPLORATION +procedió I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +realización I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +biopsia I-EXPLORATION +hepática I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +leve I-EXPLORATION +distorsión I-EXPLORATION +focal I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +bandas I-EXPLORATION +fibrosas I-EXPLORATION +porto-portales I-EXPLORATION +ocasionales, I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +linfocitario I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +espacios I-EXPLORATION +porta I-EXPLORATION +formando I-EXPLORATION +folículos I-EXPLORATION +linfoides, I-EXPLORATION +en I-EXPLORATION +ocasiones I-EXPLORATION +alrededor I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +ductos I-EXPLORATION +biliares. I-EXPLORATION +Dicho I-EXPLORATION +infiltrado I-EXPLORATION +traspasaba I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +porta, I-EXPLORATION +observándose I-EXPLORATION +necrosis I-EXPLORATION +"piecemeal" I-EXPLORATION +moderada/severa. I-EXPLORATION +Se I-EXPLORATION +apreciaron I-EXPLORATION +hepatocitos I-EXPLORATION +alrededor I-EXPLORATION +del I-EXPLORATION +espacio I-EXPLORATION +porta I-EXPLORATION +con I-EXPLORATION +acúmulo I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +transportadora I-EXPLORATION +de I-EXPLORATION +cobre, I-EXPLORATION +e I-EXPLORATION +incremento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +celularidad I-EXPLORATION +inflamatoria I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +lobulillo, I-EXPLORATION +tanto I-EXPLORATION +en I-EXPLORATION +sinusoides I-EXPLORATION +como I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima, I-EXPLORATION +con I-EXPLORATION +citolisis I-EXPLORATION +e I-EXPLORATION +incremento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +trama I-EXPLORATION +fibrosa I-EXPLORATION +intersticial. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +30 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +prednisona I-TREATMENT +con I-TREATMENT +posterior I-TREATMENT +reducción I-TREATMENT +de I-TREATMENT +su I-TREATMENT +dosis, I-TREATMENT +50 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +azatioprina I-TREATMENT +y I-TREATMENT +ácido I-TREATMENT +ursodesoxicólico. I-TREATMENT +Se B-EVOLUTION +produjo I-EVOLUTION +la I-EVOLUTION +resolución I-EVOLUTION +completa I-EVOLUTION +del I-EVOLUTION +cuadro I-EVOLUTION +clínico I-EVOLUTION +con I-EVOLUTION +normalización I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +análisis, I-EVOLUTION +persistiendo I-EVOLUTION +discretamente I-EVOLUTION +elevadas, I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +seis I-EVOLUTION +años I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +la I-EVOLUTION +FA I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +GGT. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +78 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que B-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +cuando I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +le I-DERIVED_FROM/TO +detectó I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +bloqueo I-DERIVED_FROM/TO +auriculoventricular I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +tercer I-DERIVED_FROM/TO +grado I-DERIVED_FROM/TO +durante I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +examen I-DERIVED_FROM/TO +rutinario. I-DERIVED_FROM/TO +La B-TREATMENT +paciente I-TREATMENT +quedó I-TREATMENT +ingresada I-TREATMENT +y I-TREATMENT +se I-TREATMENT +implantó I-TREATMENT +un I-TREATMENT +marcapasos I-TREATMENT +temporal I-TREATMENT +endovenoso I-TREATMENT +7F I-TREATMENT +(electrodos I-TREATMENT +de I-TREATMENT +platino) I-TREATMENT +en I-TREATMENT +el I-TREATMENT +ventrículo I-TREATMENT +derecho I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vena I-TREATMENT +yugular I-TREATMENT +interna I-TREATMENT +derecha. I-TREATMENT +Fue I-TREATMENT +necesario I-TREATMENT +recolocarlo I-TREATMENT +en I-TREATMENT +cinco I-TREATMENT +ocasiones I-TREATMENT +durante I-TREATMENT +las I-TREATMENT +primeras I-TREATMENT +24 I-TREATMENT +horas I-TREATMENT +debido I-TREATMENT +a I-TREATMENT +un I-TREATMENT +insuficiente I-TREATMENT +sensado I-TREATMENT +auricular. I-TREATMENT +El I-TREATMENT +tercer I-TREATMENT +día I-TREATMENT +de I-TREATMENT +ingreso I-TREATMENT +se I-TREATMENT +colocó I-TREATMENT +un I-TREATMENT +marcapasos I-TREATMENT +permanente I-TREATMENT +VDD I-TREATMENT +a I-TREATMENT +través I-TREATMENT +de I-TREATMENT +la I-TREATMENT +vía I-TREATMENT +subclavia I-TREATMENT +izquierda I-TREATMENT +sin I-TREATMENT +incidencias. I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tuvo I-EVOLUTION +febrícula I-EVOLUTION +y B-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +ambulatoriamente I-TREATMENT +con I-TREATMENT +cloxacilina. I-TREATMENT +Los B-EXPLORATION +hemocultivos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Diez B-EVOLUTION +días I-EVOLUTION +mas I-EVOLUTION +tarde, I-EVOLUTION +ingresó I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +hospital I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +febrícula I-EVOLUTION +intermitente, I-EVOLUTION +disnea, I-EVOLUTION +tos I-EVOLUTION +no I-EVOLUTION +productiva I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +pleurítico I-EVOLUTION +en I-EVOLUTION +hemitórax I-EVOLUTION +derecho. I-EVOLUTION +La B-EXPLORATION +herida I-EXPLORATION +quirúrgica I-EXPLORATION +estaba I-EXPLORATION +limpia I-EXPLORATION +e I-EXPLORATION +indolora. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +reveló I-EXPLORATION +cardiomegalia I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho. I-EXPLORATION +El I-EXPLORATION +ECG I-EXPLORATION +mostraba I-EXPLORATION +un I-EXPLORATION +bloqueo I-EXPLORATION +auriculoventricular I-EXPLORATION +de I-EXPLORATION +tercer I-EXPLORATION +grado I-EXPLORATION +con I-EXPLORATION +ritmo I-EXPLORATION +de I-EXPLORATION +escape I-EXPLORATION +de I-EXPLORATION +marcapasos. I-EXPLORATION +No B-TREATMENT +había I-TREATMENT +sensado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +onda I-TREATMENT +P, I-TREATMENT +por I-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +aumentó I-TREATMENT +la I-TREATMENT +sensibilidad I-TREATMENT +del I-TREATMENT +electrodo I-TREATMENT +auricular I-TREATMENT +y I-TREATMENT +el I-TREATMENT +dispositivo I-TREATMENT +funcionó I-TREATMENT +adecuadamente. I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +tenía I-EVOLUTION +mayor I-EVOLUTION +disnea, I-EVOLUTION +ingurgitación I-EVOLUTION +yugular I-EVOLUTION +y I-EVOLUTION +edemas I-EVOLUTION +en I-EVOLUTION +miembros I-EVOLUTION +inferiores. I-EVOLUTION +Se B-EXPLORATION +auscultó I-EXPLORATION +por I-EXPLORATION +primera I-EXPLORATION +vez I-EXPLORATION +un I-EXPLORATION +fuerte I-EXPLORATION +roce I-EXPLORATION +pericárdico I-EXPLORATION +sobre I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +precordial. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +ecocardiograma I-EXPLORATION +se I-EXPLORATION +vio I-EXPLORATION +un I-EXPLORATION +derrame I-EXPLORATION +pericárdico I-EXPLORATION +de I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +sin I-EXPLORATION +colapso I-EXPLORATION +ventricular I-EXPLORATION +derecho. I-EXPLORATION +El I-EXPLORATION +cable I-EXPLORATION +del I-EXPLORATION +electrodo I-EXPLORATION +estaba I-EXPLORATION +dentro I-EXPLORATION +del I-EXPLORATION +tracto I-EXPLORATION +de I-EXPLORATION +salida I-EXPLORATION +del I-EXPLORATION +ventrículo I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +proteína I-EXPLORATION +C-reactiva I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +153 I-EXPLORATION +mg/dl, I-EXPLORATION +el I-EXPLORATION +fibrinógeno I-EXPLORATION +de I-EXPLORATION +659 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +VSG I-EXPLORATION +de I-EXPLORATION +57 I-EXPLORATION +mm I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +hora. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares, I-EXPLORATION +anticuerpos I-EXPLORATION +antimúsculo I-EXPLORATION +cardiaco, I-EXPLORATION +complemento I-EXPLORATION +y I-EXPLORATION +factor I-EXPLORATION +reumatoide I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +frente I-EXPLORATION +Coxsackie I-EXPLORATION +B1 I-EXPLORATION +a I-EXPLORATION +B6 I-EXPLORATION +y I-EXPLORATION +Echovirus I-EXPLORATION +fueron I-EXPLORATION +también I-EXPLORATION +negativos. I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +fue I-TREATMENT +tratada I-TREATMENT +con I-TREATMENT +diuréticos I-TREATMENT +y I-TREATMENT +prednisona I-TREATMENT +(30 I-TREATMENT +mg/día). I-TREATMENT +Su B-EVOLUTION +estado I-EVOLUTION +mejoró I-EVOLUTION +rápidamente. I-EVOLUTION +Dos I-EVOLUTION +semanas I-EVOLUTION +después, I-EVOLUTION +el I-EVOLUTION +roce I-EVOLUTION +pericárdico I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +derrame I-EVOLUTION +pleural I-EVOLUTION +habían I-EVOLUTION +desaparecido I-EVOLUTION +y I-EVOLUTION +los I-EVOLUTION +marcadores I-EVOLUTION +inflamatorios I-EVOLUTION +se I-EVOLUTION +habían I-EVOLUTION +normalizado. I-EVOLUTION +La B-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +prednisona I-TREATMENT +fue I-TREATMENT +reduciéndose I-TREATMENT +gradualmente I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +hasta I-TREATMENT +suspender, I-TREATMENT +con I-TREATMENT +recurrencia I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +(dolor I-TREATMENT +torácico I-TREATMENT +pleurítico I-TREATMENT +y I-TREATMENT +elevación I-TREATMENT +de I-TREATMENT +los I-TREATMENT +marcadores I-TREATMENT +de I-TREATMENT +inflamación) I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +después. I-TREATMENT +Se I-TREATMENT +trató I-TREATMENT +con I-TREATMENT +un I-TREATMENT +nuevo I-TREATMENT +curso I-TREATMENT +de I-TREATMENT +prednisona I-TREATMENT +sin I-TREATMENT +recurrencias I-TREATMENT +posteriores. I-TREATMENT + I-TREATMENT + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +63 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +esencial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +valsartan I-PAST_MEDICAL_HISTORY +(80 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +temblor I-PAST_MEDICAL_HISTORY +esencial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +propanolol I-PAST_MEDICAL_HISTORY +(80 I-PAST_MEDICAL_HISTORY +mg/día), I-PAST_MEDICAL_HISTORY +insuficiencia I-PAST_MEDICAL_HISTORY +venosa I-PAST_MEDICAL_HISTORY +crónica I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +miembros I-PAST_MEDICAL_HISTORY +inferiores I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +medidas I-PAST_MEDICAL_HISTORY +higiénico-posturales, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +otros I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +externa I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Medicina I-PRESENT_ILLNESS +Interna I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +valoración I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +seguimiento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +clínico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +insuficiencia I-PRESENT_ILLNESS +venosa I-PRESENT_ILLNESS +crónica I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +referir I-PRESENT_ILLNESS +ninguna I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +estaba I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad, I-EXPLORATION +salvo I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +soplo I-EXPLORATION +sistólico I-EXPLORATION +grado I-EXPLORATION +II/VI I-EXPLORATION +en I-EXPLORATION +borde I-EXPLORATION +esternal I-EXPLORATION +izquierdo I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +auscultación I-EXPLORATION +cardiaca I-EXPLORATION +y I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +insuficiencia I-EXPLORATION +venosa I-EXPLORATION +crónica I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +exploraciones I-EXPLORATION +complementarias I-EXPLORATION +destacaba I-EXPLORATION +hemograma, I-EXPLORATION +VSG, I-EXPLORATION +coagulación, I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +orina I-EXPLORATION +normales. I-EXPLORATION +ECG: I-EXPLORATION +normal. I-EXPLORATION +Radiografía I-EXPLORATION +de I-EXPLORATION +tórax: I-EXPLORATION +imagen I-EXPLORATION +vascular I-EXPLORATION +bien I-EXPLORATION +delimitada I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +mediastino I-EXPLORATION +superior I-EXPLORATION +izquierdo. I-EXPLORATION +Ecocardiografía I-EXPLORATION +doppler: I-EXPLORATION +normal. I-EXPLORATION +TAC I-EXPLORATION +torácica I-EXPLORATION +con I-EXPLORATION +contraste I-EXPLORATION +intravenoso: I-EXPLORATION +dilatación I-EXPLORATION +aneurismática I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +izquierda I-EXPLORATION +de I-EXPLORATION +47x75 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro, I-EXPLORATION +sin I-EXPLORATION +otros I-EXPLORATION +hallazgos. I-EXPLORATION +Cateterismo I-EXPLORATION +cardiaco I-EXPLORATION +con I-EXPLORATION +angiografía I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +coronaria: I-EXPLORATION +coronarias I-EXPLORATION +sin I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +dilatación I-EXPLORATION +aneurismática I-EXPLORATION +del I-EXPLORATION +tronco I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +pulmonar I-EXPLORATION +izquierda. I-EXPLORATION +La B-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Cardiovascular I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +referencia, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +sometida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +intervención I-DERIVED_FROM/TO +quirúrgica, I-DERIVED_FROM/TO +objetivándose B-TREATMENT +en I-TREATMENT +el I-TREATMENT +acto I-TREATMENT +quirúrgico I-TREATMENT +una I-TREATMENT +arteria I-TREATMENT +pulmonar I-TREATMENT +derecha I-TREATMENT +de I-TREATMENT +calibre I-TREATMENT +normal I-TREATMENT +y I-TREATMENT +realizándose I-TREATMENT +resección I-TREATMENT +parcial I-TREATMENT +y I-TREATMENT +plicatura I-TREATMENT +de I-TREATMENT +las I-TREATMENT +arterias I-TREATMENT +pulmonares I-TREATMENT +común I-TREATMENT +e I-TREATMENT +izquierda I-TREATMENT +hasta I-TREATMENT +reducir I-TREATMENT +a I-TREATMENT +un I-TREATMENT +diámetro I-TREATMENT +de I-TREATMENT +2-3 I-TREATMENT +centímetros, I-TREATMENT +cursando B-EVOLUTION +el I-EVOLUTION +postoperatorio I-EVOLUTION +sin I-EVOLUTION +complicaciones I-EVOLUTION +y I-EVOLUTION +permaneciendo I-EVOLUTION +asintomática I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +cirugía. I-EVOLUTION + I-EVOLUTION + +Dos B-PRESENT_ILLNESS +pacientes I-PRESENT_ILLNESS +varones I-PRESENT_ILLNESS +A I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +B, I-PRESENT_ILLNESS +diagnosticados I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +enfermedad I-PRESENT_ILLNESS +inflamatoria I-PRESENT_ILLNESS +intestinal I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +presentaron I-PRESENT_ILLNESS +urticaria I-PRESENT_ILLNESS +generalizada I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +varios I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mesalazina. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +A, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +31 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +presentado I-PRESENT_ILLNESS +urticaria I-PRESENT_ILLNESS +generalizada I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +toma I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +mesalazina I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +así B-PAST_MEDICAL_HISTORY +como I-PAST_MEDICAL_HISTORY +reacciones I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +urticaria I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +angioedema I-PAST_MEDICAL_HISTORY +tras I-PAST_MEDICAL_HISTORY +toma I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +AAS I-PAST_MEDICAL_HISTORY +(ácido I-PAST_MEDICAL_HISTORY +acetilsalicílico). I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +caso I-PRESENT_ILLNESS +B, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mesalazina, I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +rash I-PRESENT_ILLNESS +maculopapuloso I-PRESENT_ILLNESS +generalizado, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +retira. I-PRESENT_ILLNESS +Seis I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +tarde I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +reinicia I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +mesalazina, I-PRESENT_ILLNESS +aunque I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +introducido I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +budesonida I-PRESENT_ILLNESS +vía I-PRESENT_ILLNESS +oral I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rectal. I-PRESENT_ILLNESS +Tras I-PRESENT_ILLNESS +otros I-PRESENT_ILLNESS +tres I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +todo I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +anterior I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +después I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +retirada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +corticoides, I-PRESENT_ILLNESS +presenta I-PRESENT_ILLNESS +urticaria I-PRESENT_ILLNESS +generalizada. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Test B-EXPLORATION +cutáneos I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +pruebas I-EXPLORATION +cutáneas I-EXPLORATION +según I-EXPLORATION +las I-EXPLORATION +recomendaciones I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +Academia I-EXPLORATION +Europea I-EXPLORATION +de I-EXPLORATION +Alergología I-EXPLORATION +e I-EXPLORATION +Inmunología I-EXPLORATION +Clínica I-EXPLORATION +(EAACI) I-EXPLORATION +(5). I-EXPLORATION +Prick I-EXPLORATION +a I-EXPLORATION +1/10 I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +1/1 I-EXPLORATION +con I-EXPLORATION +mesalazina I-EXPLORATION +(10 I-EXPLORATION +mg/ml I-EXPLORATION +de I-EXPLORATION +Claversal®) I-EXPLORATION +y I-EXPLORATION +sulfasalazina I-EXPLORATION +(10 I-EXPLORATION +mg/ml I-EXPLORATION +de I-EXPLORATION +Salazopyrina®). I-EXPLORATION +Se I-EXPLORATION +usó I-EXPLORATION +histamina I-EXPLORATION +a I-EXPLORATION +1/10 I-EXPLORATION +y I-EXPLORATION +1/1 I-EXPLORATION +como I-EXPLORATION +control I-EXPLORATION +positivo. I-EXPLORATION +El I-EXPLORATION +suero I-EXPLORATION +salino I-EXPLORATION +en I-EXPLORATION +prick I-EXPLORATION +se I-EXPLORATION +utilizó I-EXPLORATION +como I-EXPLORATION +control I-EXPLORATION +negativo. I-EXPLORATION +Los I-EXPLORATION +resultados I-EXPLORATION +se I-EXPLORATION +consideran I-EXPLORATION +negativos I-EXPLORATION +cuando I-EXPLORATION +la I-EXPLORATION +pápula I-EXPLORATION +obtenida I-EXPLORATION +es I-EXPLORATION +< I-EXPLORATION +o I-EXPLORATION +igual I-EXPLORATION +a I-EXPLORATION +3 I-EXPLORATION +mm I-EXPLORATION +o I-EXPLORATION +menor I-EXPLORATION +que I-EXPLORATION +la I-EXPLORATION +histamina. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +prick I-EXPLORATION +en I-EXPLORATION +10 I-EXPLORATION +pacientes I-EXPLORATION +sanos I-EXPLORATION +no I-EXPLORATION +expuestos I-EXPLORATION +a I-EXPLORATION +5-ASA I-EXPLORATION +previamente. I-EXPLORATION + I-EXPLORATION +Provocación I-EXPLORATION +oral I-EXPLORATION +controlada I-EXPLORATION +con I-EXPLORATION +placebo I-EXPLORATION +a I-EXPLORATION +simple I-EXPLORATION +ciego I-EXPLORATION + I-EXPLORATION +Tras B-TREATMENT +la I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +un I-TREATMENT +placebo, I-TREATMENT +se I-TREATMENT +administran I-TREATMENT +dosis I-TREATMENT +crecientes I-TREATMENT +del I-TREATMENT +fármaco I-TREATMENT +implicado I-TREATMENT +en I-TREATMENT +una I-TREATMENT +reacción I-TREATMENT +durante I-TREATMENT +un I-TREATMENT +tiempo I-TREATMENT +determinado, I-TREATMENT +a I-TREATMENT +partir I-TREATMENT +del I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +llega I-TREATMENT +a I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +deseada I-TREATMENT +para I-TREATMENT +el I-TREATMENT +tratamiento, I-TREATMENT +la I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +mantiene I-TREATMENT +desde I-TREATMENT +entonces. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +deben I-TREATMENT +descartar I-TREATMENT +enfermedades I-TREATMENT +o I-TREATMENT +tratamientos I-TREATMENT +que I-TREATMENT +contraindiquen I-TREATMENT +el I-TREATMENT +uso I-TREATMENT +de I-TREATMENT +adrenalina, I-TREATMENT +o I-TREATMENT +enfermedades I-TREATMENT +mal I-TREATMENT +controladas I-TREATMENT +(hipertensión I-TREATMENT +arterial, I-TREATMENT +diabetes). I-TREATMENT + I-TREATMENT +Se I-TREATMENT +deben I-TREATMENT +suspender I-TREATMENT +medicaciones I-TREATMENT +que I-TREATMENT +puedan I-TREATMENT +interferir I-TREATMENT +los I-TREATMENT +resultados I-TREATMENT +de I-TREATMENT +las I-TREATMENT +pruebas I-TREATMENT +(corticoides, I-TREATMENT +antihistamínicos, I-TREATMENT +etc.). I-TREATMENT + I-TREATMENT +Si I-TREATMENT +aparecen I-TREATMENT +reacciones I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +administración, I-TREATMENT +como I-TREATMENT +urticaria, I-TREATMENT +angioedema, I-TREATMENT +etc., I-TREATMENT +se I-TREATMENT +le I-TREATMENT +administra I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +preciso I-TREATMENT +para I-TREATMENT +revertirlas I-TREATMENT +en I-TREATMENT +cada I-TREATMENT +caso I-TREATMENT +y I-TREATMENT +se I-TREATMENT +suspende I-TREATMENT +la I-TREATMENT +provocación. I-TREATMENT + I-TREATMENT +"Desensibilización" I-TREATMENT +a I-TREATMENT +mesalazina I-TREATMENT + I-TREATMENT +Se I-TREATMENT +pide I-TREATMENT +consentimiento I-TREATMENT +informado I-TREATMENT +firmado I-TREATMENT +por I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +para I-TREATMENT +la I-TREATMENT +realización I-TREATMENT +de I-TREATMENT +pruebas I-TREATMENT +cutáneas I-TREATMENT +y I-TREATMENT +de I-TREATMENT +provocación I-TREATMENT +oral. I-TREATMENT + I-TREATMENT +Se I-TREATMENT +llevó I-TREATMENT +a I-TREATMENT +cabo I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +ambulatoria I-TREATMENT +el I-TREATMENT +protocolo I-TREATMENT +de I-TREATMENT +desensibilización, I-TREATMENT +elaborado I-TREATMENT +en I-TREATMENT +nuestro I-TREATMENT +Servicio I-TREATMENT +de I-TREATMENT +Alergia I-TREATMENT +como I-TREATMENT +se I-TREATMENT +puede I-TREATMENT +observar I-TREATMENT +en I-TREATMENT +la I-TREATMENT +Tabla I-TREATMENT +I. I-TREATMENT + I-TREATMENT +En I-TREATMENT +el I-TREATMENT +caso I-TREATMENT +B, I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +budesonida I-TREATMENT +en I-TREATMENT +enemas I-TREATMENT +7 I-TREATMENT +días I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +iniciar I-TREATMENT +la I-TREATMENT +desensibilización. I-TREATMENT + I-TREATMENT +Con I-TREATMENT +este I-TREATMENT +protocolo I-TREATMENT +se I-TREATMENT +administran I-TREATMENT +en I-TREATMENT +17 I-TREATMENT +días I-TREATMENT +dosis I-TREATMENT +(mg) I-TREATMENT +crecientes I-TREATMENT +de I-TREATMENT +mesalazina, I-TREATMENT +con I-TREATMENT +varias I-TREATMENT +dosis I-TREATMENT +diarias, I-TREATMENT +con I-TREATMENT +un I-TREATMENT +intervalo I-TREATMENT +de I-TREATMENT +tiempo I-TREATMENT +que I-TREATMENT +va I-TREATMENT +aumentando I-TREATMENT +cada I-TREATMENT +día I-TREATMENT +(45 I-TREATMENT +minutos, I-TREATMENT +1 I-TREATMENT +hora I-TREATMENT +y I-TREATMENT +8 I-TREATMENT +horas). I-TREATMENT +Se I-TREATMENT +administran I-TREATMENT +dosis I-TREATMENT +hasta I-TREATMENT +alcanzar I-TREATMENT +la I-TREATMENT +tolerancia I-TREATMENT +de I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +terapéutica I-TREATMENT +requerida I-TREATMENT +por I-TREATMENT +el I-TREATMENT +paciente. I-TREATMENT +Se I-TREATMENT +señala I-TREATMENT +en I-TREATMENT +la I-TREATMENT +tabla I-TREATMENT +I I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +diaria I-TREATMENT +tolerada I-TREATMENT +y I-TREATMENT +la I-TREATMENT +acumulada I-TREATMENT +(la I-TREATMENT +suma I-TREATMENT +de I-TREATMENT +los I-TREATMENT +miligramos I-TREATMENT +tolerados I-TREATMENT +por I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +hasta I-TREATMENT +ese I-TREATMENT +momento). I-TREATMENT + I-TREATMENT +El I-TREATMENT +día I-TREATMENT +17 I-TREATMENT +se I-TREATMENT +administran I-TREATMENT +finalmente I-TREATMENT +1.000 I-TREATMENT +mg/1.000 I-TREATMENT +mg/1.000 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +mesalazina I-TREATMENT +(3.000 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día). I-TREATMENT + I-TREATMENT +Prick B-EXPLORATION +a I-EXPLORATION +1/10 I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +1/1 I-EXPLORATION +con I-EXPLORATION +mesalazina I-EXPLORATION +y I-EXPLORATION +sulfasalazina I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +pacientes I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +controles. I-EXPLORATION +Provocación I-EXPLORATION +oral I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +A I-EXPLORATION +con I-EXPLORATION +ácido I-EXPLORATION +acetilsalicílico I-EXPLORATION +hasta I-EXPLORATION +500 I-EXPLORATION +mg, I-EXPLORATION +con I-EXPLORATION +urticaria I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +cara. I-EXPLORATION +"Desensibilización" B-TREATMENT +a I-TREATMENT +mesalazina I-TREATMENT +desarrollado I-TREATMENT +en I-TREATMENT +17 I-TREATMENT +días, I-TREATMENT +con I-TREATMENT +tolerancia I-TREATMENT +de I-TREATMENT +1.000 I-TREATMENT +mg I-TREATMENT +de I-TREATMENT +mesalazina I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +horas I-TREATMENT +(3.000 I-TREATMENT +mg I-TREATMENT +al I-TREATMENT +día) I-TREATMENT +en I-TREATMENT +el I-TREATMENT +paciente I-TREATMENT +A I-TREATMENT +y I-TREATMENT +B. I-TREATMENT +Desde B-EVOLUTION +entonces, I-EVOLUTION +y I-EVOLUTION +durante I-EVOLUTION +seis I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +existe I-EVOLUTION +buena I-EVOLUTION +tolerancia I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +mesalazina I-EVOLUTION +y I-EVOLUTION +mantienen I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +la I-EVOLUTION +misma I-EVOLUTION +dosis I-EVOLUTION +tolerada I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +continuada, I-EVOLUTION +para I-EVOLUTION +evitar I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +reacciones. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +76 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +fumador B-PAST_MEDICAL_HISTORY +durante I-PAST_MEDICAL_HISTORY +60 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +cesó I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +este I-PAST_MEDICAL_HISTORY +hábito, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +forma I-PAST_MEDICAL_HISTORY +habitual. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +malestar I-PRESENT_ILLNESS +general, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +pleurítico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +lado I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +aumento I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +expectoración I-PRESENT_ILLNESS +habituales. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +corporal I-EXPLORATION +de I-EXPLORATION +38 I-EXPLORATION +ºC I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +difusa I-EXPLORATION +del I-EXPLORATION +murmullo I-EXPLORATION +vesicular I-EXPLORATION +con I-EXPLORATION +crepitantes I-EXPLORATION +y I-EXPLORATION +sibilancias I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +base I-EXPLORATION +pulmonar I-EXPLORATION +izda. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +general I-EXPLORATION +al I-EXPLORATION +ingreso I-EXPLORATION +destacaron I-EXPLORATION +18.600 I-EXPLORATION +leucocitos/mm3, I-EXPLORATION +92% I-EXPLORATION +neutrófilos, I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +gasometría I-EXPLORATION +con I-EXPLORATION +pCO2 I-EXPLORATION +de I-EXPLORATION +27 I-EXPLORATION +mm I-EXPLORATION +Hg, I-EXPLORATION +pO2 I-EXPLORATION +56, I-EXPLORATION +8, I-EXPLORATION +pH I-EXPLORATION +7, I-EXPLORATION +48 I-EXPLORATION +y I-EXPLORATION +HCO3 I-EXPLORATION +23, I-EXPLORATION +6 I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +O2 I-EXPLORATION +del I-EXPLORATION +92%. I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +torácica I-EXPLORATION +mostró I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +alveolar I-EXPLORATION +en I-EXPLORATION +LII, I-EXPLORATION +LSI I-EXPLORATION +y I-EXPLORATION +língula I-EXPLORATION +y I-EXPLORATION +cardiomegalia. I-EXPLORATION +Se B-TREATMENT +procedió I-TREATMENT +al I-TREATMENT +ingreso I-TREATMENT +del I-TREATMENT +paciente I-TREATMENT +iniciando I-TREATMENT +oxigenoterapia, I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +broncodilatadores I-TREATMENT +inhalados, I-TREATMENT +heparina I-TREATMENT +de I-TREATMENT +bajo I-TREATMENT +peso I-TREATMENT +molecular I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +profiláctica I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +antimicrobiano I-TREATMENT +con I-TREATMENT +levofloxacino I-TREATMENT +intravenoso I-TREATMENT +(500 I-TREATMENT +mg/24 I-TREATMENT +horas). I-TREATMENT +El B-EVOLUTION +cuadro I-EVOLUTION +evolucionó I-EVOLUTION +lentamente, I-EVOLUTION +manteniéndose I-EVOLUTION +la I-EVOLUTION +febrícula I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +insuficiencia I-EVOLUTION +respiratoria I-EVOLUTION +y B-EXPLORATION +las I-EXPLORATION +muestras I-EXPLORATION +de I-EXPLORATION +esputo I-EXPLORATION +para I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +no I-EXPLORATION +fueron I-EXPLORATION +valorables, I-EXPLORATION +resultando I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +negativos. I-EXPLORATION +Por I-EXPLORATION +todo I-EXPLORATION +ello, I-EXPLORATION +6 I-EXPLORATION +días I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +realizar I-EXPLORATION +una I-EXPLORATION +fibrobroncoscopia. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +del I-EXPLORATION +aspirado I-EXPLORATION +bronquial I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Gram I-EXPLORATION +abundantes I-EXPLORATION +polimorfonucleares I-EXPLORATION +(> I-EXPLORATION +25 I-EXPLORATION +PMN/c I-EXPLORATION +x100) I-EXPLORATION +y I-EXPLORATION +bacilos I-EXPLORATION +gram I-EXPLORATION +positivos I-EXPLORATION +difterimorfos I-EXPLORATION +extra I-EXPLORATION +e I-EXPLORATION +intracelulares, I-EXPLORATION +creciendo I-EXPLORATION +posteriormente I-EXPLORATION +en I-EXPLORATION +cultivo I-EXPLORATION +puro I-EXPLORATION +C. I-EXPLORATION +pseudodiphteriticum I-EXPLORATION +resistente I-EXPLORATION +a I-EXPLORATION +clindamicina, I-EXPLORATION +eritromicina I-EXPLORATION +y I-EXPLORATION +ciprofloxacina I-EXPLORATION +y I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +penilina, I-EXPLORATION +amoxicilina-clavulánico, I-EXPLORATION +cefalosporinas I-EXPLORATION +de I-EXPLORATION +2ª I-EXPLORATION +y I-EXPLORATION +3ª I-EXPLORATION +generación I-EXPLORATION +y I-EXPLORATION +glicopéptidos. I-EXPLORATION +El I-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +frotis I-EXPLORATION +del I-EXPLORATION +exudado I-EXPLORATION +bronquial I-EXPLORATION +como I-EXPLORATION +proceso I-EXPLORATION +inflamatorio I-EXPLORATION +agudo I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +otras I-EXPLORATION +lesiones. I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +neumonía I-TREATMENT +por I-TREATMENT +C. I-TREATMENT +pseudodiphteriticum I-TREATMENT +se I-TREATMENT +cambió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +a I-TREATMENT +amoxicilina-clavulánico I-TREATMENT +2 I-TREATMENT +g/ I-TREATMENT +8 I-TREATMENT +h I-TREATMENT +i.v., I-TREATMENT +evolucionando B-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +de I-EVOLUTION +forma I-EVOLUTION +favorable. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +hacía I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +adenopatías I-PRESENT_ILLNESS +laterocervicales I-PRESENT_ILLNESS +izquierdas I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +odinofagia. I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +asoció I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +kg I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +La B-EXPLORATION +exploración I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +salvo I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +fiebre I-EXPLORATION +(38 I-EXPLORATION +ºC), I-EXPLORATION +conglomerado I-EXPLORATION +adenopático I-EXPLORATION +látero-cervical I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +mínimas I-EXPLORATION +adenopatías I-EXPLORATION +latero-cervicales I-EXPLORATION +derechas. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +un I-EXPLORATION +TAC I-EXPLORATION +cervical I-EXPLORATION +que I-EXPLORATION +mostraba I-EXPLORATION +adenopatías I-EXPLORATION +cervicales, I-EXPLORATION +analítica I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +con I-EXPLORATION +leucopenia I-EXPLORATION +y I-EXPLORATION +trombopenia I-EXPLORATION +y I-EXPLORATION +biopsia I-EXPLORATION +ganglionar I-EXPLORATION +informada I-EXPLORATION +de I-EXPLORATION +linfadenitis I-EXPLORATION +aguda. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +analítica I-EXPLORATION +destacaba: I-EXPLORATION +leucocitos I-EXPLORATION +2.500 I-EXPLORATION +con I-EXPLORATION +26% I-EXPLORATION +linfocitos, I-EXPLORATION +plaquetas I-EXPLORATION +57.000 I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +816 I-EXPLORATION +U/L. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +PPD I-EXPLORATION +5U I-EXPLORATION +fue I-EXPLORATION +negativa I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +hemocultivos, I-EXPLORATION +coprocultivo I-EXPLORATION +RPR I-EXPLORATION +y I-EXPLORATION +serologías I-EXPLORATION +frente I-EXPLORATION +a I-EXPLORATION +CMV, I-EXPLORATION +VEB, I-EXPLORATION +Brucella, I-EXPLORATION +Leptospira, I-EXPLORATION +Francisella I-EXPLORATION +tularensis I-EXPLORATION +y I-EXPLORATION +Bartonella I-EXPLORATION +fueron I-EXPLORATION +así I-EXPLORATION +mismo I-EXPLORATION +negativas. I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fiebre I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +nueva I-EXPLORATION +biopsia I-EXPLORATION +cervical I-EXPLORATION +observándose I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +cortical-paracortical I-EXPLORATION +una I-EXPLORATION +linfadenitis I-EXPLORATION +necrotizante I-EXPLORATION +parcheada, I-EXPLORATION +con I-EXPLORATION +abundantes I-EXPLORATION +restos I-EXPLORATION +celulares I-EXPLORATION +y I-EXPLORATION +rodeada I-EXPLORATION +por I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +CD4+, I-EXPLORATION +histiocitos I-EXPLORATION +CD68, I-EXPLORATION +escasos I-EXPLORATION +polimorfonucleares I-EXPLORATION +y I-EXPLORATION +células I-EXPLORATION +plasmáticas.; I-EXPLORATION +características I-EXPLORATION +histopatológicas I-EXPLORATION +que I-EXPLORATION +definen I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Kikuchi. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +antiinflamatorios I-TREATMENT +no I-TREATMENT +esteroides I-TREATMENT +con B-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +fiebre. I-EVOLUTION +Año I-EVOLUTION +y I-EVOLUTION +medio I-EVOLUTION +después I-EVOLUTION +sigue I-EVOLUTION +asintomático. I-EVOLUTION + I-EVOLUTION + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +remitida B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +pediatra I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +hospital I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +estudio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +adenopatía I-DERIVED_FROM/TO +cervical I-DERIVED_FROM/TO +dolorosa I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +una I-DERIVED_FROM/TO +semana I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución, I-DERIVED_FROM/TO +sin I-DERIVED_FROM/TO +respuesta I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +amoxicilina-clavulánico. I-DERIVED_FROM/TO +No B-PRESENT_ILLNESS +refería I-PRESENT_ILLNESS +fiebre, I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +anorexia I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +asociada. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +se I-EXPLORATION +apreciaron I-EXPLORATION +adenopatías I-EXPLORATION +laterocervicales I-EXPLORATION +izquierdas I-EXPLORATION +menores I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +cm I-EXPLORATION +y I-EXPLORATION +adenopatía I-EXPLORATION +laterocervical I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +3, I-EXPLORATION +5 I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +consistencia I-EXPLORATION +dura, I-EXPLORATION +no I-EXPLORATION +adherida, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +inflamatorios I-EXPLORATION +asociados. I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +destacaba I-EXPLORATION +hemograma, I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +coagulación I-EXPLORATION +normales, I-EXPLORATION +VSG I-EXPLORATION +30 I-EXPLORATION +mm, I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares I-EXPLORATION +y I-EXPLORATION +factor I-EXPLORATION +reumatoideo I-EXPLORATION +negativos. I-EXPLORATION +PPD I-EXPLORATION +5U I-EXPLORATION +negativo. I-EXPLORATION +Serología I-EXPLORATION +Herpesvirus I-EXPLORATION +6 I-EXPLORATION +IgM I-EXPLORATION +positiva. I-EXPLORATION +Serologías I-EXPLORATION +CMV, I-EXPLORATION +VEB, I-EXPLORATION +VHS I-EXPLORATION +I I-EXPLORATION +- I-EXPLORATION +II, I-EXPLORATION +Hepatitis I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C, I-EXPLORATION +VIH, I-EXPLORATION +Toxoplasma I-EXPLORATION +gondii, I-EXPLORATION +Bartonella I-EXPLORATION +henselae, I-EXPLORATION +Parvovirus I-EXPLORATION +B19 I-EXPLORATION +y I-EXPLORATION +Salmonella I-EXPLORATION +typhi I-EXPLORATION +negativas. I-EXPLORATION +La I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +fueron I-EXPLORATION +normales I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +cervical I-EXPLORATION +se I-EXPLORATION +confirmaron I-EXPLORATION +las I-EXPLORATION +adenopatías. I-EXPLORATION + I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +persistencia I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +adenopatías I-EXPLORATION +se I-EXPLORATION +practicó I-EXPLORATION +biopsia I-EXPLORATION +abierta I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +18 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +evolución. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histológico I-EXPLORATION +mostró I-EXPLORATION +focos I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +paracortical, I-EXPLORATION +rodeados I-EXPLORATION +por I-EXPLORATION +linfocitos I-EXPLORATION +T I-EXPLORATION +CD4 I-EXPLORATION +y I-EXPLORATION +CD8 I-EXPLORATION ++ I-EXPLORATION +y I-EXPLORATION +abundantes I-EXPLORATION +histiocitos I-EXPLORATION +CD68+, I-EXPLORATION +entremezclados I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +plasmocitoides I-EXPLORATION +y I-EXPLORATION +ausencia I-EXPLORATION +significativa I-EXPLORATION +de I-EXPLORATION +neutrófilos. I-EXPLORATION +La I-EXPLORATION +tinción I-EXPLORATION +de I-EXPLORATION +Auramina, I-EXPLORATION +cultivo I-EXPLORATION +para I-EXPLORATION +micobacterias, I-EXPLORATION +PCR I-EXPLORATION +de I-EXPLORATION +Enterovirus, I-EXPLORATION +HSV, I-EXPLORATION +VVZ, I-EXPLORATION +CMV, I-EXPLORATION +VEB I-EXPLORATION +y I-EXPLORATION +Herpesvirus I-EXPLORATION +tipos I-EXPLORATION +6, I-EXPLORATION +7 I-EXPLORATION +y I-EXPLORATION +8 I-EXPLORATION +del I-EXPLORATION +tejido I-EXPLORATION +ganglionar I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +El B-EVOLUTION +curso I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +autolimitado. I-EVOLUTION +Dos I-EVOLUTION +años I-EVOLUTION +después I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomática. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +73 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +diabetes I-PAST_MEDICAL_HISTORY +mellitus I-PAST_MEDICAL_HISTORY +tipo I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antidiabéticos I-PAST_MEDICAL_HISTORY +orales, I-PAST_MEDICAL_HISTORY +cardiopatía I-PAST_MEDICAL_HISTORY +isquémica, I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +fibrilación I-PAST_MEDICAL_HISTORY +auricular I-PAST_MEDICAL_HISTORY +paroxística I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +amiodarona, I-PAST_MEDICAL_HISTORY +calcioantagonistas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antiagregantes I-PAST_MEDICAL_HISTORY +plaquetarios. I-PAST_MEDICAL_HISTORY +Refería B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos, I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +disnea. I-PRESENT_ILLNESS +En B-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +destacaban I-EXPLORATION +anemia I-EXPLORATION +normocítica, I-EXPLORATION +hipoxemia, I-EXPLORATION +elevación I-EXPLORATION +de I-EXPLORATION +reactantes I-EXPLORATION +de I-EXPLORATION +fase I-EXPLORATION +aguda I-EXPLORATION +e I-EXPLORATION +infiltrados I-EXPLORATION +"parcheados" I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +hemitórax I-EXPLORATION +con I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +derecho. I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +múltiples I-EXPLORATION +estudios I-EXPLORATION +microbiológicos, I-EXPLORATION +serológicos, I-EXPLORATION +citológicos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +imagen I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +o I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +estableció I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +presunción I-TREATMENT +bronquiolitis I-TREATMENT +obliterante I-TREATMENT +con I-TREATMENT +neumonía I-TREATMENT +organizada I-TREATMENT +(BONO) I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +60 I-TREATMENT +mg/día I-TREATMENT +con I-TREATMENT +desaparición I-TREATMENT +de I-TREATMENT +la I-TREATMENT +fiebre I-TREATMENT +y I-TREATMENT +mejoría I-TREATMENT +de I-TREATMENT +los I-TREATMENT +síntomas I-TREATMENT +respiratorios, I-TREATMENT +de I-TREATMENT +la I-TREATMENT +anemia I-TREATMENT +y I-TREATMENT +de I-TREATMENT +los I-TREATMENT +reactantes I-TREATMENT +de I-TREATMENT +fase I-TREATMENT +aguda. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +fue I-EVOLUTION +ingresada I-EVOLUTION +de I-EVOLUTION +nuevo I-EVOLUTION +un I-EVOLUTION +mes I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +por I-EVOLUTION +disnea I-EVOLUTION +de I-EVOLUTION +reposo, I-EVOLUTION +edemas I-EVOLUTION +y I-EVOLUTION +oliguria. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +destacaban I-EXPLORATION +taquipnea, I-EXPLORATION +taquicardia I-EXPLORATION +rítmica I-EXPLORATION +sin I-EXPLORATION +soplos, I-EXPLORATION +disminución I-EXPLORATION +global I-EXPLORATION +del I-EXPLORATION +murmullo I-EXPLORATION +vesicular I-EXPLORATION +con I-EXPLORATION +crepitantes I-EXPLORATION +en I-EXPLORATION +bases I-EXPLORATION +y I-EXPLORATION +edemas I-EXPLORATION +en I-EXPLORATION +extremidades I-EXPLORATION +inferiores. I-EXPLORATION +Entre I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +destacaban I-EXPLORATION +20.600 I-EXPLORATION +leucocitos/mm3, I-EXPLORATION +con I-EXPLORATION +85% I-EXPLORATION +polimorfonucleares, I-EXPLORATION +LDH I-EXPLORATION +537 I-EXPLORATION +U/L, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina I-EXPLORATION +249 I-EXPLORATION +U/L, I-EXPLORATION +albúmina I-EXPLORATION +2, I-EXPLORATION +3 I-EXPLORATION +g/dL, I-EXPLORATION +pO2 I-EXPLORATION +58 I-EXPLORATION +mmHg I-EXPLORATION +y I-EXPLORATION +CA I-EXPLORATION +19.9 I-EXPLORATION +214 I-EXPLORATION +U/L I-EXPLORATION +(normal I-EXPLORATION +0-27 I-EXPLORATION +U/L). I-EXPLORATION +Eran I-EXPLORATION +normales I-EXPLORATION +las I-EXPLORATION +cifras I-EXPLORATION +de I-EXPLORATION +hemoglobina, I-EXPLORATION +plaquetas, I-EXPLORATION +glucemia, I-EXPLORATION +bilirrubina, I-EXPLORATION +función I-EXPLORATION +renal, I-EXPLORATION +calcio, I-EXPLORATION +electrolitos, I-EXPLORATION +antígeno I-EXPLORATION +carcinoembrionario, I-EXPLORATION +CA I-EXPLORATION +125 I-EXPLORATION +y I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +hormonas I-EXPLORATION +tiroideas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +tomografía I-EXPLORATION +computarizada I-EXPLORATION +(TC) I-EXPLORATION +torácica I-EXPLORATION +se I-EXPLORATION +observaban I-EXPLORATION +derrame I-EXPLORATION +pleural I-EXPLORATION +bilateral I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +densidad I-EXPLORATION +bilateral I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +parénquima I-EXPLORATION +pulmonar, I-EXPLORATION +de I-EXPLORATION +predominio I-EXPLORATION +perihiliar. I-EXPLORATION +El I-EXPLORATION +mediastino I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +había I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +embolismo I-EXPLORATION +pulmonar I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +angio-TC. I-EXPLORATION +Un I-EXPLORATION +ecocardiograma I-EXPLORATION +transtorácico I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +TC I-EXPLORATION +abdominal I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +toracocentesis I-EXPLORATION +bilateral I-EXPLORATION +obteniendo I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +casos I-EXPLORATION +un I-EXPLORATION +líquido I-EXPLORATION +pleural I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +lechoso, I-EXPLORATION +con I-EXPLORATION +características I-EXPLORATION +de I-EXPLORATION +exudado, I-EXPLORATION +concentración I-EXPLORATION +de I-EXPLORATION +triglicéridos I-EXPLORATION +de I-EXPLORATION +433 I-EXPLORATION +mg/dL I-EXPLORATION +y I-EXPLORATION +163 I-EXPLORATION +mg/dL I-EXPLORATION +respectivamente, I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +quilomicrones. I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +citológicos I-EXPLORATION +y I-EXPLORATION +microbiológicos I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +líquidos I-EXPLORATION +pleurales I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +broncoscopia I-EXPLORATION +con I-EXPLORATION +biopsia I-EXPLORATION +transbronquial I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +observaba I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +bronquial I-EXPLORATION +infiltrada I-EXPLORATION +por I-EXPLORATION +una I-EXPLORATION +proliferación I-EXPLORATION +neoplásica I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +adenocarcinoma. I-EXPLORATION +Las I-EXPLORATION +citologías I-EXPLORATION +y I-EXPLORATION +estudios I-EXPLORATION +microbiológicos I-EXPLORATION +del I-EXPLORATION +broncoaspirado I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +lavado I-EXPLORATION +broncoalveolar I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se B-TREATMENT +incrementó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +esteroides I-TREATMENT +y I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +tubo I-TREATMENT +de I-TREATMENT +drenaje I-TREATMENT +torácico I-TREATMENT +bilateral I-TREATMENT +y I-TREATMENT +nutrición I-TREATMENT +parenteral. I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +posterior I-EVOLUTION +se I-EVOLUTION +caracterizó I-EVOLUTION +por I-EVOLUTION +una I-EVOLUTION +insuficiencia I-EVOLUTION +respiratoria I-EVOLUTION +progresiva I-EVOLUTION +que I-EVOLUTION +condujo I-EVOLUTION +al I-EVOLUTION +fallecimiento I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +paciente. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +necropsia I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +una I-EXPLORATION +linfangitis I-EXPLORATION +carcinomatosa I-EXPLORATION +diseminada I-EXPLORATION +con I-EXPLORATION +afectación I-EXPLORATION +de I-EXPLORATION +pulmones, I-EXPLORATION +hígado, I-EXPLORATION +pericardio, I-EXPLORATION +páncreas I-EXPLORATION +y I-EXPLORATION +suprarrenales, I-EXPLORATION +secundaria I-EXPLORATION +a I-EXPLORATION +adenocarcinoma I-EXPLORATION +de I-EXPLORATION +primario I-EXPLORATION +desconocido. I-EXPLORATION + I-EXPLORATION + +Paciente, B-PRESENT_ILLNESS +mujer, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +66 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Crohn I-PAST_MEDICAL_HISTORY +diagnosticada I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +prolapso I-PAST_MEDICAL_HISTORY +genital I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +grado I-PAST_MEDICAL_HISTORY +III. I-PAST_MEDICAL_HISTORY +Acude B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +clínica I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución., I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +discreta I-PRESENT_ILLNESS +rigidez I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +musculatura I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cintura I-PRESENT_ILLNESS +escapular I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pelviana. I-PRESENT_ILLNESS +No I-PRESENT_ILLNESS +aquejaba I-PRESENT_ILLNESS +cefalea, I-PRESENT_ILLNESS +síntomas I-PRESENT_ILLNESS +visuales I-PRESENT_ILLNESS +ni I-PRESENT_ILLNESS +claudicación I-PRESENT_ILLNESS +mandibular. I-PRESENT_ILLNESS +Un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +antes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +visita I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +intervenida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +histerectomía I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +colpoperineoplastia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +prolapso I-PRESENT_ILLNESS +uterino I-PRESENT_ILLNESS +grado I-PRESENT_ILLNESS +III. I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +descripción I-PRESENT_ILLNESS +microscópica I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +cuerpo I-PRESENT_ILLNESS +uterino I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +aprecian I-PRESENT_ILLNESS +vasos I-PRESENT_ILLNESS +arteriales I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +esclerosis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +pared I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +inflamación I-PRESENT_ILLNESS +granulomatosa I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +células I-PRESENT_ILLNESS +gigantes, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +necrosis, I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +nivel I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +capas I-PRESENT_ILLNESS +media I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +perivascular I-PRESENT_ILLNESS +aconsejándose I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +clínico. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +paciente I-EXPLORATION +con I-EXPLORATION +coloración I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +y I-EXPLORATION +mucosas I-EXPLORATION +normal. I-EXPLORATION +Auscultación I-EXPLORATION +cardíaca I-EXPLORATION +y I-EXPLORATION +pulmonar I-EXPLORATION +anodina. I-EXPLORATION +Abdomen I-EXPLORATION +blando, I-EXPLORATION +depresible, I-EXPLORATION +no I-EXPLORATION +doloroso I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación, I-EXPLORATION +cicatriz I-EXPLORATION +de I-EXPLORATION +histerectomía I-EXPLORATION +con I-EXPLORATION +buen I-EXPLORATION +aspecto. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpan I-EXPLORATION +masas. I-EXPLORATION +No I-EXPLORATION +adenopatías I-EXPLORATION +ni I-EXPLORATION +edemas I-EXPLORATION +maleolares. I-EXPLORATION +Los I-EXPLORATION +pulsos I-EXPLORATION +periféricos I-EXPLORATION +estaban I-EXPLORATION +conservados. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemograma, I-EXPLORATION +el I-EXPLORATION +hematocrito I-EXPLORATION +era I-EXPLORATION +del I-EXPLORATION +37, I-EXPLORATION +5% I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +11'9 I-EXPLORATION +g/dl, I-EXPLORATION +serie I-EXPLORATION +blanca I-EXPLORATION +y I-EXPLORATION +hemostasia I-EXPLORATION +normales. I-EXPLORATION +VSG I-EXPLORATION +52 I-EXPLORATION +mm/1ª I-EXPLORATION +hora I-EXPLORATION +y I-EXPLORATION +PCR I-EXPLORATION +66, I-EXPLORATION +3 I-EXPLORATION +g/dl. I-EXPLORATION +La I-EXPLORATION +bioquímica I-EXPLORATION +y I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +eran I-EXPLORATION +normales. I-EXPLORATION +El I-EXPLORATION +FR, I-EXPLORATION +ANA I-EXPLORATION +y I-EXPLORATION +ANCA I-EXPLORATION +negativos. I-EXPLORATION +HLA I-EXPLORATION +B27 I-EXPLORATION +positivo. I-EXPLORATION +Proteinograma I-EXPLORATION +normal. I-EXPLORATION +Mantoux I-EXPLORATION +negativo. I-EXPLORATION +Rx I-EXPLORATION +tórax: I-EXPLORATION +no I-EXPLORATION +cardiomegalia, I-EXPLORATION +campos I-EXPLORATION +pulmonares I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +practicó I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +arteria I-EXPLORATION +temporal I-EXPLORATION +izquierda I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +negativa. I-EXPLORATION + I-EXPLORATION +Con B-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +ACG I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +Prednisona I-TREATMENT +1 I-TREATMENT +mg/kg/día. I-TREATMENT +Dos B-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +permanecía I-EVOLUTION +asintomática I-EVOLUTION +con B-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +20 I-TREATMENT +mg/día. I-TREATMENT + I-TREATMENT + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +49 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +consultado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +varias I-PRESENT_ILLNESS +ocasiones I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +médico I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +familia I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +38º I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +nauseas, I-PRESENT_ILLNESS +vómitos I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +unos I-PRESENT_ILLNESS +10 I-PRESENT_ILLNESS +kilogramos I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +era I-PAST_MEDICAL_HISTORY +exfumador, I-PAST_MEDICAL_HISTORY +estaba I-PAST_MEDICAL_HISTORY +diagnosticado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +hepatopatía I-PAST_MEDICAL_HISTORY +criptogenética, I-PAST_MEDICAL_HISTORY +taquicardia I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +vía I-PAST_MEDICAL_HISTORY +aberrante I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +ablación I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +atrás, I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +angor I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +coronariografía I-PAST_MEDICAL_HISTORY +normal, I-PAST_MEDICAL_HISTORY +síndrome I-PAST_MEDICAL_HISTORY +ansioso-depresivo I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +intervenido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +ulcus I-PAST_MEDICAL_HISTORY +duodenal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +apendicitis. I-PAST_MEDICAL_HISTORY +No I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +realizado I-PAST_MEDICAL_HISTORY +viajes I-PAST_MEDICAL_HISTORY +recientemente I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +refería I-PAST_MEDICAL_HISTORY +prácticas I-PAST_MEDICAL_HISTORY +sexuales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +riesgo. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +clínico I-EXPLORATION +se I-EXPLORATION +objetivaba I-EXPLORATION +una I-EXPLORATION +temperatura I-EXPLORATION +de I-EXPLORATION +39, I-EXPLORATION +7 I-EXPLORATION +ºC, I-EXPLORATION +se I-EXPLORATION +palpaba I-EXPLORATION +hepatomegalia I-EXPLORATION +a I-EXPLORATION +unos I-EXPLORATION +3-4 I-EXPLORATION +centímetros I-EXPLORATION +del I-EXPLORATION +reborde I-EXPLORATION +costal, I-EXPLORATION +siendo I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +cuanto I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +destacaban I-EXPLORATION +15.900/mm3 I-EXPLORATION +leucocitos I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +izquierda, I-EXPLORATION +hemoglobina I-EXPLORATION +de I-EXPLORATION +10.5 I-EXPLORATION +g/dl I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +VSG I-EXPLORATION +de I-EXPLORATION +101 I-EXPLORATION +mm. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +bioquímica I-EXPLORATION +existía I-EXPLORATION +una I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +parámetros I-EXPLORATION +hepáticos: I-EXPLORATION +GOT I-EXPLORATION +101 I-EXPLORATION +U/l, I-EXPLORATION +GPT I-EXPLORATION +128 I-EXPLORATION +U/l, I-EXPLORATION +FA I-EXPLORATION +208 I-EXPLORATION +U/l, I-EXPLORATION +GGT I-EXPLORATION +172 I-EXPLORATION +U/l, I-EXPLORATION +LDH I-EXPLORATION +1366 I-EXPLORATION +UI/l. I-EXPLORATION +La I-EXPLORATION +PCR I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +asimismo I-EXPLORATION +elevada. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +sistemático I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +Mantoux I-EXPLORATION +negativo. I-EXPLORATION +Serologías I-EXPLORATION +de I-EXPLORATION +Brucella, I-EXPLORATION +Leishmania, I-EXPLORATION +C. I-EXPLORATION +Burnetti, I-EXPLORATION +lúes, I-EXPLORATION +Salmonella, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hepatitis I-EXPLORATION +A, I-EXPLORATION +B I-EXPLORATION +y I-EXPLORATION +C I-EXPLORATION +y I-EXPLORATION +VIH I-EXPLORATION +negativos. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +serologías I-EXPLORATION +de I-EXPLORATION +citomegalovirus, I-EXPLORATION +virus I-EXPLORATION +de I-EXPLORATION +Epstein-Barr I-EXPLORATION +y I-EXPLORATION +toxoplasma I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +IgG I-EXPLORATION ++ I-EXPLORATION +y I-EXPLORATION +IgM I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Hemocultivos I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +ambulatorio I-EXPLORATION +y I-EXPLORATION +hospitalizado I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +hígado, I-EXPLORATION +vía I-EXPLORATION +biliar, I-EXPLORATION +vesícula, I-EXPLORATION +porción I-EXPLORATION +visible I-EXPLORATION +de I-EXPLORATION +retroperitoneo I-EXPLORATION +superior I-EXPLORATION +y I-EXPLORATION +porta I-EXPLORATION +sin I-EXPLORATION +hallazgos I-EXPLORATION +ecográficos I-EXPLORATION +significativos. I-EXPLORATION +Posteriormente I-EXPLORATION +se I-EXPLORATION +efectúo I-EXPLORATION +una I-EXPLORATION +TAC I-EXPLORATION +abdominal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +un I-EXPLORATION +extenso I-EXPLORATION +engrosamiento I-EXPLORATION +mamelonado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +transverso I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +de I-EXPLORATION +aproximadamente I-EXPLORATION +12 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud, I-EXPLORATION +sugestivo I-EXPLORATION +de I-EXPLORATION +neoplasia I-EXPLORATION +de I-EXPLORATION +colon; I-EXPLORATION +gran I-EXPLORATION +lesión I-EXPLORATION +sólida I-EXPLORATION +con I-EXPLORATION +captación I-EXPLORATION +heterogénea I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +en I-EXPLORATION +lóbulo I-EXPLORATION +hepático I-EXPLORATION +izquierdo I-EXPLORATION +segmento I-EXPLORATION +IV, I-EXPLORATION +sugestiva I-EXPLORATION +de I-EXPLORATION +metástasis. I-EXPLORATION +Ante I-EXPLORATION +estos I-EXPLORATION +hallazgos I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +un I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +donde I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +defecto I-EXPLORATION +de I-EXPLORATION +repleción I-EXPLORATION +en I-EXPLORATION +"corazón I-EXPLORATION +de I-EXPLORATION +manzana" I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +unión I-EXPLORATION +de I-EXPLORATION +colon I-EXPLORATION +transverso I-EXPLORATION +con I-EXPLORATION +ángulo I-EXPLORATION +hepático I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +tramo I-EXPLORATION +aproximadamente I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +centímetros. I-EXPLORATION +Además I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +colonoscopia I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +neoplasia I-EXPLORATION +circunferencial I-EXPLORATION +a I-EXPLORATION +110 I-EXPLORATION +cm I-EXPLORATION +del I-EXPLORATION +ano I-EXPLORATION +que I-EXPLORATION +impedía I-EXPLORATION +el I-EXPLORATION +paso I-EXPLORATION +del I-EXPLORATION +endoscopio, I-EXPLORATION +tomándose I-EXPLORATION +biopsias. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +fue I-EXPLORATION +informada I-EXPLORATION +como I-EXPLORATION +tejido I-EXPLORATION +de I-EXPLORATION +granulación I-EXPLORATION +y I-EXPLORATION +tejido I-EXPLORATION +conectivo I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +apreciaban I-EXPLORATION +densos I-EXPLORATION +infiltrados I-EXPLORATION +linfocitarios I-EXPLORATION +con I-EXPLORATION +predominio I-EXPLORATION +CD20+ I-EXPLORATION +que I-EXPLORATION +con I-EXPLORATION +frecuencia I-EXPLORATION +expresaban I-EXPLORATION +tinción I-EXPLORATION +nuclear I-EXPLORATION +bcl-6. I-EXPLORATION +Los I-EXPLORATION +cambios I-EXPLORATION +morfológicos I-EXPLORATION +sugerían I-EXPLORATION +un I-EXPLORATION +linfoma I-EXPLORATION +tipo I-EXPLORATION +B I-EXPLORATION +aunque I-EXPLORATION +no I-EXPLORATION +era I-EXPLORATION +concluyente I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +PAAF I-EXPLORATION +hepática I-EXPLORATION +confirmando I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +linfoma I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +grandes I-EXPLORATION +difuso I-EXPLORATION +tipo I-EXPLORATION +B. I-EXPLORATION + I-EXPLORATION +Posteriormente B-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +paciente I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +hematología, I-DERIVED_FROM/TO +donde I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +inició I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +quimioterapia I-DERIVED_FROM/TO +siguiendo I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +esquema I-DERIVED_FROM/TO +CHOP I-DERIVED_FROM/TO +(ciclofosfamida, I-DERIVED_FROM/TO +doxorrubicina, I-DERIVED_FROM/TO +vincristina I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +prednisona) I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +momento I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +tenemos I-DERIVED_FROM/TO +datos I-DERIVED_FROM/TO +sobre I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +eventual I-DERIVED_FROM/TO +respuesta I-DERIVED_FROM/TO +tumoral. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cefaleas I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tabaquismo. I-PAST_MEDICAL_HISTORY +Desde B-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +año I-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +visión I-PRESENT_ILLNESS +borrosa, I-PRESENT_ILLNESS +notando I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +alguna I-PRESENT_ILLNESS +ocasión I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +visual I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +hemicampo I-PRESENT_ILLNESS +derecho, I-PRESENT_ILLNESS +acompañándose I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +cefaleas I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +cedían I-PRESENT_ILLNESS +tras I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +analgésico. I-PRESENT_ILLNESS +Hace I-PRESENT_ILLNESS +nueve I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +presentó I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +ictal I-PRESENT_ILLNESS +transitorio I-PRESENT_ILLNESS +hemisférico I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +desapareció I-PRESENT_ILLNESS +pasados I-PRESENT_ILLNESS +30 I-PRESENT_ILLNESS +minutos. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +En I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mañana I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +presente I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +notó I-PRESENT_ILLNESS +torpeza I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +mano I-PRESENT_ILLNESS +derecha, I-PRESENT_ILLNESS +desviación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +comisura I-PRESENT_ILLNESS +bucal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dificultad I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +articulación I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +palabra. I-PRESENT_ILLNESS +Por I-PRESENT_ILLNESS +este I-PRESENT_ILLNESS +motivo I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +urgencias, I-PRESENT_ILLNESS +siendo I-PRESENT_ILLNESS +valorada I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +neurólogo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +objetivó I-PRESENT_ILLNESS +paresia I-PRESENT_ILLNESS +facial I-PRESENT_ILLNESS +supranuclear I-PRESENT_ILLNESS +derecha I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +disartria, I-PRESENT_ILLNESS +inestabilidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +superior I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +torpeza I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +movimientos I-PRESENT_ILLNESS +finos I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hipoestesia I-PRESENT_ILLNESS +táctil I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +algésica I-PRESENT_ILLNESS +facio-braquial I-PRESENT_ILLNESS +derecha. I-PRESENT_ILLNESS +En B-EXPLORATION +urgencias I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +ECG, I-EXPLORATION +en I-EXPLORATION +ritmo I-EXPLORATION +sinusal, I-EXPLORATION +TAC I-EXPLORATION +craneal I-EXPLORATION +que I-EXPLORATION +inicialmente I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +infarto I-EXPLORATION +y I-EXPLORATION +Doppler I-EXPLORATION +de I-EXPLORATION +troncos I-EXPLORATION +supraaórticos I-EXPLORATION +y I-EXPLORATION +transcraneal I-EXPLORATION +que I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +decidió I-EXPLORATION +ingreso I-EXPLORATION +en I-EXPLORATION +planta, I-EXPLORATION +solicitándose I-EXPLORATION +perfiles I-EXPLORATION +analíticos I-EXPLORATION +completos I-EXPLORATION +incluyendo I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +hipercoagulabilidad, I-EXPLORATION +ANAS, I-EXPLORATION +c-ANCA, I-EXPLORATION +p-ANCA, I-EXPLORATION +DNA I-EXPLORATION +nativo I-EXPLORATION +y I-EXPLORATION +anticuerpos I-EXPLORATION +antimitocondriales. I-EXPLORATION +También I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +imagen: I-EXPLORATION +RNM I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +ecocardiografía. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +RNM I-EXPLORATION +mostró I-EXPLORATION +infarto I-EXPLORATION +isquémico I-EXPLORATION +agudo I-EXPLORATION +en I-EXPLORATION +territorio I-EXPLORATION +silviano I-EXPLORATION +superior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +arteria I-EXPLORATION +cerebral I-EXPLORATION +media I-EXPLORATION +izquierda. I-EXPLORATION +Los I-EXPLORATION +anticuerpos I-EXPLORATION +antineutrófilos, I-EXPLORATION +anticuerpos I-EXPLORATION +antinucleares, I-EXPLORATION +anticentrómero I-EXPLORATION +y I-EXPLORATION +antimitocondrias I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +trombofilia I-EXPLORATION +tan I-EXPLORATION +sólo I-EXPLORATION +detectó I-EXPLORATION +ligera I-EXPLORATION +hiperfibrinogenemia. I-EXPLORATION + I-EXPLORATION +Finalmente I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +ecocardiografía, I-EXPLORATION +prueba I-EXPLORATION +que I-EXPLORATION +resultó I-EXPLORATION +crucial I-EXPLORATION +al I-EXPLORATION +proporcionar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo, I-EXPLORATION +observándose I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +pedunculada I-EXPLORATION +en I-EXPLORATION +AI I-EXPLORATION +que I-EXPLORATION +prolapsaba I-EXPLORATION +a I-EXPLORATION +través I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +válvula I-EXPLORATION +mitral I-EXPLORATION +en I-EXPLORATION +diástole, I-EXPLORATION +correspondiente I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +mixoma I-EXPLORATION +(35 I-EXPLORATION +x I-EXPLORATION +26 I-EXPLORATION +mm), I-EXPLORATION +con I-EXPLORATION +pedículo I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +fosa I-EXPLORATION +oval. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +programó I-TREATMENT +para I-TREATMENT +cirugía I-TREATMENT +realizándose I-TREATMENT +previamente I-TREATMENT +RNM I-TREATMENT +cardiaca I-TREATMENT +para I-TREATMENT +determinar I-TREATMENT +con I-TREATMENT +mayor I-TREATMENT +precisión I-TREATMENT +las I-TREATMENT +características I-TREATMENT +morfológicas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +masa I-TREATMENT +auricular. I-TREATMENT +Se I-TREATMENT +realizó I-TREATMENT +atriotomía I-TREATMENT +izquierda, I-TREATMENT +extrayéndose I-TREATMENT +el I-TREATMENT +tumor I-TREATMENT +en I-TREATMENT +su I-TREATMENT +totalidad, I-TREATMENT +siendo I-TREATMENT +éste I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +morulado. I-TREATMENT +Se I-TREATMENT +abrió I-TREATMENT +también I-TREATMENT +aurícula I-TREATMENT +derecha I-TREATMENT +y I-TREATMENT +se I-TREATMENT +resecó I-TREATMENT +la I-TREATMENT +zona I-TREATMENT +de I-TREATMENT +implantación, I-TREATMENT +cerrándose I-TREATMENT +posteriormente I-TREATMENT +la I-TREATMENT +comunicación I-TREATMENT +interauricular I-TREATMENT +creada. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +evolución I-EVOLUTION +posquirúrgica I-EVOLUTION +resultó I-EVOLUTION +muy I-EVOLUTION +satisfactoria, I-EVOLUTION +siendo I-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +sin I-EVOLUTION +déficit I-EVOLUTION +neurológico. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +60 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +EPOC I-PAST_MEDICAL_HISTORY +moderado, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +incremento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +perímetro I-PRESENT_ILLNESS +abdominal I-PRESENT_ILLNESS +durante I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +previos I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +otra I-PRESENT_ILLNESS +sintomatología I-PRESENT_ILLNESS +acompañante. I-PRESENT_ILLNESS +En B-EXPLORATION +las I-EXPLORATION +pruebas I-EXPLORATION +complementarias I-EXPLORATION +solicitadas I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +y I-EXPLORATION +coagulación I-EXPLORATION +son I-EXPLORATION +normales. I-EXPLORATION +Glucosa, I-EXPLORATION +urea, I-EXPLORATION +ácido I-EXPLORATION +úrico, I-EXPLORATION +creatinina, I-EXPLORATION +calcio I-EXPLORATION +total, I-EXPLORATION +fósforo, I-EXPLORATION +triglicéridos, I-EXPLORATION +colesterol I-EXPLORATION +LDL, I-EXPLORATION +bilirrubina I-EXPLORATION +total, I-EXPLORATION +GOT, I-EXPLORATION +GPT, I-EXPLORATION +GGT, I-EXPLORATION +LDH, I-EXPLORATION +fosfatasa I-EXPLORATION +alcalina, I-EXPLORATION +amilasa, I-EXPLORATION +proteínas I-EXPLORATION +totales, I-EXPLORATION +albúmina, I-EXPLORATION +sodio, I-EXPLORATION +potasio, I-EXPLORATION +cloro, I-EXPLORATION +ferritina, I-EXPLORATION +transferrina, I-EXPLORATION +vitamina I-EXPLORATION +B12 I-EXPLORATION +y I-EXPLORATION +folato I-EXPLORATION +normales. I-EXPLORATION +Colesterol I-EXPLORATION +total I-EXPLORATION +243 I-EXPLORATION +mg/dl I-EXPLORATION +(110-200), I-EXPLORATION +colesterol I-EXPLORATION +HDL I-EXPLORATION +120 I-EXPLORATION +mg/dl I-EXPLORATION +(42-68), I-EXPLORATION +hierro I-EXPLORATION +44 I-EXPLORATION +microg/dl I-EXPLORATION +(65-165); I-EXPLORATION +Ca I-EXPLORATION +19, I-EXPLORATION +9, I-EXPLORATION +82, I-EXPLORATION +03 I-EXPLORATION +U/l I-EXPLORATION +(< I-EXPLORATION +40). I-EXPLORATION +CEA, I-EXPLORATION +PSA I-EXPLORATION +y I-EXPLORATION +alfa-fetoproteína I-EXPLORATION +normales. I-EXPLORATION +Velocidad I-EXPLORATION +de I-EXPLORATION +sedimentación I-EXPLORATION +globular I-EXPLORATION +41 I-EXPLORATION +mm I-EXPLORATION +(< I-EXPLORATION +14). I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +Ca I-EXPLORATION +19, I-EXPLORATION +9, I-EXPLORATION +91, I-EXPLORATION +23 I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +normales. I-EXPLORATION +Resonancia I-EXPLORATION +magnética I-EXPLORATION +(RM) I-EXPLORATION +abdomino-pelvica: I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +gran I-EXPLORATION +masa I-EXPLORATION +multilobulada I-EXPLORATION +abdomino I-EXPLORATION +pelvica, I-EXPLORATION +cuya I-EXPLORATION +señal I-EXPLORATION +a I-EXPLORATION +excepción I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +tabiques I-EXPLORATION +es I-EXPLORATION +preferentemente I-EXPLORATION +grasa. I-EXPLORATION +Las I-EXPLORATION +dimensiones I-EXPLORATION +máximas I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +masa I-EXPLORATION +son I-EXPLORATION +de I-EXPLORATION +26 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +cráneo I-EXPLORATION +caudal, I-EXPLORATION +24, I-EXPLORATION +5 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +transverso I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +21 I-EXPLORATION +cm I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +eje I-EXPLORATION +anteroposterior. I-EXPLORATION +Cruza I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +media I-EXPLORATION +y I-EXPLORATION +produce I-EXPLORATION +importante I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +riñón I-EXPLORATION +izquierdo, I-EXPLORATION +al I-EXPLORATION +que I-EXPLORATION +rota I-EXPLORATION +y I-EXPLORATION +desplaza I-EXPLORATION +cranealmente, I-EXPLORATION +sin I-EXPLORATION +observarse I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +uropatía I-EXPLORATION +obstructiva. I-EXPLORATION +También I-EXPLORATION +ejerce I-EXPLORATION +efecto I-EXPLORATION +de I-EXPLORATION +masa I-EXPLORATION +sobre I-EXPLORATION +el I-EXPLORATION +colon I-EXPLORATION +transverso I-EXPLORATION +izquierdo, I-EXPLORATION +desplazándolo I-EXPLORATION +contra I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +abdominal. I-EXPLORATION +Los I-EXPLORATION +hallazgos I-EXPLORATION +son I-EXPLORATION +muy I-EXPLORATION +sugerentes I-EXPLORATION +de I-EXPLORATION +liposarcoma. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +intervención I-TREATMENT +quirúrgica I-TREATMENT +mediante I-TREATMENT +laparotomía I-TREATMENT +media I-TREATMENT +suprainfraumbilical I-TREATMENT +donde I-TREATMENT +se I-TREATMENT +encontró I-TREATMENT +una I-TREATMENT +gran I-TREATMENT +masa I-TREATMENT +de I-TREATMENT +aspecto I-TREATMENT +lipomatoso I-TREATMENT +desde I-TREATMENT +la I-TREATMENT +celda I-TREATMENT +renal I-TREATMENT +izquierda I-TREATMENT +hasta I-TREATMENT +espacio I-TREATMENT +retrovesical. I-TREATMENT +Se I-TREATMENT +intentó I-TREATMENT +extirpación I-TREATMENT +en I-TREATMENT +bloque I-TREATMENT +con I-TREATMENT +resección I-TREATMENT +de I-TREATMENT +fibras I-TREATMENT +del I-TREATMENT +psoas I-TREATMENT +izquierdo I-TREATMENT +infiltrado. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +informe I-EXPLORATION +anatomopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pieza I-EXPLORATION +extraída I-EXPLORATION +fue I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +descripción I-EXPLORATION +macroscópica: I-EXPLORATION +Pieza I-EXPLORATION +de I-EXPLORATION +45 I-EXPLORATION +x I-EXPLORATION +40 I-EXPLORATION +x I-EXPLORATION +15 I-EXPLORATION +cm. I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +peso I-EXPLORATION +de I-EXPLORATION +6.300 I-EXPLORATION +gr. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +superficie I-EXPLORATION +presenta I-EXPLORATION +una I-EXPLORATION +coloración I-EXPLORATION +amarillenta, I-EXPLORATION +y I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +sección I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +que I-EXPLORATION +mantiene I-EXPLORATION +esta I-EXPLORATION +coloración I-EXPLORATION +con I-EXPLORATION +finos I-EXPLORATION +tractos I-EXPLORATION +conectivos, I-EXPLORATION +sin I-EXPLORATION +apreciarse I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +clara I-EXPLORATION +áreas I-EXPLORATION +de I-EXPLORATION +necrosis I-EXPLORATION +y I-EXPLORATION +sí I-EXPLORATION +una I-EXPLORATION +distribución I-EXPLORATION +en I-EXPLORATION +lóbulos. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +descripción I-EXPLORATION +microscópica I-EXPLORATION +las I-EXPLORATION +secciones I-EXPLORATION +histológicas I-EXPLORATION +muestran I-EXPLORATION +todas I-EXPLORATION +ellas I-EXPLORATION +un I-EXPLORATION +mismo I-EXPLORATION +aspecto: I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +mayor I-EXPLORATION +parte I-EXPLORATION +están I-EXPLORATION +constituidas I-EXPLORATION +por I-EXPLORATION +tejido I-EXPLORATION +adiposo I-EXPLORATION +con I-EXPLORATION +células I-EXPLORATION +adiposas I-EXPLORATION +con I-EXPLORATION +tamaño I-EXPLORATION +grande I-EXPLORATION +de I-EXPLORATION +vacuola I-EXPLORATION +grande I-EXPLORATION +y I-EXPLORATION +aspecto I-EXPLORATION +maduro. I-EXPLORATION +Se I-EXPLORATION +observa I-EXPLORATION +también I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +núcleos I-EXPLORATION +atípicos I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +focal, I-EXPLORATION +con I-EXPLORATION +citoplasma I-EXPLORATION +vacuolado. I-EXPLORATION +Estas I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +tejido I-EXPLORATION +maduro I-EXPLORATION +están I-EXPLORATION +distribuidas I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +difusa I-EXPLORATION +por I-EXPLORATION +toda I-EXPLORATION +la I-EXPLORATION +neoplasia, I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +focos I-EXPLORATION +con I-EXPLORATION +núcleos I-EXPLORATION +atípicos, I-EXPLORATION +en I-EXPLORATION +ocasiones I-EXPLORATION +hipercromáticos I-EXPLORATION +se I-EXPLORATION +muestran I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +aislada. I-EXPLORATION +Diagnóstico: I-EXPLORATION +Liposarcoma I-EXPLORATION +bien I-EXPLORATION +diferenciado. I-EXPLORATION +Una I-EXPLORATION +nueva I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +Ca I-EXPLORATION +19, I-EXPLORATION +9, I-EXPLORATION +posterior I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +quirúrgica I-EXPLORATION +presenta I-EXPLORATION +normalización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +(24, I-EXPLORATION +17 I-EXPLORATION +U/l), I-EXPLORATION +manteniéndose I-EXPLORATION +el I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +marcadores I-EXPLORATION +tumorales I-EXPLORATION +normales. I-EXPLORATION +Posteriormente B-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +radioterapia I-TREATMENT +complementaria, I-TREATMENT +presentando I-TREATMENT +una I-TREATMENT +evolución I-TREATMENT +favorable I-TREATMENT +y I-TREATMENT +permaneciendo I-TREATMENT +asintomático. I-TREATMENT +La B-EXPLORATION +RM I-EXPLORATION +abdominopélvica I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +realizada I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +cinco I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +intervención I-EXPLORATION +quirurgica I-EXPLORATION +presenta I-EXPLORATION +un I-EXPLORATION +estado I-EXPLORATION +postoperatorio I-EXPLORATION +del I-EXPLORATION +liposarcoma I-EXPLORATION +retroperitoneal, I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +macroscópica I-EXPLORATION +de I-EXPLORATION +lesión. I-EXPLORATION +Así B-EVOLUTION +este I-EVOLUTION +paciente I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +evolución I-EVOLUTION +favorable, I-EVOLUTION +permaneciendo I-EVOLUTION +asintomático I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +transcurriendo I-EVOLUTION +más I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +año I-EVOLUTION +desde I-EVOLUTION +la I-EVOLUTION +intervención I-EVOLUTION +quirúrgica. I-EVOLUTION + I-EVOLUTION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +23 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +artritis. I-PRESENT_ILLNESS +Tres B-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +ingreso I-PAST_MEDICAL_HISTORY +comienza I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fiebre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +39º I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +carácter I-PAST_MEDICAL_HISTORY +intermitente I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +artralgias I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tumefacción I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ambos I-PAST_MEDICAL_HISTORY +tobillos, I-PAST_MEDICAL_HISTORY +rodillas, I-PAST_MEDICAL_HISTORY +codos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +muñecas. I-PAST_MEDICAL_HISTORY +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +destaca I-EXPLORATION +palidez I-EXPLORATION +y I-EXPLORATION +discreto I-EXPLORATION +dolor I-EXPLORATION +abdominal I-EXPLORATION +difuso I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +profunda. I-EXPLORATION +Datos I-EXPLORATION +analíticos: I-EXPLORATION +Hb I-EXPLORATION +9, I-EXPLORATION +6 I-EXPLORATION +mg/dL; I-EXPLORATION +HTO I-EXPLORATION +31%, I-EXPLORATION +VCM I-EXPLORATION +65 I-EXPLORATION +mm, I-EXPLORATION +660.000 I-EXPLORATION +plaquetas/mL, I-EXPLORATION +ferritina I-EXPLORATION +65 I-EXPLORATION +ng/mL, I-EXPLORATION +Fe I-EXPLORATION +15 I-EXPLORATION +microg/dL, I-EXPLORATION +fibrinógeno I-EXPLORATION +644 I-EXPLORATION +mg/dL, I-EXPLORATION +PCR I-EXPLORATION +55 I-EXPLORATION +mg/dL. I-EXPLORATION +Resto I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +bioquímicos, I-EXPLORATION +serológicos I-EXPLORATION +e I-EXPLORATION +inmunológicos I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Ecografía I-EXPLORATION +abdominal I-EXPLORATION +sin I-EXPLORATION +alteraciones. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +enema I-EXPLORATION +opaco I-EXPLORATION +se I-EXPLORATION +objetiva I-EXPLORATION +afectación I-EXPLORATION +del I-EXPLORATION +colon I-EXPLORATION +sigmoide I-EXPLORATION +hasta I-EXPLORATION +ciego, I-EXPLORATION +observándose I-EXPLORATION +úlceras I-EXPLORATION +transversales I-EXPLORATION +y I-EXPLORATION +longitudinales I-EXPLORATION +del I-EXPLORATION +colon. I-EXPLORATION +La I-EXPLORATION +colonoscopia I-EXPLORATION +demuestra I-EXPLORATION +en I-EXPLORATION +colon I-EXPLORATION +descendente I-EXPLORATION +y I-EXPLORATION +sigmoide, I-EXPLORATION +una I-EXPLORATION +mucosa I-EXPLORATION +eritematosa I-EXPLORATION +y I-EXPLORATION +edematosa, I-EXPLORATION +con I-EXPLORATION +múltiples I-EXPLORATION +ulceraciones I-EXPLORATION +y I-EXPLORATION +pseudopólipos I-EXPLORATION +los I-EXPLORATION +hallazgos I-EXPLORATION +anatomopatológicos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +son I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +Crohn. I-EXPLORATION + I-EXPLORATION +Curso B-EVOLUTION +evolutivo: I-EVOLUTION +la I-EVOLUTION +enferma I-EVOLUTION +cursó I-EVOLUTION +posteriormente I-EVOLUTION +con I-EVOLUTION +diarrea I-EVOLUTION +con I-EVOLUTION +2-3 I-EVOLUTION +deposiciones I-EVOLUTION +líquidas I-EVOLUTION +diarias I-EVOLUTION +sin I-EVOLUTION +productos I-EVOLUTION +patológicos I-EVOLUTION +y I-EVOLUTION +lesiones I-EVOLUTION +cutáneas I-EVOLUTION +de I-EVOLUTION +eritema I-EVOLUTION +nodoso. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +56 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +diagnosticado B-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Cowden I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +presentar I-PAST_MEDICAL_HISTORY +múltiples I-PAST_MEDICAL_HISTORY +formaciones I-PAST_MEDICAL_HISTORY +papilomatosas I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dorso I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +lengua I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tamaño I-PAST_MEDICAL_HISTORY +variable, I-PAST_MEDICAL_HISTORY +macroglosia I-PAST_MEDICAL_HISTORY +saburral I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pápulas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +color I-PAST_MEDICAL_HISTORY +piel I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +mucosa I-PAST_MEDICAL_HISTORY +lingual I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +modo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +empedrado. I-PAST_MEDICAL_HISTORY +El I-PAST_MEDICAL_HISTORY +resultado I-PAST_MEDICAL_HISTORY +anatomopatoógico I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +fibroepiteliales I-PAST_MEDICAL_HISTORY +(12). I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +diagnóstico I-PAST_MEDICAL_HISTORY +dermatológico I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +inició I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +estudio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +extensión: I-PAST_MEDICAL_HISTORY +a) I-PAST_MEDICAL_HISTORY +tránsito I-PAST_MEDICAL_HISTORY +EGD I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +enema I-PAST_MEDICAL_HISTORY +opaco I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +evidencian I-PAST_MEDICAL_HISTORY +numerosos I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +antro I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +ampolla I-PAST_MEDICAL_HISTORY +rectal; I-PAST_MEDICAL_HISTORY +b) I-PAST_MEDICAL_HISTORY +endoscopias I-PAST_MEDICAL_HISTORY +digestivas I-PAST_MEDICAL_HISTORY +alta I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +baja: I-PAST_MEDICAL_HISTORY +parcheado I-PAST_MEDICAL_HISTORY +difuso I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +esófago I-PAST_MEDICAL_HISTORY +cervical I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +cardias I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +histológicamente I-PAST_MEDICAL_HISTORY +coincide I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +acantosis I-PAST_MEDICAL_HISTORY +glucogénica; I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +sésiles I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +alguno I-PAST_MEDICAL_HISTORY +pediculado I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +estómago I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +ampolla I-PAST_MEDICAL_HISTORY +rectal I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +corresponden I-PAST_MEDICAL_HISTORY +histológicamente I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +pólipos I-PAST_MEDICAL_HISTORY +hamartomatosos; I-PAST_MEDICAL_HISTORY +c) I-PAST_MEDICAL_HISTORY +ecografía I-PAST_MEDICAL_HISTORY +tiroidea: I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +nódulos I-PAST_MEDICAL_HISTORY +sólidos, I-PAST_MEDICAL_HISTORY +uno I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +cada I-PAST_MEDICAL_HISTORY +lóbulo. I-PAST_MEDICAL_HISTORY +Tras I-PAST_MEDICAL_HISTORY +punción I-PAST_MEDICAL_HISTORY +(PAAF) I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +diagnostica I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bocio I-PAST_MEDICAL_HISTORY +coloidal; I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +d) I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +tomografía I-PAST_MEDICAL_HISTORY +computerizada I-PAST_MEDICAL_HISTORY +craneal I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +demostró I-PAST_MEDICAL_HISTORY +alteraciones I-PAST_MEDICAL_HISTORY +significativas. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +En B-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +actualidad I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +cefalea. I-PRESENT_ILLNESS +Dada B-EXPLORATION +su I-EXPLORATION +enfermedad I-EXPLORATION +de I-EXPLORATION +base I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realiza I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +demostrándose I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +en I-EXPLORATION +hemisferio I-EXPLORATION +cerebeloso I-EXPLORATION +derecho I-EXPLORATION +descrita I-EXPLORATION +como I-EXPLORATION +un I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +volumen I-EXPLORATION +debido I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +masa I-EXPLORATION +mal I-EXPLORATION +delimitada I-EXPLORATION +que I-EXPLORATION +muestra I-EXPLORATION +discreta I-EXPLORATION +hipodensidad I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +T1 I-EXPLORATION +y I-EXPLORATION +discreta I-EXPLORATION +hiperdensidad I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +T2 I-EXPLORATION +y I-EXPLORATION +FLAIR I-EXPLORATION +que I-EXPLORATION +afecta I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +cortical I-EXPLORATION +cerebelosa I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +posterolateral I-EXPLORATION +y I-EXPLORATION +que I-EXPLORATION +condiciona I-EXPLORATION +un I-EXPLORATION +leve I-EXPLORATION +desplazamiento I-EXPLORATION +hacia I-EXPLORATION +la I-EXPLORATION +izquierda I-EXPLORATION +del I-EXPLORATION +IV I-EXPLORATION +ventrículo I-EXPLORATION +sin I-EXPLORATION +evidencia I-EXPLORATION +de I-EXPLORATION +hidrocefalia I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +supratentorial. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +administración I-EXPLORATION +de I-EXPLORATION +contraste I-EXPLORATION +paramagnético I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +visualiza I-EXPLORATION +captación I-EXPLORATION +significativa I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +parece I-EXPLORATION +tratarse I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +gangliocitoma I-EXPLORATION +displásico I-EXPLORATION +cerebeloso I-EXPLORATION +con I-EXPLORATION +engrosamiento I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +capas I-EXPLORATION +del I-EXPLORATION +cerebelo I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +produce I-EXPLORATION +un I-EXPLORATION +aparente I-EXPLORATION +laminado I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cortical. I-EXPLORATION + I-EXPLORATION + +Paciente B-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +43 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +haber I-PAST_MEDICAL_HISTORY +vivido I-PAST_MEDICAL_HISTORY +7 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +Amazonas I-PAST_MEDICAL_HISTORY +(desde I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +28 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +hasta I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +35 I-PAST_MEDICAL_HISTORY +años), I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +profesión I-PAST_MEDICAL_HISTORY +médica, I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +dispepsia I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +regular. I-PAST_MEDICAL_HISTORY + I-PAST_MEDICAL_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +sudoración I-PRESENT_ILLNESS +nocturna I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Niega B-EXPLORATION +fiebre, I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +peso, I-EXPLORATION +tabaquismo, I-EXPLORATION +consumo I-EXPLORATION +de I-EXPLORATION +fármacos I-EXPLORATION +o I-EXPLORATION +drogas I-EXPLORATION +ilícitas. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +presentaba I-EXPLORATION +datos I-EXPLORATION +significativos I-EXPLORATION +al I-EXPLORATION +exámen I-EXPLORATION +físico. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +realizó I-EXPLORATION +laboratorio, I-EXPLORATION +velocidad I-EXPLORATION +de I-EXPLORATION +eritrosedimentación I-EXPLORATION +globular I-EXPLORATION +(VSG), I-EXPLORATION +hormonas I-EXPLORATION +tiroideas, I-EXPLORATION +proteinograma I-EXPLORATION +electroforético I-EXPLORATION +y I-EXPLORATION +complemento, I-EXPLORATION +encontrándose I-EXPLORATION +todos I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +límites I-EXPLORATION +normales. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizaron I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +orina I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos I-EXPLORATION +(3 I-EXPLORATION +pares I-EXPLORATION +de I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +2 I-EXPLORATION +cultivos I-EXPLORATION +de I-EXPLORATION +orina). I-EXPLORATION +Reacción I-EXPLORATION +de I-EXPLORATION +Mantoux I-EXPLORATION +y I-EXPLORATION +serologías I-EXPLORATION +virales, I-EXPLORATION +bacterianas I-EXPLORATION +y I-EXPLORATION +parasitarias I-EXPLORATION +negativas. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +agregaron I-EXPLORATION +factor I-EXPLORATION +reumatoideo, I-EXPLORATION +factor I-EXPLORATION +antinuclear, I-EXPLORATION +ANCA I-EXPLORATION +C I-EXPLORATION +y I-EXPLORATION +P, I-EXPLORATION +siendo I-EXPLORATION +todos I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +no I-EXPLORATION +evidenció I-EXPLORATION +patología. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +presentaba I-EXPLORATION +dispepsia I-EXPLORATION +y I-EXPLORATION +pirosis, I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +sugiere I-EXPLORATION +enfermedad I-EXPLORATION +por I-EXPLORATION +RGE I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +endoscopia I-EXPLORATION +digestiva I-EXPLORATION +que I-EXPLORATION +evidenció I-EXPLORATION +esofagitis I-EXPLORATION +grado I-EXPLORATION +dos. I-EXPLORATION +Inició B-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +omeprazol I-TREATMENT +40 I-TREATMENT +mg/día, I-TREATMENT +desapareciendo B-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +también I-EVOLUTION +la I-EVOLUTION +sudoración I-EVOLUTION +nocturna, I-EVOLUTION +y I-EVOLUTION +reapareciendo I-EVOLUTION +esta I-EVOLUTION +última I-EVOLUTION +al I-EVOLUTION +suspender I-EVOLUTION +el I-EVOLUTION +fármaco. I-EVOLUTION +Se B-EXPLORATION +realizó I-EXPLORATION +pHmetría I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +no I-EXPLORATION +demostrando I-EXPLORATION +reflujo. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +36 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +tabaquismo I-PAST_MEDICAL_HISTORY +leve, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +celiaca, I-PAST_MEDICAL_HISTORY +enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Graves I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +drogas I-PAST_MEDICAL_HISTORY +anti-tiroideas, I-PAST_MEDICAL_HISTORY +posterior I-PAST_MEDICAL_HISTORY +tiroidectomía I-PAST_MEDICAL_HISTORY +total I-PAST_MEDICAL_HISTORY +e I-PAST_MEDICAL_HISTORY +hipotiroidismo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +vasculitis I-PAST_MEDICAL_HISTORY +ANCA I-PAST_MEDICAL_HISTORY +C I-PAST_MEDICAL_HISTORY +positiva I-PAST_MEDICAL_HISTORY +(enfermedad I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Wegener I-PAST_MEDICAL_HISTORY +limitada). I-PAST_MEDICAL_HISTORY +En I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +meprednisona I-PAST_MEDICAL_HISTORY +60 I-PAST_MEDICAL_HISTORY +mg/día I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +ciclofosfamida I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +mg/kg/día I-PAST_MEDICAL_HISTORY +1 I-PAST_MEDICAL_HISTORY +mes I-PAST_MEDICAL_HISTORY +previo I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +internación. I-PAST_MEDICAL_HISTORY +Ingresó B-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +UTI I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +disnea I-PRESENT_ILLNESS +súbita I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +asociado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +estridor I-PRESENT_ILLNESS +laríngeo I-PRESENT_ILLNESS +inspiratorio, I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +sibilancias. I-PRESENT_ILLNESS +Presentó I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +crisis I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +diez I-PRESENT_ILLNESS +minutos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +aproximadamente I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +horas, I-PRESENT_ILLNESS +permaneciendo I-PRESENT_ILLNESS +asintomática I-PRESENT_ILLNESS +intercrisis. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +fibrolaringoscopía I-EXPLORATION +hasta I-EXPLORATION +cuarto I-EXPLORATION +anillo I-EXPLORATION +traqueal I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +lesiones I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +movilidad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +cuerdas I-EXPLORATION +impresionó I-EXPLORATION +normal I-EXPLORATION +fuera I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +crisis. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +cuello I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +disminución I-EXPLORATION +del I-EXPLORATION +calibre I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +glótica I-EXPLORATION +en I-EXPLORATION +inspiración I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +simétrica I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +traquea I-EXPLORATION +era I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +RGE I-EXPLORATION +y I-EXPLORATION +este I-EXPLORATION +se I-EXPLORATION +diagnóstico I-EXPLORATION +mediante I-EXPLORATION +SEGD. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +EFR I-EXPLORATION +que I-EXPLORATION +mostró I-EXPLORATION +obstrucción I-EXPLORATION +moderada I-EXPLORATION +fija, I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +alteración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +curva I-EXPLORATION +inspiratoria. I-EXPLORATION +Permanece B-TREATMENT +en I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +corticoides, I-TREATMENT +beta I-TREATMENT +2 I-TREATMENT +inhalados I-TREATMENT +de I-TREATMENT +larga I-TREATMENT +duración I-TREATMENT +y I-TREATMENT +omeprazol I-TREATMENT +40 I-TREATMENT +mg/día. I-TREATMENT +No I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +tratamiento I-TREATMENT +psicológico I-TREATMENT +ni I-TREATMENT +fonoudiológico. I-TREATMENT +Se B-EVOLUTION +encuentra I-EVOLUTION +asintomática I-EVOLUTION +desde I-EVOLUTION +hace I-EVOLUTION +4 I-EVOLUTION +meses. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +leucoderma, I-PRESENT_ILLNESS +fue B-DERIVED_FROM/TO +enviado I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +Ambulatorio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Estomatología I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +Hospital I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Clínicas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Porto I-DERIVED_FROM/TO +Alegre I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +Cirujano I-DERIVED_FROM/TO +Dentista I-DERIVED_FROM/TO +debido I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +múltiples I-DERIVED_FROM/TO +lesiones I-DERIVED_FROM/TO +papilomatosas I-DERIVED_FROM/TO +dispersas I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +mucosa I-DERIVED_FROM/TO +bucal. I-DERIVED_FROM/TO +La B-FAMILY_HISTORY +madre I-FAMILY_HISTORY +del I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +relató I-FAMILY_HISTORY +que I-FAMILY_HISTORY +la I-FAMILY_HISTORY +hermana I-FAMILY_HISTORY +del I-FAMILY_HISTORY +paciente I-FAMILY_HISTORY +presentaba I-FAMILY_HISTORY +lesiones I-FAMILY_HISTORY +semejantes, I-FAMILY_HISTORY +las I-FAMILY_HISTORY +cuales I-FAMILY_HISTORY +fueron I-FAMILY_HISTORY +tratadas I-FAMILY_HISTORY +por I-FAMILY_HISTORY +cauterización. I-FAMILY_HISTORY +En B-EXPLORATION +el I-EXPLORATION +análisis I-EXPLORATION +físico I-EXPLORATION +intraoral, I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +papilomatosas, I-EXPLORATION +algunas I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +nodular, I-EXPLORATION +otras I-EXPLORATION +con I-EXPLORATION +aspecto I-EXPLORATION +de I-EXPLORATION +verrugas, I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +coloración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +bucal I-EXPLORATION +e I-EXPLORATION +indoloras. I-EXPLORATION +Las I-EXPLORATION +lesiones I-EXPLORATION +se I-EXPLORATION +localizaban I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +comisura I-EXPLORATION +labial I-EXPLORATION +bilateral, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +retrocomisural, I-EXPLORATION +bilateral, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +del I-EXPLORATION +labio I-EXPLORATION +superior I-EXPLORATION +e I-EXPLORATION +inferior, I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +borde I-EXPLORATION +anterior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +lengua I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +1/3 I-EXPLORATION +posterior I-EXPLORATION +del I-EXPLORATION +palato I-EXPLORATION +duro, I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +línea I-EXPLORATION +mediana. I-EXPLORATION +El I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +variaba I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +5 I-EXPLORATION +a I-EXPLORATION +5 I-EXPLORATION +mm I-EXPLORATION +de I-EXPLORATION +diámetro. I-EXPLORATION +La I-EXPLORATION +sospecha I-EXPLORATION +clínica I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +Hiperplasia I-EXPLORATION +Focal I-EXPLORATION +del I-EXPLORATION +Epitelio. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +excisional I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones, I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +comisura I-EXPLORATION +labial I-EXPLORATION +lado I-EXPLORATION +derecho. I-EXPLORATION +El I-EXPLORATION +aspecto I-EXPLORATION +histopatológico I-EXPLORATION +demostró I-EXPLORATION +acantosis I-EXPLORATION +del I-EXPLORATION +epitelio, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +crestas I-EXPLORATION +interpapilares I-EXPLORATION +ensanchadas, I-EXPLORATION +coilocitosis I-EXPLORATION +y I-EXPLORATION +alteración I-EXPLORATION +nuclear, I-EXPLORATION +conocida I-EXPLORATION +como I-EXPLORATION +figura I-EXPLORATION +mitosoide. I-EXPLORATION +La I-EXPLORATION +presencia I-EXPLORATION +del I-EXPLORATION +virus I-EXPLORATION +del I-EXPLORATION +HPV I-EXPLORATION +13 I-EXPLORATION +fue I-EXPLORATION +comprobada I-EXPLORATION +por I-EXPLORATION +análisis I-EXPLORATION +inmunohistoquímica. I-EXPLORATION +Esas I-EXPLORATION +características I-EXPLORATION +llevan I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +de I-EXPLORATION +Hiperplasia I-EXPLORATION +Focal I-EXPLORATION +del I-EXPLORATION +Epitelio. I-EXPLORATION +A B-EVOLUTION +la I-EVOLUTION +madre I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +le I-EVOLUTION +informó I-EVOLUTION +sobre I-EVOLUTION +las I-EVOLUTION +características I-EVOLUTION +de I-EVOLUTION +benignidad I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +y, I-EVOLUTION +se I-EVOLUTION +espera I-EVOLUTION +que I-EVOLUTION +disminuyan I-EVOLUTION +las I-EVOLUTION +lesiones. I-EVOLUTION +El I-EVOLUTION +paciente I-EVOLUTION +está I-EVOLUTION +en I-EVOLUTION +acompañamiento I-EVOLUTION +semestral. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +femenina I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +84 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que B-DERIVED_FROM/TO +es I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +servicio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Estomatología I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +Cirugía I-DERIVED_FROM/TO +Oral I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Universidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Cartagena I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +presentar I-DERIVED_FROM/TO +molestia I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +cavidad I-DERIVED_FROM/TO +oral. I-DERIVED_FROM/TO +Al B-EXPLORATION +examen I-EXPLORATION +clínico I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +múltiples I-EXPLORATION +placas, I-EXPLORATION +manchas I-EXPLORATION +y I-EXPLORATION +verrugosidades I-EXPLORATION +distribuidas I-EXPLORATION +en I-EXPLORATION +forma I-EXPLORATION +irregular I-EXPLORATION +de I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +paladar I-EXPLORATION +duro I-EXPLORATION +comprometiendo I-EXPLORATION +tercio I-EXPLORATION +anterior I-EXPLORATION +y I-EXPLORATION +medio, I-EXPLORATION +del I-EXPLORATION +lado I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +derecho; I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +coloración I-EXPLORATION +de I-EXPLORATION +tonalidad I-EXPLORATION +variante I-EXPLORATION +desde I-EXPLORATION +un I-EXPLORATION +blanco I-EXPLORATION +grisáceo I-EXPLORATION +hasta I-EXPLORATION +un I-EXPLORATION +blanco I-EXPLORATION +amarillo; I-EXPLORATION +tamaño I-EXPLORATION +que I-EXPLORATION +oscila I-EXPLORATION +aproximadamente I-EXPLORATION +sobre I-EXPLORATION +3×5 I-EXPLORATION +cm, I-EXPLORATION +forma I-EXPLORATION +variada I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +verrugosa I-EXPLORATION +y I-EXPLORATION +consistencia I-EXPLORATION +blanda, I-EXPLORATION +bordes I-EXPLORATION +definidos, I-EXPLORATION +asintomática; I-EXPLORATION +no I-EXPLORATION +desprende I-EXPLORATION +al I-EXPLORATION +raspado I-EXPLORATION +e I-EXPLORATION +imperceptible I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +misma. I-EXPLORATION +La B-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +reporta I-PAST_MEDICAL_HISTORY +ser I-PAST_MEDICAL_HISTORY +fumadora I-PAST_MEDICAL_HISTORY +invertida I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +hace I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +refiere I-PAST_MEDICAL_HISTORY +fumar I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +cigarrillos I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +día. I-PAST_MEDICAL_HISTORY +En B-EXPLORATION +esta I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +da I-EXPLORATION +una I-EXPLORATION +impresión I-EXPLORATION +clínica I-EXPLORATION +de I-EXPLORATION +leucoplasia I-EXPLORATION +homogénea I-EXPLORATION +y, I-EXPLORATION +para I-EXPLORATION +realizar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo, I-EXPLORATION +se I-EXPLORATION +programó I-EXPLORATION +biopsia I-EXPLORATION +incisional. I-EXPLORATION + I-EXPLORATION +Procedimiento B-TREATMENT + I-TREATMENT +Previo I-TREATMENT +consentimiento I-TREATMENT +informado, I-TREATMENT +se I-TREATMENT +aplica I-TREATMENT +técnica I-TREATMENT +anestésica I-TREATMENT +nasopalatina I-TREATMENT +y I-TREATMENT +palatina I-TREATMENT +anterior I-TREATMENT +bilateral, I-TREATMENT +utilizando I-TREATMENT +lidocaína I-TREATMENT +con I-TREATMENT +epinefrina I-TREATMENT +al I-TREATMENT +2%; I-TREATMENT +luego I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +incisión I-TREATMENT +romboidal I-TREATMENT +con I-TREATMENT +hoja I-TREATMENT +de I-TREATMENT +bisturí I-TREATMENT +número I-TREATMENT +15 I-TREATMENT +en I-TREATMENT +borde I-TREATMENT +anterior I-TREATMENT +de I-TREATMENT +paladar I-TREATMENT +duro I-TREATMENT +del I-TREATMENT +lado I-TREATMENT +derecho, I-TREATMENT +seguido I-TREATMENT +de I-TREATMENT +la I-TREATMENT +disección I-TREATMENT +del I-TREATMENT +tejido, I-TREATMENT +el I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +tomó I-TREATMENT +con I-TREATMENT +pinza I-TREATMENT +Alix I-TREATMENT +para I-TREATMENT +proteger I-TREATMENT +y I-TREATMENT +manipular I-TREATMENT +mejor I-TREATMENT +la I-TREATMENT +muestra I-TREATMENT +de I-TREATMENT +tejido, I-TREATMENT +se I-TREATMENT +hace I-TREATMENT +hemostasia I-TREATMENT +con I-TREATMENT +una I-TREATMENT +torunda I-TREATMENT +de I-TREATMENT +gasa I-TREATMENT +estéril, I-TREATMENT +tomando I-TREATMENT +cuatro I-TREATMENT +puntos I-TREATMENT +de I-TREATMENT +sutura I-TREATMENT +con I-TREATMENT +seda I-TREATMENT +3/0, I-TREATMENT +lavado I-TREATMENT +y I-TREATMENT +secado I-TREATMENT +de I-TREATMENT +la I-TREATMENT +zona. I-TREATMENT +Se I-TREATMENT +dieron I-TREATMENT +indicaciones I-TREATMENT +a I-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +de I-TREATMENT +forma I-TREATMENT +verbal I-TREATMENT +y I-TREATMENT +por I-TREATMENT +escrito. I-TREATMENT + I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +regresa I-EVOLUTION +a I-EVOLUTION +un I-EVOLUTION +control I-EVOLUTION +posquirúrgico I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +observándose I-EVOLUTION +tejidos I-EVOLUTION +en I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +proceso I-EVOLUTION +de I-EVOLUTION +cicatrización. I-EVOLUTION +El B-EXPLORATION +reporte I-EXPLORATION +histopatológico I-EXPLORATION +indica I-EXPLORATION +mucosa I-EXPLORATION +palatina I-EXPLORATION +con I-EXPLORATION +marcada I-EXPLORATION +queratosis I-EXPLORATION +sin I-EXPLORATION +"displasia". I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizan I-EXPLORATION +controles I-EXPLORATION +mensuales I-EXPLORATION +observando I-EXPLORATION +la I-EXPLORATION +desaparición I-EXPLORATION +casi I-EXPLORATION +total I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +patología; I-EXPLORATION +sin B-EVOLUTION +embargo I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +reporta I-EVOLUTION +que I-EVOLUTION +ha I-EVOLUTION +iniciado I-EVOLUTION +otra I-EVOLUTION +vez I-EVOLUTION +el I-EVOLUTION +hábito I-EVOLUTION +de I-EVOLUTION +fumar I-EVOLUTION +invertido I-EVOLUTION +y, I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +último I-EVOLUTION +control, I-EVOLUTION +se I-EVOLUTION +observa I-EVOLUTION +aparición I-EVOLUTION +nuevamente I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +placas I-EVOLUTION +blancas. I-EVOLUTION +Observamos I-EVOLUTION +entonces I-EVOLUTION +una I-EVOLUTION +fuerte I-EVOLUTION +asociación I-EVOLUTION +entre I-EVOLUTION +el I-EVOLUTION +fumar I-EVOLUTION +invertido I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +lesiones I-EVOLUTION +premalignas. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +17 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino; I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +reiterados I-PRESENT_ILLNESS +accesos I-PRESENT_ILLNESS +dolorosos I-PRESENT_ILLNESS +caracterizados I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +hemicrania I-PRESENT_ILLNESS +pulsátil, I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +urente I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tipo I-PRESENT_ILLNESS +neurálgico I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +área I-PRESENT_ILLNESS +frontal I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +retroorbitaria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +fenómenos I-PRESENT_ILLNESS +productivos I-PRESENT_ILLNESS +autonómicos I-PRESENT_ILLNESS +homolaterales I-PRESENT_ILLNESS +(rinorrea I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +lagrimeo). I-PRESENT_ILLNESS +Los I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +eran I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +corta I-PRESENT_ILLNESS +duración I-PRESENT_ILLNESS +(de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +segundos I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +5 I-PRESENT_ILLNESS +minutos), I-PRESENT_ILLNESS +reiterados, I-PRESENT_ILLNESS +subintrantes, I-PRESENT_ILLNESS +postraban I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +deterioraban I-PRESENT_ILLNESS +sensiblemente I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +actividad I-PRESENT_ILLNESS +diaria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +vigilia. I-PRESENT_ILLNESS +Ocasionalmente I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +acompañaban I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vómitos. I-PRESENT_ILLNESS +Este I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +presentaba, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +momento I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +ingreso I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +nuestro I-PRESENT_ILLNESS +servicio, I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución; I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +tratamiento I-PRESENT_ILLNESS +analgésico I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +antimigrañoso I-PRESENT_ILLNESS +había I-PRESENT_ILLNESS +sido I-PRESENT_ILLNESS +totalmente I-PRESENT_ILLNESS +ineficaz. I-PRESENT_ILLNESS +Examen B-EXPLORATION +neurológico I-EXPLORATION +intercrítico I-EXPLORATION +normal. I-EXPLORATION +Valoración I-EXPLORATION +oftalmológica I-EXPLORATION +y I-EXPLORATION +otorrinolaringológica I-EXPLORATION +normales. I-EXPLORATION +Psicodiagnóstico I-EXPLORATION +y I-EXPLORATION +perfil I-EXPLORATION +de I-EXPLORATION +personalidad I-EXPLORATION +sin I-EXPLORATION +elementos I-EXPLORATION +remarcables. I-EXPLORATION +Se I-EXPLORATION +efectuaron I-EXPLORATION +neuroimágenes I-EXPLORATION +(RMN/RMN I-EXPLORATION +angiográfica), I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se B-TREATMENT +empleó I-TREATMENT +indometacina, I-TREATMENT +con I-TREATMENT +muy I-TREATMENT +pobres I-TREATMENT +resultados. I-TREATMENT +Los B-EVOLUTION +indicadores I-EVOLUTION +de I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +y I-EVOLUTION +el I-EVOLUTION +calendario I-EVOLUTION +de I-EVOLUTION +cefaleas I-EVOLUTION +mostraban I-EVOLUTION +un I-EVOLUTION +importante I-EVOLUTION +deterioro. I-EVOLUTION + I-EVOLUTION +Se B-TREATMENT +decidió I-TREATMENT +usar I-TREATMENT +entonces I-TREATMENT +alguno I-TREATMENT +de I-TREATMENT +los I-TREATMENT +fármacos I-TREATMENT +que I-TREATMENT +cumplen I-TREATMENT +un I-TREATMENT +rol I-TREATMENT +de I-TREATMENT +estabilizadores I-TREATMENT +de I-TREATMENT +membrana, I-TREATMENT +como I-TREATMENT +el I-TREATMENT +grupo I-TREATMENT +de I-TREATMENT +drogas I-TREATMENT +antiepilépticas I-TREATMENT +(DAE) I-TREATMENT +relativamente I-TREATMENT +nuevas, I-TREATMENT +entre I-TREATMENT +las I-TREATMENT +cuales I-TREATMENT +se I-TREATMENT +eligió I-TREATMENT +el I-TREATMENT +topiramato I-TREATMENT +(TPM). I-TREATMENT +Tal I-TREATMENT +decisión I-TREATMENT +tuvo I-TREATMENT +en I-TREATMENT +cuenta I-TREATMENT +informes I-TREATMENT +sobre I-TREATMENT +indicios I-TREATMENT +de I-TREATMENT +eficacia I-TREATMENT +en I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +del I-TREATMENT +SUNCT8 I-TREATMENT +y I-TREATMENT +su I-TREATMENT +mejor I-TREATMENT +perfil I-TREATMENT +de I-TREATMENT +bioseguridad, I-TREATMENT +respecto I-TREATMENT +de I-TREATMENT +los I-TREATMENT +otros I-TREATMENT +agentes I-TREATMENT +(gabapentín, I-TREATMENT +lamotrigina). I-TREATMENT +Se I-TREATMENT +comenzó I-TREATMENT +con I-TREATMENT +25 I-TREATMENT +mg/d I-TREATMENT +en I-TREATMENT +una I-TREATMENT +sola I-TREATMENT +toma I-TREATMENT +nocturna I-TREATMENT +hasta I-TREATMENT +llegar I-TREATMENT +a I-TREATMENT +75 I-TREATMENT +mg/d I-TREATMENT +con I-TREATMENT +idéntica I-TREATMENT +posología. I-TREATMENT +La B-EVOLUTION +introducción I-EVOLUTION +del I-EVOLUTION +TPM I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +esquema I-EVOLUTION +redundó I-EVOLUTION +en I-EVOLUTION +una I-EVOLUTION +reducción I-EVOLUTION +parcial I-EVOLUTION +importante I-EVOLUTION +(50-75%, I-EVOLUTION +no I-EVOLUTION +completa) I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +episodios, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +evidente I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +calidad I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +documentada I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +MIDAS, I-EVOLUTION +instrumento I-EVOLUTION +que I-EVOLUTION +si I-EVOLUTION +bien I-EVOLUTION +no I-EVOLUTION +fue I-EVOLUTION +desarrollado I-EVOLUTION +específicamente I-EVOLUTION +para I-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +este I-EVOLUTION +cuadro I-EVOLUTION +permite I-EVOLUTION +valorar, I-EVOLUTION +mediante I-EVOLUTION +una I-EVOLUTION +escala I-EVOLUTION +global, I-EVOLUTION +el I-EVOLUTION +compromiso I-EVOLUTION +diario I-EVOLUTION +del I-EVOLUTION +paciente I-EVOLUTION +afectado. I-EVOLUTION + I-EVOLUTION + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +niño I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +7 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +relevantes, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +síndrome I-PRESENT_ILLNESS +febril I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +foco I-PRESENT_ILLNESS +detectable. I-PRESENT_ILLNESS +A B-EXPLORATION +las I-EXPLORATION +72 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +iniciado I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +clínico, I-EXPLORATION +el I-EXPLORATION +niño I-EXPLORATION +refiere I-EXPLORATION +dolor I-EXPLORATION +e I-EXPLORATION +impotencia I-EXPLORATION +funcional I-EXPLORATION +en I-EXPLORATION +hombro I-EXPLORATION +derecho, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +flogosis I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +evaluación I-EXPLORATION +inicial I-EXPLORATION +se I-EXPLORATION +solicitó I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +simple I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +del I-EXPLORATION +hombro I-EXPLORATION +afectado, I-EXPLORATION +ambos I-EXPLORATION +estudios I-EXPLORATION +con I-EXPLORATION +resultados I-EXPLORATION +normales. I-EXPLORATION +Luego I-EXPLORATION +de I-EXPLORATION +presentar I-EXPLORATION +fiebre I-EXPLORATION +elevada I-EXPLORATION +y I-EXPLORATION +persistente I-EXPLORATION +durante I-EXPLORATION +6 I-EXPLORATION +días, I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +detecta I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +esternoclavicular I-EXPLORATION +derecha, I-EXPLORATION +motivo I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +su I-EXPLORATION +internación. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +iniciales I-EXPLORATION +revelan I-EXPLORATION +leucocitosis I-EXPLORATION +(GB: I-EXPLORATION +19.890/mm3 I-EXPLORATION +) I-EXPLORATION +con I-EXPLORATION +neutrofilia I-EXPLORATION +(85%) I-EXPLORATION +proteína I-EXPLORATION +C-reactiva I-EXPLORATION +(PC-R: I-EXPLORATION +90) I-EXPLORATION +y I-EXPLORATION +eritrosedimentación I-EXPLORATION +elevadas I-EXPLORATION +(ERS: I-EXPLORATION +57 I-EXPLORATION +mm). I-EXPLORATION +La I-EXPLORATION +CPK I-EXPLORATION +informa I-EXPLORATION +valores I-EXPLORATION +normales I-EXPLORATION +(50 I-EXPLORATION +UI/L). I-EXPLORATION +Ante I-EXPLORATION +la I-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +foco I-EXPLORATION +profundo I-EXPLORATION +de I-EXPLORATION +infección, I-EXPLORATION +se I-EXPLORATION +solicita I-EXPLORATION +una I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +(RMN) I-EXPLORATION +que I-EXPLORATION +evidencia I-EXPLORATION +un I-EXPLORATION +intenso I-EXPLORATION +mioedema I-EXPLORATION +que I-EXPLORATION +compromete I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +trapecio I-EXPLORATION +y I-EXPLORATION +pectoral I-EXPLORATION +mayor I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizan I-EXPLORATION +dos I-EXPLORATION +hemocultivos I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +inicia I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cefalotina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +parenteral. I-TREATMENT +Luego B-EVOLUTION +de I-EVOLUTION +48 I-EVOLUTION +h I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +continúa I-EVOLUTION +febril; I-EVOLUTION +además, I-EVOLUTION +presenta I-EVOLUTION +aumento I-EVOLUTION +del I-EVOLUTION +eritema I-EVOLUTION +y I-EVOLUTION +edema I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +zona I-EVOLUTION +afectada. I-EVOLUTION +Se B-EXPLORATION +reciben I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +hemocultivos I-EXPLORATION +tomados I-EXPLORATION +al I-EXPLORATION +ingreso, I-EXPLORATION +que I-EXPLORATION +resultan I-EXPLORATION +positivos I-EXPLORATION +para I-EXPLORATION +SAMRC I-EXPLORATION +(resistente I-EXPLORATION +a I-EXPLORATION +clindamicina); I-EXPLORATION +se B-TREATMENT +modifica I-TREATMENT +el I-TREATMENT +esquema I-TREATMENT +terapéutico I-TREATMENT +y I-TREATMENT +se I-TREATMENT +indica I-TREATMENT +vancomicina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +endovenosa I-TREATMENT +y I-TREATMENT +rifampicina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT +Dos B-EVOLUTION +días I-EVOLUTION +más I-EVOLUTION +tarde, I-EVOLUTION +la I-EVOLUTION +fiebre I-EVOLUTION +comienza I-EVOLUTION +a I-EVOLUTION +disminuir I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +lesión I-EVOLUTION +se I-EVOLUTION +torna I-EVOLUTION +circunscripta I-EVOLUTION +y I-EVOLUTION +fluctuante. I-EVOLUTION +Aparece I-EVOLUTION +además I-EVOLUTION +un I-EVOLUTION +exantema I-EVOLUTION +cutáneo I-EVOLUTION +eritematopustuloso I-EVOLUTION +con I-EVOLUTION +descamación I-EVOLUTION +que I-EVOLUTION +predomina I-EVOLUTION +en I-EVOLUTION +tronco I-EVOLUTION +y I-EVOLUTION +axila. I-EVOLUTION +Se B-EXPLORATION +realiza I-EXPLORATION +hisopado I-EXPLORATION +nasal, I-EXPLORATION +axilar I-EXPLORATION +y I-EXPLORATION +anal, I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +obtiene I-EXPLORATION +el I-EXPLORATION +germen I-EXPLORATION +aislado I-EXPLORATION +previamente I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mucosa I-EXPLORATION +nasal. I-EXPLORATION + I-EXPLORATION +En I-EXPLORATION +una I-EXPLORATION +segunda I-EXPLORATION +RMN, I-EXPLORATION +se I-EXPLORATION +comprueba I-EXPLORATION +mayor I-EXPLORATION +jerarquía I-EXPLORATION +del I-EXPLORATION +edema I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +trapecio I-EXPLORATION +y I-EXPLORATION +pectoral I-EXPLORATION +mayor I-EXPLORATION +derecho, I-EXPLORATION +extendiéndose I-EXPLORATION +el I-EXPLORATION +proceso I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +músculos I-EXPLORATION +pectoral I-EXPLORATION +menor, I-EXPLORATION +subclavio, I-EXPLORATION +romboides I-EXPLORATION +y I-EXPLORATION +al I-EXPLORATION +tejido I-EXPLORATION +blando I-EXPLORATION +adyacente. I-EXPLORATION +Formación I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +colección I-EXPLORATION +líquida I-EXPLORATION +que I-EXPLORATION +rodea I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +proximal I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +clavícula I-EXPLORATION +derecha. I-EXPLORATION + I-EXPLORATION +Posteriormente, B-TREATMENT +se I-TREATMENT +realiza I-TREATMENT +el I-TREATMENT +drenaje I-TREATMENT +del I-TREATMENT +absceso I-TREATMENT +por I-TREATMENT +punción I-TREATMENT +y I-TREATMENT +se I-TREATMENT +solicita I-TREATMENT +un I-TREATMENT +centellograma I-TREATMENT +que I-TREATMENT +descarta I-TREATMENT +el I-TREATMENT +compromiso I-TREATMENT +óseo. I-TREATMENT +El B-EVOLUTION +niño I-EVOLUTION +evoluciona I-EVOLUTION +favorablemente I-EVOLUTION +y B-TREATMENT +completa I-TREATMENT +diez I-TREATMENT +días I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +vancomicina I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +parenteral I-TREATMENT +y I-TREATMENT +luego, I-TREATMENT +veinte I-TREATMENT +días I-TREATMENT +con I-TREATMENT +trimetroprimasulfametoxasol I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral. I-TREATMENT + I-TREATMENT + +Niña B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +patología I-PAST_MEDICAL_HISTORY +alérgica, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +presentaba I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urticaria I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +angioedema I-PRESENT_ILLNESS +intratable I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +14 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Pese B-TREATMENT +a I-TREATMENT +utilizarse I-TREATMENT +dosis I-TREATMENT +máximas I-TREATMENT +de I-TREATMENT +varios I-TREATMENT +antihistamínicos I-TREATMENT +combinados, I-TREATMENT +antileucotrienos I-TREATMENT +y I-TREATMENT +esteroides I-TREATMENT +orales I-TREATMENT +no I-TREATMENT +se I-TREATMENT +observó I-TREATMENT +respuesta I-TREATMENT +al I-TREATMENT +tratamiento. I-TREATMENT + I-TREATMENT +El B-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +repercutía I-PRESENT_ILLNESS +sobremanera I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +calidad I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +niña, I-PRESENT_ILLNESS +tanto I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +prurito I-PRESENT_ILLNESS +intenso I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +continuo I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +múltiples I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +placa I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +angioedema I-PRESENT_ILLNESS +claramente I-PRESENT_ILLNESS +visibles, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +afectan I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +sueño, I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +escolaridad I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +relación I-PRESENT_ILLNESS +interpersonal. I-PRESENT_ILLNESS +El B-EXPLORATION +laboratorio I-EXPLORATION +presentaba, I-EXPLORATION +como I-EXPLORATION +datos I-EXPLORATION +positivos: I-EXPLORATION +PCR, I-EXPLORATION +21; I-EXPLORATION +factor I-EXPLORATION +reumatoideo, I-EXPLORATION +24 I-EXPLORATION +UI/ml I-EXPLORATION +(normal I-EXPLORATION +hasta I-EXPLORATION +20). I-EXPLORATION +Se I-EXPLORATION +descartaron I-EXPLORATION +posibles I-EXPLORATION +causas I-EXPLORATION +infecciosas. I-EXPLORATION + I-EXPLORATION +Una I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +piel I-EXPLORATION +no I-EXPLORATION +reveló I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +vasculitis. I-EXPLORATION +Se I-EXPLORATION +efectuaron I-EXPLORATION +dietas I-EXPLORATION +de I-EXPLORATION +exclusión I-EXPLORATION +de I-EXPLORATION +alimentos, I-EXPLORATION +aditivos I-EXPLORATION +y I-EXPLORATION +colorantes, I-EXPLORATION +sin I-EXPLORATION +mejoría I-EXPLORATION +sintomática. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +una I-EXPLORATION +prueba I-EXPLORATION +de I-EXPLORATION +suero I-EXPLORATION +autólogo, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +positiva I-EXPLORATION +hasta I-EXPLORATION +una I-EXPLORATION +dilución I-EXPLORATION +1: I-EXPLORATION +100, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +cual I-EXPLORATION +se I-EXPLORATION +estableció I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +urticaria I-EXPLORATION +crónica I-EXPLORATION +autoinmunitaria. I-EXPLORATION +Previamente B-TREATMENT +a I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +omalizumab I-TREATMENT +se I-TREATMENT +evaluaron I-TREATMENT +los I-TREATMENT +beneficios I-TREATMENT +y I-TREATMENT +riesgos I-TREATMENT +de I-TREATMENT +otros I-TREATMENT +tratamientos, I-TREATMENT +como I-TREATMENT +ciclosporina I-TREATMENT +o I-TREATMENT +gammaglobulina I-TREATMENT +intravenosa, I-TREATMENT +y I-TREATMENT +dadas I-TREATMENT +las I-TREATMENT +potenciales I-TREATMENT +y I-TREATMENT +mayores I-TREATMENT +complicaciones I-TREATMENT +y I-TREATMENT +riesgos I-TREATMENT +de I-TREATMENT +estos I-TREATMENT +tratamientos, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +iniciar I-TREATMENT +omalizumab I-TREATMENT +en I-TREATMENT +una I-TREATMENT +dosis I-TREATMENT +calculada I-TREATMENT +de I-TREATMENT +acuerdo I-TREATMENT +al I-TREATMENT +valor I-TREATMENT +de I-TREATMENT +IgE I-TREATMENT +total I-TREATMENT +y I-TREATMENT +del I-TREATMENT +peso I-TREATMENT +corporal, I-TREATMENT +según I-TREATMENT +la I-TREATMENT +dosificación I-TREATMENT +aprobada I-TREATMENT +para I-TREATMENT +asma I-TREATMENT +bronquial I-TREATMENT +(150 I-TREATMENT +mg I-TREATMENT +subcutáneos I-TREATMENT +mensuales). I-TREATMENT +Luego B-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +primera I-EVOLUTION +dosis I-EVOLUTION +recrudecieron I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +por I-EVOLUTION +3 I-EVOLUTION +días I-EVOLUTION +y, I-EVOLUTION +posteriormente, I-EVOLUTION +la I-EVOLUTION +urticaria I-EVOLUTION +permaneció I-EVOLUTION +activa, I-EVOLUTION +pero I-EVOLUTION +estable. I-EVOLUTION +Luego I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +dosis I-EVOLUTION +se I-EVOLUTION +repite I-EVOLUTION +el I-EVOLUTION +patrón, I-EVOLUTION +pero I-EVOLUTION +posteriormente I-EVOLUTION +comienza I-EVOLUTION +a I-EVOLUTION +disminuir I-EVOLUTION +la I-EVOLUTION +intensidad I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +pápulas I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +angioedema; I-EVOLUTION +esta I-EVOLUTION +mejoría I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +torna I-EVOLUTION +más I-EVOLUTION +notable I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +tercera I-EVOLUTION +dosis, I-EVOLUTION +al I-EVOLUTION +cuarto I-EVOLUTION +mes I-EVOLUTION +(cuarta I-EVOLUTION +dosis) I-EVOLUTION +llega I-EVOLUTION +a I-EVOLUTION +una I-EVOLUTION +aparente I-EVOLUTION +remisión, I-EVOLUTION +hecho B-TREATMENT +que I-TREATMENT +permite I-TREATMENT +suspender I-TREATMENT +en I-TREATMENT +forma I-TREATMENT +sucesiva I-TREATMENT +el I-TREATMENT +montelukast I-TREATMENT +y I-TREATMENT +la I-TREATMENT +ranitidina, I-TREATMENT +y I-TREATMENT +reducir I-TREATMENT +a I-TREATMENT +la I-TREATMENT +mitad I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +hidroxicina I-TREATMENT +sin I-TREATMENT +signos I-TREATMENT +de I-TREATMENT +recaída. I-TREATMENT +Hacia B-EVOLUTION +el I-EVOLUTION +quinto I-EVOLUTION +mes, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encontraba I-EVOLUTION +por I-EVOLUTION +completo I-EVOLUTION +asintomática, I-EVOLUTION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspenden I-TREATMENT +los I-TREATMENT +antihistamínicos I-TREATMENT +remanentes. I-TREATMENT +Al B-EXPLORATION +sexto I-EXPLORATION +mes, I-EXPLORATION +se I-EXPLORATION +repite I-EXPLORATION +la I-EXPLORATION +prueba I-EXPLORATION +del I-EXPLORATION +suero I-EXPLORATION +autólogo, I-EXPLORATION +que I-EXPLORATION +es I-EXPLORATION +negativa; I-EXPLORATION +se I-EXPLORATION +verifica I-EXPLORATION +normalización I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +PCR I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +factor I-EXPLORATION +reumatoideo. I-EXPLORATION +Posteriormente B-EVOLUTION +se I-EVOLUTION +completan I-EVOLUTION +12 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +omalizumab. I-EVOLUTION +Seis I-EVOLUTION +meses I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +suspensión I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +continuó I-EVOLUTION +asintomática I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +alteraciones I-EVOLUTION +del I-EVOLUTION +laboratorio. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +concurre I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +consultorio I-PRESENT_ILLNESS +luego I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +tos I-PRESENT_ILLNESS +interpretado, I-PRESENT_ILLNESS +doce I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +antes, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencia, I-PRESENT_ILLNESS +como I-PRESENT_ILLNESS +episodio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +broncoobstrucción I-PRESENT_ILLNESS +aguda I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +trató I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +salbutamol I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +prednisolona. I-PRESENT_ILLNESS +El B-PAST_MEDICAL_HISTORY +niño I-PAST_MEDICAL_HISTORY +es I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +paciente I-PAST_MEDICAL_HISTORY +eutrófico, I-PAST_MEDICAL_HISTORY +recién I-PAST_MEDICAL_HISTORY +nacido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +término, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +destacar. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presenta I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +fiebre I-EXPLORATION +de I-EXPLORATION +38, I-EXPLORATION +2ºC, I-EXPLORATION +tumoración I-EXPLORATION +bilateral I-EXPLORATION +en I-EXPLORATION +cuello, I-EXPLORATION +blanda, I-EXPLORATION +dolorosa I-EXPLORATION +y I-EXPLORATION +con I-EXPLORATION +crepitación I-EXPLORATION +localizada I-EXPLORATION +en I-EXPLORATION +zona I-EXPLORATION +submandibular. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +del I-EXPLORATION +examen I-EXPLORATION +es I-EXPLORATION +normal, I-EXPLORATION +a I-EXPLORATION +excepción I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +otitis I-EXPLORATION +media I-EXPLORATION +aguda I-EXPLORATION +(OMA) I-EXPLORATION +congestiva I-EXPLORATION +izquierda. I-EXPLORATION +Al I-EXPLORATION +examen I-EXPLORATION +respiratorio I-EXPLORATION +presenta I-EXPLORATION +tos I-EXPLORATION +húmeda I-EXPLORATION +leve, I-EXPLORATION +sin I-EXPLORATION +disnea I-EXPLORATION +ni I-EXPLORATION +polipnea; I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria I-EXPLORATION +30 I-EXPLORATION +por I-EXPLORATION +minuto, I-EXPLORATION +sin I-EXPLORATION +tiraje; I-EXPLORATION +buena I-EXPLORATION +entrada I-EXPLORATION +de I-EXPLORATION +aire I-EXPLORATION +bilateral; I-EXPLORATION +rales I-EXPLORATION +subcrepitantes I-EXPLORATION +diseminados. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +auscultan I-EXPLORATION +roncus I-EXPLORATION +o I-EXPLORATION +sibilancias I-EXPLORATION +(última I-EXPLORATION +nebulización I-EXPLORATION +con I-EXPLORATION +salbutamol I-EXPLORATION +hacía I-EXPLORATION +7 I-EXPLORATION +h). I-EXPLORATION +Se I-EXPLORATION +interpreta I-EXPLORATION +el I-EXPLORATION +cuadro I-EXPLORATION +como I-EXPLORATION +enfisema I-EXPLORATION +subcutáneo I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +acceso I-EXPLORATION +de I-EXPLORATION +tos I-EXPLORATION +intensa I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +solicitan I-EXPLORATION +radiografías I-EXPLORATION +con I-EXPLORATION +nota I-EXPLORATION +al I-EXPLORATION +Servicio I-EXPLORATION +de I-EXPLORATION +Urgencias I-EXPLORATION +para I-EXPLORATION +eventual I-EXPLORATION +internación. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +interna I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +realiza: I-EXPLORATION +saturometría I-EXPLORATION +O2 I-EXPLORATION +(FIO2 I-EXPLORATION +aire I-EXPLORATION +ambiental): I-EXPLORATION +97%, I-EXPLORATION +hemograma: I-EXPLORATION +glóbulos I-EXPLORATION +blancos: I-EXPLORATION +6.000 I-EXPLORATION +por I-EXPLORATION +mm3, I-EXPLORATION +hemoglobina: I-EXPLORATION +11 I-EXPLORATION +g%, I-EXPLORATION +fórmula I-EXPLORATION +leucocitaria: I-EXPLORATION +6/72/2/0/16/4; I-EXPLORATION +proteína I-EXPLORATION +C-reactiva: I-EXPLORATION +45 I-EXPLORATION +mg/dl; I-EXPLORATION +medio I-EXPLORATION +interno I-EXPLORATION +normal I-EXPLORATION +y I-EXPLORATION +serología I-EXPLORATION +para I-EXPLORATION +bacterias I-EXPLORATION +atípicas. I-EXPLORATION +Se I-EXPLORATION +realiza I-EXPLORATION +TAC. I-EXPLORATION +Se I-EXPLORATION +interna I-EXPLORATION +por I-EXPLORATION +72 I-EXPLORATION +h, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +constatan I-EXPLORATION +sibilancias I-EXPLORATION +ni I-EXPLORATION +espiración I-EXPLORATION +prolongada I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +da I-TREATMENT +tratamiento I-TREATMENT +de I-TREATMENT +sostén I-TREATMENT +con I-TREATMENT +analgesia, I-TREATMENT +O2 I-TREATMENT +por I-TREATMENT +cánula I-TREATMENT +nasal I-TREATMENT +y I-TREATMENT +amoxicilina I-TREATMENT +para I-TREATMENT +la I-TREATMENT +OMA. I-TREATMENT +Presenta B-EVOLUTION +buena I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +con I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +tumoración I-EVOLUTION +cervical, I-EVOLUTION +el I-EVOLUTION +dolor I-EVOLUTION +cervical I-EVOLUTION +y I-EVOLUTION +la I-EVOLUTION +fiebre. I-EVOLUTION +La B-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +al I-EXPLORATION +alta I-EXPLORATION +es I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Al I-EXPLORATION +5 I-EXPLORATION +to I-EXPLORATION +día I-EXPLORATION +de I-EXPLORATION +evolución, I-EXPLORATION +ya I-EXPLORATION +en I-EXPLORATION +seguimiento I-EXPLORATION +ambulatorio, I-EXPLORATION +se I-EXPLORATION +recibe I-EXPLORATION +serología: I-EXPLORATION +IgM I-EXPLORATION +e I-EXPLORATION +IgG I-EXPLORATION +anti-Clamidia I-EXPLORATION +e I-EXPLORATION +IgM I-EXPLORATION +anti-Mycoplasma I-EXPLORATION +pneumoniae: I-EXPLORATION +negativos. I-EXPLORATION +La I-EXPLORATION +IgG I-EXPLORATION +anti-Mycoplasma I-EXPLORATION +pneumoniae I-EXPLORATION +fue I-EXPLORATION +positiva: I-EXPLORATION +1/80 I-EXPLORATION +por I-EXPLORATION +inmunofluorescencia I-EXPLORATION +indirecta. I-EXPLORATION +Se B-TREATMENT +decide I-TREATMENT +rotar I-TREATMENT +la I-TREATMENT +amoxicilina I-TREATMENT +por I-TREATMENT +claritromicina I-TREATMENT +y I-TREATMENT +repetir I-TREATMENT +serología I-TREATMENT +a I-TREATMENT +los I-TREATMENT +15 I-TREATMENT +días I-TREATMENT +de I-TREATMENT +evolución. I-TREATMENT +A B-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +d I-EVOLUTION +ías I-EVOLUTION +de I-EVOLUTION +evolución I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +asintomático. I-EVOLUTION +Serología: B-EXPLORATION +IgM I-EXPLORATION +anti-Mycoplasma: I-EXPLORATION +negativa I-EXPLORATION +e I-EXPLORATION +IgG I-EXPLORATION +anti-Mycoplasma: I-EXPLORATION +positiva I-EXPLORATION +1/64 I-EXPLORATION +(IFI). I-EXPLORATION +IgA: I-EXPLORATION +108 I-EXPLORATION +mg/dl, I-EXPLORATION +IgE: I-EXPLORATION +31, I-EXPLORATION +1 I-EXPLORATION +UI/ml I-EXPLORATION +(vn: I-EXPLORATION +60-144), I-EXPLORATION +IgG: I-EXPLORATION +818 I-EXPLORATION +mg/dl I-EXPLORATION +(vn: I-EXPLORATION +315-1236), I-EXPLORATION +IgM: I-EXPLORATION +72 I-EXPLORATION +mg/dl I-EXPLORATION +(vn: I-EXPLORATION +43-207), I-EXPLORATION +proteinograma: I-EXPLORATION +proteínas I-EXPLORATION +totales: I-EXPLORATION +7, I-EXPLORATION +51, I-EXPLORATION +albúmina: I-EXPLORATION +4, I-EXPLORATION +49, I-EXPLORATION +alfa I-EXPLORATION +1: I-EXPLORATION +0, I-EXPLORATION +27, I-EXPLORATION +alfa I-EXPLORATION +2: I-EXPLORATION +101 I-EXPLORATION +(elevada), I-EXPLORATION +β-globulina: I-EXPLORATION +0, I-EXPLORATION +90, I-EXPLORATION +gamma: I-EXPLORATION +0, I-EXPLORATION +84. I-EXPLORATION +Relación I-EXPLORATION +albúmina-globulina: I-EXPLORATION +1, I-EXPLORATION +49 I-EXPLORATION +(normal). I-EXPLORATION +Luego B-EVOLUTION +de I-EVOLUTION +tres I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +evolución, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +sigue I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +presentar I-EVOLUTION +recurrencias. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +varón I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +salud I-PAST_MEDICAL_HISTORY +relevantes, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +consultó I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Hospital I-PRESENT_ILLNESS +Universitario I-PRESENT_ILLNESS +Austral I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tumefacción I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +pie I-PRESENT_ILLNESS +izquierdo, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +15 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Se B-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +normotenso I-EXPLORATION +y I-EXPLORATION +afebril; I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +presentaba I-EXPLORATION +una I-EXPLORATION +placa I-EXPLORATION +eritematosa I-EXPLORATION +y I-EXPLORATION +dolorosa I-EXPLORATION +en I-EXPLORATION +planta I-EXPLORATION +izquierda. I-EXPLORATION +Por B-EVOLUTION +sospecha I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +proceso I-EVOLUTION +infeccioso I-EVOLUTION +se I-EVOLUTION +decidió I-EVOLUTION +su I-EVOLUTION +internación. I-EVOLUTION +Se B-EXPLORATION +realizaron I-EXPLORATION +pruebas I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +que I-EXPLORATION +demostraron I-EXPLORATION +leucocitosis I-EXPLORATION +leve I-EXPLORATION +y I-EXPLORATION +eritrosedimentación I-EXPLORATION +elevada; I-EXPLORATION +dos I-EXPLORATION +hemocultivos I-EXPLORATION +y I-EXPLORATION +punción I-EXPLORATION +por I-EXPLORATION +piel I-EXPLORATION +sana, I-EXPLORATION +todos I-EXPLORATION +ellos I-EXPLORATION +negativos. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +solicitaron: I-EXPLORATION +radiografía, I-EXPLORATION +centellografía I-EXPLORATION +y I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +afectado, I-EXPLORATION +descartándose I-EXPLORATION +compromiso I-EXPLORATION +óseo. I-EXPLORATION +Se B-TREATMENT +indicaron I-TREATMENT +ibuprofeno I-TREATMENT +400 I-TREATMENT +mg I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +cefalotina I-TREATMENT +100 I-TREATMENT +mg/kg/día I-TREATMENT +cada I-TREATMENT +6 I-TREATMENT +h I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +gentamicina I-TREATMENT +5 I-TREATMENT +mg/kg/día I-TREATMENT +por I-TREATMENT +3 I-TREATMENT +días. I-TREATMENT +Por I-TREATMENT +evolución I-TREATMENT +desfavorable I-TREATMENT +se I-TREATMENT +rotó I-TREATMENT +a I-TREATMENT +clindamicina, I-TREATMENT +40 I-TREATMENT +mg/kg/día I-TREATMENT +cada I-TREATMENT +8 I-TREATMENT +h I-TREATMENT +asociada I-TREATMENT +a I-TREATMENT +rifampicina, I-TREATMENT +20 I-TREATMENT +mg/kg/día I-TREATMENT +cada I-TREATMENT +12 I-TREATMENT +h. I-TREATMENT +Al B-EVOLUTION +sexto I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +internación, I-EVOLUTION +por I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +nódulos I-EVOLUTION +en I-EVOLUTION +miembros I-EVOLUTION +superiores, I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +artralgias I-EVOLUTION +de I-EVOLUTION +tobillos I-EVOLUTION +y I-EVOLUTION +muñecas I-EVOLUTION +se I-EVOLUTION +realizó I-EVOLUTION +una I-EVOLUTION +interconsulta I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +Servicio I-EVOLUTION +de I-EVOLUTION +Dermatología. I-EVOLUTION +En B-EXPLORATION +esa I-EXPLORATION +oportunidad, I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +múltiples I-EXPLORATION +nódulos I-EXPLORATION +eritematosos, I-EXPLORATION +dolorosos, I-EXPLORATION +de I-EXPLORATION +1-2 I-EXPLORATION +cm, I-EXPLORATION +agrupados I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +superiores I-EXPLORATION +e I-EXPLORATION +inferiores; I-EXPLORATION +otros I-EXPLORATION +nódulos I-EXPLORATION +eritematopurpúricos, I-EXPLORATION +de I-EXPLORATION +mayor I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +en I-EXPLORATION +arco I-EXPLORATION +interno I-EXPLORATION +de I-EXPLORATION +pie I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +otro I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +posterior I-EXPLORATION +de I-EXPLORATION +tobillo I-EXPLORATION +derecho. I-EXPLORATION + I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +palpaban I-EXPLORATION +adenomegalias I-EXPLORATION +ni I-EXPLORATION +se I-EXPLORATION +evidenciaban I-EXPLORATION +livedo I-EXPLORATION +reticular, I-EXPLORATION +ulceraciones I-EXPLORATION +u I-EXPLORATION +otros I-EXPLORATION +signos I-EXPLORATION +cutáneos. I-EXPLORATION +Con I-EXPLORATION +diagnósticos I-EXPLORATION +presuntivos I-EXPLORATION +de I-EXPLORATION +panarteritis I-EXPLORATION +nudosa I-EXPLORATION +cutánea I-EXPLORATION +(PANC), I-EXPLORATION +eritema I-EXPLORATION +nudoso I-EXPLORATION +atípico I-EXPLORATION +u I-EXPLORATION +otras I-EXPLORATION +paniculitis, I-EXPLORATION +se I-EXPLORATION +solicitaron I-EXPLORATION +estudios I-EXPLORATION +complementarios: I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +glóbulos I-EXPLORATION +blancos, I-EXPLORATION +10.900 I-EXPLORATION +(neutrófilos I-EXPLORATION +61%; I-EXPLORATION +linfocitos I-EXPLORATION +29%); I-EXPLORATION +hemoglobina, I-EXPLORATION +13, I-EXPLORATION +5 I-EXPLORATION +mg/dl; I-EXPLORATION +hematocrito, I-EXPLORATION +40%; I-EXPLORATION +plaquetas, I-EXPLORATION +292.000/ I-EXPLORATION +mm3; I-EXPLORATION +ESD I-EXPLORATION +32 I-EXPLORATION +mm/h, I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina, I-EXPLORATION +96%; I-EXPLORATION +KPTT I-EXPLORATION +36 I-EXPLORATION +seg; I-EXPLORATION +ASTO I-EXPLORATION +400 I-EXPLORATION +UI/ml I-EXPLORATION +(VN<200 I-EXPLORATION +UI/ I-EXPLORATION +ml); I-EXPLORATION +complemento: I-EXPLORATION +C3 I-EXPLORATION +214 I-EXPLORATION +(VN: I-EXPLORATION +90-180); I-EXPLORATION +C4 I-EXPLORATION +45, I-EXPLORATION +3 I-EXPLORATION +(VN: I-EXPLORATION +10-40); I-EXPLORATION +FAN, I-EXPLORATION +ANCA, I-EXPLORATION +FR, I-EXPLORATION +serologías I-EXPLORATION +para I-EXPLORATION +VHB, I-EXPLORATION +VHC, I-EXPLORATION +Bartonella, I-EXPLORATION +Mycoplasma I-EXPLORATION +y I-EXPLORATION +EBV: I-EXPLORATION +negativas. I-EXPLORATION +Cultivo I-EXPLORATION +de I-EXPLORATION +fauces: I-EXPLORATION +negativo. I-EXPLORATION +La I-EXPLORATION +PPD I-EXPLORATION +2 I-EXPLORATION +UT I-EXPLORATION +fue I-EXPLORATION +no I-EXPLORATION +reactiva. I-EXPLORATION +Además, I-EXPLORATION +se I-EXPLORATION +realizaron I-EXPLORATION +estudios I-EXPLORATION +para I-EXPLORATION +descartar I-EXPLORATION +compromiso I-EXPLORATION +sistémico: I-EXPLORATION +hepatograma, I-EXPLORATION +urea, I-EXPLORATION +creatinina, I-EXPLORATION +ionograma, I-EXPLORATION +gases I-EXPLORATION +en I-EXPLORATION +sangre, I-EXPLORATION +análisis I-EXPLORATION +de I-EXPLORATION +orina, I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo, I-EXPLORATION +presión I-EXPLORATION +ocular, I-EXPLORATION +ecocardiografía I-EXPLORATION +Doppler, I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax, I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +Doppler I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +inferiores, I-EXPLORATION +sin I-EXPLORATION +evidenciarse I-EXPLORATION +alteraciones. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +histopatológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +biopsia I-EXPLORATION +de I-EXPLORATION +un I-EXPLORATION +nódulo I-EXPLORATION +del I-EXPLORATION +miembro I-EXPLORATION +inferior I-EXPLORATION +demostró I-EXPLORATION +a I-EXPLORATION +nivel I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +interfaz I-EXPLORATION +dermohipodérmica I-EXPLORATION +y, I-EXPLORATION +en I-EXPLORATION +hipodermis, I-EXPLORATION +compromiso I-EXPLORATION +inflamatorio I-EXPLORATION +neutrofílico I-EXPLORATION +y I-EXPLORATION +material I-EXPLORATION +fibrinoide I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +paredes I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +vasos I-EXPLORATION +y I-EXPLORATION +arterias I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +calibre, I-EXPLORATION +con I-EXPLORATION +oclusión I-EXPLORATION +luminal I-EXPLORATION +focal I-EXPLORATION +y I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +algunos I-EXPLORATION +linfocitos I-EXPLORATION +y I-EXPLORATION +numerosos I-EXPLORATION +eosinófilos. I-EXPLORATION +Estos I-EXPLORATION +hallazgos I-EXPLORATION +histopatológicos I-EXPLORATION +permiten I-EXPLORATION +arribar I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +vasculitis I-EXPLORATION +de I-EXPLORATION +pequeños I-EXPLORATION +vasos I-EXPLORATION +dermohipodérmicos I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +arterias I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +calibre. I-EXPLORATION + I-EXPLORATION +Por I-EXPLORATION +las I-EXPLORATION +manifestaciones I-EXPLORATION +cutáneas I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +complementarios I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +PANC. I-EXPLORATION +Se B-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +suspensión I-TREATMENT +del I-TREATMENT +antibiótico I-TREATMENT +y I-TREATMENT +comenzar I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +meprednisona I-TREATMENT +1 I-TREATMENT +mg/kg/día, I-TREATMENT +dosis I-TREATMENT +diaria I-TREATMENT +total I-TREATMENT +de I-TREATMENT +40 I-TREATMENT +mg I-TREATMENT +y I-TREATMENT +penicilina I-TREATMENT +profiláctica, I-TREATMENT +por I-TREATMENT +el I-TREATMENT +antecedente I-TREATMENT +de I-TREATMENT +un I-TREATMENT +ASTO I-TREATMENT +positivo. I-TREATMENT +Hubo B-EVOLUTION +mejoría I-EVOLUTION +parcial I-EVOLUTION +al I-EVOLUTION +inicio I-EVOLUTION +del I-EVOLUTION +tratamiento, I-EVOLUTION +pero I-EVOLUTION +debido I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +lesiones, I-EVOLUTION +fiebre I-EVOLUTION +y I-EVOLUTION +artralgias, I-EVOLUTION +se B-TREATMENT +aumentó I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +meprednisona I-TREATMENT +a I-TREATMENT +60 I-TREATMENT +mg/día I-TREATMENT +a I-TREATMENT +los I-TREATMENT +ocho I-TREATMENT +días I-TREATMENT +con B-EVOLUTION +respuesta I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +evidencia I-EVOLUTION +de I-EVOLUTION +rebrote I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +controles I-EVOLUTION +posteriores. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +derivada B-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +guardia I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +sanatorio I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +celulitis I-DERIVED_FROM/TO +orbitaria I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +internación, I-DERIVED_FROM/TO +tratamiento I-DERIVED_FROM/TO +antibiótico I-DERIVED_FROM/TO +endovenoso I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +evaluación I-DERIVED_FROM/TO +urgente I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +oftalmología. I-DERIVED_FROM/TO +Datos B-EXPLORATION +positivos I-EXPLORATION +al I-EXPLORATION +examen I-EXPLORATION +físico: I-EXPLORATION +eritema I-EXPLORATION +y I-EXPLORATION +edema I-EXPLORATION +de I-EXPLORATION +párpado I-EXPLORATION +superior I-EXPLORATION +derecho I-EXPLORATION +de I-EXPLORATION +12 I-EXPLORATION +h I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +que I-EXPLORATION +dificultaba I-EXPLORATION +la I-EXPLORATION +apertura I-EXPLORATION +ocular, I-EXPLORATION +limitación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mirada I-EXPLORATION +vertical, I-EXPLORATION +prurito I-EXPLORATION +y I-EXPLORATION +crepitación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +del I-EXPLORATION +párpado. I-EXPLORATION +Se I-EXPLORATION +encontraba I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general I-EXPLORATION +y I-EXPLORATION +afebril. I-EXPLORATION + I-EXPLORATION +Al B-PAST_MEDICAL_HISTORY +profundizar I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +interrogatorio, I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +descubre I-PAST_MEDICAL_HISTORY +mínimo I-PAST_MEDICAL_HISTORY +traumatismo I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +cara I-PAST_MEDICAL_HISTORY +ocurrido I-PAST_MEDICAL_HISTORY +20 I-PAST_MEDICAL_HISTORY +h I-PAST_MEDICAL_HISTORY +previas I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +consulta I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +episodio I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +estornudo I-PAST_MEDICAL_HISTORY +inmediatamente I-PAST_MEDICAL_HISTORY +antes I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +inicio I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +cuadro I-PAST_MEDICAL_HISTORY +clínico. I-PAST_MEDICAL_HISTORY +Con B-EXPLORATION +sospecha I-EXPLORATION +de I-EXPLORATION +enfisema I-EXPLORATION +subcutáneo I-EXPLORATION +secundario I-EXPLORATION +a I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +seno I-EXPLORATION +etmoidal I-EXPLORATION +se I-EXPLORATION +solicita: I-EXPLORATION +Rx I-EXPLORATION +de I-EXPLORATION +senos I-EXPLORATION +paranasales I-EXPLORATION +(velamiento I-EXPLORATION +del I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho), I-EXPLORATION +TAC I-EXPLORATION +de I-EXPLORATION +orbita I-EXPLORATION +en I-EXPLORATION +cortes I-EXPLORATION +axiales I-EXPLORATION +y I-EXPLORATION +coronales I-EXPLORATION +(zona I-EXPLORATION +de I-EXPLORATION +hipodensidad I-EXPLORATION +en I-EXPLORATION +párpado I-EXPLORATION +superior I-EXPLORATION +derecho, I-EXPLORATION +zona I-EXPLORATION +de I-EXPLORATION +seno I-EXPLORATION +maxilar I-EXPLORATION +derecho I-EXPLORATION +levemente I-EXPLORATION +hiperdensa, I-EXPLORATION +desplazamiento I-EXPLORATION +del I-EXPLORATION +globo I-EXPLORATION +ocular I-EXPLORATION +derecho I-EXPLORATION +hacia I-EXPLORATION +abajo). I-EXPLORATION +Lámpara I-EXPLORATION +de I-EXPLORATION +hendidura, I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +y I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +diagnostica I-EXPLORATION +fractura I-EXPLORATION +de I-EXPLORATION +lámina I-EXPLORATION +papirácea I-EXPLORATION +del I-EXPLORATION +etmoides. I-EXPLORATION +El B-EVOLUTION +enfisema I-EVOLUTION +subcutáneo I-EVOLUTION +secundario I-EVOLUTION +se I-EVOLUTION +reabsorbe I-EVOLUTION +espontáneamente I-EVOLUTION +en I-EVOLUTION +forma I-EVOLUTION +completa I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +4 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +evolución. I-EVOLUTION +Recibió B-TREATMENT +tratamiento I-TREATMENT +profiláctico I-TREATMENT +con I-TREATMENT +amoxicilina/clavulánico I-TREATMENT +y I-TREATMENT +tratamiento I-TREATMENT +sintomático. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +presentar I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +(39 I-PRESENT_ILLNESS +ºC) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +seis I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +abdominal. I-PRESENT_ILLNESS +Antecedentes B-PAST_MEDICAL_HISTORY +personales: I-PAST_MEDICAL_HISTORY +recién I-PAST_MEDICAL_HISTORY +nacido I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gesta I-PAST_MEDICAL_HISTORY +1, I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +controlado, I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +normal, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +término I-PAST_MEDICAL_HISTORY +(40 I-PAST_MEDICAL_HISTORY +semanas), I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +adecuado I-PAST_MEDICAL_HISTORY +(3360 I-PAST_MEDICAL_HISTORY +kg). I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +diagnosticaron I-PAST_MEDICAL_HISTORY +miopía, I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +lo I-PAST_MEDICAL_HISTORY +que I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +encuentra I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +oftalmología. I-PAST_MEDICAL_HISTORY +A I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +3 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +meses I-PAST_MEDICAL_HISTORY +presentó I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +infección I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +tracto I-PAST_MEDICAL_HISTORY +urinario I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +Escherichia I-PAST_MEDICAL_HISTORY +coli, I-PAST_MEDICAL_HISTORY +recibió I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +ambulatorio, I-PAST_MEDICAL_HISTORY +pero I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +realizaron I-PAST_MEDICAL_HISTORY +controles I-PAST_MEDICAL_HISTORY +posteriores I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +esta I-PAST_MEDICAL_HISTORY +patología. I-PAST_MEDICAL_HISTORY +Refiere I-PAST_MEDICAL_HISTORY +poliuria I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +polidipsia I-PAST_MEDICAL_HISTORY +desde I-PAST_MEDICAL_HISTORY +temprana I-PAST_MEDICAL_HISTORY +edad. I-PAST_MEDICAL_HISTORY +Antecedentes B-FAMILY_HISTORY +familiares: I-FAMILY_HISTORY +abuela I-FAMILY_HISTORY +paterna I-FAMILY_HISTORY +hipoacúsica, I-FAMILY_HISTORY +primo I-FAMILY_HISTORY +paterno I-FAMILY_HISTORY +con I-FAMILY_HISTORY +litiasis I-FAMILY_HISTORY +renal, I-FAMILY_HISTORY +padre I-FAMILY_HISTORY +con I-FAMILY_HISTORY +microhematuria. I-FAMILY_HISTORY +Al B-EXPLORATION +ingreso, I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +eutrófica I-EXPLORATION +(peso: I-EXPLORATION +17.400 I-EXPLORATION +kg, I-EXPLORATION +talla: I-EXPLORATION +104 I-EXPLORATION +cm), I-EXPLORATION +en I-EXPLORATION +buen I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +febril, I-EXPLORATION +normotensa. I-EXPLORATION +Por I-EXPLORATION +presentar I-EXPLORATION +orina I-EXPLORATION +patológica I-EXPLORATION +se I-EXPLORATION +solicitan: I-EXPLORATION +urocultivo, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +informa I-EXPLORATION +positivo I-EXPLORATION +para I-EXPLORATION +Escherichia I-EXPLORATION +coli, I-EXPLORATION +y I-EXPLORATION +ecografía I-EXPLORATION +renal I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +evidencian I-EXPLORATION +imágenes I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +nefrocalcinosis. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +abdomen I-EXPLORATION +se I-EXPLORATION +observan I-EXPLORATION +calcificaciones I-EXPLORATION +renales. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +exámenes I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +manifestaron I-EXPLORATION +insuficiencia I-EXPLORATION +renal I-EXPLORATION +(depuración I-EXPLORATION +de I-EXPLORATION +creatinina I-EXPLORATION +50 I-EXPLORATION +ml/min/1, I-EXPLORATION +73, I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +calculó I-EXPLORATION +por I-EXPLORATION +fórmula), I-EXPLORATION +hipercalciuria I-EXPLORATION +(13 I-EXPLORATION +mg/kg/d), I-EXPLORATION +hipomagnesemia, I-EXPLORATION +hipermagnesuria, I-EXPLORATION +anemia I-EXPLORATION +y I-EXPLORATION +acidosis. I-EXPLORATION + I-EXPLORATION +La I-EXPLORATION +evaluación I-EXPLORATION +cardiológica I-EXPLORATION +y I-EXPLORATION +otorrinolaringológica I-EXPLORATION +fue I-EXPLORATION +normal. I-EXPLORATION +En I-EXPLORATION +oftalmología I-EXPLORATION +se I-EXPLORATION +diagnosticó I-EXPLORATION +"coriorretinitis I-EXPLORATION +cicatrizal I-EXPLORATION +macular, I-EXPLORATION +coriopatía I-EXPLORATION +miópica". I-EXPLORATION +Se I-EXPLORATION +arriba I-EXPLORATION +al I-EXPLORATION +diagnóstico I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +hipercalciuria, I-EXPLORATION +nefrocalcinosis, I-EXPLORATION +hipomagnesemia, I-EXPLORATION +hipermagnesuria I-EXPLORATION +e I-EXPLORATION +insuficiencia I-EXPLORATION +renal, I-EXPLORATION +asociadas I-EXPLORATION +a I-EXPLORATION +patología I-EXPLORATION +ocular I-EXPLORATION +y I-EXPLORATION +antecedentes I-EXPLORATION +personales I-EXPLORATION +y I-EXPLORATION +familiares I-EXPLORATION +compatibles. I-EXPLORATION +Cumplió B-TREATMENT +tratamiento I-TREATMENT +para I-TREATMENT +infección I-TREATMENT +urinaria. I-TREATMENT +Se I-TREATMENT +indicó I-TREATMENT +citrato I-TREATMENT +de I-TREATMENT +potasio, I-TREATMENT +amiloride-hidroclorotiazida I-TREATMENT +25 I-TREATMENT +mg/día, I-TREATMENT +pidolato I-TREATMENT +de I-TREATMENT +magnesio I-TREATMENT +1, I-TREATMENT +5 I-TREATMENT +g/ I-TREATMENT +día, I-TREATMENT +ácido I-TREATMENT +fólico I-TREATMENT +5 I-TREATMENT +mg/día, I-TREATMENT +sulfato I-TREATMENT +ferroso I-TREATMENT +3 I-TREATMENT +mg/ I-TREATMENT +kg/día, I-TREATMENT +dieta I-TREATMENT +hiposódica I-TREATMENT +controlada I-TREATMENT +en I-TREATMENT +proteínas I-TREATMENT +y I-TREATMENT +líquidos I-TREATMENT +a I-TREATMENT +demanda. I-TREATMENT +Durante B-EVOLUTION +su I-EVOLUTION +evolución I-EVOLUTION +presentó I-EVOLUTION +nueva I-EVOLUTION +infección I-EVOLUTION +urinaria I-EVOLUTION +a I-EVOLUTION +E. I-EVOLUTION +coli, I-EVOLUTION +se B-EXPLORATION +realizó I-EXPLORATION +cistouretrografía I-EXPLORATION +miccional, I-EXPLORATION +que I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +inició I-TREATMENT +profilaxis I-TREATMENT +antibiótica I-TREATMENT +con I-TREATMENT +nitrofurantoína. I-TREATMENT +Se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +hidroclorotiazida I-TREATMENT +a I-TREATMENT +los I-TREATMENT +dos I-TREATMENT +meses I-TREATMENT +de I-TREATMENT +tratamiento I-TREATMENT +por I-TREATMENT +brusco I-TREATMENT +aumento I-TREATMENT +de I-TREATMENT +urea I-TREATMENT +y I-TREATMENT +creatinina, I-TREATMENT +con I-TREATMENT +mejoría I-TREATMENT +posterior I-TREATMENT +y I-TREATMENT +mantenimiento I-TREATMENT +de I-TREATMENT +valores I-TREATMENT +de I-TREATMENT +calciuria I-TREATMENT +dentro I-TREATMENT +de I-TREATMENT +la I-TREATMENT +normalidad. I-TREATMENT +Se B-EVOLUTION +mantiene I-EVOLUTION +hasta I-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +el I-EVOLUTION +resto I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +medicación. I-EVOLUTION + I-EVOLUTION + +Embarazada B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +28 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +procedente B-FAMILY_HISTORY +de I-FAMILY_HISTORY +Embarcación I-FAMILY_HISTORY +(Salta), I-FAMILY_HISTORY +que I-FAMILY_HISTORY +cursaba I-FAMILY_HISTORY +su I-FAMILY_HISTORY +segunda I-FAMILY_HISTORY +gesta I-FAMILY_HISTORY +en I-FAMILY_HISTORY +semana I-FAMILY_HISTORY +38 I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +patológicos. I-FAMILY_HISTORY +Consultó B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +(39,4°C), I-PRESENT_ILLNESS +mialgias I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +cefalea I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +internó I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +estudio I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tratamiento. I-PRESENT_ILLNESS +Al B-EVOLUTION +tercer I-EVOLUTION +día I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +sangrado I-EVOLUTION +de I-EVOLUTION +mucosas, I-EVOLUTION +en I-EVOLUTION +zonas I-EVOLUTION +de I-EVOLUTION +venopuntura I-EVOLUTION +y I-EVOLUTION +deterioro I-EVOLUTION +progresivo I-EVOLUTION +del I-EVOLUTION +estado I-EVOLUTION +general. I-EVOLUTION +Veinticuatro B-TREATMENT +horas I-TREATMENT +más I-TREATMENT +tarde I-TREATMENT +se I-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +cesárea I-TREATMENT +de I-TREATMENT +urgencia I-TREATMENT +por I-TREATMENT +sufrimiento I-TREATMENT +fetal I-TREATMENT +agudo, I-TREATMENT +con I-TREATMENT +una I-TREATMENT +grave I-TREATMENT +metrorragia I-TREATMENT +posparto. I-TREATMENT +La B-EVOLUTION +madre I-EVOLUTION +recibió I-EVOLUTION +tratamiento I-EVOLUTION +de I-EVOLUTION +sostén I-EVOLUTION +que I-EVOLUTION +requirió I-EVOLUTION +múltiples I-EVOLUTION +transfusiones I-EVOLUTION +sanguíneas. I-EVOLUTION +Se I-EVOLUTION +recuperó I-EVOLUTION +favorablemente I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +h I-EVOLUTION +posparto. I-EVOLUTION +El I-EVOLUTION +niño I-EVOLUTION +nació I-EVOLUTION +a I-EVOLUTION +las I-EVOLUTION +38 I-EVOLUTION +semanas I-EVOLUTION +de I-EVOLUTION +edad I-EVOLUTION +gestacional, I-EVOLUTION +con I-EVOLUTION +un I-EVOLUTION +peso I-EVOLUTION +de I-EVOLUTION +3900 I-EVOLUTION +g I-EVOLUTION +y I-EVOLUTION +puntaje I-EVOLUTION +de I-EVOLUTION +Apgar I-EVOLUTION +4/4. I-EVOLUTION +Durante I-EVOLUTION +la I-EVOLUTION +internación I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +Unidad I-EVOLUTION +de I-EVOLUTION +cuidado I-EVOLUTION +intensivo I-EVOLUTION +neonatal I-EVOLUTION +requirió I-EVOLUTION +asistencia I-EVOLUTION +respiratoria I-EVOLUTION +mecánica I-EVOLUTION +por I-EVOLUTION +un I-EVOLUTION +síndrome I-EVOLUTION +de I-EVOLUTION +aspiración I-EVOLUTION +meconial I-EVOLUTION +e I-EVOLUTION +hipertensión I-EVOLUTION +pulmonar I-EVOLUTION +y I-EVOLUTION +luminoterapia I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +ictericia. I-EVOLUTION +Al I-EVOLUTION +5to I-EVOLUTION +día I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +comenzó I-EVOLUTION +con I-EVOLUTION +fiebre I-EVOLUTION +(39°C), I-EVOLUTION +hepatomegalia I-EVOLUTION +y I-EVOLUTION +un I-EVOLUTION +exantema I-EVOLUTION +evanescente I-EVOLUTION +generalizado. I-EVOLUTION +Pasadas I-EVOLUTION +24 I-EVOLUTION +h I-EVOLUTION +se I-EVOLUTION +agregaron I-EVOLUTION +hemorragias I-EVOLUTION +por I-EVOLUTION +sonda I-EVOLUTION +nasogástrica I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +venopunturas. I-EVOLUTION +El B-EXPLORATION +hemograma I-EXPLORATION +presentó I-EXPLORATION +5800 I-EXPLORATION +glóbulos I-EXPLORATION +blancos I-EXPLORATION +(linfocitos I-EXPLORATION +43%, I-EXPLORATION +neutrófilos I-EXPLORATION +segmentados I-EXPLORATION +47%, I-EXPLORATION +monocitos I-EXPLORATION +6%, I-EXPLORATION +basófilos I-EXPLORATION +4%), I-EXPLORATION +hematócrito I-EXPLORATION +34%, I-EXPLORATION +hemoglobina I-EXPLORATION +11, I-EXPLORATION +2 I-EXPLORATION +mg% I-EXPLORATION +y I-EXPLORATION +recuento I-EXPLORATION +de I-EXPLORATION +plaquetas I-EXPLORATION +de I-EXPLORATION +13 I-EXPLORATION +000/mm³. I-EXPLORATION +Con I-EXPLORATION +diagnóstico I-EXPLORATION +presuntivo I-EXPLORATION +de I-EXPLORATION +sepsis I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +realizaron I-EXPLORATION +hemocultivos, I-EXPLORATION +urocultivo I-EXPLORATION +y I-EXPLORATION +punción I-EXPLORATION +lumbar. I-EXPLORATION +También I-EXPLORATION +se I-EXPLORATION +le I-EXPLORATION +solicitó I-EXPLORATION +detección I-EXPLORATION +de I-EXPLORATION +anticuerpos I-EXPLORATION +IgM I-EXPLORATION +para I-EXPLORATION +virus I-EXPLORATION +dengue. I-EXPLORATION +Se I-EXPLORATION +le I-EXPLORATION +indicaron I-EXPLORATION +antibióticos I-EXPLORATION +y I-EXPLORATION +transfusiones I-EXPLORATION +de I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +plaquetas. I-EXPLORATION +Los I-EXPLORATION +cultivos I-EXPLORATION +para I-EXPLORATION +gérmenes I-EXPLORATION +comunes I-EXPLORATION +y I-EXPLORATION +hongos I-EXPLORATION +fueron I-EXPLORATION +negativos. I-EXPLORATION +El I-EXPLORATION +laboratorio I-EXPLORATION +informó I-EXPLORATION +IgM I-EXPLORATION +por I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +ELISA I-EXPLORATION +positiva I-EXPLORATION +para I-EXPLORATION +dengue. I-EXPLORATION +Para I-EXPLORATION +la I-EXPLORATION +confirmación I-EXPLORATION +del I-EXPLORATION +resultado I-EXPLORATION +se I-EXPLORATION +envió I-EXPLORATION +la I-EXPLORATION +muestra I-EXPLORATION +al I-EXPLORATION +Instituto I-EXPLORATION +Nacional I-EXPLORATION +de I-EXPLORATION +Enfermedades I-EXPLORATION +Virales I-EXPLORATION +Humanas I-EXPLORATION +de I-EXPLORATION +Pergamino, I-EXPLORATION +quienes I-EXPLORATION +certificaron I-EXPLORATION +por I-EXPLORATION +pruebas I-EXPLORATION +serológicas I-EXPLORATION +de I-EXPLORATION +ELISA, I-EXPLORATION +neutralización I-EXPLORATION +y I-EXPLORATION +detección I-EXPLORATION +molecular I-EXPLORATION +del I-EXPLORATION +genoma I-EXPLORATION +viral I-EXPLORATION +(RT-PCR), I-EXPLORATION +la I-EXPLORATION +infección I-EXPLORATION +por I-EXPLORATION +serotipo I-EXPLORATION +DEN-1. I-EXPLORATION +Se B-EVOLUTION +administró I-EVOLUTION +oxígeno I-EVOLUTION +hasta I-EVOLUTION +los I-EVOLUTION +26 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION +A I-EVOLUTION +los I-EVOLUTION +7 I-EVOLUTION +días I-EVOLUTION +del I-EVOLUTION +comienzo I-EVOLUTION +de I-EVOLUTION +los I-EVOLUTION +síntomas I-EVOLUTION +se I-EVOLUTION +normalizó I-EVOLUTION +el I-EVOLUTION +recuento I-EVOLUTION +de I-EVOLUTION +plaquetas. I-EVOLUTION +La I-EVOLUTION +evolución I-EVOLUTION +clínica I-EVOLUTION +fue I-EVOLUTION +favorable I-EVOLUTION +y I-EVOLUTION +se I-EVOLUTION +dio I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +al I-EVOLUTION +mes I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION +Como I-EVOLUTION +consecuencia I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +asfixia I-EVOLUTION +perinatal I-EVOLUTION +relacionada I-EVOLUTION +a I-EVOLUTION +la I-EVOLUTION +forma I-EVOLUTION +de I-EVOLUTION +dengue I-EVOLUTION +grave I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +madre, I-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +presentó I-EVOLUTION +encefalopatía I-EVOLUTION +hipóxico-isquémica I-EVOLUTION +y I-EVOLUTION +compromiso I-EVOLUTION +respiratorio I-EVOLUTION +secuelar. I-EVOLUTION +Se I-EVOLUTION +le I-EVOLUTION +realizaron I-EVOLUTION +controles I-EVOLUTION +clínicos I-EVOLUTION +y I-EVOLUTION +serológicos I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +8 I-EVOLUTION +y I-EVOLUTION +13 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +con I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +títulos I-EVOLUTION +de I-EVOLUTION +anticuerpos I-EVOLUTION +IgG I-EVOLUTION +antidengue, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +se I-EVOLUTION +confirmó I-EVOLUTION +el I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +infección I-EVOLUTION +congénita. I-EVOLUTION +Los B-EXPLORATION +resultados I-EXPLORATION +serológicos I-EXPLORATION +mediante I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +ELISA I-EXPLORATION +mostraron I-EXPLORATION +títulos I-EXPLORATION +positivos I-EXPLORATION +elevados, I-EXPLORATION +con I-EXPLORATION +una I-EXPLORATION +RP I-EXPLORATION +1, I-EXPLORATION +92 I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +37 I-EXPLORATION +para I-EXPLORATION +dengue I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +8 I-EXPLORATION +y I-EXPLORATION +13 I-EXPLORATION +meses, I-EXPLORATION +respectivamente. I-EXPLORATION +Actualmente, B-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +realiza I-EVOLUTION +estimulación I-EVOLUTION +neurológica I-EVOLUTION +y I-EVOLUTION +tratamiento I-EVOLUTION +preventivo I-EVOLUTION +respiratorio I-EVOLUTION +con I-EVOLUTION +corticoides I-EVOLUTION +inhalatorios, I-EVOLUTION +con I-EVOLUTION +buena I-EVOLUTION +evolución. I-EVOLUTION + I-EVOLUTION + +Neonato B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +11 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida, I-PRESENT_ILLNESS +nacida B-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +término I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +adecuado I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +7/9, I-PAST_MEDICAL_HISTORY +de B-FAMILY_HISTORY +padres I-FAMILY_HISTORY +sanos, I-FAMILY_HISTORY +no I-FAMILY_HISTORY +consanguíneos. I-FAMILY_HISTORY +Tiene I-FAMILY_HISTORY +tres I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +vivos I-FAMILY_HISTORY +y I-FAMILY_HISTORY +sanos. I-FAMILY_HISTORY +Sin I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +de I-FAMILY_HISTORY +abortos I-FAMILY_HISTORY +maternos. I-FAMILY_HISTORY +Consulta B-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ampollas, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +presentaron I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +nacimiento, I-PRESENT_ILLNESS +dispuestas I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembro I-PRESENT_ILLNESS +inferior I-PRESENT_ILLNESS +(MI) I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +siguiendo I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +líneas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Blaschko, I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +correr I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +aumentaron I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +número. I-PRESENT_ILLNESS +Recibe B-TREATMENT +cefotaxima-oxacilina I-TREATMENT +parenteral I-TREATMENT +(VP) I-TREATMENT +por I-TREATMENT +dos I-TREATMENT +días, I-TREATMENT +con I-TREATMENT +mejoría. I-TREATMENT +Es B-EVOLUTION +dada I-EVOLUTION +de I-EVOLUTION +alta I-EVOLUTION +afebril, I-EVOLUTION +con I-EVOLUTION +buen I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +e I-EVOLUTION +indicación I-EVOLUTION +de I-EVOLUTION +continuar I-EVOLUTION +con I-EVOLUTION +cefixima I-EVOLUTION +oral I-EVOLUTION +(VO). I-EVOLUTION +Dos I-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +aparecen I-EVOLUTION +nuevas I-EVOLUTION +lesiones I-EVOLUTION +de I-EVOLUTION +iguales I-EVOLUTION +características I-EVOLUTION +en I-EVOLUTION +MI I-EVOLUTION +derecho I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +miembro I-EVOLUTION +superior I-EVOLUTION +(MS) I-EVOLUTION +izquierdo, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +que I-EVOLUTION +queda I-EVOLUTION +internada. I-EVOLUTION +Se B-TREATMENT +reinicia I-TREATMENT +cefotaxima-oxacilina I-TREATMENT +VP, I-TREATMENT +se B-EXPLORATION +solicitan I-EXPLORATION +frotis I-EXPLORATION +y I-EXPLORATION +cultivo I-EXPLORATION +de I-EXPLORATION +lesiones, I-EXPLORATION +y I-EXPLORATION +VDRL. I-EXPLORATION +Con I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +estudios I-EXPLORATION +negativos I-EXPLORATION +se B-EVOLUTION +decide I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +y B-TREATMENT +se I-TREATMENT +indica I-TREATMENT +aplicar I-TREATMENT +ácido I-TREATMENT +fusídico I-TREATMENT +tópico I-TREATMENT +sobre I-TREATMENT +las I-TREATMENT +vesículas I-TREATMENT +cutáneas I-TREATMENT +y I-TREATMENT +continuar I-TREATMENT +con I-TREATMENT +cefixima I-TREATMENT +VO. I-TREATMENT +Dos B-EVOLUTION +días I-EVOLUTION +después I-EVOLUTION +del I-EVOLUTION +alta I-EVOLUTION +consulta I-EVOLUTION +a I-EVOLUTION +nuestro I-EVOLUTION +servicio I-EVOLUTION +por I-EVOLUTION +persistencia I-EVOLUTION +de I-EVOLUTION +lesiones. I-EVOLUTION +El B-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +general I-EXPLORATION +se I-EXPLORATION +encontraba I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +los I-EXPLORATION +límites I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +dermatológico I-EXPLORATION +se I-EXPLORATION +constatan I-EXPLORATION +múltiples I-EXPLORATION +vesículas, I-EXPLORATION +firmes, I-EXPLORATION +amarillentas, I-EXPLORATION +sobre I-EXPLORATION +una I-EXPLORATION +base I-EXPLORATION +inflamatoria, I-EXPLORATION +de I-EXPLORATION +distribución I-EXPLORATION +lineal I-EXPLORATION +que I-EXPLORATION +afectan I-EXPLORATION +MS I-EXPLORATION +izquierdo I-EXPLORATION +y I-EXPLORATION +ambos I-EXPLORATION +MI. I-EXPLORATION +El I-EXPLORATION +tamaño I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +lesiones I-EXPLORATION +es I-EXPLORATION +variable, I-EXPLORATION +con I-EXPLORATION +diámetros I-EXPLORATION +que I-EXPLORATION +oscilan I-EXPLORATION +entre I-EXPLORATION +0, I-EXPLORATION +1-1 I-EXPLORATION +cm. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +afectación I-EXPLORATION +ungueal. I-EXPLORATION +Se B-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +remite I-DERIVED_FROM/TO +al I-DERIVED_FROM/TO +neurólogo I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +oftalmólogo, I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +descartan I-DERIVED_FROM/TO +afectación I-DERIVED_FROM/TO +en I-DERIVED_FROM/TO +tales I-DERIVED_FROM/TO +áreas. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +Métodos B-EXPLORATION +auxiliares I-EXPLORATION +de I-EXPLORATION +diagnóstico: I-EXPLORATION +hemograma: I-EXPLORATION +Hb: I-EXPLORATION +15, I-EXPLORATION +4 I-EXPLORATION +g/dl; I-EXPLORATION +leucocitos: I-EXPLORATION +16 I-EXPLORATION +700 I-EXPLORATION +cél./mm3; I-EXPLORATION +N: I-EXPLORATION +68%; I-EXPLORATION +L: I-EXPLORATION +20%; I-EXPLORATION +Eo: I-EXPLORATION +10%; I-EXPLORATION +plaquetas: I-EXPLORATION +330 I-EXPLORATION +000 I-EXPLORATION +cél./mm3. I-EXPLORATION +Examen I-EXPLORATION +directo I-EXPLORATION +y I-EXPLORATION +cultivo: I-EXPLORATION +negativo I-EXPLORATION +para I-EXPLORATION +hongos I-EXPLORATION +y I-EXPLORATION +bacterias. I-EXPLORATION +Dos I-EXPLORATION +hemocultivos: I-EXPLORATION +negativos. I-EXPLORATION +VDRL: I-EXPLORATION +no I-EXPLORATION +reactiva. I-EXPLORATION +Biopsia I-EXPLORATION +cutánea: I-EXPLORATION +Se I-EXPLORATION +efectúa I-EXPLORATION +biopsia I-EXPLORATION +cutánea I-EXPLORATION +incisional I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +vesículas I-EXPLORATION +de I-EXPLORATION +MI, I-EXPLORATION +se I-EXPLORATION +fija I-EXPLORATION +en I-EXPLORATION +formol I-EXPLORATION +neutro I-EXPLORATION +tamponado I-EXPLORATION +al I-EXPLORATION +10% I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +procesa I-EXPLORATION +de I-EXPLORATION +manera I-EXPLORATION +convencional. I-EXPLORATION +Se I-EXPLORATION +efectúa I-EXPLORATION +coloración I-EXPLORATION +HE. I-EXPLORATION +La I-EXPLORATION +anatomía I-EXPLORATION +patológica I-EXPLORATION +informa: I-EXPLORATION +dermatitis I-EXPLORATION +psoriasiforme I-EXPLORATION +perivascular I-EXPLORATION +superficial, I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +marcada I-EXPLORATION +espongiosis I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +tercio I-EXPLORATION +inferior I-EXPLORATION +del I-EXPLORATION +epitelio I-EXPLORATION +con I-EXPLORATION +exocitosis I-EXPLORATION +eosinofílica I-EXPLORATION +y I-EXPLORATION +presencia I-EXPLORATION +de I-EXPLORATION +células I-EXPLORATION +disqueratósicas. I-EXPLORATION +En I-EXPLORATION +dermis I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +un I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +perivascular I-EXPLORATION +superficial I-EXPLORATION +de I-EXPLORATION +linfocitos I-EXPLORATION +con I-EXPLORATION +eosinófilos I-EXPLORATION +y I-EXPLORATION +edema. I-EXPLORATION + I-EXPLORATION +Diagnóstico I-EXPLORATION +anatomopatológico I-EXPLORATION +final: I-EXPLORATION +incontinentia I-EXPLORATION +pigmenti I-EXPLORATION +estadio I-EXPLORATION +eritemato-ampollar. I-EXPLORATION +Evolución B-TREATMENT +y I-TREATMENT +tratamiento: I-TREATMENT +Se I-TREATMENT +higienizan I-TREATMENT +las I-TREATMENT +lesiones I-TREATMENT +con I-TREATMENT +infusión I-TREATMENT +de I-TREATMENT +manzanilla I-TREATMENT +fría I-TREATMENT +y I-TREATMENT +pasta I-TREATMENT +al I-TREATMENT +agua I-TREATMENT +luego I-TREATMENT +de I-TREATMENT +la I-TREATMENT +higiene, I-TREATMENT +dos I-TREATMENT +veces I-TREATMENT +por I-TREATMENT +día, I-TREATMENT +hasta I-TREATMENT +la I-TREATMENT +desaparición I-TREATMENT +de I-TREATMENT +las I-TREATMENT +ampollas. I-TREATMENT +Acude B-EVOLUTION +a I-EVOLUTION +control I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +15 I-EVOLUTION +días, I-EVOLUTION +con I-EVOLUTION +marcada I-EVOLUTION +desaparición I-EVOLUTION +de I-EVOLUTION +ampollas I-EVOLUTION +y I-EVOLUTION +sin I-EVOLUTION +aparición I-EVOLUTION +de I-EVOLUTION +nuevas I-EVOLUTION +lesiones. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +45 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +producto B-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +tercera I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +34 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +padre I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +40 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +edad, I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +consanguíneos; I-PAST_MEDICAL_HISTORY +con B-FAMILY_HISTORY +dos I-FAMILY_HISTORY +hermanos I-FAMILY_HISTORY +aparentemente I-FAMILY_HISTORY +sanos; I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares I-FAMILY_HISTORY +de I-FAMILY_HISTORY +importancia. I-FAMILY_HISTORY +Durante I-FAMILY_HISTORY +todo I-FAMILY_HISTORY +el I-FAMILY_HISTORY +embarazo I-FAMILY_HISTORY +la I-FAMILY_HISTORY +madre I-FAMILY_HISTORY +cursó I-FAMILY_HISTORY +con I-FAMILY_HISTORY +tos I-FAMILY_HISTORY +productiva, I-FAMILY_HISTORY +persistente, I-FAMILY_HISTORY +sin I-FAMILY_HISTORY +predominio I-FAMILY_HISTORY +de I-FAMILY_HISTORY +horario, I-FAMILY_HISTORY +tratada I-FAMILY_HISTORY +con I-FAMILY_HISTORY +nebulizaciones I-FAMILY_HISTORY +con I-FAMILY_HISTORY +salbutamol I-FAMILY_HISTORY +y, I-FAMILY_HISTORY +en I-FAMILY_HISTORY +el I-FAMILY_HISTORY +segundo I-FAMILY_HISTORY +trimestre I-FAMILY_HISTORY +de I-FAMILY_HISTORY +gestación, I-FAMILY_HISTORY +con I-FAMILY_HISTORY +infecciones I-FAMILY_HISTORY +vaginales I-FAMILY_HISTORY +reiteradas I-FAMILY_HISTORY +cuyo I-FAMILY_HISTORY +manejo I-FAMILY_HISTORY +se I-FAMILY_HISTORY +desconoce. I-FAMILY_HISTORY +El B-PAST_MEDICAL_HISTORY +producto I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +obtenido I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +cesárea I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +36 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gestación; I-PAST_MEDICAL_HISTORY +peso: I-PAST_MEDICAL_HISTORY +2800 I-PAST_MEDICAL_HISTORY +g, I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +atresia I-PAST_MEDICAL_HISTORY +bilateral I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +coanas I-PAST_MEDICAL_HISTORY +(ABC), I-PAST_MEDICAL_HISTORY +encefalocele, I-PAST_MEDICAL_HISTORY +hidrocefalia, I-PAST_MEDICAL_HISTORY +microftalmía I-PAST_MEDICAL_HISTORY +derecha I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +restos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +bandas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +constricción I-PAST_MEDICAL_HISTORY +oscuras I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +dedos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +manos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +pies; I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +datos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +características I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +placenta. I-PAST_MEDICAL_HISTORY +Al I-PAST_MEDICAL_HISTORY +5to I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +le I-PAST_MEDICAL_HISTORY +colocó I-PAST_MEDICAL_HISTORY +válvula I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +derivación I-PAST_MEDICAL_HISTORY +ventriculoperitoneal I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +realizó I-PAST_MEDICAL_HISTORY +plastia I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +encefalocele; I-PAST_MEDICAL_HISTORY +a B-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +desarrolla I-PRESENT_ILLNESS +neumonía I-PRESENT_ILLNESS +nosocomial. I-PRESENT_ILLNESS +A B-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +actual, I-EXPLORATION +peso: I-EXPLORATION +3150 I-EXPLORATION +g I-EXPLORATION +(percentil I-EXPLORATION +3); I-EXPLORATION +talla: I-EXPLORATION +52 I-EXPLORATION +cm I-EXPLORATION +(percentil I-EXPLORATION +20); I-EXPLORATION +plagiocefalia I-EXPLORATION +frontotemporal I-EXPLORATION +izquierda, I-EXPLORATION +dolicocefalia, I-EXPLORATION +cicatriz I-EXPLORATION +de I-EXPLORATION +plastia I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +occipital I-EXPLORATION +de I-EXPLORATION +10 I-EXPLORATION +cm I-EXPLORATION +de I-EXPLORATION +longitud I-EXPLORATION +y I-EXPLORATION +válvula I-EXPLORATION +de I-EXPLORATION +pudens I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +temporal I-EXPLORATION +derecha, I-EXPLORATION +frontal I-EXPLORATION +prominente; I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +cejas; I-EXPLORATION +microftalmía I-EXPLORATION +derecha; I-EXPLORATION +puente I-EXPLORATION +nasal I-EXPLORATION +deprimido; I-EXPLORATION +hiperplasia I-EXPLORATION +gingival; I-EXPLORATION +paladar I-EXPLORATION +ojival; I-EXPLORATION +pectus I-EXPLORATION +excavatum; I-EXPLORATION +hernia I-EXPLORATION +umbilical; I-EXPLORATION +marca I-EXPLORATION +de I-EXPLORATION +constricción I-EXPLORATION +circular I-EXPLORATION +por I-EXPLORATION +bandas I-EXPLORATION +en I-EXPLORATION +región I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +antebrazo I-EXPLORATION +derecho I-EXPLORATION +y I-EXPLORATION +dedos I-EXPLORATION +2, I-EXPLORATION +3 I-EXPLORATION +y I-EXPLORATION +4; I-EXPLORATION +además I-EXPLORATION +de I-EXPLORATION +aplasia I-EXPLORATION +ungueal I-EXPLORATION +y I-EXPLORATION +acrosindactilia I-EXPLORATION +de I-EXPLORATION +éstos; I-EXPLORATION +mano I-EXPLORATION +izquierda I-EXPLORATION +con I-EXPLORATION +marca I-EXPLORATION +de I-EXPLORATION +constricción I-EXPLORATION +circular I-EXPLORATION +por I-EXPLORATION +bandas I-EXPLORATION +en I-EXPLORATION +4to I-EXPLORATION +dedo I-EXPLORATION +y I-EXPLORATION +acrosindactilia I-EXPLORATION +con I-EXPLORATION +ausencia I-EXPLORATION +ungueal I-EXPLORATION +de I-EXPLORATION +dedos I-EXPLORATION +2do I-EXPLORATION +y I-EXPLORATION +3ro; I-EXPLORATION +pie I-EXPLORATION +derecho I-EXPLORATION +con I-EXPLORATION +acrosindactilia I-EXPLORATION +de I-EXPLORATION +dedos I-EXPLORATION +2do I-EXPLORATION +y I-EXPLORATION +3ro; I-EXPLORATION +pie I-EXPLORATION +izquierdo I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +dedos I-EXPLORATION +1ro, I-EXPLORATION +2do I-EXPLORATION +y I-EXPLORATION +3ro, I-EXPLORATION +acrosindactilia I-EXPLORATION +y I-EXPLORATION +marca I-EXPLORATION +de I-EXPLORATION +banda I-EXPLORATION +de I-EXPLORATION +constricción I-EXPLORATION +de I-EXPLORATION +5to I-EXPLORATION +dedo. I-EXPLORATION + I-EXPLORATION +Los I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +se I-EXPLORATION +encontraron I-EXPLORATION +dentro I-EXPLORATION +de I-EXPLORATION +parámetros I-EXPLORATION +normales; I-EXPLORATION +el I-EXPLORATION +cariotipo I-EXPLORATION +con I-EXPLORATION +resolución I-EXPLORATION +de I-EXPLORATION +550 I-EXPLORATION +bandas I-EXPLORATION +y I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +bandeo I-EXPLORATION +G I-EXPLORATION +en I-EXPLORATION +40 I-EXPLORATION +metafases I-EXPLORATION +se I-EXPLORATION +informó: I-EXPLORATION +46, I-EXPLORATION +XY; I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +radiografías I-EXPLORATION +se I-EXPLORATION +observó I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +2da I-EXPLORATION +falange I-EXPLORATION +distal I-EXPLORATION +de I-EXPLORATION +mano I-EXPLORATION +derecha I-EXPLORATION +y I-EXPLORATION +de I-EXPLORATION +2da I-EXPLORATION +y I-EXPLORATION +3era I-EXPLORATION +falanges I-EXPLORATION +distales I-EXPLORATION +en I-EXPLORATION +mano I-EXPLORATION +izquierda; I-EXPLORATION +pie I-EXPLORATION +derecho, I-EXPLORATION +pérdida I-EXPLORATION +de I-EXPLORATION +falanges I-EXPLORATION +medias I-EXPLORATION +y I-EXPLORATION +distales; I-EXPLORATION +en I-EXPLORATION +pie I-EXPLORATION +izquierdo I-EXPLORATION +ausencia I-EXPLORATION +de I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +falanges I-EXPLORATION +distales. I-EXPLORATION +Ecocardiograma I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada I-EXPLORATION +simple I-EXPLORATION +de I-EXPLORATION +cráneo I-EXPLORATION +reveló: I-EXPLORATION +microftalmía I-EXPLORATION +derecha, I-EXPLORATION +encefalocele I-EXPLORATION +frontoparietal I-EXPLORATION +y I-EXPLORATION +megaventrículo I-EXPLORATION +derecho. I-EXPLORATION +La I-EXPLORATION +ABC I-EXPLORATION +con I-EXPLORATION +placa I-EXPLORATION +atrésica I-EXPLORATION +mixta I-EXPLORATION +se I-EXPLORATION +confirmó I-EXPLORATION +por I-EXPLORATION +tomografía I-EXPLORATION +axial I-EXPLORATION +computada, I-EXPLORATION +realizándose I-EXPLORATION +corrección I-EXPLORATION +vía I-EXPLORATION +endoscópica I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +10 I-EXPLORATION +meses I-EXPLORATION +de I-EXPLORATION +edad. I-EXPLORATION + I-EXPLORATION + +Presentamos B-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +recién I-PRESENT_ILLNESS +nacido I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +12 I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acudió I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +fiebre I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +38, I-PRESENT_ILLNESS +5ºC I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +hora I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +rechazo I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +alimentación. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +se I-PAST_MEDICAL_HISTORY +destacaban I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +embarazo I-PAST_MEDICAL_HISTORY +controlado I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +normal; I-PAST_MEDICAL_HISTORY +serologías I-PAST_MEDICAL_HISTORY +negativas I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +hepatitis I-PAST_MEDICAL_HISTORY +B I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +C, I-PAST_MEDICAL_HISTORY +virus I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +inmunodeficiencia I-PAST_MEDICAL_HISTORY +humana, I-PAST_MEDICAL_HISTORY +sífilis I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +toxoplasma; I-PAST_MEDICAL_HISTORY +frotis I-PAST_MEDICAL_HISTORY +vaginal I-PAST_MEDICAL_HISTORY +negativo I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +Streptococcus I-PAST_MEDICAL_HISTORY +grupo I-PAST_MEDICAL_HISTORY +B; I-PAST_MEDICAL_HISTORY +ruptura I-PAST_MEDICAL_HISTORY +espontánea I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +membranas I-PAST_MEDICAL_HISTORY +intraparto, I-PAST_MEDICAL_HISTORY +parto I-PAST_MEDICAL_HISTORY +instrumental I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +fórceps I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +41 I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +gestación I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +nacimiento I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +3880 I-PAST_MEDICAL_HISTORY +g. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +prueba I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +Apgar I-PAST_MEDICAL_HISTORY +fue I-PAST_MEDICAL_HISTORY +al I-PAST_MEDICAL_HISTORY +minuto I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +8 I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +5 I-PAST_MEDICAL_HISTORY +minutos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +9, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +requerir I-PAST_MEDICAL_HISTORY +reanimación. I-PAST_MEDICAL_HISTORY +Comenzó I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +esquema I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +inmunización. I-PAST_MEDICAL_HISTORY +Alimentación I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +lactancia I-PAST_MEDICAL_HISTORY +materna I-PAST_MEDICAL_HISTORY +exclusiva. I-PAST_MEDICAL_HISTORY +Respecto B-FAMILY_HISTORY +a I-FAMILY_HISTORY +los I-FAMILY_HISTORY +antecedentes I-FAMILY_HISTORY +familiares, I-FAMILY_HISTORY +los I-FAMILY_HISTORY +padres I-FAMILY_HISTORY +refirieron I-FAMILY_HISTORY +haber I-FAMILY_HISTORY +padecido I-FAMILY_HISTORY +amigdalitis I-FAMILY_HISTORY +los I-FAMILY_HISTORY +días I-FAMILY_HISTORY +previos. I-FAMILY_HISTORY +La B-EXPLORATION +exploración I-EXPLORATION +física I-EXPLORATION +mostró I-EXPLORATION +decaimiento I-EXPLORATION +y I-EXPLORATION +regular I-EXPLORATION +perfusión I-EXPLORATION +periférica I-EXPLORATION +con I-EXPLORATION +constantes I-EXPLORATION +vitales I-EXPLORATION +normales, I-EXPLORATION +sin I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +objetivasen I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +foco. I-EXPLORATION +La I-EXPLORATION +analítica I-EXPLORATION +inicial I-EXPLORATION +mostró I-EXPLORATION +una I-EXPLORATION +determinación I-EXPLORATION +de I-EXPLORATION +proteína I-EXPLORATION +C I-EXPLORATION +reactiva I-EXPLORATION +cuantitativa I-EXPLORATION +(PC-R) I-EXPLORATION +133, I-EXPLORATION +4 I-EXPLORATION +mg/L, I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +hemograma I-EXPLORATION +coagulado I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +sedimento I-EXPLORATION +de I-EXPLORATION +orina I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +resultó I-EXPLORATION +hemorrágica. I-EXPLORATION +Ingresó B-TREATMENT +con I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +síndrome I-TREATMENT +febril I-TREATMENT +sin I-TREATMENT +foco I-TREATMENT +y I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +antibioterapia I-TREATMENT +empírica I-TREATMENT +con I-TREATMENT +ampicilina I-TREATMENT +y I-TREATMENT +cefotaxima I-TREATMENT +intravenosas I-TREATMENT +tras I-TREATMENT +la I-TREATMENT +toma I-TREATMENT +de I-TREATMENT +cultivos. I-TREATMENT +En B-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +repetido I-EXPLORATION +se I-EXPLORATION +observaron I-EXPLORATION +5800 I-EXPLORATION +leucocitos/mm3, I-EXPLORATION +con I-EXPLORATION +fórmula I-EXPLORATION +normal, I-EXPLORATION +13, I-EXPLORATION +4 I-EXPLORATION +g/dl I-EXPLORATION +de I-EXPLORATION +hemoglobina, I-EXPLORATION +32 I-EXPLORATION +000 I-EXPLORATION +plaquetas/mm3. I-EXPLORATION +A B-EVOLUTION +las I-EVOLUTION +18 I-EVOLUTION +h I-EVOLUTION +del I-EVOLUTION +ingreso I-EVOLUTION +empeoró I-EVOLUTION +su I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +y I-EVOLUTION +presentó I-EVOLUTION +crisis I-EVOLUTION +convulsivas I-EVOLUTION +generalizadas I-EVOLUTION +que B-TREATMENT +requirieron I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +fenobarbital I-TREATMENT +y I-TREATMENT +perfusión I-TREATMENT +de I-TREATMENT +midazolam. I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +evolución I-EVOLUTION +desarrolló I-EVOLUTION +afectación I-EVOLUTION +sistémica I-EVOLUTION +con I-EVOLUTION +hipotensión I-EVOLUTION +arterial, I-EVOLUTION +acidosis I-EVOLUTION +metabólica, I-EVOLUTION +hiponatremia, I-EVOLUTION +oliguria I-EVOLUTION +y I-EVOLUTION +plaquetopenia I-EVOLUTION +grave; I-EVOLUTION +requirió B-TREATMENT +ventilación I-TREATMENT +mecánica I-TREATMENT +convencional, I-TREATMENT +transfusión I-TREATMENT +de I-TREATMENT +hemoderivados, I-TREATMENT +soporte I-TREATMENT +inotrópico I-TREATMENT +con I-TREATMENT +dopamina I-TREATMENT +y I-TREATMENT +diurético I-TREATMENT +con I-TREATMENT +furosemida. I-TREATMENT +El B-EXPLORATION +tercer I-EXPLORATION +día I-EXPLORATION +del I-EXPLORATION +ingreso I-EXPLORATION +se I-EXPLORATION +informó I-EXPLORATION +el I-EXPLORATION +aislamiento I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +hemocultivo I-EXPLORATION +de I-EXPLORATION +Streptococcus I-EXPLORATION +pyogenes I-EXPLORATION +sensible I-EXPLORATION +a I-EXPLORATION +penicilina, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +que I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +la I-TREATMENT +ampicilina I-TREATMENT +y I-TREATMENT +se I-TREATMENT +mantuvo I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +cefotaxima I-TREATMENT +intravenosa. I-TREATMENT +Tras B-EVOLUTION +su I-EVOLUTION +estabilización I-EVOLUTION +presentó I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +y I-EVOLUTION +analítica, I-EVOLUTION +que B-TREATMENT +permitió I-TREATMENT +suspender I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +inotrópico I-TREATMENT +a I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +h I-TREATMENT +y I-TREATMENT +realizar I-TREATMENT +extubación I-TREATMENT +al I-TREATMENT +cuarto I-TREATMENT +día. I-TREATMENT +No B-EVOLUTION +se I-EVOLUTION +repitieron I-EVOLUTION +las I-EVOLUTION +crisis I-EVOLUTION +clínicas I-EVOLUTION +y B-EXPLORATION +el I-EXPLORATION +electroencefalograma I-EXPLORATION +fue I-EXPLORATION +normal, I-EXPLORATION +por B-TREATMENT +lo I-TREATMENT +cual I-TREATMENT +se I-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +anticomicial. I-TREATMENT +Se B-EXPLORATION +repitió I-EXPLORATION +la I-EXPLORATION +punción I-EXPLORATION +lumbar I-EXPLORATION +sin I-EXPLORATION +éxito. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +cerebral I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +angiorresonancia I-EXPLORATION +iniciales I-EXPLORATION +mostraron I-EXPLORATION +hemorragia I-EXPLORATION +intraventricular I-EXPLORATION +con I-EXPLORATION +discreta I-EXPLORATION +ventriculomegalia I-EXPLORATION +y I-EXPLORATION +lesiones I-EXPLORATION +hemisféricas I-EXPLORATION +cortico-subcorticales I-EXPLORATION +bilaterales, I-EXPLORATION +compatibles I-EXPLORATION +con I-EXPLORATION +meningoencefalitis. I-EXPLORATION +No I-EXPLORATION +superó I-EXPLORATION +el I-EXPLORATION +tamizaje I-EXPLORATION +auditivo I-EXPLORATION +realizado I-EXPLORATION +durante I-EXPLORATION +el I-EXPLORATION +ingreso I-EXPLORATION +mediante I-EXPLORATION +la I-EXPLORATION +técnica I-EXPLORATION +de I-EXPLORATION +exploración I-EXPLORATION +de I-EXPLORATION +potenciales I-EXPLORATION +provocados I-EXPLORATION +auditivos I-EXPLORATION +de I-EXPLORATION +tronco I-EXPLORATION +cerebral I-EXPLORATION +automatizados I-EXPLORATION +(PEATC-A I-EXPLORATION +> I-EXPLORATION +40 I-EXPLORATION +dB). I-EXPLORATION +En I-EXPLORATION +las I-EXPLORATION +ecografías I-EXPLORATION +cerebrales I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +presentó I-EXPLORATION +buena I-EXPLORATION +evolución I-EXPLORATION +sin I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +dilatación I-EXPLORATION +ventricular. I-EXPLORATION + I-EXPLORATION +A B-EVOLUTION +los I-EVOLUTION +34 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +después I-EVOLUTION +de I-EVOLUTION +completar I-EVOLUTION +21 I-EVOLUTION +días I-EVOLUTION +de I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +cefotaxima, I-EVOLUTION +se I-EVOLUTION +otorgó I-EVOLUTION +el I-EVOLUTION +alta I-EVOLUTION +hospitalaria I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +exploración I-EVOLUTION +neurológica I-EVOLUTION +normal, I-EVOLUTION +excepto I-EVOLUTION +una I-EVOLUTION +leve I-EVOLUTION +hipotonía I-EVOLUTION +de I-EVOLUTION +eje. I-EVOLUTION +Se I-EVOLUTION +realizó I-EVOLUTION +seguimiento I-EVOLUTION +por I-EVOLUTION +especialistas I-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +unidades I-EVOLUTION +de I-EVOLUTION +rehabilitación, I-EVOLUTION +otorrinolaringología I-EVOLUTION +y I-EVOLUTION +neurología; I-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +vida, I-EVOLUTION +no I-EVOLUTION +presentaba I-EVOLUTION +patología I-EVOLUTION +auditiva I-EVOLUTION +ni I-EVOLUTION +neurológica I-EVOLUTION +residual. I-EVOLUTION + I-EVOLUTION + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +16 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +masculino, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +patológicos I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +importancia, I-PAST_MEDICAL_HISTORY +que B-PRESENT_ILLNESS +comienza I-PRESENT_ILLNESS +hace I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cuadro I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +astenia, I-PRESENT_ILLNESS +adinamia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +pérdida I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +peso, I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +se I-PRESENT_ILLNESS +agrega I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +atrás I-PRESENT_ILLNESS +erección I-PRESENT_ILLNESS +peneana I-PRESENT_ILLNESS +persistente, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +dolor I-PRESENT_ILLNESS +moderado, I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +lo I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +hospital I-PRESENT_ILLNESS +zonal, I-PRESENT_ILLNESS +donde B-TREATMENT +le I-TREATMENT +indican I-TREATMENT +analgésicos I-TREATMENT +y I-TREATMENT +medios I-TREATMENT +físicos I-TREATMENT +citándose I-TREATMENT +a I-TREATMENT +las I-TREATMENT +24 I-TREATMENT +h I-TREATMENT +para I-TREATMENT +control. I-TREATMENT +Al B-EVOLUTION +día I-EVOLUTION +siguiente I-EVOLUTION +concurre I-EVOLUTION +a I-EVOLUTION +dicho I-EVOLUTION +hospital, I-EVOLUTION +donde I-EVOLUTION +por I-EVOLUTION +continuar I-EVOLUTION +con I-EVOLUTION +erección I-EVOLUTION +peneana I-EVOLUTION +y I-EVOLUTION +palidez I-EVOLUTION +generalizada I-EVOLUTION +deciden B-EXPLORATION +realizar I-EXPLORATION +estudios I-EXPLORATION +de I-EXPLORATION +laboratorio I-EXPLORATION +que I-EXPLORATION +muestran: I-EXPLORATION +plaquetopenia I-EXPLORATION +(plaquetas I-EXPLORATION +60 I-EXPLORATION +000/mm3), I-EXPLORATION +anemia I-EXPLORATION +(hematócrito I-EXPLORATION +12%) I-EXPLORATION +e I-EXPLORATION +hiperleucocitosis I-EXPLORATION +(glóbulos I-EXPLORATION +blancos I-EXPLORATION +312 I-EXPLORATION +000/mm3) I-EXPLORATION +y I-EXPLORATION +LDH I-EXPLORATION +2056 I-EXPLORATION +UI/ml, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +decide I-EXPLORATION +su I-EXPLORATION +internación I-EXPLORATION +y B-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +solicita I-DERIVED_FROM/TO +su I-DERIVED_FROM/TO +derivación I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +un I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +mayor I-DERIVED_FROM/TO +complejidad. I-DERIVED_FROM/TO +A B-EXPLORATION +su I-EXPLORATION +ingreso I-EXPLORATION +al I-EXPLORATION +Hospital I-EXPLORATION +Posadas I-EXPLORATION +se I-EXPLORATION +constata I-EXPLORATION +paciente I-EXPLORATION +en I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +palidez I-EXPLORATION +cutáneomucosa, I-EXPLORATION +fiebre I-EXPLORATION +y I-EXPLORATION +equimosis I-EXPLORATION +en I-EXPLORATION +miembros I-EXPLORATION +inferiores. I-EXPLORATION +Se I-EXPLORATION +palpa I-EXPLORATION +esplenomegalia. I-EXPLORATION +Se I-EXPLORATION +observa I-EXPLORATION +pene I-EXPLORATION +erecto I-EXPLORATION +con I-EXPLORATION +cambios I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +coloración I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +piel I-EXPLORATION +del I-EXPLORATION +cuerpo, I-EXPLORATION +palidez I-EXPLORATION +y I-EXPLORATION +leve I-EXPLORATION +cianosis I-EXPLORATION +del I-EXPLORATION +glande. I-EXPLORATION +Se B-TREATMENT +realiza I-TREATMENT +interconsulta I-TREATMENT +con I-TREATMENT +urología, I-TREATMENT +quien I-TREATMENT +realiza I-TREATMENT +drenaje I-TREATMENT +de I-TREATMENT +cuerpos I-TREATMENT +cavernosos I-TREATMENT +con I-TREATMENT +solución I-TREATMENT +fisiológica I-TREATMENT +y I-TREATMENT +adrenalina; I-TREATMENT +el I-TREATMENT +procedimiento I-TREATMENT +arroja I-TREATMENT +sangre I-TREATMENT +oscura I-TREATMENT +y I-TREATMENT +coagulada. I-TREATMENT +Por B-EVOLUTION +presentar I-EVOLUTION +registro I-EVOLUTION +febril, I-EVOLUTION +se B-EXPLORATION +realizan I-EXPLORATION +hemocultivos I-EXPLORATION +x I-EXPLORATION +2 I-EXPLORATION +y B-TREATMENT +se I-TREATMENT +decide I-TREATMENT +iniciar I-TREATMENT +tratamiento I-TREATMENT +empírico I-TREATMENT +con I-TREATMENT +ceftazidima-amikacina I-TREATMENT +y I-TREATMENT +transfundir I-TREATMENT +glóbulos I-TREATMENT +rojos I-TREATMENT +desplasmatizados. I-TREATMENT +El B-EVOLUTION +paciente I-EVOLUTION +evoluciona I-EVOLUTION +en I-EVOLUTION +mal I-EVOLUTION +estado I-EVOLUTION +general, I-EVOLUTION +con I-EVOLUTION +dificultad I-EVOLUTION +respiratoria I-EVOLUTION +creciente, I-EVOLUTION +por I-EVOLUTION +lo I-EVOLUTION +cual I-EVOLUTION +se I-EVOLUTION +lo I-EVOLUTION +traslada I-EVOLUTION +a I-EVOLUTION +terapia I-EVOLUTION +intensiva. I-EVOLUTION +Se I-EVOLUTION +realiza I-EVOLUTION +diagnóstico I-EVOLUTION +de I-EVOLUTION +leucemia I-EVOLUTION +mieloide I-EVOLUTION +crónica I-EVOLUTION +por I-EVOLUTION +biopsia I-EVOLUTION +de I-EVOLUTION +medula I-EVOLUTION +ósea I-EVOLUTION +y I-EVOLUTION +presencia I-EVOLUTION +de I-EVOLUTION +blastos I-EVOLUTION +en I-EVOLUTION +sangre I-EVOLUTION +periférica. I-EVOLUTION +Se I-EVOLUTION +descartan I-EVOLUTION +otros I-EVOLUTION +diagnósticos, I-EVOLUTION +como I-EVOLUTION +la I-EVOLUTION +anemia I-EVOLUTION +de I-EVOLUTION +células I-EVOLUTION +falciforme, I-EVOLUTION +por I-EVOLUTION +no I-EVOLUTION +presentar I-EVOLUTION +depranocitos I-EVOLUTION +en I-EVOLUTION +frotis I-EVOLUTION +de I-EVOLUTION +sangre I-EVOLUTION +periférica; I-EVOLUTION +causa I-EVOLUTION +medicamentosa, I-EVOLUTION +por I-EVOLUTION +no I-EVOLUTION +presentar I-EVOLUTION +ingesta I-EVOLUTION +de I-EVOLUTION +medicamentos; I-EVOLUTION +causa I-EVOLUTION +traumática, I-EVOLUTION +por I-EVOLUTION +falta I-EVOLUTION +de I-EVOLUTION +traumatismos I-EVOLUTION +previos I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +pene; I-EVOLUTION +asimismo, I-EVOLUTION +se I-EVOLUTION +descartan I-EVOLUTION +tumores I-EVOLUTION +sólidos I-EVOLUTION +genitourinarios I-EVOLUTION +y I-EVOLUTION +enfermedades I-EVOLUTION +neurológicas I-EVOLUTION +e I-EVOLUTION +infecciosas. I-EVOLUTION +Actualmente, I-EVOLUTION +el I-EVOLUTION +paciente I-EVOLUTION +se I-EVOLUTION +encuentra I-EVOLUTION +con I-EVOLUTION +disfunción I-EVOLUTION +eréctil I-EVOLUTION +secundaria I-EVOLUTION +a I-EVOLUTION +priapismo I-EVOLUTION +y I-EVOLUTION +permanece I-EVOLUTION +en I-EVOLUTION +tratamiento I-EVOLUTION +oncológico I-EVOLUTION +por I-EVOLUTION +su I-EVOLUTION +patología I-EVOLUTION +de I-EVOLUTION +base. I-EVOLUTION + I-EVOLUTION + +Una B-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +9 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +cirrosis I-PRESENT_ILLNESS +fue B-DERIVED_FROM/TO +derivada I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestro I-DERIVED_FROM/TO +centro I-DERIVED_FROM/TO +para I-DERIVED_FROM/TO +evaluación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +trasplante I-DERIVED_FROM/TO +hepático. I-DERIVED_FROM/TO +Se B-EXPLORATION +presentó I-EXPLORATION +con I-EXPLORATION +un I-EXPLORATION +cuadro I-EXPLORATION +referido I-EXPLORATION +como I-EXPLORATION +de I-EXPLORATION +reciente I-EXPLORATION +comienzo, I-EXPLORATION +aunque I-EXPLORATION +por I-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +físico I-EXPLORATION +y I-EXPLORATION +los I-EXPLORATION +resultados I-EXPLORATION +de I-EXPLORATION +estudios I-EXPLORATION +se I-EXPLORATION +trataba I-EXPLORATION +de I-EXPLORATION +una I-EXPLORATION +hepatopatía I-EXPLORATION +crónica. I-EXPLORATION +Presentaba I-EXPLORATION +estigmas I-EXPLORATION +de I-EXPLORATION +cronicidad I-EXPLORATION +como I-EXPLORATION +eritema I-EXPLORATION +palmar, I-EXPLORATION +telangiectasias, I-EXPLORATION +circulación I-EXPLORATION +colateral I-EXPLORATION +en I-EXPLORATION +pared I-EXPLORATION +abdominal I-EXPLORATION +y I-EXPLORATION +esplenomegalia. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +ecografía I-EXPLORATION +abdominal I-EXPLORATION +se I-EXPLORATION +constató I-EXPLORATION +un I-EXPLORATION +hígado I-EXPLORATION +de I-EXPLORATION +pequeño I-EXPLORATION +tamaño I-EXPLORATION +con I-EXPLORATION +heterogeneidad I-EXPLORATION +y I-EXPLORATION +bazo I-EXPLORATION +con I-EXPLORATION +diámetro I-EXPLORATION +longitudinal I-EXPLORATION +aumentado. I-EXPLORATION +No B-TREATMENT +recibía I-TREATMENT +medicación I-TREATMENT +antes I-TREATMENT +de I-TREATMENT +la I-TREATMENT +admisión I-TREATMENT +en I-TREATMENT +nuestro I-TREATMENT +hospital. I-TREATMENT +En B-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +contexto I-PAST_MEDICAL_HISTORY +social I-PAST_MEDICAL_HISTORY +complejo I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +poca I-PAST_MEDICAL_HISTORY +percepción I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +enfermedad, I-PAST_MEDICAL_HISTORY +la I-PAST_MEDICAL_HISTORY +familia I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +había I-PAST_MEDICAL_HISTORY +consultado I-PAST_MEDICAL_HISTORY +previamente. I-PAST_MEDICAL_HISTORY +Tampoco I-PAST_MEDICAL_HISTORY +tenía I-PAST_MEDICAL_HISTORY +seguimiento I-PAST_MEDICAL_HISTORY +periódico I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +salud. I-PAST_MEDICAL_HISTORY +Al B-EXPLORATION +ingreso, I-EXPLORATION +el I-EXPLORATION +puntaje I-EXPLORATION +de I-EXPLORATION +gravedad I-EXPLORATION +PELD I-EXPLORATION +(Pediatric I-EXPLORATION +End-Stage I-EXPLORATION +Liver I-EXPLORATION +Disease, I-EXPLORATION +hepatopatía I-EXPLORATION +terminal I-EXPLORATION +pediátrica) I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +24, I-EXPLORATION +con I-EXPLORATION +bilirrubina I-EXPLORATION +de I-EXPLORATION +15 I-EXPLORATION +mg/dl, I-EXPLORATION +un I-EXPLORATION +valor I-EXPLORATION +de I-EXPLORATION +relación I-EXPLORATION +internacional I-EXPLORATION +normalizada I-EXPLORATION +(RIN) I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5, I-EXPLORATION +albúmina I-EXPLORATION +de I-EXPLORATION +2, I-EXPLORATION +5 I-EXPLORATION +g/dl; I-EXPLORATION +su I-EXPLORATION +peso I-EXPLORATION +y I-EXPLORATION +talla I-EXPLORATION +eran I-EXPLORATION +de I-EXPLORATION +30 I-EXPLORATION +kg I-EXPLORATION +y I-EXPLORATION +127 I-EXPLORATION +cm, I-EXPLORATION +respectivamente. I-EXPLORATION +Mientras B-EVOLUTION +esperaba I-EVOLUTION +en I-EVOLUTION +lista I-EVOLUTION +de I-EVOLUTION +trasplante I-EVOLUTION +hepático, I-EVOLUTION +desarrolló I-EVOLUTION +encefalopatía I-EVOLUTION +hepática I-EVOLUTION +espontánea, I-EVOLUTION +de I-EVOLUTION +tipo I-EVOLUTION +C, I-EVOLUTION +grado I-EVOLUTION +II-III1 I-EVOLUTION +con I-EVOLUTION +períodos I-EVOLUTION +de I-EVOLUTION +conducta I-EVOLUTION +inapropiada I-EVOLUTION +que I-EVOLUTION +alternaban I-EVOLUTION +con I-EVOLUTION +confusión I-EVOLUTION +y I-EVOLUTION +excitación. I-EVOLUTION +Previamente, I-EVOLUTION +no I-EVOLUTION +había I-EVOLUTION +presentado I-EVOLUTION +episodios I-EVOLUTION +de I-EVOLUTION +encefalopatía. I-EVOLUTION +Su B-EXPLORATION +amonio I-EXPLORATION +sérico I-EXPLORATION +aumentó I-EXPLORATION +de I-EXPLORATION +139 I-EXPLORATION +µg% I-EXPLORATION +a I-EXPLORATION +324 I-EXPLORATION +µg% I-EXPLORATION +(valor I-EXPLORATION +normal I-EXPLORATION +de I-EXPLORATION +referencia I-EXPLORATION +19-82 I-EXPLORATION +µg%). I-EXPLORATION +Se I-EXPLORATION +descartaron I-EXPLORATION +factores I-EXPLORATION +precipitantes I-EXPLORATION +conocidos I-EXPLORATION +de I-EXPLORATION +encefalopatía I-EXPLORATION +hepática, I-EXPLORATION +como I-EXPLORATION +medicaciones, I-EXPLORATION +sangrado I-EXPLORATION +gastrointestinal, I-EXPLORATION +infecciones I-EXPLORATION +bacterianas, I-EXPLORATION +constipación, I-EXPLORATION +fallo I-EXPLORATION +renal, I-EXPLORATION +desequilibrios I-EXPLORATION +electrolíticos, I-EXPLORATION +hipovolemia I-EXPLORATION +o I-EXPLORATION +hipoxemia. I-EXPLORATION +La I-EXPLORATION +paciente I-EXPLORATION +no I-EXPLORATION +tenía I-EXPLORATION +antecedentes I-EXPLORATION +de I-EXPLORATION +ascitis I-EXPLORATION +y I-EXPLORATION +una I-EXPLORATION +ecografía I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +líquido I-EXPLORATION +libre I-EXPLORATION +abdominal. I-EXPLORATION +Se B-TREATMENT +indicó I-TREATMENT +una I-TREATMENT +dieta I-TREATMENT +con I-TREATMENT +restricción I-TREATMENT +de I-TREATMENT +proteínas I-TREATMENT +(0, I-TREATMENT +8 I-TREATMENT +g/kg/día) I-TREATMENT +y I-TREATMENT +lactulosa I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral I-TREATMENT +(40 I-TREATMENT +ml/día, I-TREATMENT +divididos I-TREATMENT +en I-TREATMENT +4 I-TREATMENT +tomas), I-TREATMENT +logrando I-TREATMENT +3-4 I-TREATMENT +deposiciones I-TREATMENT +blandas I-TREATMENT +por I-TREATMENT +día. I-TREATMENT +A B-EVOLUTION +pesar I-EVOLUTION +de I-EVOLUTION +estas I-EVOLUTION +medidas, I-EVOLUTION +el I-EVOLUTION +estado I-EVOLUTION +neurológico I-EVOLUTION +no I-EVOLUTION +mejoró I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +4 I-EVOLUTION +días. I-EVOLUTION +Sobre B-TREATMENT +la I-TREATMENT +base I-TREATMENT +de I-TREATMENT +experiencias I-TREATMENT +en I-TREATMENT +pacientes I-TREATMENT +adultos, I-TREATMENT +se I-TREATMENT +decidió I-TREATMENT +agregar I-TREATMENT +rifaximina I-TREATMENT +(20 I-TREATMENT +mg/kg/día, I-TREATMENT +por I-TREATMENT +vía I-TREATMENT +oral, I-TREATMENT +divididos I-TREATMENT +en I-TREATMENT +dos I-TREATMENT +tomas), I-TREATMENT +con I-TREATMENT +previa I-TREATMENT +firma I-TREATMENT +del I-TREATMENT +consentimiento I-TREATMENT +informado I-TREATMENT +por I-TREATMENT +parte I-TREATMENT +de I-TREATMENT +los I-TREATMENT +padres. I-TREATMENT +La B-EVOLUTION +paciente I-EVOLUTION +mostró I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +en I-EVOLUTION +3 I-EVOLUTION +días, I-EVOLUTION +sin I-EVOLUTION +confusión I-EVOLUTION +ni I-EVOLUTION +excitación I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +ritmo I-EVOLUTION +sueño/ I-EVOLUTION +vigilia I-EVOLUTION +normal. I-EVOLUTION +La I-EVOLUTION +concentración I-EVOLUTION +de I-EVOLUTION +amonio I-EVOLUTION +descendió I-EVOLUTION +gradualmente I-EVOLUTION +(236 I-EVOLUTION +µg% I-EVOLUTION +y I-EVOLUTION +162 I-EVOLUTION +µg%, I-EVOLUTION +4 I-EVOLUTION +y I-EVOLUTION +10 I-EVOLUTION +días I-EVOLUTION +luego I-EVOLUTION +de I-EVOLUTION +iniciado I-EVOLUTION +el I-EVOLUTION +tratamiento, I-EVOLUTION +respectivamente). I-EVOLUTION +No I-EVOLUTION +presentó I-EVOLUTION +cefaleas, I-EVOLUTION +dolor I-EVOLUTION +abdominal, I-EVOLUTION +náuseas I-EVOLUTION +ni I-EVOLUTION +vómitos I-EVOLUTION +relacionados I-EVOLUTION +con I-EVOLUTION +el I-EVOLUTION +tratamiento I-EVOLUTION +con I-EVOLUTION +rifaximina. I-EVOLUTION +Finalmente, B-TREATMENT +la I-TREATMENT +paciente I-TREATMENT +recibió I-TREATMENT +trasplante I-TREATMENT +hepático I-TREATMENT +pasado I-TREATMENT +un I-TREATMENT +mes I-TREATMENT +del I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +rifaximina, I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT + I-TREATMENT + +Paciente B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +sexo I-PRESENT_ILLNESS +femenino I-PRESENT_ILLNESS +internada I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +dos I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +vida I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +ictericia I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +siete I-PRESENT_ILLNESS +días I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución I-PRESENT_ILLNESS +según I-PRESENT_ILLNESS +referencia I-PRESENT_ILLNESS +materna I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +tumoración I-PRESENT_ILLNESS +frontoparietal I-PRESENT_ILLNESS +izquierda I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +empeoró I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +las I-PRESENT_ILLNESS +24 I-PRESENT_ILLNESS +h I-PRESENT_ILLNESS +previas I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +ingreso. I-PRESENT_ILLNESS +Antecedentes: B-PAST_MEDICAL_HISTORY +recién I-PAST_MEDICAL_HISTORY +nacida I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +término, I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +peso I-PAST_MEDICAL_HISTORY +adecuado I-PAST_MEDICAL_HISTORY +para I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +edad I-PAST_MEDICAL_HISTORY +gestacional. I-PAST_MEDICAL_HISTORY +Tuvo I-PAST_MEDICAL_HISTORY +buena I-PAST_MEDICAL_HISTORY +progresión I-PAST_MEDICAL_HISTORY +ponderal I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +ictericia I-PAST_MEDICAL_HISTORY +clínica. I-PAST_MEDICAL_HISTORY +La I-PAST_MEDICAL_HISTORY +madre I-PAST_MEDICAL_HISTORY +refirió I-PAST_MEDICAL_HISTORY +ictericia I-PAST_MEDICAL_HISTORY +a I-PAST_MEDICAL_HISTORY +las I-PAST_MEDICAL_HISTORY +siete I-PAST_MEDICAL_HISTORY +semanas I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vida. I-PAST_MEDICAL_HISTORY +Evolución: B-EVOLUTION +al I-EVOLUTION +ingreso I-EVOLUTION +presentaba I-EVOLUTION +sopor, I-EVOLUTION +ictericia I-EVOLUTION +generalizada, I-EVOLUTION +hepatomegalia I-EVOLUTION +y I-EVOLUTION +tumoración I-EVOLUTION +frontoparietal I-EVOLUTION +izquierda. I-EVOLUTION +Laboratorio B-EXPLORATION +de I-EXPLORATION +ingreso: I-EXPLORATION +GOT I-EXPLORATION +262 I-EXPLORATION +UI/L, I-EXPLORATION +GPT I-EXPLORATION +143 I-EXPLORATION +UI/L, I-EXPLORATION +FAL I-EXPLORATION +2289 I-EXPLORATION +UI/L, I-EXPLORATION +bilirrubinemia I-EXPLORATION +total I-EXPLORATION +12, I-EXPLORATION +3 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +directa I-EXPLORATION +8, I-EXPLORATION +6 I-EXPLORATION +mg/ I-EXPLORATION +dl, I-EXPLORATION +coagulograma I-EXPLORATION +informado I-EXPLORATION +como I-EXPLORATION +"no I-EXPLORATION +coagula". I-EXPLORATION +TC: I-EXPLORATION +hemorragia I-EXPLORATION +de I-EXPLORATION +ventrículos I-EXPLORATION +laterales I-EXPLORATION +e I-EXPLORATION +intraparenquimatosa I-EXPLORATION +temporal I-EXPLORATION +derecha. I-EXPLORATION +Fue B-DERIVED_FROM/TO +evaluada I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +Neurocirugía I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +indicación I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +conducta I-DERIVED_FROM/TO +expectante. I-DERIVED_FROM/TO +Recibió B-EXPLORATION +vitamina I-EXPLORATION +K I-EXPLORATION +5 I-EXPLORATION +mg I-EXPLORATION +diarios I-EXPLORATION +por I-EXPLORATION +48 I-EXPLORATION +h I-EXPLORATION +como I-EXPLORATION +único I-EXPLORATION +tratamiento I-EXPLORATION +corrector I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +coagulopatía I-EXPLORATION +con I-EXPLORATION +laboratorio I-EXPLORATION +de I-EXPLORATION +control I-EXPLORATION +normal: I-EXPLORATION +tiempo I-EXPLORATION +de I-EXPLORATION +protrombina I-EXPLORATION +100%, I-EXPLORATION +KPTT I-EXPLORATION +45 I-EXPLORATION +segundos, I-EXPLORATION +fibrinógeno I-EXPLORATION +274 I-EXPLORATION +mg/dl. I-EXPLORATION +El I-EXPLORATION +centellograma I-EXPLORATION +con I-EXPLORATION +HIDA I-EXPLORATION +no I-EXPLORATION +mostró I-EXPLORATION +captación I-EXPLORATION +hepática I-EXPLORATION +del I-EXPLORATION +contraste, I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +visualizó I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +biliar I-EXPLORATION +intrahepática I-EXPLORATION +ni I-EXPLORATION +extrahepática, I-EXPLORATION +ni I-EXPLORATION +pasaje I-EXPLORATION +al I-EXPLORATION +intestino I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +24 I-EXPLORATION +h. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +portoentero-anastomosis, I-TREATMENT +después I-TREATMENT +de I-TREATMENT +confirmar I-TREATMENT +el I-TREATMENT +diagnóstico I-TREATMENT +de I-TREATMENT +atresia I-TREATMENT +de I-TREATMENT +vías I-TREATMENT +biliares I-TREATMENT +durante I-TREATMENT +la I-TREATMENT +cirugía. I-TREATMENT +En B-EVOLUTION +el I-EVOLUTION +seguimiento I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +vida I-EVOLUTION +presentaba I-EVOLUTION +valoración I-EVOLUTION +clínico-neurológica I-EVOLUTION +normal I-EVOLUTION +y I-EVOLUTION +recibió I-EVOLUTION +trasplante I-EVOLUTION +de I-EVOLUTION +hígado I-EVOLUTION +al I-EVOLUTION +año I-EVOLUTION +de I-EVOLUTION +edad. I-EVOLUTION + I-EVOLUTION + +Un B-PRESENT_ILLNESS +lactante I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +2 I-PRESENT_ILLNESS +meses, I-PRESENT_ILLNESS +sin B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +un I-PAST_MEDICAL_HISTORY +estado I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +vacunación I-PAST_MEDICAL_HISTORY +según I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +calendario I-PAST_MEDICAL_HISTORY +(primera I-PAST_MEDICAL_HISTORY +dosis I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +HBV), I-PAST_MEDICAL_HISTORY +2 I-PAST_MEDICAL_HISTORY +después B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +8 I-PRESENT_ILLNESS +horas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +recibir I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +vacuna I-PRESENT_ILLNESS +correspondiente I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +su I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +subsector I-PRESENT_ILLNESS +privado I-PRESENT_ILLNESS +(vacuna I-PRESENT_ILLNESS +séxtuple I-PRESENT_ILLNESS +[DTPa, I-PRESENT_ILLNESS +Hib, I-PRESENT_ILLNESS +IPV, I-PRESENT_ILLNESS +HB] I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +meningocócica I-PRESENT_ILLNESS +C), I-PRESENT_ILLNESS +fue I-PRESENT_ILLNESS +llevado I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +al I-PRESENT_ILLNESS +Servicio I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +Urgencias I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +instauración I-PRESENT_ILLNESS +brusca I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +palidez I-PRESENT_ILLNESS +cutánea I-PRESENT_ILLNESS +acompañada I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +hipotonía I-PRESENT_ILLNESS +e I-PRESENT_ILLNESS +hiporreactividad. I-PRESENT_ILLNESS +En B-EXPLORATION +el I-EXPLORATION +examen I-EXPLORATION +se I-EXPLORATION +destacaba I-EXPLORATION +un I-EXPLORATION +regular I-EXPLORATION +estado I-EXPLORATION +general, I-EXPLORATION +con I-EXPLORATION +cianosis I-EXPLORATION +y I-EXPLORATION +frialdad I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +extremidades, I-EXPLORATION +así I-EXPLORATION +como I-EXPLORATION +hipotonía I-EXPLORATION +y I-EXPLORATION +escasa I-EXPLORATION +respuesta I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +estímulos. I-EXPLORATION +Las I-EXPLORATION +constantes I-EXPLORATION +vitales I-EXPLORATION +(frecuencia I-EXPLORATION +cardíaca, I-EXPLORATION +frecuencia I-EXPLORATION +respiratoria, I-EXPLORATION +tensión I-EXPLORATION +arterial) I-EXPLORATION +y I-EXPLORATION +la I-EXPLORATION +saturación I-EXPLORATION +de I-EXPLORATION +oxígeno I-EXPLORATION +respirando I-EXPLORATION +aire I-EXPLORATION +ambiente I-EXPLORATION +se I-EXPLORATION +encontraban I-EXPLORATION +en I-EXPLORATION +rangos I-EXPLORATION +normales; I-EXPLORATION +la I-EXPLORATION +temperatura I-EXPLORATION +rectal I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +38, I-EXPLORATION +6ºC. I-EXPLORATION +Ante B-TREATMENT +la I-TREATMENT +sospecha I-TREATMENT +inicial I-TREATMENT +de I-TREATMENT +un I-TREATMENT +cuadro I-TREATMENT +séptico, I-TREATMENT +se I-TREATMENT +inició I-TREATMENT +expansión I-TREATMENT +volumétrica I-TREATMENT +y, I-TREATMENT +después I-TREATMENT +de I-TREATMENT +practicar I-TREATMENT +un I-TREATMENT +estudio I-TREATMENT +analítico I-TREATMENT +y I-TREATMENT +de I-TREATMENT +obtener I-TREATMENT +muestras I-TREATMENT +para I-TREATMENT +cultivo, I-TREATMENT +se I-TREATMENT +comenzó I-TREATMENT +con I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +antibiótico I-TREATMENT +empírico. I-TREATMENT +En B-EVOLUTION +las I-EVOLUTION +dos I-EVOLUTION +horas I-EVOLUTION +sucesivas I-EVOLUTION +al I-EVOLUTION +ingreso, I-EVOLUTION +presentó I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +clínica I-EVOLUTION +llamativa, I-EVOLUTION +con I-EVOLUTION +recuperación I-EVOLUTION +del I-EVOLUTION +tono I-EVOLUTION +muscular I-EVOLUTION +y I-EVOLUTION +reactividad I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +estímulos I-EVOLUTION +normales, I-EVOLUTION +así I-EVOLUTION +como I-EVOLUTION +buena I-EVOLUTION +perfusión I-EVOLUTION +tisular, I-EVOLUTION +observándose I-EVOLUTION +un I-EVOLUTION +lactante I-EVOLUTION +asintomático I-EVOLUTION +y I-EVOLUTION +con I-EVOLUTION +examen I-EVOLUTION +físico I-EVOLUTION +normal. I-EVOLUTION +Tanto B-EXPLORATION +el I-EXPLORATION +despistaje I-EXPLORATION +infeccioso I-EXPLORATION +inicial I-EXPLORATION +como I-EXPLORATION +los I-EXPLORATION +diversos I-EXPLORATION +cultivos I-EXPLORATION +obtenidos I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +sangre, I-EXPLORATION +la I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +líquido I-EXPLORATION +cefalorraquídeo I-EXPLORATION +resultaron I-EXPLORATION +negativos, I-EXPLORATION +por I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +replanteó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +inicial I-EXPLORATION +de I-EXPLORATION +sepsis I-EXPLORATION +y I-EXPLORATION +se I-EXPLORATION +atribuyó I-EXPLORATION +el I-EXPLORATION +episodio I-EXPLORATION +a I-EXPLORATION +un I-EXPLORATION +posible I-EXPLORATION +efecto I-EXPLORATION +adverso I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vacuna I-EXPLORATION +acelular I-EXPLORATION +contra I-EXPLORATION +la I-EXPLORATION +tos I-EXPLORATION +ferina. I-EXPLORATION +Siguiendo B-TREATMENT +las I-TREATMENT +recomendaciones I-TREATMENT +del I-TREATMENT +Comité I-TREATMENT +de I-TREATMENT +Enfermedades I-TREATMENT +Infecciosas I-TREATMENT +de I-TREATMENT +la I-TREATMENT +Academia I-TREATMENT +Estadounidense I-TREATMENT +de I-TREATMENT +Pediatría I-TREATMENT +y, I-TREATMENT +ante I-TREATMENT +la I-TREATMENT +ausencia I-TREATMENT +de I-TREATMENT +contraindicaciones I-TREATMENT +absolutas, I-TREATMENT +se I-TREATMENT +administró I-TREATMENT +la I-TREATMENT +dosis I-TREATMENT +correspondiente I-TREATMENT +a I-TREATMENT +la I-TREATMENT +vacunación I-TREATMENT +de I-TREATMENT +los I-TREATMENT +4 I-TREATMENT +meses I-TREATMENT +bajo I-TREATMENT +observación I-TREATMENT +hospitalaria, I-TREATMENT +sin I-TREATMENT +que I-TREATMENT +se I-TREATMENT +presentaran I-TREATMENT +manifestaciones I-TREATMENT +clínicas I-TREATMENT +en I-TREATMENT +las I-TREATMENT +48 I-TREATMENT +horas I-TREATMENT +siguientes. I-TREATMENT + I-TREATMENT + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +3 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +lesiones I-PRESENT_ILLNESS +eritematosas, I-PRESENT_ILLNESS +redondeadas, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +bordes I-PRESENT_ILLNESS +definidos, I-PRESENT_ILLNESS +con I-PRESENT_ILLNESS +centro I-PRESENT_ILLNESS +más I-PRESENT_ILLNESS +pálido I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +rostro, I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +superiores, I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +aspecto I-PRESENT_ILLNESS +reticulado I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +miembros I-PRESENT_ILLNESS +inferiores I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +dorso I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +1 I-PRESENT_ILLNESS +mes I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +Hepatoesplenomegalia. I-PRESENT_ILLNESS + I-PRESENT_ILLNESS +Madre B-FAMILY_HISTORY +y I-FAMILY_HISTORY +abuela I-FAMILY_HISTORY +materna I-FAMILY_HISTORY +con I-FAMILY_HISTORY +diagnóstico I-FAMILY_HISTORY +de I-FAMILY_HISTORY +Lupus I-FAMILY_HISTORY +Eritematoso I-FAMILY_HISTORY +sistémico I-FAMILY_HISTORY +(LES) I-FAMILY_HISTORY + I-FAMILY_HISTORY +Exámenes B-EXPLORATION +complementarios: I-EXPLORATION +Hb I-EXPLORATION +10g/dl, I-EXPLORATION +Hto I-EXPLORATION +30%, I-EXPLORATION +GPT I-EXPLORATION +78 I-EXPLORATION +UI/L, I-EXPLORATION +C3 I-EXPLORATION +53 I-EXPLORATION +mg/dl I-EXPLORATION +y I-EXPLORATION +C4 I-EXPLORATION +3mg/dl, I-EXPLORATION +FAN+ I-EXPLORATION +1/100, I-EXPLORATION +acs. I-EXPLORATION +anti I-EXPLORATION +Ro, I-EXPLORATION +anti I-EXPLORATION +La, I-EXPLORATION +anti I-EXPLORATION +Sm I-EXPLORATION +y I-EXPLORATION +anti I-EXPLORATION +U1RNP I-EXPLORATION +negativos. I-EXPLORATION + I-EXPLORATION +Estudio I-EXPLORATION +histopatológico: I-EXPLORATION +hiperqueratosis, I-EXPLORATION +atrofia I-EXPLORATION +epidérmica, I-EXPLORATION +vacuolización I-EXPLORATION +de I-EXPLORATION +queratinocitos I-EXPLORATION +basales I-EXPLORATION +e I-EXPLORATION +infiltrado I-EXPLORATION +difuso I-EXPLORATION +mononuclear I-EXPLORATION +en I-EXPLORATION +dermis I-EXPLORATION +superficial. I-EXPLORATION +Inmunofluorescencia I-EXPLORATION +directa I-EXPLORATION +(IFD): I-EXPLORATION +banda I-EXPLORATION +segmentaria I-EXPLORATION +dermoepidérmica I-EXPLORATION +de I-EXPLORATION +disposición I-EXPLORATION +granular I-EXPLORATION +fina I-EXPLORATION +IgG+ I-EXPLORATION +y I-EXPLORATION +C3+. I-EXPLORATION + I-EXPLORATION +Valoración I-EXPLORATION +cardiológica I-EXPLORATION +normal. I-EXPLORATION + I-EXPLORATION +Tratamiento: B-TREATMENT +hidrocortisona I-TREATMENT +1% I-TREATMENT +crema. I-TREATMENT + I-TREATMENT +Resolución B-EVOLUTION +de I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +cutáneas, I-EVOLUTION +negativización I-EVOLUTION +del I-EVOLUTION +FAN I-EVOLUTION +y I-EVOLUTION +normalización I-EVOLUTION +del I-EVOLUTION +hepatograma I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +de I-EVOLUTION +vida. I-EVOLUTION + I-EVOLUTION + +Varón B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +32 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +hermano I-PRESENT_ILLNESS +del I-PRESENT_ILLNESS +anterior, I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +revisión. I-PRESENT_ILLNESS +Refiere I-PRESENT_ILLNESS +hemeralopia I-PRESENT_ILLNESS +desde I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +tiene I-PRESENT_ILLNESS +conocimiento I-PRESENT_ILLNESS +y, I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +los I-PRESENT_ILLNESS +últimos I-PRESENT_ILLNESS +tiempos, I-PRESENT_ILLNESS +ligera I-PRESENT_ILLNESS +fotodisforia I-PRESENT_ILLNESS +y I-PRESENT_ILLNESS +leve I-PRESENT_ILLNESS +disminución I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +la I-PRESENT_ILLNESS +agudeza I-PRESENT_ILLNESS +visual. I-PRESENT_ILLNESS +La B-EXPLORATION +visión I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +1, I-EXPLORATION +0 I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos; I-EXPLORATION +tanto I-EXPLORATION +el I-EXPLORATION +fondo I-EXPLORATION +de I-EXPLORATION +ojo I-EXPLORATION +como I-EXPLORATION +la I-EXPLORATION +angiografía I-EXPLORATION +son I-EXPLORATION +similares I-EXPLORATION +a I-EXPLORATION +las I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +hermano, I-EXPLORATION +aunque I-EXPLORATION +con I-EXPLORATION +menores I-EXPLORATION +alteraciones I-EXPLORATION +maculares I-EXPLORATION +y I-EXPLORATION +del I-EXPLORATION +EPR. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +campimetría I-EXPLORATION +aparece I-EXPLORATION +un I-EXPLORATION +estotoma I-EXPLORATION +central. I-EXPLORATION + I-EXPLORATION +Se I-EXPLORATION +realizan I-EXPLORATION +sendos I-EXPLORATION +estudios I-EXPLORATION +electrofisiológicos I-EXPLORATION +no I-EXPLORATION +estandarizados I-EXPLORATION +consistentes I-EXPLORATION +en I-EXPLORATION +un I-EXPLORATION +primer I-EXPLORATION +electrorretinograma I-EXPLORATION +(ERG) I-EXPLORATION +basal I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +segundo I-EXPLORATION +realizado I-EXPLORATION +a I-EXPLORATION +los I-EXPLORATION +180 I-EXPLORATION +minutos I-EXPLORATION +de I-EXPLORATION +adaptación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +oscuridad. I-EXPLORATION +En I-EXPLORATION +ambos I-EXPLORATION +casos, I-EXPLORATION +el I-EXPLORATION +ERG I-EXPLORATION +basal I-EXPLORATION +revela I-EXPLORATION +una I-EXPLORATION +disminución I-EXPLORATION +evidente I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +amplitud I-EXPLORATION +de I-EXPLORATION +todas I-EXPLORATION +las I-EXPLORATION +ondas. I-EXPLORATION +Tras I-EXPLORATION +la I-EXPLORATION +adaptación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +oscuridad, I-EXPLORATION +se I-EXPLORATION +pone I-EXPLORATION +de I-EXPLORATION +manifiesto I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +primer I-EXPLORATION +caso I-EXPLORATION +una I-EXPLORATION +tendencia I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +normalización I-EXPLORATION +del I-EXPLORATION +flash I-EXPLORATION +y I-EXPLORATION +escotópico, I-EXPLORATION +no I-EXPLORATION +modificándose I-EXPLORATION +ni I-EXPLORATION +el I-EXPLORATION +flicker I-EXPLORATION +ni I-EXPLORATION +el I-EXPLORATION +fotópico. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +segundo I-EXPLORATION +caso, I-EXPLORATION +la I-EXPLORATION +adaptación I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +oscuridad I-EXPLORATION +normaliza I-EXPLORATION +las I-EXPLORATION +ondas, I-EXPLORATION +incluido I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +de I-EXPLORATION +conos I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +queda I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +límite I-EXPLORATION +inferior I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +normalidad I-EXPLORATION +para I-EXPLORATION +su I-EXPLORATION +edad. I-EXPLORATION + I-EXPLORATION + +La B-PRESENT_ILLNESS +paciente, I-PRESENT_ILLNESS +una I-PRESENT_ILLNESS +niña I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +4 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +estudiada B-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +retraso I-DERIVED_FROM/TO +psicomotor, I-DERIVED_FROM/TO +fue I-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +sección I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +motilidad I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +déficit I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +fijación I-DERIVED_FROM/TO +ocular. I-DERIVED_FROM/TO +Se B-EXPLORATION +observaba I-EXPLORATION +que, I-EXPLORATION +para I-EXPLORATION +cambiar I-EXPLORATION +la I-EXPLORATION +dirección I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +mirada, I-EXPLORATION +la I-EXPLORATION +niña I-EXPLORATION +se I-EXPLORATION +veía I-EXPLORATION +obligada I-EXPLORATION +a I-EXPLORATION +realizar I-EXPLORATION +unos I-EXPLORATION +movimientos I-EXPLORATION +bruscos I-EXPLORATION +laterales I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +cabeza I-EXPLORATION +con I-EXPLORATION +los I-EXPLORATION +que I-EXPLORATION +arrastraba I-EXPLORATION +sus I-EXPLORATION +ojos I-EXPLORATION +al I-EXPLORATION +nuevo I-EXPLORATION +objeto. I-EXPLORATION +Se I-EXPLORATION +realizó I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +habitual I-EXPLORATION +para I-EXPLORATION +buscar I-EXPLORATION +alteraciones I-EXPLORATION +que I-EXPLORATION +justificasen I-EXPLORATION +esa I-EXPLORATION +dificultad: I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +ocular, I-EXPLORATION +BMC I-EXPLORATION +y I-EXPLORATION +F.O. I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +Se I-EXPLORATION +siguió I-EXPLORATION +con I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +neurooftalmológica: I-EXPLORATION +el I-EXPLORATION +reflejo I-EXPLORATION +optocinético I-EXPLORATION +aparecía I-EXPLORATION +alterado I-EXPLORATION +en I-EXPLORATION +su I-EXPLORATION +fase I-EXPLORATION +rápida I-EXPLORATION +(disminuida I-EXPLORATION +o I-EXPLORATION +ausente) I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +plano I-EXPLORATION +horizontal. I-EXPLORATION +Los I-EXPLORATION +potenciales I-EXPLORATION +evocados I-EXPLORATION +visuales I-EXPLORATION +(P.E.V.) I-EXPLORATION +fueron I-EXPLORATION +normales. I-EXPLORATION +No I-EXPLORATION +se I-EXPLORATION +realizó I-EXPLORATION +electrorretinograma I-EXPLORATION +(ERG) I-EXPLORATION +dada I-EXPLORATION +la I-EXPLORATION +corta I-EXPLORATION +edad I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +paciente. I-EXPLORATION +La I-EXPLORATION +exploración I-EXPLORATION +neurológica I-EXPLORATION +evidenciaba I-EXPLORATION +hipertonía I-EXPLORATION +de I-EXPLORATION +miembros I-EXPLORATION +inferiores I-EXPLORATION +con I-EXPLORATION +hiperreflexia. I-EXPLORATION +Las I-EXPLORATION +exploraciones I-EXPLORATION +encaminadas I-EXPLORATION +a I-EXPLORATION +detectar I-EXPLORATION +procesos I-EXPLORATION +neurológicos I-EXPLORATION +o I-EXPLORATION +sistémicos I-EXPLORATION +(EEG, I-EXPLORATION +RM I-EXPLORATION +cerebral, I-EXPLORATION +aminoácidos I-EXPLORATION +en I-EXPLORATION +sangre, I-EXPLORATION +orina I-EXPLORATION +y I-EXPLORATION +LCR, I-EXPLORATION +amoníaco, I-EXPLORATION +ácido I-EXPLORATION +pirúvico I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +LCR, I-EXPLORATION +ácidos I-EXPLORATION +grasos I-EXPLORATION +de I-EXPLORATION +cadena I-EXPLORATION +larga, I-EXPLORATION +serología I-EXPLORATION +TORCH) I-EXPLORATION +resultaron I-EXPLORATION +normales. I-EXPLORATION +Sólo I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +ácido I-EXPLORATION +láctico I-EXPLORATION +en I-EXPLORATION +sangre I-EXPLORATION +y I-EXPLORATION +proteínas I-EXPLORATION +en I-EXPLORATION +LCR I-EXPLORATION +levemente I-EXPLORATION +altas, I-EXPLORATION +sin I-EXPLORATION +demostrarse I-EXPLORATION +enfermedad. I-EXPLORATION +Por I-EXPLORATION +PCR I-EXPLORATION +se I-EXPLORATION +amplificó I-EXPLORATION +virus I-EXPLORATION +del I-EXPLORATION +herpes I-EXPLORATION +humano I-EXPLORATION +tipo I-EXPLORATION +6 I-EXPLORATION +(HHV-6), I-EXPLORATION +del I-EXPLORATION +que I-EXPLORATION +no I-EXPLORATION +se I-EXPLORATION +han I-EXPLORATION +descrito I-EXPLORATION +asociaciones I-EXPLORATION +con I-EXPLORATION +apraxia I-EXPLORATION +oculomotora. I-EXPLORATION + I-EXPLORATION +Fue I-EXPLORATION +diagnosticada I-EXPLORATION +de I-EXPLORATION +C.O.M.A. I-EXPLORATION +con I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +afectación I-EXPLORATION +piramidal I-EXPLORATION +bilateral I-EXPLORATION +inespecífica. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +74 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +que I-PRESENT_ILLNESS +acude I-PRESENT_ILLNESS +a I-PRESENT_ILLNESS +consulta I-PRESENT_ILLNESS +por I-PRESENT_ILLNESS +epífora I-PRESENT_ILLNESS +bilateral, I-PRESENT_ILLNESS +mayor I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +izquierdo I-PRESENT_ILLNESS +(OI), I-PRESENT_ILLNESS +sin I-PRESENT_ILLNESS +episodios I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +dacriocistitis I-PRESENT_ILLNESS +aguda. I-PRESENT_ILLNESS +Como B-PAST_MEDICAL_HISTORY +antecedentes I-PAST_MEDICAL_HISTORY +personales I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +interés I-PAST_MEDICAL_HISTORY +presenta I-PAST_MEDICAL_HISTORY +una I-PAST_MEDICAL_HISTORY +hipertensión I-PAST_MEDICAL_HISTORY +arterial I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +drenaje I-PAST_MEDICAL_HISTORY +quirúrgico I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +los I-PAST_MEDICAL_HISTORY +senos I-PAST_MEDICAL_HISTORY +etmoidales I-PAST_MEDICAL_HISTORY +por I-PAST_MEDICAL_HISTORY +sinusitis I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +su I-PAST_MEDICAL_HISTORY +juventud. I-PAST_MEDICAL_HISTORY +Presenta B-EXPLORATION +una I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +3 I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos. I-EXPLORATION +Esta I-EXPLORATION +visión I-EXPLORATION +estaba I-EXPLORATION +justificada I-EXPLORATION +por I-EXPLORATION +la I-EXPLORATION +existencia I-EXPLORATION +de I-EXPLORATION +cataratas I-EXPLORATION +y I-EXPLORATION +además I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +obstrucción I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +vía I-EXPLORATION +lagrimal. I-EXPLORATION +Se B-TREATMENT +realizó I-TREATMENT +una I-TREATMENT +dacriocistografía I-TREATMENT +izquierda I-TREATMENT +y I-TREATMENT +posteriormente I-TREATMENT +se I-TREATMENT +le I-TREATMENT +implantó I-TREATMENT +una I-TREATMENT +prótesis I-TREATMENT +recta I-TREATMENT +de I-TREATMENT +Wacrees I-TREATMENT +sin I-TREATMENT +complicaciones. I-TREATMENT + I-TREATMENT +A B-EVOLUTION +las I-EVOLUTION +24 I-EVOLUTION +horas I-EVOLUTION +comienzó I-EVOLUTION +una I-EVOLUTION +inflamación I-EVOLUTION +palpebral I-EVOLUTION +y I-EVOLUTION +dolor I-EVOLUTION +en I-EVOLUTION +región I-EVOLUTION +orbitaria I-EVOLUTION +izquierda. I-EVOLUTION +Tras I-EVOLUTION +48 I-EVOLUTION +horas I-EVOLUTION +refirió I-EVOLUTION +pérdida I-EVOLUTION +brusca I-EVOLUTION +de I-EVOLUTION +agudeza I-EVOLUTION +visual I-EVOLUTION +del I-EVOLUTION +OI I-EVOLUTION +con I-EVOLUTION +mal I-EVOLUTION +estado I-EVOLUTION +general I-EVOLUTION +y I-EVOLUTION +febrícula I-EVOLUTION +(37,6º). I-EVOLUTION +A I-EVOLUTION +las I-EVOLUTION +72 I-EVOLUTION +horas I-EVOLUTION +acudió I-EVOLUTION +a I-EVOLUTION +urgencias, I-EVOLUTION +presentando I-EVOLUTION +una I-EVOLUTION +visión I-EVOLUTION +de I-EVOLUTION +movimiento I-EVOLUTION +de I-EVOLUTION +manos I-EVOLUTION +a I-EVOLUTION +50 I-EVOLUTION +cms, I-EVOLUTION +marcado I-EVOLUTION +exoftalmos I-EVOLUTION +con I-EVOLUTION +clínica I-EVOLUTION +inflamatoria I-EVOLUTION +periocular, I-EVOLUTION +oftalmoplejia I-EVOLUTION +con I-EVOLUTION +dolor I-EVOLUTION +a I-EVOLUTION +los I-EVOLUTION +movimientos I-EVOLUTION +oculares I-EVOLUTION +y I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +biomicroscopía I-EVOLUTION +midriasis I-EVOLUTION +paralítica I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +OI I-EVOLUTION +con I-EVOLUTION +anestesia I-EVOLUTION +corneal. I-EVOLUTION +Oftalmoscópicamente B-EXPLORATION +la I-EXPLORATION +papila I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +aspecto I-EXPLORATION +normal I-EXPLORATION +con I-EXPLORATION +pulso I-EXPLORATION +venoso I-EXPLORATION +espontáneo I-EXPLORATION +negativo. I-EXPLORATION +En I-EXPLORATION +el I-EXPLORATION +hemograma I-EXPLORATION +de I-EXPLORATION +urgencias I-EXPLORATION +presentaba I-EXPLORATION +leucocitosis I-EXPLORATION +con I-EXPLORATION +desviación I-EXPLORATION +izquierda. I-EXPLORATION +El I-EXPLORATION +TAC I-EXPLORATION +craneal I-EXPLORATION +realizado I-EXPLORATION +era I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +celulitis I-EXPLORATION +orbitaria I-EXPLORATION +OI. I-EXPLORATION +Asimismo I-EXPLORATION +la I-EXPLORATION +paciente I-EXPLORATION +tenía I-EXPLORATION +una I-EXPLORATION +neuritis I-EXPLORATION +óptica I-EXPLORATION +izquierda I-EXPLORATION +por I-EXPLORATION +compresión I-EXPLORATION +intraorbitaria. I-EXPLORATION + I-EXPLORATION +Se B-TREATMENT +instaura I-TREATMENT +tratamiento I-TREATMENT +sistémico I-TREATMENT +con I-TREATMENT +metil-prednisolona I-TREATMENT +(250 I-TREATMENT +mgr/iv/6 I-TREATMENT +h), I-TREATMENT +ceftriaxona I-TREATMENT +(2 I-TREATMENT +gr/iv/12 I-TREATMENT +h) I-TREATMENT +y I-TREATMENT +Vancomicina I-TREATMENT +(1 I-TREATMENT +gr/iv/12 I-TREATMENT +h), I-TREATMENT +así I-TREATMENT +como I-TREATMENT +tratamiento I-TREATMENT +tópico I-TREATMENT +en I-TREATMENT +OI. I-TREATMENT + I-TREATMENT +El B-EVOLUTION +cuadro I-EVOLUTION +inflamatorio I-EVOLUTION +periocular I-EVOLUTION +mejoró I-EVOLUTION +notablemente I-EVOLUTION +en I-EVOLUTION +las I-EVOLUTION +primeras I-EVOLUTION +24 I-EVOLUTION +horas, I-EVOLUTION +pero I-EVOLUTION +no I-EVOLUTION +la I-EVOLUTION +agudeza I-EVOLUTION +visual, I-EVOLUTION +que I-EVOLUTION +se I-EVOLUTION +limitaba I-EVOLUTION +a I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +colores I-EVOLUTION +parcheados I-EVOLUTION +(azul, I-EVOLUTION +marrón). I-EVOLUTION + I-EVOLUTION +Transcurrida B-EXPLORATION +1 I-EXPLORATION +semana I-EXPLORATION +se I-EXPLORATION +retiró I-EXPLORATION +la I-EXPLORATION +prótesis I-EXPLORATION +lacrimonasal, I-EXPLORATION +a I-EXPLORATION +pesar I-EXPLORATION +de I-EXPLORATION +su I-EXPLORATION +buena I-EXPLORATION +localización I-EXPLORATION +y I-EXPLORATION +funcionamiento, I-EXPLORATION +haciéndose I-EXPLORATION +un I-EXPLORATION +estudio I-EXPLORATION +microbiológico I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +misma I-EXPLORATION +y I-EXPLORATION +aislándose I-EXPLORATION +tres I-EXPLORATION +gérmenes: I-EXPLORATION +Streptococcus I-EXPLORATION +mitis, I-EXPLORATION +Staphylococcus I-EXPLORATION +epidérmidis I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +bacilo I-EXPLORATION +gram I-EXPLORATION +negativo I-EXPLORATION +oxidasa I-EXPLORATION +positivo I-EXPLORATION +(sin I-EXPLORATION +determinar). I-EXPLORATION + I-EXPLORATION +Durante B-TREATMENT +la I-TREATMENT +evolución I-TREATMENT +se I-TREATMENT +desarrolló I-TREATMENT +un I-TREATMENT +piocele I-TREATMENT +que I-TREATMENT +precisó I-TREATMENT +dacriocistectomía I-TREATMENT +izquierda. I-TREATMENT + I-TREATMENT +En B-EVOLUTION +la I-EVOLUTION +actualidad I-EVOLUTION +la I-EVOLUTION +paciente I-EVOLUTION +presenta I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +OI I-EVOLUTION +una I-EVOLUTION +visión I-EVOLUTION +de I-EVOLUTION +percepción I-EVOLUTION +de I-EVOLUTION +luz, I-EVOLUTION +con I-EVOLUTION +leve I-EVOLUTION +midriasis I-EVOLUTION +arreactiva I-EVOLUTION +y I-EVOLUTION +atrofia I-EVOLUTION +óptica I-EVOLUTION +izquierda. I-EVOLUTION +En B-EXPLORATION +la I-EXPLORATION +angiografía I-EXPLORATION +fluoresceínica I-EXPLORATION +se I-EXPLORATION +observa I-EXPLORATION +hipofluorescencia I-EXPLORATION +papilar I-EXPLORATION +durante I-EXPLORATION +todo I-EXPLORATION +el I-EXPLORATION +angiograma I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +RMN I-EXPLORATION +un I-EXPLORATION +dudoso I-EXPLORATION +aumento I-EXPLORATION +de I-EXPLORATION +señal I-EXPLORATION +tardío I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +nervio I-EXPLORATION +óptico. I-EXPLORATION + I-EXPLORATION + +Mujer B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +48 I-PRESENT_ILLNESS +años I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +edad I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +artritis I-PAST_MEDICAL_HISTORY +reumatoide I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +10 I-PAST_MEDICAL_HISTORY +años I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +evolución I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +tratamiento I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +leflunomida, I-PAST_MEDICAL_HISTORY +deflazacort I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +antiinflamatorios I-PAST_MEDICAL_HISTORY +no I-PAST_MEDICAL_HISTORY +esteroideos I-PAST_MEDICAL_HISTORY +(AINEs), I-PAST_MEDICAL_HISTORY +es B-DERIVED_FROM/TO +remitida I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +Unidad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +Inflamación I-DERIVED_FROM/TO +Ocular I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +cuadro I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +ojo I-DERIVED_FROM/TO +derecho I-DERIVED_FROM/TO +rojo I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +doloroso I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +dos I-DERIVED_FROM/TO +semanas I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +evolución I-DERIVED_FROM/TO +asociado I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +empeoramiento I-DERIVED_FROM/TO +clínico I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +laboratorio I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +enfermedad I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +base. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +La B-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +inicial I-EXPLORATION +era I-EXPLORATION +de I-EXPLORATION +0, I-EXPLORATION +6 I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +(OD) I-EXPLORATION +y I-EXPLORATION +1 I-EXPLORATION +en I-EXPLORATION +ojo I-EXPLORATION +izquierdo I-EXPLORATION +(OI). I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +biomicroscopía I-EXPLORATION +destacaba I-EXPLORATION +una I-EXPLORATION +ingurgitación I-EXPLORATION +vascular I-EXPLORATION +con I-EXPLORATION +edema I-EXPLORATION +y I-EXPLORATION +engrosamiento I-EXPLORATION +escleral I-EXPLORATION +temporal I-EXPLORATION +superior I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +compatible I-EXPLORATION +con I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +escleritis I-EXPLORATION +anterior I-EXPLORATION +difusa I-EXPLORATION +severa. I-EXPLORATION +El I-EXPLORATION +resto I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +AO. I-EXPLORATION +Se B-TREATMENT +inició I-TREATMENT +tratamiento I-TREATMENT +esteroideo I-TREATMENT +oral I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +a I-TREATMENT +dosis I-TREATMENT +de I-TREATMENT +1 I-TREATMENT +mg/kg/día, I-TREATMENT +manteniendo I-TREATMENT +el I-TREATMENT +resto I-TREATMENT +del I-TREATMENT +tratamiento, I-TREATMENT +sin I-TREATMENT +obtener I-TREATMENT +mejoría I-TREATMENT +clínica I-TREATMENT +tras I-TREATMENT +tres I-TREATMENT +semanas I-TREATMENT +de I-TREATMENT +seguimiento. I-TREATMENT +Una B-EXPLORATION +vez I-EXPLORATION +realizadas I-EXPLORATION +una I-EXPLORATION +radiografía I-EXPLORATION +de I-EXPLORATION +tórax I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +test I-EXPLORATION +de I-EXPLORATION +Mantoux I-EXPLORATION +que I-EXPLORATION +fueron I-EXPLORATION +negativos, I-EXPLORATION +se B-TREATMENT +decidió I-TREATMENT +la I-TREATMENT +administración I-TREATMENT +de I-TREATMENT +Infliximab I-TREATMENT +(Remicade®, I-TREATMENT +Schering-Plough, I-TREATMENT +Welwyn I-TREATMENT +Garden I-TREATMENT +City, I-TREATMENT +UK) I-TREATMENT +en I-TREATMENT +tres I-TREATMENT +dosis I-TREATMENT +intravenosas I-TREATMENT +de I-TREATMENT +3 I-TREATMENT +mg/kg/día I-TREATMENT +en I-TREATMENT +las I-TREATMENT +semanas I-TREATMENT +0, I-TREATMENT +2 I-TREATMENT +y I-TREATMENT +6. I-TREATMENT +Tras B-EVOLUTION +la I-EVOLUTION +segunda I-EVOLUTION +dosis I-EVOLUTION +se I-EVOLUTION +objetivó I-EVOLUTION +una I-EVOLUTION +reducción I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +ingurgitación I-EVOLUTION +vascular I-EVOLUTION +y I-EVOLUTION +del I-EVOLUTION +edema I-EVOLUTION +escleral I-EVOLUTION +y I-EVOLUTION +tras I-EVOLUTION +la I-EVOLUTION +tercera I-EVOLUTION +se I-EVOLUTION +obtuvo I-EVOLUTION +una I-EVOLUTION +desaparición I-EVOLUTION +completa I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +inflamación I-EVOLUTION +escleral, I-EVOLUTION +quedando I-EVOLUTION +un I-EVOLUTION +cierto I-EVOLUTION +adelgazamiento I-EVOLUTION +residual I-EVOLUTION +con I-EVOLUTION +transparencia I-EVOLUTION +del I-EVOLUTION +tejido I-EVOLUTION +uveal I-EVOLUTION +subyacente. I-EVOLUTION +Paralelamente, I-EVOLUTION +se I-EVOLUTION +observó I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +en I-EVOLUTION +los I-EVOLUTION +signos I-EVOLUTION +y I-EVOLUTION +síntomas I-EVOLUTION +articulares, I-EVOLUTION +con I-EVOLUTION +una I-EVOLUTION +disminución I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +actividad I-EVOLUTION +global I-EVOLUTION +de I-EVOLUTION +la I-EVOLUTION +enfermedad I-EVOLUTION +representada I-EVOLUTION +por I-EVOLUTION +el I-EVOLUTION +Disease I-EVOLUTION +Activity I-EVOLUTION +Score I-EVOLUTION +(DAS I-EVOLUTION +28), I-EVOLUTION +obteniéndose I-EVOLUTION +una I-EVOLUTION +mejoría I-EVOLUTION +de I-EVOLUTION +un I-EVOLUTION +40% I-EVOLUTION +en I-EVOLUTION +el I-EVOLUTION +DAS I-EVOLUTION +28. I-EVOLUTION + I-EVOLUTION +Tras I-EVOLUTION +un I-EVOLUTION +período I-EVOLUTION +de I-EVOLUTION +seguimiento I-EVOLUTION +de I-EVOLUTION +6 I-EVOLUTION +meses I-EVOLUTION +no I-EVOLUTION +se I-EVOLUTION +han I-EVOLUTION +detectado I-EVOLUTION +recidivas I-EVOLUTION +en I-EVOLUTION +la I-EVOLUTION +inflamación I-EVOLUTION +escleral. I-EVOLUTION +La B-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +es I-EXPLORATION +de I-EXPLORATION +1 I-EXPLORATION +en I-EXPLORATION +ambos I-EXPLORATION +ojos I-EXPLORATION +(AO). I-EXPLORATION +La B-TREATMENT +paciente I-TREATMENT +sigue I-TREATMENT +en I-TREATMENT +la I-TREATMENT +actualidad I-TREATMENT +tratamiento I-TREATMENT +sistémico I-TREATMENT +únicamente I-TREATMENT +con I-TREATMENT +prednisona I-TREATMENT +7, I-TREATMENT +5 I-TREATMENT +mg/día, I-TREATMENT +leflunomida I-TREATMENT +y I-TREATMENT +AINEs. I-TREATMENT + I-TREATMENT + +Se B-PRESENT_ILLNESS +trata I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +paciente I-PRESENT_ILLNESS +masculino I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +29 I-PRESENT_ILLNESS +años, I-PRESENT_ILLNESS +con B-PAST_MEDICAL_HISTORY +antecedente I-PAST_MEDICAL_HISTORY +de I-PAST_MEDICAL_HISTORY +herida I-PAST_MEDICAL_HISTORY +corneal I-PAST_MEDICAL_HISTORY +postraumática I-PAST_MEDICAL_HISTORY +en I-PAST_MEDICAL_HISTORY +ojo I-PAST_MEDICAL_HISTORY +izquierdo I-PAST_MEDICAL_HISTORY +(OI), I-PAST_MEDICAL_HISTORY +suturada I-PAST_MEDICAL_HISTORY +el I-PAST_MEDICAL_HISTORY +mismo I-PAST_MEDICAL_HISTORY +día I-PAST_MEDICAL_HISTORY +del I-PAST_MEDICAL_HISTORY +accidente, I-PAST_MEDICAL_HISTORY +sin I-PAST_MEDICAL_HISTORY +cuerpo I-PAST_MEDICAL_HISTORY +extraño I-PAST_MEDICAL_HISTORY +intraocular, I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +tratada I-PAST_MEDICAL_HISTORY +con I-PAST_MEDICAL_HISTORY +antibióticos, I-PAST_MEDICAL_HISTORY +ciclopléjicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +esteroides I-PAST_MEDICAL_HISTORY +tópicos I-PAST_MEDICAL_HISTORY +y I-PAST_MEDICAL_HISTORY +sistémicos. I-PAST_MEDICAL_HISTORY +Al B-DERIVED_FROM/TO +suspender I-DERIVED_FROM/TO +los I-DERIVED_FROM/TO +esteroides, I-DERIVED_FROM/TO +presentó I-DERIVED_FROM/TO +disminución I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +agudeza I-DERIVED_FROM/TO +visual I-DERIVED_FROM/TO +del I-DERIVED_FROM/TO +ojo I-DERIVED_FROM/TO +no I-DERIVED_FROM/TO +traumatizado, I-DERIVED_FROM/TO +por I-DERIVED_FROM/TO +lo I-DERIVED_FROM/TO +que I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +reinició I-DERIVED_FROM/TO +la I-DERIVED_FROM/TO +administración I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +prednisona I-DERIVED_FROM/TO +vía I-DERIVED_FROM/TO +oral I-DERIVED_FROM/TO +y I-DERIVED_FROM/TO +se I-DERIVED_FROM/TO +envió I-DERIVED_FROM/TO +a I-DERIVED_FROM/TO +nuestra I-DERIVED_FROM/TO +institución I-DERIVED_FROM/TO +con I-DERIVED_FROM/TO +el I-DERIVED_FROM/TO +diagnóstico I-DERIVED_FROM/TO +de I-DERIVED_FROM/TO +oftalmía I-DERIVED_FROM/TO +simpática. I-DERIVED_FROM/TO + I-DERIVED_FROM/TO +A B-EXPLORATION +su I-EXPLORATION +ingreso, I-EXPLORATION +un I-EXPLORATION +mes I-EXPLORATION +y I-EXPLORATION +medio I-EXPLORATION +después I-EXPLORATION +del I-EXPLORATION +traumatismo, I-EXPLORATION +el I-EXPLORATION +paciente I-EXPLORATION +refería I-EXPLORATION +disminución I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +agudeza I-EXPLORATION +visual I-EXPLORATION +(AV) I-EXPLORATION +del I-EXPLORATION +ojo I-EXPLORATION +derecho I-EXPLORATION +(OD) I-EXPLORATION +de I-EXPLORATION +21 I-EXPLORATION +días I-EXPLORATION +de I-EXPLORATION +evolución I-EXPLORATION +y I-EXPLORATION +un I-EXPLORATION +escotoma I-EXPLORATION +central I-EXPLORATION +relativo I-EXPLORATION +en I-EXPLORATION +AO. I-EXPLORATION +A I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica I-EXPLORATION +se I-EXPLORATION +encontró I-EXPLORATION +una I-EXPLORATION +AV I-EXPLORATION +de I-EXPLORATION +20/60 I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +20/400 I-EXPLORATION +OI, I-EXPLORATION +presión I-EXPLORATION +intraocular I-EXPLORATION +de I-EXPLORATION +11 I-EXPLORATION +mmHg I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +12 I-EXPLORATION +mmHg I-EXPLORATION +OI. I-EXPLORATION +El I-EXPLORATION +OD I-EXPLORATION +presentaba I-EXPLORATION +además I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +pigmento I-EXPLORATION +1/2 I-EXPLORATION ++ I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cámara I-EXPLORATION +anterior, I-EXPLORATION +sin I-EXPLORATION +flare. I-EXPLORATION +El I-EXPLORATION +segmento I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +OI I-EXPLORATION +presentaba I-EXPLORATION +conjuntiva I-EXPLORATION +hiperémica, I-EXPLORATION +herida I-EXPLORATION +corneal I-EXPLORATION +suturada I-EXPLORATION +con I-EXPLORATION +leucoma I-EXPLORATION +temporal, I-EXPLORATION +sinequias I-EXPLORATION +posteriores I-EXPLORATION +y I-EXPLORATION +opacidad I-EXPLORATION +subcapsular I-EXPLORATION +posterior I-EXPLORATION ++. I-EXPLORATION +La I-EXPLORATION +funduscopia I-EXPLORATION +del I-EXPLORATION +OD I-EXPLORATION +mostraba I-EXPLORATION +pliegues I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +mácula I-EXPLORATION +y I-EXPLORATION +dos I-EXPLORATION +lesiones I-EXPLORATION +blanco I-EXPLORATION +amarillentas I-EXPLORATION +con I-EXPLORATION +líquido I-EXPLORATION +subretiniano; I-EXPLORATION +el I-EXPLORATION +OI I-EXPLORATION +tenía I-EXPLORATION +tres I-EXPLORATION +lesiones I-EXPLORATION +de I-EXPLORATION +características I-EXPLORATION +similares, I-EXPLORATION +sin I-EXPLORATION +signos I-EXPLORATION +de I-EXPLORATION +panuveítis I-EXPLORATION +bilateral. I-EXPLORATION +El B-TREATMENT +tratamiento I-TREATMENT +que I-TREATMENT +recibía I-TREATMENT +consistía I-TREATMENT +en I-TREATMENT +prednisona I-TREATMENT +75 I-TREATMENT +mg/día I-TREATMENT +po, I-TREATMENT +acetato I-TREATMENT +de I-TREATMENT +prednisolona I-TREATMENT +1% I-TREATMENT +cada I-TREATMENT +2 I-TREATMENT +h, I-TREATMENT +ciclopentolato I-TREATMENT +1% I-TREATMENT +bid, I-TREATMENT +fenilefrina I-TREATMENT +10% I-TREATMENT +bid. I-TREATMENT + I-TREATMENT +El B-EXPLORATION +aspecto I-EXPLORATION +clínico I-EXPLORATION +hizo I-EXPLORATION +sospechar I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +CSC. I-EXPLORATION +Se I-EXPLORATION +solicitaron I-EXPLORATION +ecografía I-EXPLORATION +y I-EXPLORATION +estudio I-EXPLORATION +angiográfico. I-EXPLORATION +La I-EXPLORATION +ecografía I-EXPLORATION +evidenció I-EXPLORATION +un I-EXPLORATION +desprendimiento I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +hialoides I-EXPLORATION +posterior I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +DRS I-EXPLORATION +en I-EXPLORATION +área I-EXPLORATION +macular I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OI; I-EXPLORATION +el I-EXPLORATION +grosor I-EXPLORATION +coroideo I-EXPLORATION +era I-EXPLORATION +normal I-EXPLORATION +en I-EXPLORATION +AO. I-EXPLORATION +El I-EXPLORATION +estudio I-EXPLORATION +angiográfico I-EXPLORATION +mostró I-EXPLORATION +dos I-EXPLORATION +zonas I-EXPLORATION +de I-EXPLORATION +hiperfluorescencia I-EXPLORATION +que I-EXPLORATION +aumentaban I-EXPLORATION +progresivamente I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OD I-EXPLORATION +y I-EXPLORATION +tres I-EXPLORATION +lesiones I-EXPLORATION +similares I-EXPLORATION +en I-EXPLORATION +el I-EXPLORATION +OI. I-EXPLORATION + I-EXPLORATION +El I-EXPLORATION +diagnóstico I-EXPLORATION +definitivo I-EXPLORATION +fue I-EXPLORATION +de I-EXPLORATION +CSC I-EXPLORATION +bilateral I-EXPLORATION +de I-EXPLORATION +focos I-EXPLORATION +múltiples. I-EXPLORATION +Se B-TREATMENT +suspendió I-TREATMENT +el I-TREATMENT +tratamiento I-TREATMENT +con I-TREATMENT +ciclopléjicos I-TREATMENT +y I-TREATMENT +se I-TREATMENT +redujeron I-TREATMENT +rápidamente I-TREATMENT +los I-TREATMENT +esteroides I-TREATMENT +tópicos I-TREATMENT +y I-TREATMENT +sistémicos. I-TREATMENT +Un B-EVOLUTION +mes I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +la I-EVOLUTION +agudeza I-EVOLUTION +visual I-EVOLUTION +era I-EVOLUTION +de I-EVOLUTION +1 I-EVOLUTION +OD I-EVOLUTION +y I-EVOLUTION +0, I-EVOLUTION +2 I-EVOLUTION +OI; I-EVOLUTION +el I-EVOLUTION +aspecto I-EVOLUTION +clínico I-EVOLUTION +del I-EVOLUTION +fondo I-EVOLUTION +de I-EVOLUTION +ojo I-EVOLUTION +mostraba I-EVOLUTION +las I-EVOLUTION +lesiones I-EVOLUTION +pigmentadas I-EVOLUTION +sin I-EVOLUTION +líquido I-EVOLUTION +subretiniano I-EVOLUTION +en I-EVOLUTION +AO. I-EVOLUTION + I-EVOLUTION + +Niño B-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +20 I-PRESENT_ILLNESS +meses I-PRESENT_ILLNESS +enviado I-PRESENT_ILLNESS +para I-PRESENT_ILLNESS +evaluar I-PRESENT_ILLNESS +un I-PRESENT_ILLNESS +exoftalmos I-PRESENT_ILLNESS +en I-PRESENT_ILLNESS +el I-PRESENT_ILLNESS +ojo I-PRESENT_ILLNESS +derecho I-PRESENT_ILLNESS +(OD) I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +6 I-PRESENT_ILLNESS +semanas I-PRESENT_ILLNESS +de I-PRESENT_ILLNESS +evolución. I-PRESENT_ILLNESS +En B-EXPLORATION +la I-EXPLORATION +primera I-EXPLORATION +visita I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +pediátrica I-EXPLORATION +general I-EXPLORATION +era I-EXPLORATION +buena I-EXPLORATION +y I-EXPLORATION +no I-EXPLORATION +presentó I-EXPLORATION +anomalías I-EXPLORATION +neurológicas. I-EXPLORATION +En I-EXPLORATION +la I-EXPLORATION +exploración I-EXPLORATION +oftalmológica, I-EXPLORATION +se I-EXPLORATION +apreciaba I-EXPLORATION +proptosis I-EXPLORATION +e I-EXPLORATION +hipertropia I-EXPLORATION +del I-EXPLORATION +OD I-EXPLORATION +con I-EXPLORATION +franca I-EXPLORATION +asimetría I-EXPLORATION +facial. I-EXPLORATION +Con I-EXPLORATION +la I-EXPLORATION +palpación I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +región I-EXPLORATION +fronto-temporal I-EXPLORATION +el I-EXPLORATION +niño I-EXPLORATION +tenía I-EXPLORATION +dolor. I-EXPLORATION +El I-EXPLORATION +segmento I-EXPLORATION +anterior I-EXPLORATION +del I-EXPLORATION +OD I-EXPLORATION +explorado I-EXPLORATION +con I-EXPLORATION +linterna I-EXPLORATION +era I-EXPLORATION +aparentemente I-EXPLORATION +normal. I-EXPLORATION +La I-EXPLORATION +motilidad I-EXPLORATION +intrínseca I-EXPLORATION +fue I-EXPLORATION +normal I-EXPLORATION +mientras I-EXPLORATION +la I-EXPLORATION +motilidad I-EXPLORATION +extrínseca I-EXPLORATION +presentaba I-EXPLORATION +limitación I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +abducción I-EXPLORATION +y I-EXPLORATION +descenso I-EXPLORATION +del I-EXPLORATION +OD. I-EXPLORATION +La I-EXPLORATION +resonancia I-EXPLORATION +magnética I-EXPLORATION +nuclear I-EXPLORATION +(RMN) I-EXPLORATION +demostró I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +infiltrante I-EXPLORATION +que I-EXPLORATION +desplazaba I-EXPLORATION +el I-EXPLORATION +globo I-EXPLORATION +ocular I-EXPLORATION +hacia I-EXPLORATION +arriba I-EXPLORATION +con I-EXPLORATION +destrucción I-EXPLORATION +de I-EXPLORATION +la I-EXPLORATION +pared I-EXPLORATION +orbitaria I-EXPLORATION +lateral I-EXPLORATION +y I-EXPLORATION +múltiples I-EXPLORATION +lesiones I-EXPLORATION +en I-EXPLORATION +sacabocado I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +calota I-EXPLORATION +craneal. I-EXPLORATION +Otros I-EXPLORATION +estudios I-EXPLORATION +radiológicos I-EXPLORATION +demostraron I-EXPLORATION +lesiones I-EXPLORATION +semejantes I-EXPLORATION +en I-EXPLORATION +las I-EXPLORATION +vértebras I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +los I-EXPLORATION +huesos I-EXPLORATION +largos I-EXPLORATION +de I-EXPLORATION +las I-EXPLORATION +piernas. I-EXPLORATION +Las I-EXPLORATION +pruebas I-EXPLORATION +hematológicas I-EXPLORATION +y I-EXPLORATION +bioquímicas I-EXPLORATION +mostraron I-EXPLORATION +valores I-EXPLORATION +normales. I-EXPLORATION +Una I-EXPLORATION +biopsia I-EXPLORATION +ósea I-EXPLORATION +del I-EXPLORATION +fémur I-EXPLORATION +demostró I-EXPLORATION +células I-EXPLORATION +de I-EXPLORATION +Langerhans I-EXPLORATION +con I-EXPLORATION +infiltrado I-EXPLORATION +inflamatorio I-EXPLORATION +y I-EXPLORATION +el I-EXPLORATION +estudio I-EXPLORATION +immunohistológico I-EXPLORATION +para I-EXPLORATION +la I-EXPLORATION +proteína I-EXPLORATION +S100 I-EXPLORATION +(indica I-EXPLORATION +su I-EXPLORATION +origen I-EXPLORATION +en I-EXPLORATION +la I-EXPLORATION +cresta I-EXPLORATION +neural) I-EXPLORATION +y I-EXPLORATION +para I-EXPLORATION +las I-EXPLORATION +proteínas I-EXPLORATION +de I-EXPLORATION +superficie I-EXPLORATION +CD68 I-EXPLORATION +(proteína I-EXPLORATION +lisosomal I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +expresa I-EXPLORATION +en I-EXPLORATION +macrófagos I-EXPLORATION +y I-EXPLORATION +en I-EXPLORATION +células I-EXPLORATION +dendríticas I-EXPLORATION +inmaduras) I-EXPLORATION +y I-EXPLORATION +CD1a I-EXPLORATION +(glicoproteína I-EXPLORATION +de I-EXPLORATION +membrana I-EXPLORATION +de I-EXPLORATION +49 I-EXPLORATION +KDa I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +expresa I-EXPLORATION +en I-EXPLORATION +asociación I-EXPLORATION +a I-EXPLORATION +ß2 I-EXPLORATION +microglobulinas) I-EXPLORATION +confirmó I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +histiocitosis I-EXPLORATION +de I-EXPLORATION +Langerhans. I-EXPLORATION +Dos B-EVOLUTION +meses I-EVOLUTION +más I-EVOLUTION +tarde I-EVOLUTION +el I-EVOLUTION +niño I-EVOLUTION +estaba I-EVOLUTION +hipersomnoliento I-EVOLUTION +día I-EVOLUTION +y I-EVOLUTION +noche I-EVOLUTION +con I-EVOLUTION +ingesta I-EVOLUTION +excesiva I-EVOLUTION +de I-EVOLUTION +líquidos. I-EVOLUTION +En B-EXPLORATION +una I-EXPLORATION +nueva I-EXPLORATION +RMN I-EXPLORATION +se I-EXPLORATION +apreció I-EXPLORATION +una I-EXPLORATION +lesión I-EXPLORATION +infiltrante I-EXPLORATION +que I-EXPLORATION +afectaba I-EXPLORATION +a I-EXPLORATION +la I-EXPLORATION +zona I-EXPLORATION +hipotálamo-hipofisaria I-EXPLORATION +con I-EXPLORATION +lo I-EXPLORATION +que I-EXPLORATION +se I-EXPLORATION +añadió I-EXPLORATION +el I-EXPLORATION +diagnóstico I-EXPLORATION +de I-EXPLORATION +diabetes I-EXPLORATION +insípida. I-EXPLORATION + I-EXPLORATION \ No newline at end of file