Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 69 I-PRESENT_ILLNESS a. I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS con B-EXPLORATION un I-EXPLORATION PSA I-EXPLORATION en I-EXPLORATION el I-EXPLORATION momento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION consulta I-EXPLORATION de I-EXPLORATION 22 I-EXPLORATION ng/ml. I-EXPLORATION El B-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY tenía I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY previa I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY sextantes I-PAST_MEDICAL_HISTORY negativa. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION practicó I-EXPLORATION una I-EXPLORATION E-RME I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION inicialmente I-EXPLORATION un I-EXPLORATION nódulo I-EXPLORATION situado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION base I-EXPLORATION prostática I-EXPLORATION del I-EXPLORATION lóbulo I-EXPLORATION izquierdo, I-EXPLORATION morfológicamente I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION hiperplasia I-EXPLORATION nodular, I-EXPLORATION pero I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION espectroscópico I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION alteración I-EXPLORATION metabólica I-EXPLORATION de I-EXPLORATION este I-EXPLORATION nódulo, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION colina I-EXPLORATION y I-EXPLORATION una I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION citrato, I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION neoplasia. I-EXPLORATION I-EXPLORATION Un B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 19 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS acudió I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencias I-PRESENT_ILLNESS tras I-PRESENT_ILLNESS un I-PRESENT_ILLNESS accidente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tráfico I-PRESENT_ILLNESS en I-PRESENT_ILLNESS vehículo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS motor. I-PRESENT_ILLNESS No B-PAST_MEDICAL_HISTORY presentaba I-PAST_MEDICAL_HISTORY ningún I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY urológico. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS aquejaba I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS severo. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION Glasgow I-EXPLORATION de I-EXPLORATION 15 I-EXPLORATION puntos, I-EXPLORATION palpando I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION dolorosa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION hipocondrio/flanco I-EXPLORATION izquierdo I-EXPLORATION junto I-EXPLORATION con I-EXPLORATION importante I-EXPLORATION distensión I-EXPLORATION abdominal. I-EXPLORATION Presentaba I-EXPLORATION macrohematuria I-EXPLORATION a I-EXPLORATION la I-EXPLORATION micción I-EXPLORATION espontánea. I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION mantuvo I-EXPLORATION hemodinamicamente I-EXPLORATION estable I-EXPLORATION en I-EXPLORATION todo I-EXPLORATION momento, I-EXPLORATION pero I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION inicial I-EXPLORATION el I-EXPLORATION hematocrito I-EXPLORATION cayó I-EXPLORATION 10 I-EXPLORATION puntos. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computerizada I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION (TC) I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION riñón I-EXPLORATION en I-EXPLORATION herradura I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fractura I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION unión I-EXPLORATION entre I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION inferior I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION istmo, I-EXPLORATION mostrando I-EXPLORATION hemorragia I-EXPLORATION activa I-EXPLORATION y I-EXPLORATION extenso I-EXPLORATION hematoma I-EXPLORATION retroperitoneal I-EXPLORATION (10x7x23 I-EXPLORATION cm) I-EXPLORATION con I-EXPLORATION ocupación I-EXPLORATION pélvica, I-EXPLORATION desplazando I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION el I-EXPLORATION intestino. I-EXPLORATION Los I-EXPLORATION cortes I-EXPLORATION retardados I-EXPLORATION mostraron I-EXPLORATION extravasación I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION importante I-EXPLORATION urinoma. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION arteriografía I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION doble I-EXPLORATION pedículo I-EXPLORATION para I-EXPLORATION cada I-EXPLORATION riñón I-EXPLORATION y I-EXPLORATION un I-EXPLORATION tronco I-EXPLORATION lumbo-renal I-EXPLORATION distal I-EXPLORATION común I-EXPLORATION que I-EXPLORATION daba I-EXPLORATION ramas I-EXPLORATION accesorias I-EXPLORATION a I-EXPLORATION los I-EXPLORATION polos I-EXPLORATION inferiores I-EXPLORATION de I-EXPLORATION ambos I-EXPLORATION riñones I-EXPLORATION y I-EXPLORATION al I-EXPLORATION istmo I-EXPLORATION con I-EXPLORATION extravasación I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION sangrado I-EXPLORATION activo. I-EXPLORATION Se B-TREATMENT cateterizó I-TREATMENT selectivamente I-TREATMENT el I-TREATMENT tronco I-TREATMENT lumbo-renal, I-TREATMENT accediendo I-TREATMENT a I-TREATMENT la I-TREATMENT rama I-TREATMENT del I-TREATMENT riñón I-TREATMENT izquierdo I-TREATMENT e I-TREATMENT istmo I-TREATMENT permitiendo I-TREATMENT su I-TREATMENT embolización I-TREATMENT con I-TREATMENT partículas I-TREATMENT de I-TREATMENT polivinilo I-TREATMENT alcohol, I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT inmediatas. I-TREATMENT Se I-TREATMENT cateterizó I-TREATMENT la I-TREATMENT vía I-TREATMENT urinaria I-TREATMENT retrógradamente I-TREATMENT con I-TREATMENT un I-TREATMENT catéter I-TREATMENT ureteral I-TREATMENT recto I-TREATMENT para I-TREATMENT facilitar I-TREATMENT el I-TREATMENT drenaje I-TREATMENT del I-TREATMENT urinoma. I-TREATMENT I-TREATMENT En B-EVOLUTION los I-EVOLUTION días I-EVOLUTION posteriores, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION asintomático I-EVOLUTION con I-EVOLUTION una I-EVOLUTION completa I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION la I-EVOLUTION hematuria, I-EVOLUTION con I-EVOLUTION hematocritos I-EVOLUTION estables I-EVOLUTION y I-EVOLUTION una I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION que I-EVOLUTION mostró I-EVOLUTION ausencia I-EVOLUTION de I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION hemorragia, I-EVOLUTION con I-EVOLUTION completa I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION urinoma I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION de I-EVOLUTION fuga I-EVOLUTION urinaria, I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT retiró I-TREATMENT el I-TREATMENT tutor I-TREATMENT ureteral. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 3 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION la I-EVOLUTION embolización, I-EVOLUTION el I-EVOLUTION TC I-EVOLUTION de I-EVOLUTION control I-EVOLUTION demostró I-EVOLUTION una I-EVOLUTION completa I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION hematoma. I-EVOLUTION No I-EVOLUTION presentó I-EVOLUTION complicaciones I-EVOLUTION tardías, I-EVOLUTION manteniendo I-EVOLUTION un I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION y I-EVOLUTION una I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION completamente I-EVOLUTION normales I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 12 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Varón 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 que B-PRESENT_ILLNESS acude I-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 dolor I-PRESENT_ILLNESS testicular I-PRESENT_ILLNESS bilateral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 4 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La B-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION es I-EXPLORATION normal I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION escrotal I-EXPLORATION realizada I-EXPLORATION con I-EXPLORATION un I-EXPLORATION transductor I-EXPLORATION de I-EXPLORATION alta I-EXPLORATION frecuencia I-EXPLORATION (10 I-EXPLORATION Mhz) I-EXPLORATION pone I-EXPLORATION de I-EXPLORATION manifiesto I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION MT I-EXPLORATION bilateral. I-EXPLORATION Debido B-TREATMENT a I-TREATMENT la I-TREATMENT no I-TREATMENT existencia I-TREATMENT de I-TREATMENT factores I-TREATMENT de I-TREATMENT riesgo I-TREATMENT (criptorquidia, I-TREATMENT atrofia, I-TREATMENT infertilidad, I-TREATMENT neoplasia I-TREATMENT intratubular I-TREATMENT de I-TREATMENT células I-TREATMENT germinales, I-TREATMENT disgenesia I-TREATMENT gonadal, I-TREATMENT tumor I-TREATMENT testicular I-TREATMENT contralateral, I-TREATMENT administración I-TREATMENT exógena I-TREATMENT de I-TREATMENT estrógenos) I-TREATMENT se I-TREATMENT decide I-TREATMENT seguimiento I-TREATMENT con I-TREATMENT autoexploración I-TREATMENT física I-TREATMENT mensual I-TREATMENT y I-TREATMENT valoración I-TREATMENT urológica I-TREATMENT con I-TREATMENT ecografía I-TREATMENT escrotal I-TREATMENT anual, I-TREATMENT sin I-TREATMENT realización I-TREATMENT de I-TREATMENT biopsia. I-TREATMENT A B-EVOLUTION los I-EVOLUTION 4 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION desarrollado I-EVOLUTION un I-EVOLUTION tumor I-EVOLUTION invasivo I-EVOLUTION de I-EVOLUTION células I-EVOLUTION germinales. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 76 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS varón, I-PRESENT_ILLNESS blanco, I-PRESENT_ILLNESS antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nefrectomía I-PAST_MEDICAL_HISTORY derecha I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY litiasis I-PAST_MEDICAL_HISTORY coraliforme I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dicho I-PAST_MEDICAL_HISTORY riñón, I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY (HTA), I-PAST_MEDICAL_HISTORY fumador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3-4 I-PAST_MEDICAL_HISTORY puros I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día. I-PAST_MEDICAL_HISTORY Comienza B-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS ascendente, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS notando I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS urinario, I-PRESENT_ILLNESS es I-PRESENT_ILLNESS traído I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia I-PRESENT_ILLNESS por I-PRESENT_ILLNESS los I-PRESENT_ILLNESS familiares I-PRESENT_ILLNESS porque I-PRESENT_ILLNESS hace I-PRESENT_ILLNESS varios I-PRESENT_ILLNESS días I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS orina, I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS anorexia. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION constata I-EXPLORATION sequedad I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas, I-EXPLORATION auscultación I-EXPLORATION cardíaca: I-EXPLORATION ruidos I-EXPLORATION cardíacos I-EXPLORATION taquicárdicos, I-EXPLORATION tensión I-EXPLORATION arterial I-EXPLORATION 165/ I-EXPLORATION 90, I-EXPLORATION abdomen I-EXPLORATION blando, I-EXPLORATION ligeramente I-EXPLORATION distendido, I-EXPLORATION doloroso I-EXPLORATION a I-EXPLORATION la I-EXPLORATION palpación I-EXPLORATION difusamente, I-EXPLORATION dolor I-EXPLORATION a I-EXPLORATION la I-EXPLORATION compresión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION fosa I-EXPLORATION lumbar I-EXPLORATION izquierda, I-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION próstata I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION superficie I-EXPLORATION regular, I-EXPLORATION bien I-EXPLORATION delimitada, I-EXPLORATION fibroadenomatosa, I-EXPLORATION grado I-EXPLORATION II, I-EXPLORATION genitales I-EXPLORATION externos I-EXPLORATION normales, I-EXPLORATION meato I-EXPLORATION uretral I-EXPLORATION amplio. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION sanguínea I-EXPLORATION destaca I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION sérica I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION ng/ml. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION ecografía I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION hidronefrosis I-EXPLORATION (H) I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION (RI) I-EXPLORATION por I-EXPLORATION compresión I-EXPLORATION del I-EXPLORATION uréter I-EXPLORATION izquierdo I-EXPLORATION por I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION (T?) I-EXPLORATION posiblemente I-EXPLORATION aneurismática I-EXPLORATION izquierda, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION con I-EXPLORATION la I-EXPLORATION toma I-EXPLORATION de I-EXPLORATION otras I-EXPLORATION vistas I-EXPLORATION ecográficas, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION arteriografía I-EXPLORATION traslumbar I-EXPLORATION detectándose I-EXPLORATION aneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION ilíaca I-EXPLORATION externa I-EXPLORATION izquierda, I-EXPLORATION que I-EXPLORATION compromete I-EXPLORATION y I-EXPLORATION desplaza I-EXPLORATION hacia I-EXPLORATION fuera I-EXPLORATION al I-EXPLORATION uréter I-EXPLORATION izquierdo, I-EXPLORATION por B-TREATMENT todo I-TREATMENT lo I-TREATMENT anterior I-TREATMENT se I-TREATMENT decide I-TREATMENT realizar I-TREATMENT nefrostomía I-TREATMENT derivativa I-TREATMENT izquierda I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT se I-TREATMENT interconsulta I-TREATMENT con I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Angiología I-TREATMENT los I-TREATMENT que I-TREATMENT realizaron I-TREATMENT reparación I-TREATMENT del I-TREATMENT aneurisma. I-TREATMENT Evolucionó B-EVOLUTION satisfactoriamente, I-EVOLUTION con I-EVOLUTION retirada I-EVOLUTION de I-EVOLUTION la I-EVOLUTION nefrostomía I-EVOLUTION y I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION anuria I-EVOLUTION obstructiva. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS varón I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 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 de I-PAST_MEDICAL_HISTORY interés I-PAST_MEDICAL_HISTORY acude B-PRESENT_ILLNESS a I-PRESENT_ILLNESS consultas I-PRESENT_ILLNESS externas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS bulto I-PRESENT_ILLNESS peneano I-PRESENT_ILLNESS ventral I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 12 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS crecimiento I-PRESENT_ILLNESS progresivo. I-PRESENT_ILLNESS El I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS refiere I-PRESENT_ILLNESS salida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS material I-PRESENT_ILLNESS blanquecino I-PRESENT_ILLNESS por I-PRESENT_ILLNESS meato I-PRESENT_ILLNESS uretral I-PRESENT_ILLNESS al I-PRESENT_ILLNESS comprimir I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lesión, I-PRESENT_ILLNESS logrando I-PRESENT_ILLNESS una I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS disminución I-PRESENT_ILLNESS del I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS tensión I-PRESENT_ILLNESS del I-PRESENT_ILLNESS nódulo, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS miccional I-PRESENT_ILLNESS acompañante I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS poco I-PRESENT_ILLNESS confortable I-PRESENT_ILLNESS en I-PRESENT_ILLNESS las I-PRESENT_ILLNESS relaciones I-PRESENT_ILLNESS sexuales. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION se I-EXPLORATION observa I-EXPLORATION nódulo I-EXPLORATION elástico I-EXPLORATION esferoidal I-EXPLORATION parauretral I-EXPLORATION subglandar I-EXPLORATION ventral I-EXPLORATION lateralizado I-EXPLORATION a I-EXPLORATION la I-EXPLORATION derecha, I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION móvil I-EXPLORATION y I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION quística. I-EXPLORATION I-EXPLORATION Como I-EXPLORATION exploraciones I-EXPLORATION complementarias I-EXPLORATION se I-EXPLORATION le I-EXPLORATION realizan: I-EXPLORATION I-EXPLORATION - I-EXPLORATION Resonancia I-EXPLORATION magnética I-EXPLORATION nuclear: I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION características I-EXPLORATION quísticas I-EXPLORATION de I-EXPLORATION 2x2x1, I-EXPLORATION 8cm I-EXPLORATION basal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION extremo I-EXPLORATION distal I-EXPLORATION del I-EXPLORATION pene I-EXPLORATION con I-EXPLORATION compresión I-EXPLORATION y I-EXPLORATION distorsión I-EXPLORATION del I-EXPLORATION cuerpo I-EXPLORATION cavernoso I-EXPLORATION del I-EXPLORATION lado I-EXPLORATION derecho. I-EXPLORATION Se I-EXPLORATION observa I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION fina I-EXPLORATION línea I-EXPLORATION hiperintensa, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION dirige I-EXPLORATION a I-EXPLORATION contactar I-EXPLORATION con I-EXPLORATION la I-EXPLORATION uretra I-EXPLORATION anterior I-EXPLORATION peneana I-EXPLORATION con I-EXPLORATION posible I-EXPLORATION comunicación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION imagen I-EXPLORATION quística I-EXPLORATION con I-EXPLORATION la I-EXPLORATION uretra. I-EXPLORATION I-EXPLORATION - I-EXPLORATION Uretrografía I-EXPLORATION retrógrada I-EXPLORATION y I-EXPLORATION miccional: I-EXPLORATION con I-EXPLORATION canal I-EXPLORATION uretral I-EXPLORATION anterior I-EXPLORATION normal. I-EXPLORATION Elongación I-EXPLORATION uretra-prostática. I-EXPLORATION Vejiga I-EXPLORATION trabeculada I-EXPLORATION con I-EXPLORATION apertura I-EXPLORATION correcta I-EXPLORATION del I-EXPLORATION cuello I-EXPLORATION vesical I-EXPLORATION y I-EXPLORATION paso I-EXPLORATION fácil I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION por I-EXPLORATION toda I-EXPLORATION la I-EXPLORATION uretra. I-EXPLORATION Ausencia I-EXPLORATION de I-EXPLORATION residuo I-EXPLORATION potmiccional. I-EXPLORATION I-EXPLORATION Se B-TREATMENT decide I-TREATMENT intervención I-TREATMENT quirúrgica I-TREATMENT con I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT formación I-TREATMENT quística I-TREATMENT muy I-TREATMENT fija I-TREATMENT a I-TREATMENT cuerpo I-TREATMENT cavernoso I-TREATMENT derecho I-TREATMENT sin I-TREATMENT observar I-TREATMENT comunicación I-TREATMENT alguna I-TREATMENT con I-TREATMENT uretra, I-TREATMENT pero I-TREATMENT con I-TREATMENT clara I-TREATMENT dependencia I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT Al I-TREATMENT abrir I-TREATMENT el I-TREATMENT quiste I-TREATMENT sale I-TREATMENT un I-TREATMENT material I-TREATMENT líquido I-TREATMENT color I-TREATMENT blanquecino, I-TREATMENT no I-TREATMENT maloliente I-TREATMENT y I-TREATMENT con I-TREATMENT detritus. I-TREATMENT I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION tejido I-EXPLORATION conectivo I-EXPLORATION con I-EXPLORATION ligero I-EXPLORATION infiltrado I-EXPLORATION mononuclear, I-EXPLORATION revestido I-EXPLORATION por I-EXPLORATION epitelio I-EXPLORATION escamoso I-EXPLORATION queratinizante. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION actualmente I-EVOLUTION está I-EVOLUTION asintomático, I-EVOLUTION con I-EVOLUTION micción I-EVOLUTION correcta I-EVOLUTION y I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION erecciones I-EVOLUTION normales I-EVOLUTION y I-EVOLUTION satisfactorias. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 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 adenocarcinoma I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY próstata I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY bloqueo I-PAST_MEDICAL_HISTORY androgénico I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY radioterapia. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION año I-EXPLORATION siguiente I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION mediante I-EXPLORATION exploración I-EXPLORATION física I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION extratesticular I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION saco I-EXPLORATION escrotal I-EXPLORATION derecho. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION T.A.C. I-EXPLORATION se I-EXPLORATION demuestra I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION masa I-EXPLORATION sólida I-EXPLORATION extratesticular I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION saco I-EXPLORATION escrotal I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION componente I-EXPLORATION graso I-EXPLORATION y I-EXPLORATION otro I-EXPLORATION componente I-EXPLORATION de I-EXPLORATION densidad I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas.. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS masculino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de B-PAST_MEDICAL_HISTORY edad, I-PAST_MEDICAL_HISTORY procedencia I-PAST_MEDICAL_HISTORY urbana I-PAST_MEDICAL_HISTORY (campesino) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY raza I-PAST_MEDICAL_HISTORY blanca. I-PAST_MEDICAL_HISTORY Que B-PRESENT_ILLNESS acude I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestra I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS genitales. I-PRESENT_ILLNESS Tiene B-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY haber I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 26 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY lesión I-PAST_MEDICAL_HISTORY maligna I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pene I-PAST_MEDICAL_HISTORY (carcinoma I-PAST_MEDICAL_HISTORY epidermoide), I-PAST_MEDICAL_HISTORY realizándole I-PAST_MEDICAL_HISTORY amputación I-PAST_MEDICAL_HISTORY parcial I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pene I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY vaciamiento I-PAST_MEDICAL_HISTORY linfático I-PAST_MEDICAL_HISTORY inguinal I-PAST_MEDICAL_HISTORY bilateral. I-PAST_MEDICAL_HISTORY Pocos B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS después I-PRESENT_ILLNESS comienza I-PRESENT_ILLNESS a I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS genitales, I-PRESENT_ILLNESS tanto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS bolsas I-PRESENT_ILLNESS escrotales I-PRESENT_ILLNESS como I-PRESENT_ILLNESS del I-PRESENT_ILLNESS pene. I-PRESENT_ILLNESS Por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS nivel I-PRESENT_ILLNESS escolar I-PRESENT_ILLNESS y I-PRESENT_ILLNESS la I-PRESENT_ILLNESS lejanía I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS vivienda I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS servicios I-PRESENT_ILLNESS médicos, I-PRESENT_ILLNESS sumados I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS despreocupación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS sus I-PRESENT_ILLNESS familiares, I-PRESENT_ILLNESS hacen I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS acuda I-PRESENT_ILLNESS a I-PRESENT_ILLNESS consulta, I-PRESENT_ILLNESS viviendo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esta I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS mucho I-PRESENT_ILLNESS tiempo, I-PRESENT_ILLNESS refiriendo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS no I-PRESENT_ILLNESS presentaba I-PRESENT_ILLNESS trastornos I-PRESENT_ILLNESS para I-PRESENT_ILLNESS orinar, I-PRESENT_ILLNESS ni I-PRESENT_ILLNESS dolor, I-PRESENT_ILLNESS sólo I-PRESENT_ILLNESS un I-PRESENT_ILLNESS gran I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS genitales I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS imposibilitaba I-PRESENT_ILLNESS deambular, I-PRESENT_ILLNESS pues I-PRESENT_ILLNESS le I-PRESENT_ILLNESS llegaba I-PRESENT_ILLNESS casi I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS las I-PRESENT_ILLNESS rodillas. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Examen B-EXPLORATION Físico: I-EXPLORATION I-EXPLORATION Se I-EXPLORATION encuentra I-EXPLORATION gran I-EXPLORATION tumoración I-EXPLORATION genital I-EXPLORATION que I-EXPLORATION comprende I-EXPLORATION ambas I-EXPLORATION bolsas I-EXPLORATION escrotales I-EXPLORATION y I-EXPLORATION el I-EXPLORATION pene, I-EXPLORATION este I-EXPLORATION ultimo I-EXPLORATION había I-EXPLORATION sido I-EXPLORATION amputado I-EXPLORATION parcialmente I-EXPLORATION y I-EXPLORATION presentaba I-EXPLORATION una I-EXPLORATION circunferencia I-EXPLORATION de I-EXPLORATION ochos I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION dividido I-EXPLORATION en I-EXPLORATION dos I-EXPLORATION grandes I-EXPLORATION labios, I-EXPLORATION gruesos I-EXPLORATION y I-EXPLORATION duros, I-EXPLORATION que I-EXPLORATION al I-EXPLORATION separarlos I-EXPLORATION dejaba I-EXPLORATION ver I-EXPLORATION la I-EXPLORATION uretra. I-EXPLORATION Todo I-EXPLORATION esto I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION gran I-EXPLORATION volumen I-EXPLORATION escrotal I-EXPLORATION de I-EXPLORATION cerca I-EXPLORATION de I-EXPLORATION cuarenta I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION transversal, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION piel I-EXPLORATION muy I-EXPLORATION gruesa, I-EXPLORATION rugosa, I-EXPLORATION de I-EXPLORATION diferentes I-EXPLORATION colores I-EXPLORATION desde I-EXPLORATION amarillo I-EXPLORATION grisáceo I-EXPLORATION hasta I-EXPLORATION zonas I-EXPLORATION violáceas, I-EXPLORATION característico I-EXPLORATION de I-EXPLORATION la I-EXPLORATION piel I-EXPLORATION de I-EXPLORATION un I-EXPLORATION paquidermo. I-EXPLORATION En I-EXPLORATION su I-EXPLORATION parte I-EXPLORATION superior I-EXPLORATION se I-EXPLORATION estrechaba I-EXPLORATION de I-EXPLORATION donde I-EXPLORATION colgaba I-EXPLORATION el I-EXPLORATION resto. I-EXPLORATION I-EXPLORATION Regiones I-EXPLORATION inguinales I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Miembros I-EXPLORATION inferiores I-EXPLORATION normales, I-EXPLORATION no I-EXPLORATION edemas. I-EXPLORATION Complementarios: I-EXPLORATION Hematológicos, I-EXPLORATION normales. I-EXPLORATION Imagenológicos: I-EXPLORATION Radiológicos. I-EXPLORATION Radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION pelvis I-EXPLORATION ósea I-EXPLORATION (masa I-EXPLORATION de I-EXPLORATION bordes I-EXPLORATION bien I-EXPLORATION definidos, I-EXPLORATION sin I-EXPLORATION calcificaciones I-EXPLORATION en I-EXPLORATION su I-EXPLORATION interior). I-EXPLORATION I-EXPLORATION Ultrasonográficos I-EXPLORATION y I-EXPLORATION Tomografía I-EXPLORATION (No I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION actividad I-EXPLORATION tumoral). I-EXPLORATION I-EXPLORATION Material B-TREATMENT y I-TREATMENT método I-TREATMENT I-TREATMENT En I-TREATMENT estas I-TREATMENT condiciones I-TREATMENT se I-TREATMENT decide I-TREATMENT llevar I-TREATMENT al I-TREATMENT paciente I-TREATMENT al I-TREATMENT quirófano I-TREATMENT y I-TREATMENT bajo I-TREATMENT anestesia I-TREATMENT general, I-TREATMENT se I-TREATMENT realiza I-TREATMENT previamente I-TREATMENT cistostomía I-TREATMENT suprapúbica I-TREATMENT e I-TREATMENT inmediatamente I-TREATMENT la I-TREATMENT extirpación I-TREATMENT total I-TREATMENT de I-TREATMENT ambas I-TREATMENT bolsas I-TREATMENT escrotales, I-TREATMENT con I-TREATMENT todo I-TREATMENT su I-TREATMENT contenido, I-TREATMENT encontrando I-TREATMENT los I-TREATMENT elementos I-TREATMENT del I-TREATMENT cordón I-TREATMENT espermático I-TREATMENT englobados I-TREATMENT en I-TREATMENT un I-TREATMENT tejido I-TREATMENT fibroso, I-TREATMENT encartonado, I-TREATMENT rugoso, I-TREATMENT con I-TREATMENT vasos I-TREATMENT de I-TREATMENT neoformación, I-TREATMENT algunos I-TREATMENT de I-TREATMENT ellos I-TREATMENT de I-TREATMENT gran I-TREATMENT calibre. I-TREATMENT También I-TREATMENT se I-TREATMENT le I-TREATMENT realizó I-TREATMENT amputación I-TREATMENT del I-TREATMENT segmento I-TREATMENT de I-TREATMENT pene I-TREATMENT ya I-TREATMENT descrita, I-TREATMENT la I-TREATMENT uretra I-TREATMENT se I-TREATMENT anastomosa I-TREATMENT a I-TREATMENT la I-TREATMENT piel I-TREATMENT de I-TREATMENT la I-TREATMENT raíz I-TREATMENT del I-TREATMENT escroto I-TREATMENT con I-TREATMENT características I-TREATMENT normales. I-TREATMENT I-TREATMENT Descripción B-EXPLORATION anatómica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza: I-EXPLORATION 14 I-EXPLORATION kilogramos I-EXPLORATION de I-EXPLORATION peso, I-EXPLORATION y I-EXPLORATION mide I-EXPLORATION 39 I-EXPLORATION x I-EXPLORATION 35 I-EXPLORATION x I-EXPLORATION 18 I-EXPLORATION centímetros. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 51 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 dignos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mención I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS durante I-PRESENT_ILLNESS una I-PRESENT_ILLNESS ecografía I-PRESENT_ILLNESS ginecológica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS control I-PRESENT_ILLNESS rutinario I-PRESENT_ILLNESS nos I-PRESENT_ILLNESS viene I-PRESENT_ILLNESS remitida I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lesión I-PRESENT_ILLNESS sobreelevada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS cara I-PRESENT_ILLNESS lateral I-PRESENT_ILLNESS derecha. I-PRESENT_ILLNESS I-PRESENT_ILLNESS La B-EXPLORATION enferma I-EXPLORATION no I-EXPLORATION presenta I-EXPLORATION ninguna I-EXPLORATION sintomatología I-EXPLORATION urológica I-EXPLORATION de I-EXPLORATION interés. I-EXPLORATION I-EXPLORATION La I-EXPLORATION cistoscopia I-EXPLORATION revela I-EXPLORATION un I-EXPLORATION crecimiento I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION con I-EXPLORATION mucosa I-EXPLORATION indemne. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT la I-TREATMENT resección I-TREATMENT transuretral I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT fue I-TREATMENT de I-TREATMENT leiomioma I-TREATMENT vesical. I-TREATMENT I-TREATMENT Al B-EVOLUTION igual I-EVOLUTION que I-EVOLUTION el I-EVOLUTION caso I-EVOLUTION anterior I-EVOLUTION la I-EVOLUTION enferma I-EVOLUTION permanece I-EVOLUTION asintomática I-EVOLUTION a I-EVOLUTION los I-EVOLUTION dos I-EVOLUTION años I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 75 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 HTA, I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY depresivo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY estreñimiento I-PAST_MEDICAL_HISTORY crónico. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY urológicos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY interés. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Remitida B-DERIVED_FROM/TO del I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Digestivo, I-DERIVED_FROM/TO aportando I-DERIVED_FROM/TO un I-DERIVED_FROM/TO TAC I-DERIVED_FROM/TO abdomino-pélvico, I-DERIVED_FROM/TO realizado I-DERIVED_FROM/TO durante I-DERIVED_FROM/TO un I-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO su I-DERIVED_FROM/TO patología I-DERIVED_FROM/TO de I-DERIVED_FROM/TO base, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO se I-DERIVED_FROM/TO observaba I-DERIVED_FROM/TO una I-DERIVED_FROM/TO masa I-DERIVED_FROM/TO de I-DERIVED_FROM/TO aspecto I-DERIVED_FROM/TO sólido I-DERIVED_FROM/TO en I-DERIVED_FROM/TO polo I-DERIVED_FROM/TO superior I-DERIVED_FROM/TO del I-DERIVED_FROM/TO riñón I-DERIVED_FROM/TO izquierdo I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 4, I-DERIVED_FROM/TO 9 I-DERIVED_FROM/TO x I-DERIVED_FROM/TO 3, I-DERIVED_FROM/TO 6 I-DERIVED_FROM/TO cm I-DERIVED_FROM/TO que I-DERIVED_FROM/TO infiltraba I-DERIVED_FROM/TO la I-DERIVED_FROM/TO grasa I-DERIVED_FROM/TO perirrenal, I-DERIVED_FROM/TO con I-DERIVED_FROM/TO presencia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO dos I-DERIVED_FROM/TO adenopatías I-DERIVED_FROM/TO en I-DERIVED_FROM/TO el I-DERIVED_FROM/TO hilio I-DERIVED_FROM/TO renal I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 1, I-DERIVED_FROM/TO 5 I-DERIVED_FROM/TO cm. I-DERIVED_FROM/TO Posible I-DERIVED_FROM/TO afectación I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO vena I-DERIVED_FROM/TO renal I-DERIVED_FROM/TO izquierda. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION UIV, I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION era I-EXPLORATION normal; I-EXPLORATION mientras I-EXPLORATION el I-EXPLORATION riñón I-EXPLORATION izquierdo I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION anulación I-EXPLORATION funcional, I-EXPLORATION apreciándose I-EXPLORATION al I-EXPLORATION cabo I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION horas I-EXPLORATION un I-EXPLORATION discreto I-EXPLORATION nefrograma, I-EXPLORATION sin I-EXPLORATION llegar I-EXPLORATION a I-EXPLORATION visualizarse I-EXPLORATION en I-EXPLORATION ningún I-EXPLORATION momento I-EXPLORATION el I-EXPLORATION polo I-EXPLORATION superoexterno I-EXPLORATION del I-EXPLORATION mismo. I-EXPLORATION I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Angio-RM, I-EXPLORATION se I-EXPLORATION apreciaba I-EXPLORATION una I-EXPLORATION tumoración I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION que I-EXPLORATION afectaba I-EXPLORATION a I-EXPLORATION 1/3 I-EXPLORATION medio I-EXPLORATION y I-EXPLORATION polo I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION riñón I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION metástasis I-EXPLORATION en I-EXPLORATION glándula I-EXPLORATION suprarrenal I-EXPLORATION ipsilateral, I-EXPLORATION adenopatías I-EXPLORATION locorregionales I-EXPLORATION y I-EXPLORATION trombosis I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION renal I-EXPLORATION izquierda, I-EXPLORATION sin I-EXPLORATION afectación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT diagnóstica I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT renal, I-TREATMENT se I-TREATMENT practicó I-TREATMENT nefrectomía I-TREATMENT radical I-TREATMENT izquierda I-TREATMENT mediante I-TREATMENT lumbotomía, I-TREATMENT apreciando I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT un I-TREATMENT bloque I-TREATMENT adenopático I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT hilio I-TREATMENT renal. I-TREATMENT I-TREATMENT La B-EXPLORATION descripción I-EXPLORATION macroscópica I-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION anatomopatológico, I-EXPLORATION destacó I-EXPLORATION una I-EXPLORATION pieza I-EXPLORATION de I-EXPLORATION nefrectomía I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION x I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 7 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION su I-EXPLORATION mayor I-EXPLORATION parte I-EXPLORATION se I-EXPLORATION perdía I-EXPLORATION la I-EXPLORATION delimitación I-EXPLORATION córtico I-EXPLORATION -medular, I-EXPLORATION apreciándose I-EXPLORATION masas I-EXPLORATION grisáceas I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION firme I-EXPLORATION que I-EXPLORATION sustituían I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION difusa I-EXPLORATION e I-EXPLORATION irregular I-EXPLORATION gran I-EXPLORATION parte I-EXPLORATION del I-EXPLORATION parénquima I-EXPLORATION renal. I-EXPLORATION Por I-EXPLORATION otro I-EXPLORATION lado, I-EXPLORATION la I-EXPLORATION descripción I-EXPLORATION microscópica, I-EXPLORATION apreció I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION maligna I-EXPLORATION formada I-EXPLORATION por I-EXPLORATION estructuras I-EXPLORATION tubulares I-EXPLORATION y I-EXPLORATION ductales I-EXPLORATION atípicas I-EXPLORATION que I-EXPLORATION infiltraba I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION perirrenal I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION alcanzando I-EXPLORATION el I-EXPLORATION borde I-EXPLORATION quirúrgico. I-EXPLORATION Estas I-EXPLORATION estructuras I-EXPLORATION mostraron I-EXPLORATION positividad I-EXPLORATION inmunohistoquímica I-EXPLORATION para I-EXPLORATION keratinas: I-EXPLORATION CAM I-EXPLORATION 5.2; I-EXPLORATION AE1 I-EXPLORATION - I-EXPLORATION AE2 I-EXPLORATION y I-EXPLORATION 34 I-EXPLORATION BE12. I-EXPLORATION Estableciendo, I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION manera, I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION definitivo I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION ductos I-EXPLORATION colectores I-EXPLORATION con I-EXPLORATION afectación I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION renal I-EXPLORATION del I-EXPLORATION borde I-EXPLORATION quirúrgico. I-EXPLORATION I-EXPLORATION Tras B-TREATMENT un I-TREATMENT mes I-TREATMENT y I-TREATMENT medio I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT una I-TREATMENT vez I-TREATMENT valorada I-TREATMENT por I-TREATMENT el I-TREATMENT Servicio I-TREATMENT de I-TREATMENT Oncología, I-TREATMENT se I-TREATMENT decidió I-TREATMENT comenzar I-TREATMENT tratamiento I-TREATMENT quimioterápico I-TREATMENT con I-TREATMENT Carboplatino I-TREATMENT AUC I-TREATMENT 4 I-TREATMENT día I-TREATMENT 1º I-TREATMENT + I-TREATMENT Gencitabina I-TREATMENT 1250 I-TREATMENT mg/m2 I-TREATMENT días I-TREATMENT 1º I-TREATMENT y I-TREATMENT 8º I-TREATMENT cada I-TREATMENT 21 I-TREATMENT días. I-TREATMENT No I-TREATMENT se I-TREATMENT administró I-TREATMENT cisplatino I-TREATMENT debido I-TREATMENT a I-TREATMENT su I-TREATMENT nefrotoxicidad I-TREATMENT y I-TREATMENT a I-TREATMENT tratarse I-TREATMENT de I-TREATMENT una I-TREATMENT paciente I-TREATMENT monorrena I-TREATMENT con I-TREATMENT un I-TREATMENT ClCr I-TREATMENT < I-TREATMENT 30. I-TREATMENT I-TREATMENT Tras B-EXPLORATION el I-EXPLORATION 4º I-EXPLORATION ciclo I-EXPLORATION de I-EXPLORATION QMT I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION apreció: I-EXPLORATION lesión I-EXPLORATION tumoral I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION renal I-EXPLORATION izquierda, I-EXPLORATION que I-EXPLORATION infiltraba I-EXPLORATION arteria I-EXPLORATION mesentérica I-EXPLORATION superior, I-EXPLORATION músculo I-EXPLORATION psoas I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION probablemente I-EXPLORATION también I-EXPLORATION aorta, I-EXPLORATION acompañada I-EXPLORATION de I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION hepática I-EXPLORATION en I-EXPLORATION segmento I-EXPLORATION 4 I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION metástasis. I-EXPLORATION I-EXPLORATION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 48 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS es I-PRESENT_ILLNESS sometida I-PRESENT_ILLNESS a I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS ginecológica I-PRESENT_ILLNESS (histerectomía I-PRESENT_ILLNESS más I-PRESENT_ILLNESS doble I-PRESENT_ILLNESS anexectomía). I-PRESENT_ILLNESS Tras I-PRESENT_ILLNESS dicha I-PRESENT_ILLNESS intervención, I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS lumbar I-PRESENT_ILLNESS derecho, I-PRESENT_ILLNESS motivo I-PRESENT_ILLNESS por I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS es I-PRESENT_ILLNESS requerido I-PRESENT_ILLNESS el I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urología. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION urografía I-EXPLORATION intravenosa I-EXPLORATION observamos I-EXPLORATION una I-EXPLORATION concentración I-EXPLORATION y I-EXPLORATION eliminación I-EXPLORATION renal I-EXPLORATION izquierda I-EXPLORATION normal, I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION en I-EXPLORATION el I-EXPLORATION lado I-EXPLORATION derecho I-EXPLORATION se I-EXPLORATION objetiva I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION eliminación I-EXPLORATION por I-EXPLORATION el I-EXPLORATION riñón, I-EXPLORATION así I-EXPLORATION mismo I-EXPLORATION se I-EXPLORATION visualizan I-EXPLORATION múltiples I-EXPLORATION 'clips' I-EXPLORATION quirúrgicos. I-EXPLORATION I-EXPLORATION Ante B-TREATMENT la I-TREATMENT sospecha I-TREATMENT de I-TREATMENT una I-TREATMENT afectación I-TREATMENT ureteral I-TREATMENT en I-TREATMENT la I-TREATMENT cirugía I-TREATMENT se I-TREATMENT decide I-TREATMENT colocación I-TREATMENT de I-TREATMENT catéter I-TREATMENT doble I-TREATMENT J I-TREATMENT derecho, I-TREATMENT consiguiéndose I-TREATMENT la I-TREATMENT misma I-TREATMENT con I-TREATMENT cierta I-TREATMENT dificultad. I-TREATMENT I-TREATMENT En I-TREATMENT control I-TREATMENT intraoperatorio I-TREATMENT se I-TREATMENT visualiza I-TREATMENT correcta I-TREATMENT colocación I-TREATMENT del I-TREATMENT catéter, I-TREATMENT desapareciendo I-TREATMENT entonces I-TREATMENT la I-TREATMENT clínica I-TREATMENT de I-TREATMENT la I-TREATMENT paciente. I-TREATMENT I-TREATMENT Diez B-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION dicho I-EVOLUTION procedimiento I-EVOLUTION la I-EVOLUTION enferma I-EVOLUTION comienza I-EVOLUTION nuevamente I-EVOLUTION con I-EVOLUTION dolor I-EVOLUTION lumbar I-EVOLUTION derecho I-EVOLUTION y I-EVOLUTION fiebre, I-EVOLUTION se B-EXPLORATION realiza I-EXPLORATION radiografía I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION una I-EXPLORATION migración I-EXPLORATION proximal I-EXPLORATION del I-EXPLORATION catéter I-EXPLORATION doble I-EXPLORATION J. I-EXPLORATION I-EXPLORATION Se B-TREATMENT decide I-TREATMENT recolocación I-TREATMENT del I-TREATMENT catéter I-TREATMENT mediante I-TREATMENT ureteroscopia, I-TREATMENT siendo I-TREATMENT imposible I-TREATMENT realización I-TREATMENT de I-TREATMENT la I-TREATMENT misma, I-TREATMENT al I-TREATMENT no I-TREATMENT poder I-TREATMENT alcanzar I-TREATMENT luz I-TREATMENT ureteral I-TREATMENT proximal I-TREATMENT al I-TREATMENT cruce I-TREATMENT con I-TREATMENT la I-TREATMENT ilíaca. I-TREATMENT Optándose I-TREATMENT entonces I-TREATMENT por I-TREATMENT colocación I-TREATMENT de I-TREATMENT nefrostomía I-TREATMENT percutánea I-TREATMENT y I-TREATMENT retirada I-TREATMENT por I-TREATMENT dicha I-TREATMENT vía I-TREATMENT del I-TREATMENT catéter. I-TREATMENT I-TREATMENT Resuelto I-TREATMENT el I-TREATMENT cuadro I-TREATMENT inicial I-TREATMENT de I-TREATMENT la I-TREATMENT paciente I-TREATMENT se I-TREATMENT decide I-TREATMENT colocación I-TREATMENT anterógrada I-TREATMENT de I-TREATMENT catéter I-TREATMENT ureteral I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT nefrostomía, I-TREATMENT permitiendo I-TREATMENT la I-TREATMENT retirada I-TREATMENT de I-TREATMENT la I-TREATMENT misma. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 66 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS viene I-PRESENT_ILLNESS al I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS con I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS colelitiasis, I-PRESENT_ILLNESS antecedentes B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hernia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hiato I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial. I-PAST_MEDICAL_HISTORY La B-EXPLORATION analítica I-EXPLORATION es I-EXPLORATION irrelevante, I-EXPLORATION salvo I-EXPLORATION el I-EXPLORATION colesterol I-EXPLORATION total I-EXPLORATION levemente I-EXPLORATION elevado. I-EXPLORATION Marcadores I-EXPLORATION tumorales I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION informe I-EXPLORATION ecográfico I-EXPLORATION del I-EXPLORATION abdomen, I-EXPLORATION sugiere I-EXPLORATION un I-EXPLORATION conglomerado I-EXPLORATION adenopático, I-EXPLORATION si I-EXPLORATION bien I-EXPLORATION no I-EXPLORATION pueden I-EXPLORATION descartar I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION páncreas. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION realiza I-EXPLORATION un I-EXPLORATION TAC I-EXPLORATION abdominopélvico I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION intravenoso I-EXPLORATION que I-EXPLORATION informa I-EXPLORATION de I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cms I-EXPLORATION en I-EXPLORATION cabeza I-EXPLORATION de I-EXPLORATION páncreas, I-EXPLORATION que I-EXPLORATION capta I-EXPLORATION el I-EXPLORATION contraste I-EXPLORATION intravenoso I-EXPLORATION de I-EXPLORATION forma I-EXPLORATION intensa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION fase I-EXPLORATION precoz, I-EXPLORATION sugiriendo I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION hipervascular, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION tumor I-EXPLORATION endocrino. I-EXPLORATION La I-EXPLORATION gammagrafía I-EXPLORATION ósea I-EXPLORATION es I-EXPLORATION normal, I-EXPLORATION consistente I-EXPLORATION con I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente. I-EXPLORATION Se B-TREATMENT le I-TREATMENT practica I-TREATMENT una I-TREATMENT pancreatectomía, I-TREATMENT colecistectomía I-TREATMENT y I-TREATMENT coledocorrafia I-TREATMENT en I-TREATMENT Abril I-TREATMENT de I-TREATMENT 2007. I-TREATMENT En B-EVOLUTION la I-EVOLUTION actualidad, I-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION bien, I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION otras I-EVOLUTION metástasis. I-EVOLUTION Ni B-EXPLORATION en I-EXPLORATION el I-EXPLORATION acto I-EXPLORATION quirúrgico I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION la I-EXPLORATION disección I-EXPLORATION macroscópica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pieza I-EXPLORATION se I-EXPLORATION encuentran I-EXPLORATION adenopatías. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION páncreas I-EXPLORATION encontramos I-EXPLORATION 3 I-EXPLORATION nódulos I-EXPLORATION bien I-EXPLORATION delimitados I-EXPLORATION que I-EXPLORATION miden I-EXPLORATION respectivamente I-EXPLORATION 4 I-EXPLORATION cms., I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 0.7 I-EXPLORATION cms., I-EXPLORATION cuyas I-EXPLORATION superficies I-EXPLORATION de I-EXPLORATION corte I-EXPLORATION son I-EXPLORATION de I-EXPLORATION consistencia I-EXPLORATION blanda, I-EXPLORATION aspecto I-EXPLORATION homogéneo I-EXPLORATION y I-EXPLORATION coloración I-EXPLORATION amarillenta. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION de I-EXPLORATION los I-EXPLORATION nódulos I-EXPLORATION tumorales I-EXPLORATION de I-EXPLORATION los I-EXPLORATION dos I-EXPLORATION pacientes, I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION cuadro I-EXPLORATION microscópico I-EXPLORATION similar I-EXPLORATION constituido I-EXPLORATION por I-EXPLORATION una I-EXPLORATION población I-EXPLORATION celular I-EXPLORATION homogénea, I-EXPLORATION de I-EXPLORATION citoplasmas I-EXPLORATION claros, I-EXPLORATION con I-EXPLORATION atipia I-EXPLORATION nuclear I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION los I-EXPLORATION grados I-EXPLORATION 3 I-EXPLORATION (caso I-EXPLORATION 1) I-EXPLORATION y I-EXPLORATION 1 I-EXPLORATION (caso I-EXPLORATION 2) I-EXPLORATION de I-EXPLORATION Fuhrman, I-EXPLORATION mostrando I-EXPLORATION las I-EXPLORATION tumoraciones I-EXPLORATION una I-EXPLORATION marcada I-EXPLORATION red I-EXPLORATION vascular. I-EXPLORATION Los I-EXPLORATION estudios I-EXPLORATION inmunohistoquímicos I-EXPLORATION mostraron I-EXPLORATION positividad I-EXPLORATION a I-EXPLORATION citoqueratina, I-EXPLORATION vimentina, I-EXPLORATION antígeno I-EXPLORATION de I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION epitelial I-EXPLORATION y I-EXPLORATION a I-EXPLORATION CD10 I-EXPLORATION y I-EXPLORATION negatividad I-EXPLORATION a I-EXPLORATION citoqueratinas I-EXPLORATION 7 I-EXPLORATION y I-EXPLORATION 20, I-EXPLORATION cromogranina, I-EXPLORATION tiroglobulina, I-EXPLORATION sinaptofisina, I-EXPLORATION HMB45 I-EXPLORATION y I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario. I-EXPLORATION Se I-EXPLORATION emitió I-EXPLORATION un I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION metástasis I-EXPLORATION de I-EXPLORATION carcinoma I-EXPLORATION renal I-EXPLORATION de I-EXPLORATION células I-EXPLORATION claras I-EXPLORATION y B-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY revisar I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY historias I-PAST_MEDICAL_HISTORY clínicas I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encontró I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY ambos I-PAST_MEDICAL_HISTORY pacientes I-PAST_MEDICAL_HISTORY habían I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY diagnosticados I-PAST_MEDICAL_HISTORY 17 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY 16 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY antes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY células I-PAST_MEDICAL_HISTORY claras I-PAST_MEDICAL_HISTORY (hipernefroma), I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY apreciándose I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ninguno I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY casos I-PAST_MEDICAL_HISTORY infiltración I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY vena I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY cápsula I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY riñón. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Paciente B-PRESENT_ILLNESS del I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 74 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS que I-PRESENT_ILLNESS acude I-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias I-PRESENT_ILLNESS por I-PRESENT_ILLNESS hematuria I-PRESENT_ILLNESS macroscópica, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS otra I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS acompañante. I-PRESENT_ILLNESS Antecedentes B-PAST_MEDICAL_HISTORY médicos I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY quirúrgicos I-PAST_MEDICAL_HISTORY irrelevantes. I-PAST_MEDICAL_HISTORY Ex-fumadora. I-PAST_MEDICAL_HISTORY La B-EXPLORATION ecografía I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION vesical I-EXPLORATION revela I-EXPLORATION una I-EXPLORATION ectasia I-EXPLORATION pielocalicial I-EXPLORATION moderada I-EXPLORATION del I-EXPLORATION riñón I-EXPLORATION derecho I-EXPLORATION y I-EXPLORATION una I-EXPLORATION masa I-EXPLORATION sólida, I-EXPLORATION sésil, I-EXPLORATION localizada I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION endovesical I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION La I-EXPLORATION cistoscopia I-EXPLORATION (se I-EXPLORATION realiza I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mismo I-EXPLORATION acto I-EXPLORATION quirúrgico) I-EXPLORATION muestra I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION sésil I-EXPLORATION de I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION localizado I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION lateral I-EXPLORATION derecha. I-EXPLORATION La I-EXPLORATION palpación I-EXPLORATION bi-manual I-EXPLORATION no I-EXPLORATION existe I-EXPLORATION fijación. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION revela I-EXPLORATION adenocarcinoma I-EXPLORATION invasivo, I-EXPLORATION no I-EXPLORATION excluyendo I-EXPLORATION origen I-EXPLORATION ginecológico, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION examen I-EXPLORATION ginecológico I-EXPLORATION completo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION revela I-EXPLORATION negativo. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION extensión I-EXPLORATION no I-EXPLORATION muestra I-EXPLORATION metástasis. I-EXPLORATION Se B-TREATMENT le I-TREATMENT efectúa I-TREATMENT exanteración I-TREATMENT pélvica I-TREATMENT anterior I-TREATMENT y I-TREATMENT ureterostomia I-TREATMENT cutánea I-TREATMENT transileal I-TREATMENT tipo I-TREATMENT Bricker. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION describe I-EXPLORATION un I-EXPLORATION adenocarcinoma I-EXPLORATION de I-EXPLORATION patrón I-EXPLORATION en I-EXPLORATION parte I-EXPLORATION papilar I-EXPLORATION en I-EXPLORATION parte I-EXPLORATION túbulo-quístico I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION grado I-EXPLORATION citológico, I-EXPLORATION pT3aN0. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION recuperación I-EVOLUTION satisfactoria, I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION per-operatorias. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION pos-operatorio I-EVOLUTION no I-EVOLUTION revela I-EVOLUTION evolución I-EVOLUTION clínica I-EVOLUTION ni I-EVOLUTION en I-EVOLUTION la I-EVOLUTION imagen I-EVOLUTION de I-EVOLUTION la I-EVOLUTION neoplasia I-EVOLUTION o I-EVOLUTION de I-EVOLUTION complicaciones I-EVOLUTION resultantes I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION Varón B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 67 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 hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY dislipemia, I-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY hipertrófica I-PAST_MEDICAL_HISTORY obstructiva I-PAST_MEDICAL_HISTORY y 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 Insuficiencia I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY nefroangioesclerosis, I-PAST_MEDICAL_HISTORY siendo I-PAST_MEDICAL_HISTORY trasplantado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 1998 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 El I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presenta I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY injerto I-PAST_MEDICAL_HISTORY normofuncionante I-PAST_MEDICAL_HISTORY (creatinina I-PAST_MEDICAL_HISTORY sérica: I-PAST_MEDICAL_HISTORY 2, I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY mg/dL I-PAST_MEDICAL_HISTORY basal) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sigue I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY Prednisona I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY Ciclosporina I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY (CsA). I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2006, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY detecta I-PAST_MEDICAL_HISTORY lesión I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY labio I-PAST_MEDICAL_HISTORY inferior I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY es I-PAST_MEDICAL_HISTORY extirpada, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY resultado I-PAST_MEDICAL_HISTORY anatomopatológico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY carcinoma I-PAST_MEDICAL_HISTORY epidermoide I-PAST_MEDICAL_HISTORY microinfiltrante. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY realiza I-PAST_MEDICAL_HISTORY modificación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY inmunosupresión, I-PAST_MEDICAL_HISTORY sustituyéndose I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY CsA I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY Tacrolimus. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY mayo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2007 I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY detecta I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rutina I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY masa I-PAST_MEDICAL_HISTORY sólida I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY cortical I-PAST_MEDICAL_HISTORY anterior, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY zona I-PAST_MEDICAL_HISTORY media I-PAST_MEDICAL_HISTORY superior, I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diámetro I-PAST_MEDICAL_HISTORY mayor. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY encuentra I-PAST_MEDICAL_HISTORY asintomático I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY función I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY injerto I-PAST_MEDICAL_HISTORY conservada. I-PAST_MEDICAL_HISTORY Se B-EXPLORATION realiza I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION confirmación, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION lesión I-EXPLORATION focal I-EXPLORATION y I-EXPLORATION sólida I-EXPLORATION en I-EXPLORATION zona I-EXPLORATION media I-EXPLORATION superior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cara I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION injerto. I-EXPLORATION Tras B-TREATMENT punción-aspiración I-TREATMENT que I-TREATMENT confirma I-TREATMENT la I-TREATMENT lesión I-TREATMENT como I-TREATMENT carcinoma I-TREATMENT de I-TREATMENT células I-TREATMENT renales, I-TREATMENT se I-TREATMENT decide I-TREATMENT realización I-TREATMENT de I-TREATMENT cirugía I-TREATMENT conservadora I-TREATMENT de I-TREATMENT nefronas I-TREATMENT ante I-TREATMENT la I-TREATMENT buena I-TREATMENT funcionalidad I-TREATMENT del I-TREATMENT injerto I-TREATMENT y I-TREATMENT las I-TREATMENT características I-TREATMENT favorables I-TREATMENT de I-TREATMENT la I-TREATMENT lesión. I-TREATMENT Bajo I-TREATMENT isquemia I-TREATMENT fría I-TREATMENT y I-TREATMENT con I-TREATMENT control I-TREATMENT ecográfico I-TREATMENT intraoperatorio, I-TREATMENT se I-TREATMENT realiza I-TREATMENT nefrectomía I-TREATMENT parcial I-TREATMENT con I-TREATMENT abordaje I-TREATMENT intracapsular, I-TREATMENT enviándose B-EXPLORATION lecho I-EXPLORATION tumoral I-EXPLORATION para I-EXPLORATION análisis I-EXPLORATION patológico I-EXPLORATION intraoperatorio I-EXPLORATION que I-EXPLORATION confirma I-EXPLORATION la I-EXPLORATION negatividad I-EXPLORATION de I-EXPLORATION los I-EXPLORATION márgenes I-EXPLORATION quirúrgicos. I-EXPLORATION El I-EXPLORATION resultado I-EXPLORATION definitivo I-EXPLORATION del I-EXPLORATION análisis I-EXPLORATION confirmó I-EXPLORATION un I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION renales I-EXPLORATION estadio I-EXPLORATION pT1 I-EXPLORATION G1, I-EXPLORATION extirpado I-EXPLORATION en I-EXPLORATION su I-EXPLORATION totalidad. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION del I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION satisfactoria, I-EVOLUTION presentando I-EVOLUTION una I-EVOLUTION discreta I-EVOLUTION elevación I-EVOLUTION de I-EVOLUTION la I-EVOLUTION creatinina I-EVOLUTION hasta I-EVOLUTION 4, I-EVOLUTION 2 I-EVOLUTION mg/dl I-EVOLUTION con I-EVOLUTION recuperación I-EVOLUTION de I-EVOLUTION ésta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION valores I-EVOLUTION basales I-EVOLUTION al I-EVOLUTION quinto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION postoperatorio. I-EVOLUTION Actualmente, I-EVOLUTION tras I-EVOLUTION un I-EVOLUTION seguimiento I-EVOLUTION de I-EVOLUTION 14 I-EVOLUTION meses, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático I-EVOLUTION y I-EVOLUTION no I-EVOLUTION existen I-EVOLUTION datos I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION tumoral I-EVOLUTION ni I-EVOLUTION metástasis I-EVOLUTION a I-EVOLUTION distancia. I-EVOLUTION La I-EVOLUTION función I-EVOLUTION del I-EVOLUTION injerto I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION estable I-EVOLUTION con I-EVOLUTION cifras I-EVOLUTION de I-EVOLUTION creatinina I-EVOLUTION de I-EVOLUTION 2, I-EVOLUTION 3 I-EVOLUTION mg/dl. I-EVOLUTION Se B-TREATMENT mantuvo I-TREATMENT la I-TREATMENT inmunosupresión I-TREATMENT previa I-TREATMENT con I-TREATMENT Prednisona I-TREATMENT y I-TREATMENT se I-TREATMENT añadió I-TREATMENT Sirolimus. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY conocida I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ADO. I-PAST_MEDICAL_HISTORY A B-PRESENT_ILLNESS raiz I-PRESENT_ILLNESS de I-PRESENT_ILLNESS serle I-PRESENT_ILLNESS descubierta I-PRESENT_ILLNESS una I-PRESENT_ILLNESS HTA, I-PRESENT_ILLNESS en I-PRESENT_ILLNESS 1975, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS iniciaron I-PRESENT_ILLNESS estudios I-PRESENT_ILLNESS que I-PRESENT_ILLNESS incluyeron I-PRESENT_ILLNESS la I-PRESENT_ILLNESS práctica I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS UIV I-PRESENT_ILLNESS minutada I-PRESENT_ILLNESS que I-PRESENT_ILLNESS evidenció I-PRESENT_ILLNESS una I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS renal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS RI. I-PRESENT_ILLNESS Siguió B-EXPLORATION la I-EXPLORATION realización I-EXPLORATION de I-EXPLORATION una I-EXPLORATION angiografía I-EXPLORATION que I-EXPLORATION demostraba I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION masa I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm. I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION la I-EXPLORATION región I-EXPLORATION mesorrenal I-EXPLORATION e I-EXPLORATION hiliar I-EXPLORATION con I-EXPLORATION una I-EXPLORATION importante I-EXPLORATION fístula I-EXPLORATION arteriovenosa I-EXPLORATION que I-EXPLORATION ocasionaba I-EXPLORATION una I-EXPLORATION gran I-EXPLORATION laguna I-EXPLORATION vascular I-EXPLORATION pseudoaneurismática. I-EXPLORATION En I-EXPLORATION fases I-EXPLORATION venosas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION exploración I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION una I-EXPLORATION notable I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arcada I-EXPLORATION exorrenal. I-EXPLORATION Con B-TREATMENT la I-TREATMENT evidencia I-TREATMENT de I-TREATMENT riñón I-TREATMENT contralateral I-TREATMENT normal I-TREATMENT se I-TREATMENT procedió I-TREATMENT a I-TREATMENT la I-TREATMENT nefrectomía I-TREATMENT radical I-TREATMENT izquierda I-TREATMENT con I-TREATMENT linfadenectomía I-TREATMENT reducida I-TREATMENT renoaórtica. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION demostró I-EXPLORATION carcinoma I-EXPLORATION de I-EXPLORATION células I-EXPLORATION claras I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION cm., I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION de I-EXPLORATION crecimiento I-EXPLORATION sólido I-EXPLORATION con I-EXPLORATION áreas I-EXPLORATION granulomatosas. I-EXPLORATION Las I-EXPLORATION adenopatías I-EXPLORATION fueron I-EXPLORATION negativas I-EXPLORATION presentando I-EXPLORATION únicamente I-EXPLORATION histiocitosis I-EXPLORATION sinusal. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION permaneció I-EVOLUTION asintomática I-EVOLUTION hasta I-EVOLUTION que I-EVOLUTION en I-EVOLUTION una I-EVOLUTION exploración I-EVOLUTION ecográfica, I-EVOLUTION en I-EVOLUTION 1982, I-EVOLUTION se I-EVOLUTION descubre I-EVOLUTION masa I-EVOLUTION tumoral I-EVOLUTION de I-EVOLUTION polo I-EVOLUTION superior I-EVOLUTION del I-EVOLUTION RD I-EVOLUTION restante. I-EVOLUTION Pensando B-EXPLORATION ya I-EXPLORATION en I-EXPLORATION la I-EXPLORATION imperiosidad I-EXPLORATION de I-EXPLORATION realizar I-EXPLORATION una I-EXPLORATION cirugía I-EXPLORATION conservadora I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION estudio I-EXPLORATION angiográfico I-EXPLORATION completo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arquitectura I-EXPLORATION vascular I-EXPLORATION del I-EXPLORATION órgano. I-EXPLORATION Ello I-EXPLORATION nos I-EXPLORATION permitió I-EXPLORATION ver I-EXPLORATION como I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION recibía I-EXPLORATION dos I-EXPLORATION ramas I-EXPLORATION arteriales I-EXPLORATION directas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION renal I-EXPLORATION muy I-EXPLORATION extrasinusales I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION dos I-EXPLORATION que I-EXPLORATION irrigaban I-EXPLORATION el I-EXPLORATION tejido I-EXPLORATION renal I-EXPLORATION sano I-EXPLORATION que I-EXPLORATION limitaba I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION y I-EXPLORATION que I-EXPLORATION deberíamos I-EXPLORATION sacrificar I-EXPLORATION en I-EXPLORATION aras I-EXPLORATION de I-EXPLORATION la I-EXPLORATION radicalidad I-EXPLORATION necesaria. I-EXPLORATION I-EXPLORATION El B-TREATMENT 7.07.82 I-TREATMENT practicamos, I-TREATMENT bajo I-TREATMENT hipotemia I-TREATMENT in I-TREATMENT situ I-TREATMENT y I-TREATMENT perfusión I-TREATMENT con I-TREATMENT Collins, I-TREATMENT la I-TREATMENT disección I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT renal I-TREATMENT con I-TREATMENT ligadura I-TREATMENT de I-TREATMENT esas I-TREATMENT cuatro I-TREATMENT ramas I-TREATMENT ya I-TREATMENT programadas I-TREATMENT sobre I-TREATMENT el I-TREATMENT mapa I-TREATMENT vascular. I-TREATMENT La B-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION adenocarcinoma I-EXPLORATION renal I-EXPLORATION de I-EXPLORATION células I-EXPLORATION claras I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION cms, I-EXPLORATION en I-EXPLORATION contacto I-EXPLORATION con I-EXPLORATION la I-EXPLORATION grasa I-EXPLORATION perirrenal I-EXPLORATION y I-EXPLORATION con I-EXPLORATION ganglios I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION En B-EVOLUTION los I-EVOLUTION años I-EVOLUTION siguientes I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION ingresó I-EVOLUTION en I-EVOLUTION Medicina I-EVOLUTION Interna I-EVOLUTION por I-EVOLUTION descompensaciones I-EVOLUTION diabéticas I-EVOLUTION sucesivas I-EVOLUTION aprovechando I-EVOLUTION para I-EVOLUTION mantener I-EVOLUTION control I-EVOLUTION de I-EVOLUTION su I-EVOLUTION patología I-EVOLUTION renal I-EVOLUTION mediante I-EVOLUTION TAC I-EVOLUTION que I-EVOLUTION fueron I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION En I-EVOLUTION un I-EVOLUTION último I-EVOLUTION reingreso I-EVOLUTION en I-EVOLUTION MI I-EVOLUTION por I-EVOLUTION anemia I-EVOLUTION secundaria I-EVOLUTION a I-EVOLUTION HDA I-EVOLUTION por I-EVOLUTION ulcus I-EVOLUTION sangrante I-EVOLUTION y I-EVOLUTION delgadez I-EVOLUTION extrema, I-EVOLUTION se I-EVOLUTION objetivó I-EVOLUTION por I-EVOLUTION TAC I-EVOLUTION masa I-EVOLUTION retroperitoneal I-EVOLUTION pancreática. I-EVOLUTION No I-EVOLUTION pudimos I-EVOLUTION dilucidar I-EVOLUTION el I-EVOLUTION origen I-EVOLUTION de I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION falleciendo I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION y I-EVOLUTION 8 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION sus I-EVOLUTION respectivas I-EVOLUTION cirugías I-EVOLUTION renales. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 65 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS quien I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS polaquiuria, I-PRESENT_ILLNESS disuria I-PRESENT_ILLNESS y I-PRESENT_ILLNESS hesitancia. I-PRESENT_ILLNESS Adicionalmente I-PRESENT_ILLNESS el I-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS informó I-PRESENT_ILLNESS la I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS Kg. I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 6 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS refirió I-PRESENT_ILLNESS otros I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS Con B-FAMILY_HISTORY antecedente I-FAMILY_HISTORY de I-FAMILY_HISTORY padre I-FAMILY_HISTORY con I-FAMILY_HISTORY carcinoma I-FAMILY_HISTORY de I-FAMILY_HISTORY próstata, I-FAMILY_HISTORY no B-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY documento I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY presencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY inmunodeficiencias I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY prueba I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ELISA I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY VIH I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY negativa I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY dos I-PAST_MEDICAL_HISTORY oportunidades. I-PAST_MEDICAL_HISTORY En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION documentó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION próstata I-EXPLORATION aumentada I-EXPLORATION de I-EXPLORATION volumen, I-EXPLORATION irregular I-EXPLORATION y I-EXPLORATION dura, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones. I-EXPLORATION Por I-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION realizo, I-EXPLORATION Antígeno I-EXPLORATION Prostático I-EXPLORATION Específico I-EXPLORATION (APE) I-EXPLORATION (7, I-EXPLORATION 17 I-EXPLORATION ng/ml), I-EXPLORATION creatinina I-EXPLORATION (0, I-EXPLORATION 83 I-EXPLORATION mg/dl), I-EXPLORATION y I-EXPLORATION uroanálisis I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION mas I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION eritrocitos I-EXPLORATION por I-EXPLORATION campo I-EXPLORATION de I-EXPLORATION alto I-EXPLORATION poder. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION Doppler I-EXPLORATION prostática I-EXPLORATION mostró I-EXPLORATION leve I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION 39 I-EXPLORATION cm3 I-EXPLORATION y I-EXPLORATION un I-EXPLORATION peso I-EXPLORATION estimado I-EXPLORATION de I-EXPLORATION 34 I-EXPLORATION gramos, I-EXPLORATION observándose I-EXPLORATION adecuado I-EXPLORATION contraste I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION periférica I-EXPLORATION y I-EXPLORATION transicional, I-EXPLORATION con I-EXPLORATION ecogenicidad I-EXPLORATION homogénea I-EXPLORATION y I-EXPLORATION bordes I-EXPLORATION capsulares I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION zonas I-EXPLORATION de I-EXPLORATION vascularización I-EXPLORATION anormales. I-EXPLORATION Teniendo I-EXPLORATION en I-EXPLORATION cuenta I-EXPLORATION los I-EXPLORATION anteriores I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION por I-EXPLORATION sextantes, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION se I-EXPLORATION evidenciaron I-EXPLORATION múltiples I-EXPLORATION granulomas I-EXPLORATION constituidos I-EXPLORATION por I-EXPLORATION histiocitos I-EXPLORATION epitelioides, I-EXPLORATION rodeados I-EXPLORATION por I-EXPLORATION un I-EXPLORATION collar I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION y I-EXPLORATION acompañados I-EXPLORATION por I-EXPLORATION células I-EXPLORATION gigantes I-EXPLORATION multinucleadas I-EXPLORATION tipo I-EXPLORATION Langhans, I-EXPLORATION en I-EXPLORATION algunos I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION granulomas I-EXPLORATION se I-EXPLORATION reconoció I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION de I-EXPLORATION caseificación. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION de I-EXPLORATION Ziel-Nielsen I-EXPLORATION fue I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION micobacterias. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION radiográfico, I-EXPLORATION ni I-EXPLORATION tomográfico I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION no I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION evidencia I-EXPLORATION microbiológica I-EXPLORATION de I-EXPLORATION micobacterias I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION seriado I-EXPLORATION del I-EXPLORATION esputo, I-EXPLORATION ni I-EXPLORATION en I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION lavado I-EXPLORATION broncoalveolar. I-EXPLORATION Con I-EXPLORATION los I-EXPLORATION anteriores I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION el I-EXPLORATION diagnostico I-EXPLORATION de I-EXPLORATION tuberculosis I-EXPLORATION prostática I-EXPLORATION primaria, I-EXPLORATION iniciando B-TREATMENT tratamiento I-TREATMENT antituberculoso I-TREATMENT con I-TREATMENT Rifampicina, I-TREATMENT Isoniazida I-TREATMENT y I-TREATMENT Estreptomicina I-TREATMENT durante I-TREATMENT 6 I-TREATMENT semanas, I-TREATMENT posterior I-TREATMENT al I-TREATMENT cual I-TREATMENT presentó I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT sintomatología I-TREATMENT con I-TREATMENT solo I-TREATMENT un I-TREATMENT episodio I-TREATMENT de I-TREATMENT obstrucción I-TREATMENT miccional I-TREATMENT al I-TREATMENT inicio I-TREATMENT del I-TREATMENT tratamiento. I-TREATMENT Actualmente B-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático I-EVOLUTION sin I-EVOLUTION evidencia I-EVOLUTION de I-EVOLUTION enfermedad I-EVOLUTION tuberculosa I-EVOLUTION activa. I-EVOLUTION I-EVOLUTION Estrategia I-EVOLUTION de I-EVOLUTION búsqueda I-EVOLUTION de I-EVOLUTION la I-EVOLUTION literatura I-EVOLUTION I-EVOLUTION Se I-EVOLUTION realizó I-EVOLUTION una I-EVOLUTION búsqueda I-EVOLUTION estructurada I-EVOLUTION de I-EVOLUTION la I-EVOLUTION literatura, I-EVOLUTION utilizando I-EVOLUTION la I-EVOLUTION base I-EVOLUTION de I-EVOLUTION datos I-EVOLUTION MedLine, I-EVOLUTION a I-EVOLUTION través I-EVOLUTION de I-EVOLUTION su I-EVOLUTION portal I-EVOLUTION Web I-EVOLUTION PubMed, I-EVOLUTION desde I-EVOLUTION enero I-EVOLUTION de I-EVOLUTION 1915 I-EVOLUTION hasta I-EVOLUTION Abril I-EVOLUTION de I-EVOLUTION 2008, I-EVOLUTION utilizando I-EVOLUTION inicialmente I-EVOLUTION los I-EVOLUTION términos I-EVOLUTION "Prostate I-EVOLUTION tuberculosis" I-EVOLUTION obteniendo I-EVOLUTION 153 I-EVOLUTION artículos I-EVOLUTION originales. I-EVOLUTION Posteriormente I-EVOLUTION se I-EVOLUTION adiciono I-EVOLUTION el I-EVOLUTION termino I-EVOLUTION "Primary" I-EVOLUTION a I-EVOLUTION los I-EVOLUTION anteriores I-EVOLUTION términos, I-EVOLUTION lo I-EVOLUTION cual I-EVOLUTION arrojo I-EVOLUTION 15 I-EVOLUTION artículos I-EVOLUTION adicionales, I-EVOLUTION para I-EVOLUTION un I-EVOLUTION total I-EVOLUTION de I-EVOLUTION 168 I-EVOLUTION artículos, I-EVOLUTION de I-EVOLUTION los I-EVOLUTION cuales I-EVOLUTION se I-EVOLUTION seleccionaron I-EVOLUTION aquellas I-EVOLUTION publicaciones I-EVOLUTION consideradas I-EVOLUTION relevantes I-EVOLUTION por I-EVOLUTION parte I-EVOLUTION de I-EVOLUTION los I-EVOLUTION autores I-EVOLUTION para I-EVOLUTION la I-EVOLUTION discusión I-EVOLUTION del I-EVOLUTION tema. I-EVOLUTION Además I-EVOLUTION se I-EVOLUTION tomó I-EVOLUTION literatura I-EVOLUTION proveniente I-EVOLUTION de I-EVOLUTION libros I-EVOLUTION y I-EVOLUTION otras I-EVOLUTION publicaciones. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 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 ingresó I-PRESENT_ILLNESS el I-PRESENT_ILLNESS 24/07/1992, I-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 Hospital I-PRESENT_ILLNESS Clínico I-PRESENT_ILLNESS Regional I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Valdivia, I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS posterior I-PRESENT_ILLNESS a I-PRESENT_ILLNESS haber I-PRESENT_ILLNESS sufrido I-PRESENT_ILLNESS trauma I-PRESENT_ILLNESS toracoabdominal I-PRESENT_ILLNESS cerrado I-PRESENT_ILLNESS (aplastamiento I-PRESENT_ILLNESS entre I-PRESENT_ILLNESS muralla I-PRESENT_ILLNESS de I-PRESENT_ILLNESS concreto I-PRESENT_ILLNESS y I-PRESENT_ILLNESS camión). I-PRESENT_ILLNESS Al B-EXPLORATION examen, I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION conciente, I-EXPLORATION orientado I-EXPLORATION temporoespacialmente, I-EXPLORATION pálido, I-EXPLORATION taquicárdico I-EXPLORATION (pulso I-EXPLORATION 112x' I-EXPLORATION débil), I-EXPLORATION hipotenso I-EXPLORATION (PA I-EXPLORATION 70/50 I-EXPLORATION mmHg), I-EXPLORATION respiración I-EXPLORATION paradojal, I-EXPLORATION destacando I-EXPLORATION múltiples I-EXPLORATION erosiones I-EXPLORATION toracoabdominales, I-EXPLORATION crepitaciones I-EXPLORATION costales I-EXPLORATION múltiples, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION y I-EXPLORATION deformidad I-EXPLORATION del I-EXPLORATION antebrazo I-EXPLORATION izquierdo, I-EXPLORATION abolición I-EXPLORATION del I-EXPLORATION murmullo I-EXPLORATION pulmonar I-EXPLORATION en I-EXPLORATION base I-EXPLORATION derecha, I-EXPLORATION abdomen I-EXPLORATION sensible I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION la I-EXPLORATION matidez I-EXPLORATION hepática. I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION líquido I-EXPLORATION libre, I-EXPLORATION sin I-EXPLORATION identificar I-EXPLORATION lesión I-EXPLORATION hepática. I-EXPLORATION I-EXPLORATION Una I-EXPLORATION vez I-EXPLORATION estabilizado, I-EXPLORATION fue I-EXPLORATION a I-EXPLORATION pabellón, I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 2 I-EXPLORATION h I-EXPLORATION después I-EXPLORATION del I-EXPLORATION ingreso, I-EXPLORATION con I-EXPLORATION los I-EXPLORATION diagnósticos I-EXPLORATION de I-EXPLORATION trauma I-EXPLORATION toracoabdominal I-EXPLORATION complicado, I-EXPLORATION probable I-EXPLORATION rotura I-EXPLORATION de I-EXPLORATION víscera I-EXPLORATION hueca, I-EXPLORATION fractura I-EXPLORATION de I-EXPLORATION antebrazo I-EXPLORATION izquierdo, I-EXPLORATION fractura I-EXPLORATION esternal, I-EXPLORATION tórax I-EXPLORATION volante I-EXPLORATION y I-EXPLORATION hemoneumotórax I-EXPLORATION derecho. I-EXPLORATION Se B-TREATMENT instaló I-TREATMENT pleurostomía I-TREATMENT derecha, I-TREATMENT dando I-TREATMENT salida I-TREATMENT a I-TREATMENT aire I-TREATMENT y I-TREATMENT sangre. I-TREATMENT Se I-TREATMENT abordó I-TREATMENT vía I-TREATMENT laparotomía I-TREATMENT media I-TREATMENT supraumbilical, I-TREATMENT encontrando I-TREATMENT hemoperitoneo I-TREATMENT de I-TREATMENT 3 I-TREATMENT l, I-TREATMENT se I-TREATMENT identificó I-TREATMENT lesión I-TREATMENT hepática I-TREATMENT única, I-TREATMENT paralela I-TREATMENT a I-TREATMENT ligamento I-TREATMENT falciforme, I-TREATMENT que I-TREATMENT seccionaba I-TREATMENT al I-TREATMENT hígado I-TREATMENT en I-TREATMENT dos. I-TREATMENT No I-TREATMENT se I-TREATMENT logró I-TREATMENT control I-TREATMENT del I-TREATMENT sangrado I-TREATMENT con I-TREATMENT maniobra I-TREATMENT de I-TREATMENT Pringle, I-TREATMENT identificando I-TREATMENT origen I-TREATMENT de I-TREATMENT sangrado I-TREATMENT en I-TREATMENT vena I-TREATMENT cava I-TREATMENT supra I-TREATMENT y I-TREATMENT retrohepática. I-TREATMENT I-TREATMENT Se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT shunt I-TREATMENT atriocava, I-TREATMENT ampliando I-TREATMENT incisión I-TREATMENT a I-TREATMENT toracofrenolaparotomía I-TREATMENT derecha I-TREATMENT y I-TREATMENT se I-TREATMENT instaló I-TREATMENT tubo I-TREATMENT orotraqueal I-TREATMENT 7, I-TREATMENT 5 I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT aurícula I-TREATMENT derecha, I-TREATMENT cediendo I-TREATMENT el I-TREATMENT sangrado, I-TREATMENT identificando I-TREATMENT 2 I-TREATMENT lesiones I-TREATMENT en I-TREATMENT vena I-TREATMENT cava I-TREATMENT suprahepática I-TREATMENT de I-TREATMENT 1 I-TREATMENT y I-TREATMENT 2 I-TREATMENT cm I-TREATMENT y I-TREATMENT una I-TREATMENT lesión I-TREATMENT de I-TREATMENT 1 I-TREATMENT cm I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT cava I-TREATMENT retrohepática, I-TREATMENT que I-TREATMENT se I-TREATMENT suturan I-TREATMENT con I-TREATMENT prolene I-TREATMENT 4/0, I-TREATMENT completando, I-TREATMENT posteriormente, I-TREATMENT hepatectomía I-TREATMENT izquierda. I-TREATMENT Durante I-TREATMENT la I-TREATMENT cirugía I-TREATMENT se I-TREATMENT transfundieron I-TREATMENT 10 I-TREATMENT U I-TREATMENT de I-TREATMENT sangre I-TREATMENT total, I-TREATMENT 3 I-TREATMENT U I-TREATMENT de I-TREATMENT glóbulos I-TREATMENT rojos, I-TREATMENT 5 I-TREATMENT U I-TREATMENT de I-TREATMENT crioprecipitados, I-TREATMENT 2 I-TREATMENT U I-TREATMENT de I-TREATMENT plaquetas I-TREATMENT y I-TREATMENT 6 I-TREATMENT U I-TREATMENT de I-TREATMENT plasma. I-TREATMENT I-TREATMENT Ingresó B-EVOLUTION a I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos I-EVOLUTION (UCI) I-EVOLUTION con I-EVOLUTION PA I-EVOLUTION 100/60 I-EVOLUTION mmHg, I-EVOLUTION pulso I-EVOLUTION 162 I-EVOLUTION x', I-EVOLUTION PVC I-EVOLUTION 16 I-EVOLUTION cmH2O. I-EVOLUTION Se B-TREATMENT conectó I-TREATMENT a I-TREATMENT ventilación I-TREATMENT mecánica I-TREATMENT que I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT por I-TREATMENT 48 I-TREATMENT h, I-TREATMENT cursando I-TREATMENT posteriormente I-TREATMENT con I-TREATMENT coagulación I-TREATMENT intravascular. I-TREATMENT Evolucionó B-EVOLUTION favorablemente, I-EVOLUTION siendo I-EVOLUTION trasladado I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION postoperatorio I-EVOLUTION (03/08/1992) I-EVOLUTION al I-EVOLUTION Servicio I-EVOLUTION de I-EVOLUTION Cirugía I-EVOLUTION y I-EVOLUTION posteriormente I-EVOLUTION a I-EVOLUTION mutualidad I-EVOLUTION el I-EVOLUTION 08/08/1992, I-EVOLUTION desde I-EVOLUTION donde I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones I-EVOLUTION el I-EVOLUTION 20/08/1992. I-EVOLUTION I-EVOLUTION Mujer, B-PRESENT_ILLNESS 63 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS asintomática B-PAST_MEDICAL_HISTORY cardiovascular. I-PAST_MEDICAL_HISTORY Mientras B-PRESENT_ILLNESS realizaba I-PRESENT_ILLNESS ejercicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS moderada I-PRESENT_ILLNESS intensidad, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS palpitaciones I-PRESENT_ILLNESS rápidas, I-PRESENT_ILLNESS regulares, I-PRESENT_ILLNESS asociadas I-PRESENT_ILLNESS a I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general I-PRESENT_ILLNESS progresivo. I-PRESENT_ILLNESS Consultó B-EXPLORATION en I-EXPLORATION urgencia, I-EXPLORATION documentándose I-EXPLORATION taquicardia I-EXPLORATION regular, I-EXPLORATION con I-EXPLORATION frecuencia I-EXPLORATION de I-EXPLORATION 180 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION y I-EXPLORATION complejo I-EXPLORATION QRS I-EXPLORATION angosto, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION hipotensión, I-EXPLORATION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT realizó I-TREATMENT cardioversión I-TREATMENT eléctrica. I-TREATMENT I-TREATMENT Se B-EVOLUTION hospitalizó I-EVOLUTION para I-EVOLUTION monitorización I-EVOLUTION y I-EVOLUTION estudio. I-EVOLUTION Su B-EXPLORATION ECG I-EXPLORATION basal I-EXPLORATION mostró I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION con I-EXPLORATION complejos I-EXPLORATION QRS I-EXPLORATION normales. I-EXPLORATION Se I-EXPLORATION controlaron I-EXPLORATION enzimas I-EXPLORATION cardíacas I-EXPLORATION seriadas. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT EEF I-TREATMENT que I-TREATMENT mostró I-TREATMENT HPE I-TREATMENT lateral I-TREATMENT izquierdo I-TREATMENT oculto I-TREATMENT y I-TREATMENT taquicardia I-TREATMENT ortodrómica I-TREATMENT por I-TREATMENT éste, I-TREATMENT realizándose I-TREATMENT fulguración I-TREATMENT exitosa. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS 73 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 relevantes. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY sido I-PAST_MEDICAL_HISTORY sometida I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY cirugías I-PAST_MEDICAL_HISTORY abdominales I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY recientemente I-PAST_MEDICAL_HISTORY algún I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY abdominal I-PAST_MEDICAL_HISTORY agudo I-PAST_MEDICAL_HISTORY ni I-PAST_MEDICAL_HISTORY traumatismos I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY zona. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS molestias I-PRESENT_ILLNESS digestivas I-PRESENT_ILLNESS vagas, I-PRESENT_ILLNESS fundamentalmente I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tipo I-PRESENT_ILLNESS dispéptico, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS flatulencia, I-PRESENT_ILLNESS distensión I-PRESENT_ILLNESS y I-PRESENT_ILLNESS tendencia I-PRESENT_ILLNESS fluctuante I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS estitiquez. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION demostraba I-EXPLORATION una I-EXPLORATION paciente I-EXPLORATION en I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION general, I-EXPLORATION con I-EXPLORATION mucosas I-EXPLORATION rosadas I-EXPLORATION y I-EXPLORATION buen I-EXPLORATION estado I-EXPLORATION nutritivo. I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION abdominal I-EXPLORATION descartó I-EXPLORATION visceromegalia I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION masas. I-EXPLORATION Sin I-EXPLORATION soplos I-EXPLORATION abdominales, I-EXPLORATION con I-EXPLORATION buenos I-EXPLORATION pulsos I-EXPLORATION inguinales I-EXPLORATION y I-EXPLORATION distales. I-EXPLORATION Se I-EXPLORATION le I-EXPLORATION solicitó I-EXPLORATION hemograma I-EXPLORATION y I-EXPLORATION exámenes I-EXPLORATION bioquímicos, I-EXPLORATION más I-EXPLORATION una I-EXPLORATION exploración I-EXPLORATION abdominal I-EXPLORATION por I-EXPLORATION ultrasonografía I-EXPLORATION (US). I-EXPLORATION I-EXPLORATION Los I-EXPLORATION resultados I-EXPLORATION demostraron I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION anemia I-EXPLORATION y I-EXPLORATION funciones I-EXPLORATION hepática I-EXPLORATION y I-EXPLORATION renal I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION US I-EXPLORATION puso I-EXPLORATION en I-EXPLORATION evidencia I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION quístico I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 3 I-EXPLORATION centímetros I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION en I-EXPLORATION relación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION cuerpo I-EXPLORATION del I-EXPLORATION páncreas. I-EXPLORATION Este I-EXPLORATION último I-EXPLORATION examen I-EXPLORATION motivó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION del I-EXPLORATION abdomen, I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION esplénica I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION a I-EXPLORATION la I-EXPLORATION altura I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION córporo-caudal I-EXPLORATION del I-EXPLORATION páncreas. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programó I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT endovascular, I-TREATMENT efectuándose I-TREATMENT una I-TREATMENT exploración I-TREATMENT por I-TREATMENT vía I-TREATMENT femoral I-TREATMENT derecha I-TREATMENT según I-TREATMENT método I-TREATMENT de I-TREATMENT Seldinger I-TREATMENT con I-TREATMENT técnica I-TREATMENT coaxial, I-TREATMENT y I-TREATMENT embolización I-TREATMENT mediante I-TREATMENT coils I-TREATMENT metálicos, I-TREATMENT hasta I-TREATMENT oclusión I-TREATMENT completa I-TREATMENT de I-TREATMENT la I-TREATMENT cavidad. I-TREATMENT I-TREATMENT La B-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION efectuada I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 30 I-EXPLORATION días, I-EXPLORATION mostró I-EXPLORATION los I-EXPLORATION coils I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segmento I-EXPLORATION aneurismático I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION esplénica I-EXPLORATION con I-EXPLORATION permeabilidad I-EXPLORATION distal. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION visualizó I-EXPLORATION ninguna I-EXPLORATION lesión I-EXPLORATION focal I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION isquémico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION parénquima I-EXPLORATION del I-EXPLORATION bazo. I-EXPLORATION A B-EVOLUTION un I-EVOLUTION año I-EVOLUTION del I-EVOLUTION procedimiento, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones, I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION síntomas. I-EVOLUTION I-EVOLUTION Varón, B-PRESENT_ILLNESS 32 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS deportista, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY claudicación I-PAST_MEDICAL_HISTORY intermitente. I-PAST_MEDICAL_HISTORY Consultó, B-PRESENT_ILLNESS al I-PRESENT_ILLNESS cabo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS estos I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS necrosis I-PRESENT_ILLNESS del I-PRESENT_ILLNESS primer I-PRESENT_ILLNESS dedo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS pie I-PRESENT_ILLNESS derecho. I-PRESENT_ILLNESS I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacó I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION pulsos I-EXPLORATION poplíteo I-EXPLORATION y I-EXPLORATION distales I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION comprometida I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION seca I-EXPLORATION del I-EXPLORATION tercio I-EXPLORATION distal I-EXPLORATION del I-EXPLORATION 1er I-EXPLORATION dedo I-EXPLORATION derecho. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION los I-EXPLORATION pulsos I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION contralateral I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION registro I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION extremidad I-EXPLORATION derecha, I-EXPLORATION evidenciándose I-EXPLORATION alterado I-EXPLORATION de I-EXPLORATION rodilla I-EXPLORATION a I-EXPLORATION distal. I-EXPLORATION El I-EXPLORATION valor I-EXPLORATION del I-EXPLORATION índice I-EXPLORATION tobillo-brazo I-EXPLORATION fue I-EXPLORATION 0, I-EXPLORATION 64. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION acceso I-EXPLORATION femoral I-EXPLORATION izquierdo, I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION medialización I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION derecha, I-EXPLORATION asociada I-EXPLORATION a I-EXPLORATION estenosis I-EXPLORATION irregular I-EXPLORATION del I-EXPLORATION lumen I-EXPLORATION arterial I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION post-estenótica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria. I-EXPLORATION I-EXPLORATION Se B-TREATMENT procedió I-TREATMENT a I-TREATMENT cirugía I-TREATMENT electiva, I-TREATMENT abordando I-TREATMENT el I-TREATMENT hueco I-TREATMENT poplíteo I-TREATMENT por I-TREATMENT vía I-TREATMENT posterior. I-TREATMENT Durante I-TREATMENT la I-TREATMENT disección I-TREATMENT de I-TREATMENT la I-TREATMENT estructuras I-TREATMENT vasculares I-TREATMENT se I-TREATMENT observó I-TREATMENT la I-TREATMENT arteria I-TREATMENT poplítea I-TREATMENT desplazada I-TREATMENT hacia I-TREATMENT medial I-TREATMENT por I-TREATMENT la I-TREATMENT cabeza I-TREATMENT medial I-TREATMENT del I-TREATMENT gastrocnemio. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT resección I-TREATMENT del I-TREATMENT segmento I-TREATMENT comprometido I-TREATMENT (el I-TREATMENT cual I-TREATMENT se I-TREATMENT envió I-TREATMENT a I-TREATMENT estudio I-TREATMENT histológico) I-TREATMENT y I-TREATMENT reconstrucción I-TREATMENT mediante I-TREATMENT interposición I-TREATMENT de I-TREATMENT vena I-TREATMENT safena I-TREATMENT externa I-TREATMENT invertida. I-TREATMENT En B-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION inmediato I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION recuperó I-EVOLUTION los I-EVOLUTION pulsos I-EVOLUTION poplíteo I-EVOLUTION y I-EVOLUTION tibial I-EVOLUTION posterior. I-EVOLUTION I-EVOLUTION El B-EXPLORATION informe I-EXPLORATION de I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION reveló I-EXPLORATION ateroesclerosis I-EXPLORATION hialina I-EXPLORATION con I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION un I-EXPLORATION aneurisma. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION angiografía I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION no I-EXPLORATION reveló I-EXPLORATION atrapamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION poplítea I-EXPLORATION contralateral. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION sin I-EVOLUTION progresión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION necrosis. I-EVOLUTION Requirió B-TREATMENT una I-TREATMENT amputación I-TREATMENT del I-TREATMENT primer I-TREATMENT dedo, I-TREATMENT a I-TREATMENT nivel I-TREATMENT de I-TREATMENT la I-TREATMENT falange I-TREATMENT proximal, I-TREATMENT a I-TREATMENT los I-TREATMENT 3 I-TREATMENT meses I-TREATMENT del I-TREATMENT alta. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 59 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Veintiocho B-PRESENT_ILLNESS meses I-PRESENT_ILLNESS pretrasplante I-PRESENT_ILLNESS debutó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS y I-PRESENT_ILLNESS orina I-PRESENT_ILLNESS espumosa, I-PRESENT_ILLNESS objetivándose I-PRESENT_ILLNESS síndrome I-PRESENT_ILLNESS nefrótico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS proteinuria I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS g/día I-PRESENT_ILLNESS e I-PRESENT_ILLNESS hipoalbuminemia I-PRESENT_ILLNESS 1, I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS g/dL. I-PRESENT_ILLNESS El B-EXPLORATION clearance I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION y I-EXPLORATION la I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION eran I-EXPLORATION normales. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION etiológico I-EXPLORATION incluyó I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION inmunológico I-EXPLORATION (anticuerpos I-EXPLORATION antinucleares, I-EXPLORATION anticuerpos I-EXPLORATION antiADN, I-EXPLORATION anticuerpos I-EXPLORATION anticitoplasma I-EXPLORATION de I-EXPLORATION neutrófilos, I-EXPLORATION complementemia), I-EXPLORATION viral I-EXPLORATION (antígeno I-EXPLORATION de I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION virus I-EXPLORATION hepatitis I-EXPLORATION B, I-EXPLORATION anticuerpos I-EXPLORATION antivirus I-EXPLORATION hepatitis I-EXPLORATION C, I-EXPLORATION virus I-EXPLORATION de I-EXPLORATION inmunodeficiencia I-EXPLORATION humana), I-EXPLORATION y I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION proteína I-EXPLORATION en I-EXPLORATION sangre, I-EXPLORATION los I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION normales. I-EXPLORATION La I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION sólida I-EXPLORATION resultó I-EXPLORATION negativa, I-EXPLORATION incluyendo I-EXPLORATION mamografía, I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION ecotomografía I-EXPLORATION abdominal I-EXPLORATION y I-EXPLORATION pelviana, I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION y I-EXPLORATION colonoscopia. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION 24 I-EXPLORATION meses I-EXPLORATION pretrasplante, I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION amiloidosis. I-EXPLORATION La I-EXPLORATION tinción I-EXPLORATION con I-EXPLORATION Rojo I-EXPLORATION de I-EXPLORATION Congo, I-EXPLORATION y I-EXPLORATION Rojo I-EXPLORATION de I-EXPLORATION Congo I-EXPLORATION con I-EXPLORATION permanganato I-EXPLORATION de I-EXPLORATION potasio I-EXPLORATION fueron I-EXPLORATION ambas I-EXPLORATION muy I-EXPLORATION tenuemente I-EXPLORATION positivas I-EXPLORATION en I-EXPLORATION glomérulos I-EXPLORATION y I-EXPLORATION vasos I-EXPLORATION sanguíneos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION microscopia I-EXPLORATION electrónica I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION desaparición I-EXPLORATION pedicelar I-EXPLORATION parcelar I-EXPLORATION y I-EXPLORATION depósitos I-EXPLORATION densos I-EXPLORATION de I-EXPLORATION material I-EXPLORATION amiloideo I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION mesangial I-EXPLORATION y I-EXPLORATION en I-EXPLORATION algunas I-EXPLORATION asas I-EXPLORATION capilares I-EXPLORATION libres, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION fibrilar, I-EXPLORATION con I-EXPLORATION fibrillas I-EXPLORATION de I-EXPLORATION un I-EXPLORATION espesor I-EXPLORATION promedio I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION Angström. I-EXPLORATION Un I-EXPLORATION estudio I-EXPLORATION posterior I-EXPLORATION con I-EXPLORATION inmunofijación I-EXPLORATION sérica I-EXPLORATION y I-EXPLORATION urinaria I-EXPLORATION resultó I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION IgA-lambda I-EXPLORATION monoclonal. I-EXPLORATION La I-EXPLORATION cuantificación I-EXPLORATION de I-EXPLORATION inmunoglobulinas I-EXPLORATION séricas I-EXPLORATION reveló I-EXPLORATION IgA I-EXPLORATION 1.000 I-EXPLORATION mg/dL, I-EXPLORATION IgG I-EXPLORATION 852 I-EXPLORATION mg/dL I-EXPLORATION e I-EXPLORATION IgM I-EXPLORATION 93 I-EXPLORATION mg/dL. I-EXPLORATION El I-EXPLORATION mielograma I-EXPLORATION y I-EXPLORATION la I-EXPLORATION citometría I-EXPLORATION de I-EXPLORATION flujo I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION descartaron I-EXPLORATION un I-EXPLORATION mieloma I-EXPLORATION múltiple. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT melfalán I-TREATMENT oral I-TREATMENT y I-TREATMENT prednisona I-TREATMENT durante I-TREATMENT 6 I-TREATMENT meses, I-TREATMENT persistiendo I-TREATMENT la I-TREATMENT proteinuria I-TREATMENT nefrótica I-TREATMENT y I-TREATMENT la I-TREATMENT inmunofijación I-TREATMENT sérica I-TREATMENT positiva. I-TREATMENT Posteriormente I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT sólo I-TREATMENT con I-TREATMENT terapia I-TREATMENT inespecífica I-TREATMENT que I-TREATMENT incluyó I-TREATMENT enalapril, I-TREATMENT espironolactona I-TREATMENT y I-TREATMENT atorvastatina. I-TREATMENT Tres B-EVOLUTION meses I-EVOLUTION pretrasplante I-EVOLUTION se I-EVOLUTION mantenía I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION proteína I-EVOLUTION monoclonal I-EVOLUTION y I-EVOLUTION de I-EVOLUTION síndrome I-EVOLUTION nefrótico, I-EVOLUTION con I-EVOLUTION filtración I-EVOLUTION glomerular I-EVOLUTION normal. I-EVOLUTION Un B-EXPLORATION ecocardiograma I-EXPLORATION transtorácico I-EXPLORATION y I-EXPLORATION una I-EXPLORATION ventriculografía I-EXPLORATION isotópica I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION En I-EXPLORATION enero I-EXPLORATION de I-EXPLORATION 2004 I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION acondicionamiento I-EXPLORATION medular I-EXPLORATION con I-EXPLORATION factor I-EXPLORATION estimulante I-EXPLORATION de I-EXPLORATION colonias I-EXPLORATION granulocíticas I-EXPLORATION por I-EXPLORATION cinco I-EXPLORATION días, I-EXPLORATION y I-EXPLORATION cosecha I-EXPLORATION mediante I-EXPLORATION leucoaféresis I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION periférica I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 6 I-EXPLORATION x I-EXPLORATION 106 I-EXPLORATION células I-EXPLORATION troncales I-EXPLORATION hematopoyéticas. I-EXPLORATION Recibió B-TREATMENT melfalán I-TREATMENT endovenoso I-TREATMENT 200 I-TREATMENT mg/m2 I-TREATMENT de I-TREATMENT superficie I-TREATMENT corporal I-TREATMENT (día I-TREATMENT 0) I-TREATMENT y I-TREATMENT al I-TREATMENT día I-TREATMENT siguiente I-TREATMENT se I-TREATMENT realizó I-TREATMENT infusión I-TREATMENT única I-TREATMENT de I-TREATMENT las I-TREATMENT células I-TREATMENT troncales. I-TREATMENT A B-EXPLORATION partir I-EXPLORATION del I-EXPLORATION día I-EXPLORATION 2 I-EXPLORATION desarrolló I-EXPLORATION IRA I-EXPLORATION oligúrica, I-EXPLORATION con I-EXPLORATION fracción I-EXPLORATION excretada I-EXPLORATION de I-EXPLORATION sodio I-EXPLORATION 2%, I-EXPLORATION índice I-EXPLORATION uricosuria/creatininuria I-EXPLORATION <1, I-EXPLORATION 0 I-EXPLORATION a I-EXPLORATION pH I-EXPLORATION urinario I-EXPLORATION 7, I-EXPLORATION 0, I-EXPLORATION ecografía-doppler I-EXPLORATION renal I-EXPLORATION normal, I-EXPLORATION creatinquinasa I-EXPLORATION total I-EXPLORATION sérica I-EXPLORATION 285 I-EXPLORATION U/L, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION trombocitopenia I-EXPLORATION o I-EXPLORATION esquistocitosis I-EXPLORATION y I-EXPLORATION actividad I-EXPLORATION de I-EXPLORATION ADAMTS13 I-EXPLORATION de I-EXPLORATION 20%. I-EXPLORATION El I-EXPLORATION deterioro I-EXPLORATION de I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION se I-EXPLORATION acompañó I-EXPLORATION de I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION lisis I-EXPLORATION celular I-EXPLORATION (láctico-deshidrogenasa I-EXPLORATION hasta I-EXPLORATION 6.710 I-EXPLORATION U/L, I-EXPLORATION fosfatemia I-EXPLORATION hasta I-EXPLORATION 9, I-EXPLORATION 2 I-EXPLORATION mg/dL, I-EXPLORATION uricemia I-EXPLORATION hasta I-EXPLORATION 13, I-EXPLORATION 2 I-EXPLORATION mg/dL, I-EXPLORATION transaminasa I-EXPLORATION glutámico I-EXPLORATION oxaloacética I-EXPLORATION 351 I-EXPLORATION U/L) I-EXPLORATION y I-EXPLORATION rápido I-EXPLORATION ascenso I-EXPLORATION (hasta I-EXPLORATION 28.000 I-EXPLORATION células/mm3) I-EXPLORATION y I-EXPLORATION posterior I-EXPLORATION descenso I-EXPLORATION del I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION glóbulos I-EXPLORATION blancos I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION periférica, I-EXPLORATION llegando I-EXPLORATION hasta I-EXPLORATION una I-EXPLORATION completa I-EXPLORATION aplasia I-EXPLORATION que I-EXPLORATION se I-EXPLORATION prolongó I-EXPLORATION por I-EXPLORATION 12 I-EXPLORATION días. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION Tabla I-EXPLORATION 1 I-EXPLORATION se I-EXPLORATION detalla I-EXPLORATION la I-EXPLORATION evolución I-EXPLORATION de I-EXPLORATION algunos I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION representativos. I-EXPLORATION La B-TREATMENT paciente I-TREATMENT requirió I-TREATMENT del I-TREATMENT uso I-TREATMENT de I-TREATMENT factor I-TREATMENT estimulante I-TREATMENT de I-TREATMENT colonias I-TREATMENT granulocíticas I-TREATMENT entre I-TREATMENT los I-TREATMENT días I-TREATMENT 2 I-TREATMENT y I-TREATMENT 16 I-TREATMENT y I-TREATMENT de I-TREATMENT terapia I-TREATMENT de I-TREATMENT sustitución I-TREATMENT renal I-TREATMENT con I-TREATMENT hemodiafiltración I-TREATMENT veno-venosa I-TREATMENT intermitente I-TREATMENT diaria I-TREATMENT entre I-TREATMENT los I-TREATMENT días I-TREATMENT 5 I-TREATMENT al I-TREATMENT 14. I-TREATMENT Desde B-EVOLUTION el I-EVOLUTION día I-EVOLUTION 13 I-EVOLUTION recuperó I-EVOLUTION diuresis I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION el I-EVOLUTION día I-EVOLUTION 23 I-EVOLUTION post-melfalán, I-EVOLUTION con I-EVOLUTION creatininemia I-EVOLUTION 1, I-EVOLUTION 2 I-EVOLUTION mg/dL I-EVOLUTION y I-EVOLUTION recuento I-EVOLUTION de I-EVOLUTION glóbulos I-EVOLUTION blancos I-EVOLUTION 3.000/mm3. I-EVOLUTION I-EVOLUTION El I-EVOLUTION control I-EVOLUTION clínico I-EVOLUTION al I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento I-EVOLUTION reveló I-EVOLUTION excelente I-EVOLUTION estado I-EVOLUTION general, I-EVOLUTION filtración I-EVOLUTION glomerular I-EVOLUTION y I-EVOLUTION recuentos I-EVOLUTION hematológicos I-EVOLUTION normales, I-EVOLUTION proteinuria I-EVOLUTION <1 I-EVOLUTION g/día, I-EVOLUTION e I-EVOLUTION inmunofijación I-EVOLUTION sérica I-EVOLUTION negativa. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino I-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 dispepsia I-PAST_MEDICAL_HISTORY inespecífica 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 Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS estos I-PRESENT_ILLNESS síntomas. I-PRESENT_ILLNESS B-EXPLORATION El I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION hallazgos I-EXPLORATION anormales. I-EXPLORATION La I-EXPLORATION vesícula I-EXPLORATION no I-EXPLORATION era I-EXPLORATION palpable. I-EXPLORATION I-EXPLORATION Entre I-EXPLORATION sus I-EXPLORATION antecedentes I-EXPLORATION destacaba I-EXPLORATION ecotomografía I-EXPLORATION previa, I-EXPLORATION años I-EXPLORATION antes, I-EXPLORATION que I-EXPLORATION habría I-EXPLORATION sido I-EXPLORATION normal. I-EXPLORATION Panendoscopia I-EXPLORATION demostró I-EXPLORATION gastritis I-EXPLORATION crónica I-EXPLORATION erosiva. I-EXPLORATION I-EXPLORATION Fumador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 30 I-PAST_MEDICAL_HISTORY cigarrillos I-PAST_MEDICAL_HISTORY diarios, I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY neumotórax I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY No I-PAST_MEDICAL_HISTORY usaba I-PAST_MEDICAL_HISTORY medicamentos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY forma I-PAST_MEDICAL_HISTORY habitual. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue B-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO servicio I-DERIVED_FROM/TO para I-DERIVED_FROM/TO la I-DERIVED_FROM/TO realización I-DERIVED_FROM/TO de I-DERIVED_FROM/TO ecotomografía I-DERIVED_FROM/TO abdominal. I-DERIVED_FROM/TO Examen B-EXPLORATION que I-EXPLORATION fue I-EXPLORATION realizado I-EXPLORATION en I-EXPLORATION agosto I-EXPLORATION de I-EXPLORATION 2000, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION tumoración I-EXPLORATION del I-EXPLORATION lecho I-EXPLORATION vesicular I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION sólido, I-EXPLORATION caracterizada I-EXPLORATION por I-EXPLORATION engrosamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION de I-EXPLORATION fondo I-EXPLORATION y I-EXPLORATION cuerpo I-EXPLORATION que I-EXPLORATION deja I-EXPLORATION un I-EXPLORATION lumen I-EXPLORATION pequeño, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION cálculos. I-EXPLORATION Había I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION ecogénicas I-EXPLORATION con I-EXPLORATION artefacto I-EXPLORATION en I-EXPLORATION estalactita I-EXPLORATION en I-EXPLORATION su I-EXPLORATION espesor. I-EXPLORATION En I-EXPLORATION conclusión, I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION tumoración I-EXPLORATION vesicular I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION que I-EXPLORATION sugerían I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION probable I-EXPLORATION de I-EXPLORATION extensa I-EXPLORATION adenomiomatosis I-EXPLORATION del I-EXPLORATION fondo I-EXPLORATION y I-EXPLORATION cuerpo I-EXPLORATION vesicular. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION complementó I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION abdominal, I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION tumoración I-EXPLORATION del I-EXPLORATION área I-EXPLORATION vesicular, I-EXPLORATION planteando I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION neoplasia I-EXPLORATION vesicular I-EXPLORATION o I-EXPLORATION lesión I-EXPLORATION del I-EXPLORATION ángulo I-EXPLORATION esplénico I-EXPLORATION del I-EXPLORATION colon. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION no I-EXPLORATION infiltraba I-EXPLORATION el I-EXPLORATION hígado. I-EXPLORATION B-TREATMENT El I-TREATMENT paciente I-TREATMENT fue I-TREATMENT operado I-TREATMENT el I-TREATMENT 25.08.2000, I-TREATMENT realizándose I-TREATMENT colecistectomía. I-TREATMENT La B-EXPLORATION exploración I-EXPLORATION del I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cavidad I-EXPLORATION abdominal I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION adenomiomatosis I-EXPLORATION vesicular I-EXPLORATION difusa. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino, I-PRESENT_ILLNESS padres B-FAMILY_HISTORY no I-FAMILY_HISTORY consanguíneos, I-FAMILY_HISTORY sin I-FAMILY_HISTORY antecedentes I-FAMILY_HISTORY perinatales I-FAMILY_HISTORY de I-FAMILY_HISTORY relevancia; I-FAMILY_HISTORY peso B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nacimiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 3-450 I-PAST_MEDICAL_HISTORY g, I-PAST_MEDICAL_HISTORY talla I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 49, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY cm I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY circunferencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cráneo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 35, I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY cm. I-PAST_MEDICAL_HISTORY Apgar I-PAST_MEDICAL_HISTORY 9, I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY min. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-PRESENT_ILLNESS mes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS crisis I-PRESENT_ILLNESS tónico I-PRESENT_ILLNESS clónicas I-PRESENT_ILLNESS generalizadas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS segundos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS evolucionando I-PRESENT_ILLNESS con I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS mioclonías I-PRESENT_ILLNESS al I-PRESENT_ILLNESS día, I-PRESENT_ILLNESS agregándose I-PRESENT_ILLNESS espasmos I-PRESENT_ILLNESS en I-PRESENT_ILLNESS flexión. I-PRESENT_ILLNESS Recibió I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS farmacológico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS ácido I-PRESENT_ILLNESS valproico, I-PRESENT_ILLNESS fenobarbital I-PRESENT_ILLNESS y I-PRESENT_ILLNESS carbamazepina, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS clínica, I-PRESENT_ILLNESS desencadenando I-PRESENT_ILLNESS una I-PRESENT_ILLNESS reacción I-PRESENT_ILLNESS adversa I-PRESENT_ILLNESS al I-PRESENT_ILLNESS ácido I-PRESENT_ILLNESS valproico I-PRESENT_ILLNESS con I-PRESENT_ILLNESS hiperamonemia I-PRESENT_ILLNESS sintomática. I-PRESENT_ILLNESS I-PRESENT_ILLNESS A B-EXPLORATION los I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION medio I-EXPLORATION meses I-EXPLORATION de I-EXPLORATION edad I-EXPLORATION se I-EXPLORATION realizaron I-EXPLORATION exámenes I-EXPLORATION para I-EXPLORATION descartar I-EXPLORATION una I-EXPLORATION enfermedad I-EXPLORATION metabólica, I-EXPLORATION encontrándose I-EXPLORATION una I-EXPLORATION lactacidemia I-EXPLORATION de I-EXPLORATION 26, I-EXPLORATION 5 I-EXPLORATION mg/dl I-EXPLORATION (VN: I-EXPLORATION 5-15), I-EXPLORATION disminución I-EXPLORATION del I-EXPLORATION lactato I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 6 I-EXPLORATION mg/dl I-EXPLORATION (VN: I-EXPLORATION 10, I-EXPLORATION 8-18, I-EXPLORATION 9 I-EXPLORATION mg/dl). I-EXPLORATION El I-EXPLORATION ácido I-EXPLORATION pirúvico I-EXPLORATION en I-EXPLORATION plasma I-EXPLORATION estaba I-EXPLORATION aumentado I-EXPLORATION (1, I-EXPLORATION 4 I-EXPLORATION mg/dl) I-EXPLORATION (VN: I-EXPLORATION 0, I-EXPLORATION 3-0, I-EXPLORATION 9), I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION era I-EXPLORATION normal I-EXPLORATION (0, I-EXPLORATION 43 I-EXPLORATION mg/dl) I-EXPLORATION (VN: I-EXPLORATION 0, I-EXPLORATION 5-1, I-EXPLORATION 7) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION amonemia I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 85 I-EXPLORATION µg/dl I-EXPLORATION (35-100 I-EXPLORATION µg/dl). I-EXPLORATION La I-EXPLORATION cuantiñ-cación I-EXPLORATION de I-EXPLORATION aminoácidos I-EXPLORATION en I-EXPLORATION suero, I-EXPLORATION acilcarniünas I-EXPLORATION en I-EXPLORATION sangre I-EXPLORATION total, I-EXPLORATION ácidos I-EXPLORATION orgánicos I-EXPLORATION en I-EXPLORATION orina I-EXPLORATION y I-EXPLORATION carnitina I-EXPLORATION en I-EXPLORATION suero I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION A I-EXPLORATION los I-EXPLORATION 5 I-EXPLORATION meses, I-EXPLORATION el I-EXPLORATION electroencefalograma I-EXPLORATION (EEG) I-EXPLORATION detectó I-EXPLORATION una I-EXPLORATION actividad I-EXPLORATION theta-delta I-EXPLORATION polimorfa I-EXPLORATION continua, I-EXPLORATION considerada I-EXPLORATION anormal I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION la I-EXPLORATION resonancia I-EXPLORATION nuclear I-EXPLORATION magnética I-EXPLORATION mostró I-EXPLORATION atrofia I-EXPLORATION frontal I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION espacios I-EXPLORATION subaracnoídeos. I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION retardo I-EVOLUTION en I-EVOLUTION el I-EVOLUTION desarrollo I-EVOLUTION psicomotor I-EVOLUTION y I-EVOLUTION desaceleración I-EVOLUTION del I-EVOLUTION crecimiento I-EVOLUTION craneano, I-EVOLUTION ataxia I-EVOLUTION de I-EVOLUTION tronco I-EVOLUTION y I-EVOLUTION síndrome I-EVOLUTION piramidal I-EVOLUTION bilateral. I-EVOLUTION I-EVOLUTION A B-EXPLORATION los I-EXPLORATION 7 I-EXPLORATION meses I-EXPLORATION ingresó I-EXPLORATION al I-EXPLORATION Hospital I-EXPLORATION de I-EXPLORATION Niños I-EXPLORATION de I-EXPLORATION Boston, I-EXPLORATION de I-EXPLORATION Estados I-EXPLORATION Unidos I-EXPLORATION de I-EXPLORATION Norteamérica, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION glucosa I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION de I-EXPLORATION 26 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION normoglucemia I-EXPLORATION (84 I-EXPLORATION mg/dl), I-EXPLORATION obteniéndose I-EXPLORATION una I-EXPLORATION razón I-EXPLORATION entre I-EXPLORATION ambos I-EXPLORATION parámetros I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 31 I-EXPLORATION (valor I-EXPLORATION normal I-EXPLORATION sobre I-EXPLORATION 0, I-EXPLORATION 65+0, I-EXPLORATION 01), I-EXPLORATION concordante I-EXPLORATION con I-EXPLORATION una I-EXPLORATION hipo-glucorraquia, I-EXPLORATION sugiriéndose I-EXPLORATION un I-EXPLORATION SDGLUT-1. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION ha I-EXPLORATION demostrado I-EXPLORATION que I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION Glut-1 I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eritrocito I-EXPLORATION es I-EXPLORATION idéntica I-EXPLORATION a I-EXPLORATION la I-EXPLORATION proteína I-EXPLORATION Glut-1 I-EXPLORATION de I-EXPLORATION las I-EXPLORATION células I-EXPLORATION endoteliales I-EXPLORATION de I-EXPLORATION los I-EXPLORATION capilares I-EXPLORATION del I-EXPLORATION cerebro, I-EXPLORATION tanto I-EXPLORATION en I-EXPLORATION la I-EXPLORATION respuesta I-EXPLORATION inmunológica I-EXPLORATION como I-EXPLORATION química. I-EXPLORATION Por I-EXPLORATION esta I-EXPLORATION razón, I-EXPLORATION el I-EXPLORATION transporte I-EXPLORATION de I-EXPLORATION glucosa I-EXPLORATION en I-EXPLORATION el I-EXPLORATION eritrocito I-EXPLORATION es I-EXPLORATION comparable I-EXPLORATION con I-EXPLORATION el I-EXPLORATION transporte I-EXPLORATION de I-EXPLORATION glucosa I-EXPLORATION a I-EXPLORATION través I-EXPLORATION de I-EXPLORATION la I-EXPLORATION barrera I-EXPLORATION hematoencefálica. I-EXPLORATION Considerando I-EXPLORATION este I-EXPLORATION hallazgo, I-EXPLORATION se I-EXPLORATION desarrolló I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION 3-O-metil I-EXPLORATION D I-EXPLORATION glucosa, I-EXPLORATION que I-EXPLORATION determina I-EXPLORATION la I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION glucosa I-EXPLORATION por I-EXPLORATION el I-EXPLORATION eritrocito, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION permite I-EXPLORATION la I-EXPLORATION extrapolación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION transporte I-EXPLORATION de I-EXPLORATION glucosa I-EXPLORATION en I-EXPLORATION la I-EXPLORATION barrera I-EXPLORATION hematoencefálica11. I-EXPLORATION En B-TREATMENT nuestro I-TREATMENT caso, I-TREATMENT se I-TREATMENT aplicó I-TREATMENT esta I-TREATMENT técnica, I-TREATMENT obteniéndose I-TREATMENT una I-TREATMENT captación I-TREATMENT de I-TREATMENT glucosa I-TREATMENT de I-TREATMENT 44% I-TREATMENT (VN I-TREATMENT 80%-100%), I-TREATMENT confirmándose I-TREATMENT un I-TREATMENT SDGLUT-1. I-TREATMENT I-TREATMENT En B-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION molecular I-EXPLORATION se I-EXPLORATION utilizó I-EXPLORATION la I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena I-EXPLORATION (PCR) I-EXPLORATION y I-EXPLORATION el I-EXPLORATION análisis I-EXPLORATION de I-EXPLORATION polimorfismos I-EXPLORATION por I-EXPLORATION fragmentos I-EXPLORATION de I-EXPLORATION restricción I-EXPLORATION (RFLP) I-EXPLORATION 3, I-EXPLORATION 6 I-EXPLORATION determinándose I-EXPLORATION la I-EXPLORATION mutación I-EXPLORATION del I-EXPLORATION upo I-EXPLORATION deleción I-EXPLORATION 969, I-EXPLORATION C971T, I-EXPLORATION ubicada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION exon I-EXPLORATION 6, I-EXPLORATION de I-EXPLORATION gen I-EXPLORATION Glut-1 I-EXPLORATION (Estudio I-EXPLORATION molecular I-EXPLORATION realizado I-EXPLORATION por I-EXPLORATION el I-EXPLORATION Dr. I-EXPLORATION D. I-EXPLORATION De I-EXPLORATION Vivo). I-EXPLORATION I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION por I-EXPLORATION emisión I-EXPLORATION de I-EXPLORATION fotón I-EXPLORATION único I-EXPLORATION (SPECT) I-EXPLORATION mostró I-EXPLORATION hipometabolismo I-EXPLORATION talámico, I-EXPLORATION parietal I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION temporal I-EXPLORATION bilateral. I-EXPLORATION I-EXPLORATION Inmediatamente B-TREATMENT se I-TREATMENT inició I-TREATMENT la I-TREATMENT dieta I-TREATMENT cetogénica, I-TREATMENT proporcionando I-TREATMENT 90 I-TREATMENT calorías I-TREATMENT por I-TREATMENT kilo I-TREATMENT de I-TREATMENT peso, I-TREATMENT con I-TREATMENT 85% I-TREATMENT de I-TREATMENT lípidos, I-TREATMENT 9% I-TREATMENT de I-TREATMENT proteínas I-TREATMENT y I-TREATMENT 6% I-TREATMENT de I-TREATMENT carbohidratos, I-TREATMENT con I-TREATMENT relación I-TREATMENT de I-TREATMENT 3: I-TREATMENT 1 I-TREATMENT entre I-TREATMENT lípidos I-TREATMENT y I-TREATMENT proteínas I-TREATMENT más I-TREATMENT carbohidratos, I-TREATMENT basándose I-TREATMENT en I-TREATMENT el I-TREATMENT protocolo I-TREATMENT utilizado I-TREATMENT en I-TREATMENT el I-TREATMENT INTA, I-TREATMENT de I-TREATMENT la I-TREATMENT Universidad I-TREATMENT de I-TREATMENT Chile9, I-TREATMENT 10. I-TREATMENT La I-TREATMENT dieta I-TREATMENT prohibe I-TREATMENT alimentos I-TREATMENT con I-TREATMENT sacarosa, I-TREATMENT sorbitol, I-TREATMENT fructosa I-TREATMENT y I-TREATMENT se I-TREATMENT restringe I-TREATMENT el I-TREATMENT consumo I-TREATMENT de I-TREATMENT lactosa, I-TREATMENT razón I-TREATMENT por I-TREATMENT lo I-TREATMENT cual I-TREATMENT fue I-TREATMENT necesario I-TREATMENT suplementar I-TREATMENT con I-TREATMENT calcio I-TREATMENT (450 I-TREATMENT mg/día), I-TREATMENT zinc I-TREATMENT (5 I-TREATMENT mg/día), I-TREATMENT vitaminas, I-TREATMENT especialmente I-TREATMENT vitamina I-TREATMENT C I-TREATMENT (1 I-TREATMENT g/día) I-TREATMENT para I-TREATMENT prevenir I-TREATMENT oxidación I-TREATMENT celular, I-TREATMENT L-carnitina I-TREATMENT (50 I-TREATMENT mg/kg/día) I-TREATMENT y I-TREATMENT ácido I-TREATMENT lipóico I-TREATMENT (200 I-TREATMENT mg/día). I-TREATMENT I-TREATMENT Después B-EVOLUTION de I-EVOLUTION 7 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION iniciada I-EVOLUTION la I-EVOLUTION dieta I-EVOLUTION cetogénica, I-EVOLUTION desaparecieron I-EVOLUTION las I-EVOLUTION crisis, I-EVOLUTION y B-TREATMENT conjuntamente I-TREATMENT se I-TREATMENT inició I-TREATMENT la I-TREATMENT disminución I-TREATMENT de I-TREATMENT los I-TREATMENT anticonvulsivantes. I-TREATMENT I-TREATMENT Actualmente B-EVOLUTION tiene I-EVOLUTION 6 I-EVOLUTION años I-EVOLUTION de I-EVOLUTION edad, I-EVOLUTION mantiene I-EVOLUTION la I-EVOLUTION dieta I-EVOLUTION cetogénica I-EVOLUTION con I-EVOLUTION 83% I-EVOLUTION de I-EVOLUTION lípidos I-EVOLUTION (27% I-EVOLUTION de I-EVOLUTION ellos I-EVOLUTION corresponde I-EVOLUTION a I-EVOLUTION triglicéridos I-EVOLUTION de I-EVOLUTION cadena I-EVOLUTION mediana) I-EVOLUTION y I-EVOLUTION 17% I-EVOLUTION de I-EVOLUTION proteínas I-EVOLUTION más I-EVOLUTION carbohidratos I-EVOLUTION (razón I-EVOLUTION de I-EVOLUTION 2, I-EVOLUTION 5: I-EVOLUTION 1). I-EVOLUTION La I-EVOLUTION suplementación I-EVOLUTION de I-EVOLUTION nutrientes I-EVOLUTION es I-EVOLUTION la I-EVOLUTION misma I-EVOLUTION que I-EVOLUTION al I-EVOLUTION inicio, I-EVOLUTION y I-EVOLUTION se I-EVOLUTION han I-EVOLUTION ido I-EVOLUTION adecuando I-EVOLUTION según I-EVOLUTION edad I-EVOLUTION y I-EVOLUTION estado I-EVOLUTION nutricional. I-EVOLUTION I-EVOLUTION La B-EXPLORATION glicemia I-EXPLORATION se I-EXPLORATION mantiene I-EXPLORATION en I-EXPLORATION valores I-EXPLORATION de I-EXPLORATION 80 I-EXPLORATION a I-EXPLORATION 90 I-EXPLORATION mg/dl, I-EXPLORATION el I-EXPLORATION colesterol I-EXPLORATION total I-EXPLORATION en I-EXPLORATION 187 I-EXPLORATION mg/dl, I-EXPLORATION la I-EXPLORATION HDL I-EXPLORATION en I-EXPLORATION 55 I-EXPLORATION mg/dl I-EXPLORATION y I-EXPLORATION LDL I-EXPLORATION en I-EXPLORATION 121 I-EXPLORATION mg/dl. I-EXPLORATION Calciuria I-EXPLORATION creatininuria, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION gases I-EXPLORATION venosos I-EXPLORATION y I-EXPLORATION electrolitos I-EXPLORATION plasmáticos I-EXPLORATION están I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION de I-EXPLORATION normalidad. I-EXPLORATION El I-EXPLORATION ácido I-EXPLORATION beta I-EXPLORATION hidroxibutirato I-EXPLORATION en I-EXPLORATION ayuno I-EXPLORATION es I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION µM/1 I-EXPLORATION y I-EXPLORATION posprandial I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 0 I-EXPLORATION µM/l, I-EXPLORATION considerándose I-EXPLORATION cetogénesis I-EXPLORATION cuando I-EXPLORATION este I-EXPLORATION valor I-EXPLORATION se I-EXPLORATION encuentra I-EXPLORATION sobre I-EXPLORATION 2, I-EXPLORATION 0 I-EXPLORATION µM/1. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION destaca I-EXPLORATION una I-EXPLORATION conducta I-EXPLORATION hiperactiva I-EXPLORATION en I-EXPLORATION su I-EXPLORATION examen I-EXPLORATION mental. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION pares I-EXPLORATION craneanos I-EXPLORATION presenta I-EXPLORATION disartria I-EXPLORATION e I-EXPLORATION hipomimia I-EXPLORATION facial. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION motor I-EXPLORATION muestra I-EXPLORATION tono I-EXPLORATION de I-EXPLORATION tronco I-EXPLORATION y I-EXPLORATION extremidades I-EXPLORATION disminuido, I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION fuerza I-EXPLORATION ni I-EXPLORATION del I-EXPLORATION trofismo I-EXPLORATION muscular. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION cerebeloso I-EXPLORATION existe I-EXPLORATION un I-EXPLORATION temblor I-EXPLORATION fino I-EXPLORATION de I-EXPLORATION intención, I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION sincinesias, I-EXPLORATION dismetría I-EXPLORATION y I-EXPLORATION discreta I-EXPLORATION disdiadococinesia. I-EXPLORATION La I-EXPLORATION marcha I-EXPLORATION es I-EXPLORATION inestable I-EXPLORATION y I-EXPLORATION se I-EXPLORATION caracteriza I-EXPLORATION por I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION base I-EXPLORATION de I-EXPLORATION sustentación, I-EXPLORATION sin I-EXPLORATION lateralización. I-EXPLORATION I-EXPLORATION Su I-EXPLORATION coeficiente I-EXPLORATION intelectual I-EXPLORATION (CI), I-EXPLORATION evaluado I-EXPLORATION por I-EXPLORATION la I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION inteligencia I-EXPLORATION para I-EXPLORATION preescolares I-EXPLORATION de I-EXPLORATION Wechs-ler I-EXPLORATION (WISP) I-EXPLORATION 12, I-EXPLORATION obtuvo I-EXPLORATION CI I-EXPLORATION total I-EXPLORATION de I-EXPLORATION 103 I-EXPLORATION puntos, I-EXPLORATION límite I-EXPLORATION superior I-EXPLORATION del I-EXPLORATION rango I-EXPLORATION normal I-EXPLORATION promedio, I-EXPLORATION corregido I-EXPLORATION según I-EXPLORATION normas I-EXPLORATION norteamericanas. I-EXPLORATION Presenta, I-EXPLORATION sin I-EXPLORATION embargo, I-EXPLORATION una I-EXPLORATION discrepancia I-EXPLORATION significativa I-EXPLORATION entre I-EXPLORATION la I-EXPLORATION escala I-EXPLORATION verbal I-EXPLORATION y I-EXPLORATION manual, I-EXPLORATION en I-EXPLORATION desmedro I-EXPLORATION de I-EXPLORATION esta I-EXPLORATION última I-EXPLORATION (CI I-EXPLORATION verbal: I-EXPLORATION 119, I-EXPLORATION normal I-EXPLORATION alto I-EXPLORATION y I-EXPLORATION CI I-EXPLORATION manual: I-EXPLORATION 85, I-EXPLORATION normal I-EXPLORATION lento), I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION traduce I-EXPLORATION en I-EXPLORATION dificultades I-EXPLORATION específicas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION organización I-EXPLORATION visoespacial I-EXPLORATION y I-EXPLORATION visomotricidad. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estado I-EXPLORATION nutricional I-EXPLORATION es I-EXPLORATION normal: I-EXPLORATION índice I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION corporal I-EXPLORATION de I-EXPLORATION 15, I-EXPLORATION 8 I-EXPLORATION kg/m2 I-EXPLORATION (VN I-EXPLORATION entre I-EXPLORATION 15 I-EXPLORATION y I-EXPLORATION 18 I-EXPLORATION kg/m2) I-EXPLORATION 13, I-EXPLORATION con I-EXPLORATION peso I-EXPLORATION (21 I-EXPLORATION kg) I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION y I-EXPLORATION talla I-EXPLORATION (1, I-EXPLORATION 16 I-EXPLORATION m) I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad, I-EXPLORATION ambos I-EXPLORATION parámetros I-EXPLORATION en I-EXPLORATION el I-EXPLORATION percentil I-EXPLORATION 75 I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tabla I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION (National I-EXPLORATION Center I-EXPLORATION for I-EXPLORATION Health I-EXPLORATION Statistics) I-EXPLORATION 14. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 35 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS multípara, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY epilepsia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY primidona I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cuello I-PAST_MEDICAL_HISTORY uterino I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY etapa I-PAST_MEDICAL_HISTORY Ib2, I-PAST_MEDICAL_HISTORY operado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY diciembre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2000 I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY quimioterapia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY braquiterapia. I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS los I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS posteriores, I-PRESENT_ILLNESS al I-PRESENT_ILLNESS finalizar I-PRESENT_ILLNESS las I-PRESENT_ILLNESS sesiones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS radioterapia, I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS sangrado I-PRESENT_ILLNESS digestivo I-PRESENT_ILLNESS bajo I-PRESENT_ILLNESS intermitente, I-PRESENT_ILLNESS agregándose I-PRESENT_ILLNESS posteriormente I-PRESENT_ILLNESS pujo, I-PRESENT_ILLNESS tenesmo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS bajo. I-PRESENT_ILLNESS El B-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION impresionaba I-EXPLORATION con I-EXPLORATION mucosa I-EXPLORATION irregular I-EXPLORATION y I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION palpándose I-EXPLORATION una I-EXPLORATION zona I-EXPLORATION ulcerada I-EXPLORATION de I-EXPLORATION aproximadamente I-EXPLORATION 2, I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION iniciaba I-EXPLORATION a I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION esfínter I-EXPLORATION anorrectal. I-EXPLORATION Se I-EXPLORATION diagnosticó I-EXPLORATION clínicamente I-EXPLORATION una I-EXPLORATION rectitis I-EXPLORATION actínica, I-EXPLORATION indicándose I-EXPLORATION una I-EXPLORATION rectoscopia, I-EXPLORATION la I-EXPLORATION que I-EXPLORATION no I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION por I-EXPLORATION rechazo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente. I-EXPLORATION Inició B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT enemas I-TREATMENT con I-TREATMENT prednisona, I-TREATMENT que I-TREATMENT lograron I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT En B-EXPLORATION un I-EXPLORATION examen I-EXPLORATION ginecológico I-EXPLORATION 8 I-EXPLORATION meses I-EXPLORATION post I-EXPLORATION cirugía I-EXPLORATION se I-EXPLORATION apreció I-EXPLORATION en I-EXPLORATION el I-EXPLORATION recto, I-EXPLORATION a I-EXPLORATION 8 I-EXPLORATION cm I-EXPLORATION del I-EXPLORATION ano, I-EXPLORATION una I-EXPLORATION área I-EXPLORATION densa, I-EXPLORATION irregular, I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION adherencia I-EXPLORATION a I-EXPLORATION parametrio I-EXPLORATION derecho, I-EXPLORATION que I-EXPLORATION impresionaba I-EXPLORATION como I-EXPLORATION secuela I-EXPLORATION secundaria I-EXPLORATION a I-EXPLORATION fibrosis I-EXPLORATION post I-EXPLORATION radioterapia. I-EXPLORATION No B-EVOLUTION se I-EVOLUTION realizaron I-EVOLUTION exámenes I-EVOLUTION imagenológicos, I-EVOLUTION ya I-EVOLUTION que I-EVOLUTION presentado I-EVOLUTION su I-EVOLUTION caso I-EVOLUTION al I-EVOLUTION comité I-EVOLUTION oncológico, I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION realizar I-EVOLUTION sólo I-EVOLUTION seguimiento I-EVOLUTION clínico. I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION en I-EVOLUTION control I-EVOLUTION ambulatorio I-EVOLUTION periódico, I-EVOLUTION describiéndose I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION con I-EVOLUTION tactos I-EVOLUTION rectales I-EVOLUTION descritos I-EVOLUTION como I-EVOLUTION normales I-EVOLUTION hasta I-EVOLUTION su I-EVOLUTION último I-EVOLUTION control I-EVOLUTION en I-EVOLUTION mayo I-EVOLUTION de I-EVOLUTION 2005. I-EVOLUTION El I-EVOLUTION 01/02/2006, I-EVOLUTION consultó I-EVOLUTION en I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION urgencia I-EVOLUTION por I-EVOLUTION presentar I-EVOLUTION un I-EVOLUTION día I-EVOLUTION de I-EVOLUTION dolor I-EVOLUTION abdominal I-EVOLUTION cólico I-EVOLUTION difuso, I-EVOLUTION con I-EVOLUTION vómitos I-EVOLUTION abundantes, I-EVOLUTION con I-EVOLUTION abdomen I-EVOLUTION distendido, I-EVOLUTION sensible I-EVOLUTION difusamente. I-EVOLUTION Al B-EXPLORATION tacto I-EXPLORATION rectal I-EXPLORATION se I-EXPLORATION detectó I-EXPLORATION masa I-EXPLORATION rectal I-EXPLORATION indurada I-EXPLORATION (cara I-EXPLORATION anterior) I-EXPLORATION con I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION material I-EXPLORATION purulento. I-EXPLORATION Ingresó B-EVOLUTION a I-EVOLUTION pabellón I-EVOLUTION con I-EVOLUTION el I-EVOLUTION diagnóstico I-EVOLUTION clínico I-EVOLUTION de I-EVOLUTION peritonitis I-EVOLUTION difusa I-EVOLUTION y I-EVOLUTION con I-EVOLUTION probable I-EVOLUTION perforación I-EVOLUTION intestinal. I-EVOLUTION Durante B-TREATMENT la I-TREATMENT cirugía I-TREATMENT de I-TREATMENT urgencia I-TREATMENT se I-TREATMENT observó I-TREATMENT segmento I-TREATMENT rectosigmoideo I-TREATMENT este-nótico I-TREATMENT e I-TREATMENT indurado. I-TREATMENT Fue I-TREATMENT interpretado I-TREATMENT como I-TREATMENT tumoral, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT resección I-TREATMENT del I-TREATMENT segmento I-TREATMENT afectado I-TREATMENT y I-TREATMENT colostomía I-TREATMENT del I-TREATMENT cabo I-TREATMENT proximal. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION post I-EVOLUTION cirugía. I-EVOLUTION I-EVOLUTION En B-EXPLORATION patología I-EXPLORATION se I-EXPLORATION recibió I-EXPLORATION pieza I-EXPLORATION quirúrgica I-EXPLORATION de I-EXPLORATION intestino I-EXPLORATION grueso I-EXPLORATION de I-EXPLORATION 9 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION por I-EXPLORATION 8 I-EXPLORATION y I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION perímetro I-EXPLORATION en I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION sección. I-EXPLORATION Al I-EXPLORATION corte, I-EXPLORATION la I-EXPLORATION mucosa I-EXPLORATION presentaba I-EXPLORATION zona I-EXPLORATION cilindrica I-EXPLORATION estenótica I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION longitud I-EXPLORATION cercana I-EXPLORATION a I-EXPLORATION uno I-EXPLORATION de I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION de I-EXPLORATION sección, I-EXPLORATION con I-EXPLORATION segmento I-EXPLORATION proximal I-EXPLORATION dilatado I-EXPLORATION que I-EXPLORATION presentaba I-EXPLORATION áreas I-EXPLORATION hemorrágicas I-EXPLORATION y I-EXPLORATION con I-EXPLORATION depósito I-EXPLORATION superficial I-EXPLORATION de I-EXPLORATION fibrina. I-EXPLORATION I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION microscópico I-EXPLORATION reveló I-EXPLORATION distorsión I-EXPLORATION marcada I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arquitectura I-EXPLORATION intestinal, I-EXPLORATION con I-EXPLORATION fibrosis I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION cicatricial I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION crónico I-EXPLORATION con I-EXPLORATION reagudización I-EXPLORATION hemorrágica I-EXPLORATION en I-EXPLORATION granulación I-EXPLORATION superficial. I-EXPLORATION Se I-EXPLORATION observó I-EXPLORATION ausencia I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION lámina I-EXPLORATION propia I-EXPLORATION en I-EXPLORATION un I-EXPLORATION segmento, I-EXPLORATION con I-EXPLORATION glándulas I-EXPLORATION mucosas I-EXPLORATION suprayacentes I-EXPLORATION penetrando I-EXPLORATION en I-EXPLORATION la I-EXPLORATION túnica I-EXPLORATION muscular I-EXPLORATION propia, I-EXPLORATION algunas I-EXPLORATION dilatadas, I-EXPLORATION ubicadas I-EXPLORATION en I-EXPLORATION su I-EXPLORATION mitad I-EXPLORATION externa, I-EXPLORATION sin I-EXPLORATION atipias I-EXPLORATION citológicas I-EXPLORATION ni I-EXPLORATION arquitecturales. I-EXPLORATION Los I-EXPLORATION vasos I-EXPLORATION sanguíneos I-EXPLORATION se I-EXPLORATION observaban I-EXPLORATION moderadamente I-EXPLORATION escleróticos. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION adventicia I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION área I-EXPLORATION de I-EXPLORATION adiponecro-sis I-EXPLORATION y I-EXPLORATION esclerosis I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION cicatricial I-EXPLORATION con I-EXPLORATION retracción I-EXPLORATION del I-EXPLORATION tejido I-EXPLORATION adyacente. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION mitosis I-EXPLORATION ni I-EXPLORATION atipias I-EXPLORATION citológicas. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION morfológicos I-EXPLORATION confirmaron I-EXPLORATION secuelas I-EXPLORATION de I-EXPLORATION una I-EXPLORATION rectitis I-EXPLORATION actínica. I-EXPLORATION I-EXPLORATION 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 miocar-diopatía I-PAST_MEDICAL_HISTORY dilatada I-PAST_MEDICAL_HISTORY avanzada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY trasplante I-PAST_MEDICAL_HISTORY cardíaco I-PAST_MEDICAL_HISTORY ortotópico I-PAST_MEDICAL_HISTORY biauricular I-PAST_MEDICAL_HISTORY 7 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY atrás, I-PAST_MEDICAL_HISTORY procedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY donante 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 Presentó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY episodio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY rechazo I-PAST_MEDICAL_HISTORY humoral I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY cuarto I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY post I-PAST_MEDICAL_HISTORY trasplante, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY trató I-PAST_MEDICAL_HISTORY exitosamente I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY metilprednisolona; I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY esa I-PAST_MEDICAL_HISTORY oportunidad I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY coronariografía I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY normal. I-PAST_MEDICAL_HISTORY Tiene I-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 diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY adquiridas I-PAST_MEDICAL_HISTORY post I-PAST_MEDICAL_HISTORY trasplante. 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 azatioprina I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY ciclosporina, I-PAST_MEDICAL_HISTORY además I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY pravastatina, I-PAST_MEDICAL_HISTORY aspirina, I-PAST_MEDICAL_HISTORY enalapril I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY amlodipino. I-PAST_MEDICAL_HISTORY Ingresó I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY una I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY angina I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY esfuerzos I-PAST_MEDICAL_HISTORY moderados, I-PAST_MEDICAL_HISTORY asociado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY disnea, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY cedía I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY reposo. I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION sólo I-EXPLORATION destacaba I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION de I-EXPLORATION 100 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION y I-EXPLORATION un I-EXPLORATION cuarto I-EXPLORATION ruido I-EXPLORATION cardíaco. I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION de I-EXPLORATION reposo I-EXPLORATION mostró I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION regular, I-EXPLORATION imagen I-EXPLORATION de I-EXPLORATION bloqueo I-EXPLORATION completo I-EXPLORATION de I-EXPLORATION rama I-EXPLORATION derecha I-EXPLORATION con I-EXPLORATION qS I-EXPLORATION en I-EXPLORATION VI, I-EXPLORATION hemibloqueo I-EXPLORATION izquierdo I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION alteraciones I-EXPLORATION inespecíficas I-EXPLORATION de I-EXPLORATION la I-EXPLORATION repolarización I-EXPLORATION ventricular I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION anterior. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION glicemia I-EXPLORATION de I-EXPLORATION 175 I-EXPLORATION mg/dL, I-EXPLORATION creatininemia I-EXPLORATION 1.29 I-EXPLORATION mg/dL, I-EXPLORATION coleste-rol I-EXPLORATION LDL I-EXPLORATION 62 I-EXPLORATION mg/dL. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION endo-miocárdica I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION rechazo I-EXPLORATION celular. I-EXPLORATION La I-EXPLORATION ventriculografía I-EXPLORATION angiográfica I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION disfunción I-EXPLORATION leve I-EXPLORATION a I-EXPLORATION moderada I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION e I-EXPLORATION hipokinesia I-EXPLORATION anteroapical. I-EXPLORATION El I-EXPLORATION cateterismo I-EXPLORATION coronario I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION lesión I-EXPLORATION crítica I-EXPLORATION ostial I-EXPLORATION del I-EXPLORATION TCI, I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION descendente I-EXPLORATION anterior I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION ocluida I-EXPLORATION luego I-EXPLORATION del I-EXPLORATION nacimiento I-EXPLORATION del I-EXPLORATION primer I-EXPLORATION ramo I-EXPLORATION diagonal I-EXPLORATION y I-EXPLORATION se I-EXPLORATION llenaba I-EXPLORATION por I-EXPLORATION heterocolaterales I-EXPLORATION desde I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION coronaria I-EXPLORATION derecha. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION otras I-EXPLORATION lesiones I-EXPLORATION coronarias I-EXPLORATION significativas. I-EXPLORATION Luego B-TREATMENT de I-TREATMENT discutir I-TREATMENT las I-TREATMENT alternativas I-TREATMENT terapéuticas I-TREATMENT con I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT realizó I-TREATMENT angioplastia I-TREATMENT exitosa I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT del I-TREATMENT TCI, I-TREATMENT con I-TREATMENT implante I-TREATMENT directo I-TREATMENT de I-TREATMENT sfewíTaxus® I-TREATMENT 3-5 I-TREATMENT x I-TREATMENT 22 I-TREATMENT mm I-TREATMENT con I-TREATMENT flujo I-TREATMENT final I-TREATMENT TIMI I-TREATMENT 3. I-TREATMENT Un B-EXPLORATION registro I-EXPLORATION continuo I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION doce I-EXPLORATION derivaciones, I-EXPLORATION detectó I-EXPLORATION infradesnivel I-EXPLORATION significativo I-EXPLORATION y I-EXPLORATION transitorio I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION la I-EXPLORATION derivación I-EXPLORATION V4 I-EXPLORATION durante I-EXPLORATION la I-EXPLORATION angioplastia. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION registraron I-EXPLORATION otros I-EXPLORATION incidentes I-EXPLORATION durante I-EXPLORATION y I-EXPLORATION después I-EXPLORATION del I-EXPLORATION procedimiento. I-EXPLORATION Al I-EXPLORATION séptimo I-EXPLORATION día I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION cintigrama I-EXPLORATION con I-EXPLORATION I131 I-EXPLORATION MIBG, I-EXPLORATION demostrándose I-EXPLORATION captación I-EXPLORATION del I-EXPLORATION radiofármaco I-EXPLORATION en I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo. I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION 4 I-EVOLUTION días I-EVOLUTION post I-EVOLUTION angioplastia I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones, I-EVOLUTION se B-TREATMENT incrementó I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT estatina I-TREATMENT (pravastatina I-TREATMENT 40 I-TREATMENT mg/día) I-TREATMENT y I-TREATMENT se I-TREATMENT agregó I-TREATMENT clopidogrel I-TREATMENT a I-TREATMENT su I-TREATMENT terapia I-TREATMENT habitual. I-TREATMENT A B-EXPLORATION los I-EXPLORATION 16 I-EXPLORATION meses I-EXPLORATION post I-EXPLORATION procedimiento, I-EXPLORATION el I-EXPLORATION paciente I-EXPLORATION presentó I-EXPLORATION disnea I-EXPLORATION progresiva I-EXPLORATION realizándose I-EXPLORATION nueva I-EXPLORATION coronariografía. I-EXPLORATION Se I-EXPLORATION constató I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION reestenosis I-EXPLORATION angiográfica I-EXPLORATION del I-EXPLORATION TCI I-EXPLORATION y I-EXPLORATION progresión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION enfermedad I-EXPLORATION aterosclerótica I-EXPLORATION de I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION circunfleja I-EXPLORATION y I-EXPLORATION coronaria I-EXPLORATION derecha, I-EXPLORATION las I-EXPLORATION que I-EXPLORATION presentaban I-EXPLORATION estenosis I-EXPLORATION significativas. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT cirugía I-TREATMENT de I-TREATMENT revascularización I-TREATMENT miocárdica: I-TREATMENT injerto I-TREATMENT de I-TREATMENT arteria I-TREATMENT mamaria I-TREATMENT interna I-TREATMENT izquierda I-TREATMENT a I-TREATMENT arteria I-TREATMENT descendente I-TREATMENT anterior I-TREATMENT y I-TREATMENT puentes I-TREATMENT venosos I-TREATMENT sáfenos I-TREATMENT a I-TREATMENT arteria I-TREATMENT descendente I-TREATMENT anterior, I-TREATMENT rama I-TREATMENT posterolateral I-TREATMENT de I-TREATMENT la I-TREATMENT arteria I-TREATMENT circunfleja I-TREATMENT y I-TREATMENT coronaria I-TREATMENT derecha. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION bloqueo I-EVOLUTION auriculoventricular I-EVOLUTION postoperatorio I-EVOLUTION que I-EVOLUTION requirió I-EVOLUTION del I-EVOLUTION implante I-EVOLUTION de I-EVOLUTION marcapaso I-EVOLUTION definitivo I-EVOLUTION bicameral. I-EVOLUTION Su I-EVOLUTION evolución I-EVOLUTION fue I-EVOLUTION satisfactoria I-EVOLUTION y I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION 14 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION cirugía I-EVOLUTION de I-EVOLUTION revascularización. I-EVOLUTION I-EVOLUTION Se B-PRESENT_ILLNESS trata I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS mujer I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 43 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 cefalea I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY convulsivas I-PAST_MEDICAL_HISTORY generalizadas I-PAST_MEDICAL_HISTORY tónico I-PAST_MEDICAL_HISTORY clónicas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY reciente I-PAST_MEDICAL_HISTORY inicio. I-PAST_MEDICAL_HISTORY Debido B-EXPLORATION a I-EXPLORATION su I-EXPLORATION sintomatología I-EXPLORATION es I-EXPLORATION sometida I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION y I-EXPLORATION se I-EXPLORATION diagnóstica I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION malformación I-EXPLORATION arteriovenosa I-EXPLORATION (MAV) I-EXPLORATION perirrolándica I-EXPLORATION (Spetzler I-EXPLORATION III), I-EXPLORATION dependiente I-EXPLORATION de I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION cerebral I-EXPLORATION media I-EXPLORATION derecha. I-EXPLORATION Dadas B-TREATMENT las I-TREATMENT características I-TREATMENT de I-TREATMENT la I-TREATMENT lesión I-TREATMENT se I-TREATMENT decidió I-TREATMENT realizar I-TREATMENT tratamiento I-TREATMENT quirúrgico. I-TREATMENT La I-TREATMENT paciente I-TREATMENT recibía I-TREATMENT tratamiento I-TREATMENT anticonvulsivante I-TREATMENT con I-TREATMENT ácido I-TREATMENT valproico I-TREATMENT debido I-TREATMENT a I-TREATMENT que I-TREATMENT era I-TREATMENT alérgica I-TREATMENT a I-TREATMENT la I-TREATMENT fenitoína. I-TREATMENT I-TREATMENT El I-TREATMENT 13 I-TREATMENT de I-TREATMENT junio I-TREATMENT de I-TREATMENT 2006 I-TREATMENT a I-TREATMENT las I-TREATMENT 08: I-TREATMENT 00 I-TREATMENT horas, I-TREATMENT fue I-TREATMENT sometida I-TREATMENT a I-TREATMENT una I-TREATMENT craneotomía I-TREATMENT parietal I-TREATMENT derecha I-TREATMENT más I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT MAV. I-TREATMENT Durante I-TREATMENT las I-TREATMENT 7 I-TREATMENT horas I-TREATMENT que I-TREATMENT duró I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT quirúrgico, I-TREATMENT se I-TREATMENT administraron I-TREATMENT 7mg/kg/h I-TREATMENT (117 I-TREATMENT mg/kg/min) I-TREATMENT de I-TREATMENT propofol I-TREATMENT y I-TREATMENT 0, I-TREATMENT 25 I-TREATMENT mg/ I-TREATMENT kg/min I-TREATMENT de I-TREATMENT remifentanil. I-TREATMENT La I-TREATMENT exéresis I-TREATMENT de I-TREATMENT la I-TREATMENT MAV I-TREATMENT pudo I-TREATMENT ser I-TREATMENT ejecutada I-TREATMENT en I-TREATMENT forma I-TREATMENT satisfactoria I-TREATMENT y I-TREATMENT sin I-TREATMENT incidentes I-TREATMENT intraoperatorios. I-TREATMENT En I-TREATMENT el I-TREATMENT período I-TREATMENT postoperatorio I-TREATMENT inmediato I-TREATMENT (estando I-TREATMENT aún I-TREATMENT en I-TREATMENT pabellón), I-TREATMENT la I-TREATMENT paciente I-TREATMENT presentó I-TREATMENT una I-TREATMENT crisis I-TREATMENT convulsiva I-TREATMENT tónico I-TREATMENT clónica I-TREATMENT generalizada I-TREATMENT que I-TREATMENT cedió I-TREATMENT con I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT 4 I-TREATMENT mg I-TREATMENT de I-TREATMENT lorazepam I-TREATMENT por I-TREATMENT vía I-TREATMENT endovenosa. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION 16: I-EVOLUTION 00 I-EVOLUTION horas I-EVOLUTION del I-EVOLUTION mismo I-EVOLUTION día I-EVOLUTION y I-EVOLUTION una I-EVOLUTION vez I-EVOLUTION estabilizada, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION es I-EVOLUTION trasladada I-EVOLUTION desde I-EVOLUTION pabellón I-EVOLUTION a I-EVOLUTION la I-EVOLUTION Unidad I-EVOLUTION de I-EVOLUTION Cuidados I-EVOLUTION Intensivos I-EVOLUTION (UCI), I-EVOLUTION donde I-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION en I-EVOLUTION ventilación I-EVOLUTION mecánica I-EVOLUTION y B-TREATMENT se I-TREATMENT continúan I-TREATMENT las I-TREATMENT medidas I-TREATMENT de I-TREATMENT neuroprotección I-TREATMENT habituales, I-TREATMENT incluida I-TREATMENT la I-TREATMENT sedo-analgesia I-TREATMENT (midazolam/ I-TREATMENT fentanil) I-TREATMENT y I-TREATMENT el I-TREATMENT control I-TREATMENT de I-TREATMENT las I-TREATMENT crisis I-TREATMENT convulsivas I-TREATMENT con I-TREATMENT ácido I-TREATMENT valproico. I-TREATMENT I-TREATMENT Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION química I-EXPLORATION sanguínea I-EXPLORATION se I-EXPLORATION encontraban I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales, I-EXPLORATION sin I-EXPLORATION disfunción I-EXPLORATION renal, I-EXPLORATION hepática I-EXPLORATION o I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION evidencia I-EXPLORATION de I-EXPLORATION infección I-EXPLORATION activa. I-EXPLORATION Sin I-EXPLORATION embargo, I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 17: I-EXPLORATION 00 I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION una I-EXPLORATION acidosis I-EXPLORATION láctica I-EXPLORATION incipiente I-EXPLORATION con I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 34; I-EXPLORATION PaC02 I-EXPLORATION 36 I-EXPLORATION mmHg, I-EXPLORATION Bicarbonato I-EXPLORATION 19 I-EXPLORATION mmol/L; I-EXPLORATION BE I-EXPLORATION - I-EXPLORATION 6, I-EXPLORATION 4 I-EXPLORATION mmol/L I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION láctico I-EXPLORATION 4, I-EXPLORATION 1 I-EXPLORATION mmol/L. I-EXPLORATION En I-EXPLORATION ese I-EXPLORATION momento, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION estable I-EXPLORATION en I-EXPLORATION lo I-EXPLORATION hemodinámico, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION media I-EXPLORATION (PAM) I-EXPLORATION de I-EXPLORATION 80 I-EXPLORATION mmHg, I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION de I-EXPLORATION 70 I-EXPLORATION lat/min I-EXPLORATION y I-EXPLORATION una I-EXPLORATION diuresis I-EXPLORATION de I-EXPLORATION 60 I-EXPLORATION a I-EXPLORATION 80 I-EXPLORATION ml/h, I-EXPLORATION sin I-EXPLORATION evidencias I-EXPLORATION de I-EXPLORATION hipoperfusión I-EXPLORATION clínica I-EXPLORATION (piel I-EXPLORATION tibia I-EXPLORATION y I-EXPLORATION con I-EXPLORATION adecuado I-EXPLORATION llene I-EXPLORATION capilar). I-EXPLORATION I-EXPLORATION Luego I-EXPLORATION de I-EXPLORATION la I-EXPLORATION estabilización I-EXPLORATION inicial, I-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION de I-EXPLORATION control, I-EXPLORATION en I-EXPLORATION la I-EXPLORATION que I-EXPLORATION se I-EXPLORATION aprecian I-EXPLORATION cambios I-EXPLORATION post-quirúrgicos: I-EXPLORATION lecho I-EXPLORATION operatorio I-EXPLORATION sin I-EXPLORATION hematoma I-EXPLORATION y I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION conservada. I-EXPLORATION El I-EXPLORATION electroencefalograma I-EXPLORATION descartó I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION actividad I-EXPLORATION epileptógena I-EXPLORATION y I-EXPLORATION evidenció I-EXPLORATION un I-EXPLORATION ritmo I-EXPLORATION lento I-EXPLORATION generalizado I-EXPLORATION atribuible I-EXPLORATION a I-EXPLORATION la I-EXPLORATION sedación. I-EXPLORATION I-EXPLORATION Se B-TREATMENT mantuvieron I-TREATMENT las I-TREATMENT medidas I-TREATMENT habituales I-TREATMENT de I-TREATMENT manejo I-TREATMENT post-quirúrgico, I-TREATMENT garantizando I-TREATMENT una I-TREATMENT adecuada I-TREATMENT presión I-TREATMENT de I-TREATMENT perfusión I-TREATMENT cerebral. I-TREATMENT Durante B-EVOLUTION las I-EVOLUTION siguientes I-EVOLUTION horas I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION no I-EVOLUTION presentó I-EVOLUTION nuevas I-EVOLUTION crisis I-EVOLUTION convulsivas I-EVOLUTION motoras. I-EVOLUTION I-EVOLUTION A B-EXPLORATION las I-EXPLORATION 21: I-EXPLORATION 00 I-EXPLORATION horas, I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION control I-EXPLORATION gasométri-co I-EXPLORATION pone I-EXPLORATION en I-EXPLORATION evidencia I-EXPLORATION el I-EXPLORATION agravamiento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION acidosis I-EXPLORATION láctica: I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 12; I-EXPLORATION PaC02 I-EXPLORATION 31 I-EXPLORATION mmHg; I-EXPLORATION bicarbonato I-EXPLORATION 10 I-EXPLORATION mmol/L; I-EXPLORATION BE I-EXPLORATION - I-EXPLORATION 18 I-EXPLORATION mmol/L I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION láctico I-EXPLORATION 9, I-EXPLORATION 9 I-EXPLORATION mmol/L; I-EXPLORATION pero I-EXPLORATION con I-EXPLORATION una I-EXPLORATION saturación I-EXPLORATION venosa I-EXPLORATION central I-EXPLORATION de I-EXPLORATION 86%. I-EXPLORATION El I-EXPLORATION electrocardiograma I-EXPLORATION no I-EXPLORATION mostraba I-EXPLORATION cambios I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION isquemia I-EXPLORATION miocár-dica I-EXPLORATION y I-EXPLORATION las I-EXPLORATION enzimas I-EXPLORATION cardiacas I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION En I-EXPLORATION este I-EXPLORATION contexto, I-EXPLORATION se I-EXPLORATION decide I-EXPLORATION realizar I-EXPLORATION monitori-zación I-EXPLORATION hemodinámica I-EXPLORATION invasiva I-EXPLORATION con I-EXPLORATION un I-EXPLORATION catéter I-EXPLORATION de I-EXPLORATION arteria I-EXPLORATION pulmonar, I-EXPLORATION encontrándose I-EXPLORATION una I-EXPLORATION presión I-EXPLORATION de I-EXPLORATION oclusión I-EXPLORATION en I-EXPLORATION la I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION (POAP) I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION mmHg, I-EXPLORATION un I-EXPLORATION índice I-EXPLORATION cardíaco I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 2 I-EXPLORATION L/min/m2, I-EXPLORATION una I-EXPLORATION resistencia I-EXPLORATION vascular I-EXPLORATION sistémica I-EXPLORATION indexada I-EXPLORATION de I-EXPLORATION 1174 I-EXPLORATION dinassegcm^m2 I-EXPLORATION y I-EXPLORATION una I-EXPLORATION saturación I-EXPLORATION venosa I-EXPLORATION mixta I-EXPLORATION (Satvm) I-EXPLORATION de I-EXPLORATION 77%. I-EXPLORATION Se B-TREATMENT continuó I-TREATMENT el I-TREATMENT aporte I-TREATMENT de I-TREATMENT fluidos I-TREATMENT trazándose I-TREATMENT como I-TREATMENT meta I-TREATMENT una I-TREATMENT POAP I-TREATMENT de I-TREATMENT 14 I-TREATMENT a I-TREATMENT 16 I-TREATMENT mmHg I-TREATMENT y I-TREATMENT se I-TREATMENT asoció I-TREATMENT noradrenalina I-TREATMENT con I-TREATMENT el I-TREATMENT objeto I-TREATMENT de I-TREATMENT mantener I-TREATMENT una I-TREATMENT PAM I-TREATMENT de I-TREATMENT 90 I-TREATMENT a I-TREATMENT 100 I-TREATMENT mmHg. I-TREATMENT Adicionalmente, I-TREATMENT se I-TREATMENT incrementó I-TREATMENT la I-TREATMENT infusión I-TREATMENT de I-TREATMENT midazolam I-TREATMENT a I-TREATMENT 20 I-TREATMENT mg/h I-TREATMENT y I-TREATMENT se I-TREATMENT reinició I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT propofol I-TREATMENT a I-TREATMENT 3, I-TREATMENT 5 I-TREATMENT mg/kg/h I-TREATMENT (58 I-TREATMENT Lig/kg/min) I-TREATMENT para I-TREATMENT alcanzar I-TREATMENT un I-TREATMENT nivel I-TREATMENT de I-TREATMENT 2 I-TREATMENT en I-TREATMENT la I-TREATMENT escala I-TREATMENT de I-TREATMENT sedación-agitación I-TREATMENT descrita I-TREATMENT por I-TREATMENT Riker16. I-TREATMENT I-TREATMENT Sin B-EVOLUTION embargo, I-EVOLUTION pese I-EVOLUTION a I-EVOLUTION mantenerse I-EVOLUTION estable I-EVOLUTION en I-EVOLUTION lo I-EVOLUTION macro I-EVOLUTION y I-EVOLUTION microhemodinámico I-EVOLUTION y I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION disfunciones I-EVOLUTION orgánicas, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION control I-EVOLUTION de I-EVOLUTION las I-EVOLUTION 00: I-EVOLUTION 20 I-EVOLUTION se I-EVOLUTION constató I-EVOLUTION llamativamente, I-EVOLUTION un I-EVOLUTION empeoramiento I-EVOLUTION de I-EVOLUTION la I-EVOLUTION acidosis I-EVOLUTION láctica: I-EVOLUTION pH I-EVOLUTION 7, I-EVOLUTION 0 I-EVOLUTION y I-EVOLUTION ácido I-EVOLUTION láctico I-EVOLUTION 8, I-EVOLUTION 5 I-EVOLUTION con I-EVOLUTION Satvm I-EVOLUTION 80%. I-EVOLUTION No B-TREATMENT fue I-TREATMENT posible I-TREATMENT identificar I-TREATMENT una I-TREATMENT causa I-TREATMENT evidente I-TREATMENT que I-TREATMENT explicase I-TREATMENT la I-TREATMENT evolución I-TREATMENT clínica I-TREATMENT de I-TREATMENT la I-TREATMENT paciente, I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT terapia I-TREATMENT de I-TREATMENT soporte. I-TREATMENT En B-EVOLUTION las I-EVOLUTION horas I-EVOLUTION siguientes, I-EVOLUTION no I-EVOLUTION se I-EVOLUTION observó I-EVOLUTION un I-EVOLUTION cambio I-EVOLUTION significativo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION acidosis I-EVOLUTION metabólica. I-EVOLUTION I-EVOLUTION Finalmente, B-TREATMENT se I-TREATMENT sospechó I-TREATMENT que I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT propofol I-TREATMENT podría I-TREATMENT ser I-TREATMENT la I-TREATMENT causa I-TREATMENT desencadenante I-TREATMENT y I-TREATMENT la I-TREATMENT perpetuadora I-TREATMENT de I-TREATMENT la I-TREATMENT acidosis I-TREATMENT láctica, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT suspender I-TREATMENT la I-TREATMENT infusión I-TREATMENT a I-TREATMENT las I-TREATMENT 08: I-TREATMENT 30, I-TREATMENT habiendo I-TREATMENT completado I-TREATMENT 8 I-TREATMENT horas I-TREATMENT adicionales I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT cirugía. I-TREATMENT La B-EVOLUTION condición I-EVOLUTION hemodinámica I-EVOLUTION continuó I-EVOLUTION estable I-EVOLUTION durante I-EVOLUTION la I-EVOLUTION mañana. I-EVOLUTION Cuatro B-EXPLORATION horas I-EXPLORATION más I-EXPLORATION tarde I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION nuevo I-EXPLORATION control I-EXPLORATION gasométrico, I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION se I-EXPLORATION pudo I-EXPLORATION apreciar I-EXPLORATION la I-EXPLORATION corrección I-EXPLORATION de I-EXPLORATION la I-EXPLORATION acidosis I-EXPLORATION láctica: I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 53 I-EXPLORATION y I-EXPLORATION ácido I-EXPLORATION láctico I-EXPLORATION 2, I-EXPLORATION 9 I-EXPLORATION mmol/ I-EXPLORATION L I-EXPLORATION con I-EXPLORATION PaC02 I-EXPLORATION 24 I-EXPLORATION mmHg. I-EXPLORATION A B-EVOLUTION las I-EVOLUTION 19: I-EVOLUTION 00, I-EVOLUTION once I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION la I-EVOLUTION suspensión I-EVOLUTION del I-EVOLUTION propofol, I-EVOLUTION el I-EVOLUTION acido I-EVOLUTION láctico I-EVOLUTION ya I-EVOLUTION se I-EVOLUTION había I-EVOLUTION normalizado: I-EVOLUTION 1, I-EVOLUTION 6 I-EVOLUTION mmol/L. I-EVOLUTION Posteriormente, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION tuvo I-EVOLUTION una I-EVOLUTION evolución I-EVOLUTION favorable, I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION asociadas I-EVOLUTION a I-EVOLUTION la I-EVOLUTION descompensación I-EVOLUTION metabólica. I-EVOLUTION No I-EVOLUTION volvió I-EVOLUTION a I-EVOLUTION presentar I-EVOLUTION crisis I-EVOLUTION convulsivas, I-EVOLUTION pudiendo I-EVOLUTION ser I-EVOLUTION extuba-da I-EVOLUTION y I-EVOLUTION trasladada I-EVOLUTION de I-EVOLUTION la I-EVOLUTION UCI I-EVOLUTION en I-EVOLUTION buenas I-EVOLUTION condiciones. I-EVOLUTION I-EVOLUTION En B-DERIVED_FROM/TO diciembre I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2004 I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO derivado I-DERIVED_FROM/TO a I-DERIVED_FROM/TO la I-DERIVED_FROM/TO Policlínica I-DERIVED_FROM/TO Nefrológica 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 Montevideo, I-DERIVED_FROM/TO un B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 17 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS raza I-PRESENT_ILLNESS blanca, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hepatitis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY años, I-PAST_MEDICAL_HISTORY para B-DERIVED_FROM/TO estudio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO proteinuria I-DERIVED_FROM/TO aislada, I-DERIVED_FROM/TO no I-DERIVED_FROM/TO nefrótica, I-DERIVED_FROM/TO detectada I-DERIVED_FROM/TO en I-DERIVED_FROM/TO examen I-DERIVED_FROM/TO preventivo. I-DERIVED_FROM/TO Fue B-EXPLORATION descartada I-EXPLORATION en I-EXPLORATION el I-EXPLORATION interrogatorio I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION orinas I-EXPLORATION espumosas, I-EXPLORATION edemas I-EXPLORATION o I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION la I-EXPLORATION diuresis. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION fue I-EXPLORATION normal, I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 120/70 I-EXPLORATION mmHg. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION proteinuria I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 2 I-EXPLORATION g/1, I-EXPLORATION selectiva, I-EXPLORATION con I-EXPLORATION 80% I-EXPLORATION de I-EXPLORATION albúmina, I-EXPLORATION no I-EXPLORATION microhematuria, I-EXPLORATION creatininemia I-EXPLORATION de I-EXPLORATION 0, I-EXPLORATION 89 I-EXPLORATION mm/dl, I-EXPLORATION azoemia: I-EXPLORATION 0, I-EXPLORATION 12 I-EXPLORATION g/ I-EXPLORATION 1; I-EXPLORATION albuminemia: I-EXPLORATION 4, I-EXPLORATION 9 I-EXPLORATION g/dl; I-EXPLORATION proteinemia: I-EXPLORATION 7, I-EXPLORATION 8 I-EXPLORATION g/dl, I-EXPLORATION gamma I-EXPLORATION globulina: I-EXPLORATION 1, I-EXPLORATION 3 I-EXPLORATION g/dl, I-EXPLORATION colesterol: I-EXPLORATION 166 I-EXPLORATION mg/dl, I-EXPLORATION triglicéridos: I-EXPLORATION 35 I-EXPLORATION mg/dl, I-EXPLORATION HDL: I-EXPLORATION 39 I-EXPLORATION mg/dl, I-EXPLORATION LDL I-EXPLORATION 120 I-EXPLORATION mg/ I-EXPLORATION di; I-EXPLORATION urocultivo: I-EXPLORATION negativo. I-EXPLORATION Los I-EXPLORATION anticuerpos I-EXPLORATION antinucleares I-EXPLORATION (ANA) I-EXPLORATION y I-EXPLORATION anti-ADN I-EXPLORATION fueron I-EXPLORATION negativos I-EXPLORATION en I-EXPLORATION 2 I-EXPLORATION oportunidades. I-EXPLORATION Enzimograma I-EXPLORATION hepático: I-EXPLORATION BT I-EXPLORATION 0, I-EXPLORATION 82 I-EXPLORATION mg/ I-EXPLORATION di, I-EXPLORATION TGO I-EXPLORATION 22, I-EXPLORATION TGP I-EXPLORATION 15, I-EXPLORATION FA I-EXPLORATION 2, I-EXPLORATION 26, I-EXPLORATION yGT I-EXPLORATION 28 I-EXPLORATION (Ul/lt). I-EXPLORATION La I-EXPLORATION complementemia I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION serología I-EXPLORATION para I-EXPLORATION ANCA I-EXPLORATION y I-EXPLORATION HIV, I-EXPLORATION Virus I-EXPLORATION hepatitis I-EXPLORATION C I-EXPLORATION y I-EXPLORATION B I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION La I-EXPLORATION ecografía I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION abdominal I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT recibió I-TREATMENT enalapril I-TREATMENT (40 I-TREATMENT mg/día) I-TREATMENT asociado I-TREATMENT a I-TREATMENT losartán I-TREATMENT (50 I-TREATMENT mg/día). I-TREATMENT Presentó B-EVOLUTION una I-EVOLUTION remisión I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION la I-EVOLUTION proteinuria, I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION total I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION iniciado I-EVOLUTION el I-EVOLUTION tratamiento. I-EVOLUTION La I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION se I-EVOLUTION mantuvo I-EVOLUTION normal. I-EVOLUTION Con B-EXPLORATION el I-EXPLORATION planteo I-EXPLORATION clínico I-EXPLORATION de I-EXPLORATION una I-EXPLORATION EFS I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION histopatológico I-EXPLORATION con I-EXPLORATION microscopía I-EXPLORATION de I-EXPLORATION luz I-EXPLORATION (ML), I-EXPLORATION microscopía I-EXPLORATION electrónica I-EXPLORATION (ME) I-EXPLORATION e I-EXPLORATION inmunofluorescencia I-EXPLORATION (IF). I-EXPLORATION I-EXPLORATION Histopatología. I-EXPLORATION Se I-EXPLORATION observaron I-EXPLORATION 20 I-EXPLORATION glomérulos, I-EXPLORATION 1 I-EXPLORATION de I-EXPLORATION ellos I-EXPLORATION con I-EXPLORATION esclerosis I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION 50% I-EXPLORATION del I-EXPLORATION área I-EXPLORATION del I-EXPLORATION glomérulo, I-EXPLORATION en I-EXPLORATION tanto I-EXPLORATION que I-EXPLORATION 4 I-EXPLORATION evidenciaron I-EXPLORATION esclerosis I-EXPLORATION segmentaria I-EXPLORATION leve, I-EXPLORATION moderado I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION la I-EXPLORATION matriz I-EXPLORATION mesangial I-EXPLORATION y I-EXPLORATION sinequias I-EXPLORATION entre I-EXPLORATION asas I-EXPLORATION capilares I-EXPLORATION glomerulares I-EXPLORATION y I-EXPLORATION cápsula I-EXPLORATION de I-EXPLORATION Bowman. I-EXPLORATION Se I-EXPLORATION encontraron I-EXPLORATION escasos I-EXPLORATION depósitos I-EXPLORATION fucsinófilos I-EXPLORATION yux-tamesangiales I-EXPLORATION con I-EXPLORATION el I-EXPLORATION tricrómico I-EXPLORATION de I-EXPLORATION Masson. I-EXPLORATION El I-EXPLORATION sector I-EXPLORATION túbulo-intersticial I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION pequeño I-EXPLORATION foco I-EXPLORATION de I-EXPLORATION necrosis I-EXPLORATION tubular I-EXPLORATION y I-EXPLORATION algunos I-EXPLORATION cilindros I-EXPLORATION con I-EXPLORATION eritrocitos I-EXPLORATION crenados. I-EXPLORATION Las I-EXPLORATION arterias I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Inmunofluorescencia. I-EXPLORATION Demostró I-EXPLORATION positividad I-EXPLORATION para I-EXPLORATION Clq I-EXPLORATION +++, I-EXPLORATION dominante; I-EXPLORATION IgA++ I-EXPLORATION perihiliar; I-EXPLORATION IgG, I-EXPLORATION IgM, I-EXPLORATION C3 I-EXPLORATION positivas++, I-EXPLORATION con I-EXPLORATION patrón I-EXPLORATION granular I-EXPLORATION grueso, I-EXPLORATION de I-EXPLORATION distribución I-EXPLORATION a I-EXPLORATION predominio I-EXPLORATION mesangial I-EXPLORATION fibrinógeno: I-EXPLORATION negativo. I-EXPLORATION I-EXPLORATION Microscopía I-EXPLORATION electrónica. I-EXPLORATION Se I-EXPLORATION observó I-EXPLORATION aplanamiento I-EXPLORATION pedicelar I-EXPLORATION menor I-EXPLORATION a I-EXPLORATION 20% I-EXPLORATION de I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION de I-EXPLORATION las I-EXPLORATION asas I-EXPLORATION capilares, I-EXPLORATION depósitos I-EXPLORATION electrondensos I-EXPLORATION granulares I-EXPLORATION paramesangiales I-EXPLORATION en I-EXPLORATION la I-EXPLORATION región I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION refleja I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION basal I-EXPLORATION glomerular I-EXPLORATION (MBG) I-EXPLORATION y I-EXPLORATION moderada I-EXPLORATION cantidad I-EXPLORATION de I-EXPLORATION fibras I-EXPLORATION colágenas I-EXPLORATION en I-EXPLORATION el I-EXPLORATION mesangio, I-EXPLORATION en I-EXPLORATION áreas I-EXPLORATION de I-EXPLORATION esclerosis I-EXPLORATION glomerular. I-EXPLORATION El I-EXPLORATION endotelio I-EXPLORATION capilar I-EXPLORATION glomerular I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION inclusiones I-EXPLORATION túbulo I-EXPLORATION reticulares I-EXPLORATION (ITR). I-EXPLORATION I-EXPLORATION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 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 consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS frente, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS único, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS sintomatología I-PRESENT_ILLNESS asociada. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION presentaba I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION firme, I-EXPLORATION elástico, I-EXPLORATION no I-EXPLORATION adherido I-EXPLORATION a I-EXPLORATION planos I-EXPLORATION profundos, I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 7 I-EXPLORATION x I-EXPLORATION 0, I-EXPLORATION 6 I-EXPLORATION cm, I-EXPLORATION con I-EXPLORATION algunas I-EXPLORATION pápulas I-EXPLORATION eritematosas I-EXPLORATION levemente I-EXPLORATION translúcidas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION y I-EXPLORATION múltiples I-EXPLORATION telangiectasias. I-EXPLORATION Se B-TREATMENT extrajo I-TREATMENT la I-TREATMENT lesión I-TREATMENT y I-TREATMENT se I-TREATMENT envió I-TREATMENT a I-TREATMENT anatomía I-TREATMENT patológica I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT clínico I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT basocelular I-TREATMENT sobre I-TREATMENT quiste I-TREATMENT epidérmico. I-TREATMENT Al B-EVOLUTION momento I-EVOLUTION del I-EVOLUTION control I-EVOLUTION clínico, I-EVOLUTION una I-EVOLUTION semana I-EVOLUTION después, I-EVOLUTION presentó I-EVOLUTION otro I-EVOLUTION tumor I-EVOLUTION más I-EVOLUTION pequeño I-EVOLUTION en I-EVOLUTION la I-EVOLUTION región I-EVOLUTION supraciliar I-EVOLUTION derecha, I-EVOLUTION de I-EVOLUTION similares I-EVOLUTION características I-EVOLUTION al I-EVOLUTION primero. I-EVOLUTION El B-EXPLORATION examen I-EXPLORATION anatomopatológico I-EXPLORATION del I-EXPLORATION tumor I-EXPLORATION frontal I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION neoplasia I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION SH. I-EXPLORATION Estudios I-EXPLORATION de I-EXPLORATION imágenes I-EXPLORATION (tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION cabeza I-EXPLORATION y I-EXPLORATION cuello) I-EXPLORATION mostraron I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION nodulares I-EXPLORATION en I-EXPLORATION tejido I-EXPLORATION celular I-EXPLORATION subcutáneo I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION regiones I-EXPLORATION temporales, I-EXPLORATION así I-EXPLORATION como I-EXPLORATION adenopatías I-EXPLORATION submandibulares I-EXPLORATION y I-EXPLORATION yugulo-digástricas. I-EXPLORATION También I-EXPLORATION se I-EXPLORATION observaron I-EXPLORATION nodulos I-EXPLORATION en I-EXPLORATION ambas I-EXPLORATION glándulas I-EXPLORATION parótidas. I-EXPLORATION Estudios I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION incluyeron I-EXPLORATION hemograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION los I-EXPLORATION siguientes I-EXPLORATION valores: I-EXPLORATION hemoglobina, I-EXPLORATION 16, I-EXPLORATION 0 I-EXPLORATION gr/dF I-EXPLORATION (valores I-EXPLORATION de I-EXPLORATION referencia I-EXPLORATION (VR), I-EXPLORATION 13, I-EXPLORATION 5-17, I-EXPLORATION 5); I-EXPLORATION hematocrito, I-EXPLORATION 45, I-EXPLORATION 8% I-EXPLORATION (VR, I-EXPLORATION 41-53); I-EXPLORATION leucocitos, I-EXPLORATION 5, I-EXPLORATION 0 I-EXPLORATION x I-EXPLORATION 103 I-EXPLORATION /mm3 I-EXPLORATION (VR, I-EXPLORATION 4, I-EXPLORATION 5-11) I-EXPLORATION y I-EXPLORATION plaquetas, I-EXPLORATION 200 I-EXPLORATION x I-EXPLORATION 103/mm3 I-EXPLORATION (VR, I-EXPLORATION 140-400). I-EXPLORATION El I-EXPLORATION recuento I-EXPLORATION leucocitos I-EXPLORATION fue: I-EXPLORATION neutrófilos, I-EXPLORATION 53%; I-EXPLORATION eosinófilos, I-EXPLORATION 4%; I-EXPLORATION monocitos, I-EXPLORATION 18% I-EXPLORATION y I-EXPLORATION linfocitos, I-EXPLORATION 25%. I-EXPLORATION Otros I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION (perfil I-EXPLORATION bioquímico I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas) I-EXPLORATION estuvieron I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION El B-DERIVED_FROM/TO paciente I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO tratado I-DERIVED_FROM/TO en I-DERIVED_FROM/TO otra I-DERIVED_FROM/TO institución I-DERIVED_FROM/TO y I-DERIVED_FROM/TO desafortunadamente I-DERIVED_FROM/TO se I-DERIVED_FROM/TO perdió I-DERIVED_FROM/TO para I-DERIVED_FROM/TO seguimiento I-DERIVED_FROM/TO clínico. I-DERIVED_FROM/TO I-DERIVED_FROM/TO HALLAZGOS B-EXPLORATION HISTOLÓGICOS I-EXPLORATION I-EXPLORATION Microscópicamente, I-EXPLORATION el I-EXPLORATION tumor I-EXPLORATION frontal I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION proliferación I-EXPLORATION celular I-EXPLORATION atípica, I-EXPLORATION difusa, I-EXPLORATION en I-EXPLORATION dermis I-EXPLORATION superficial I-EXPLORATION y I-EXPLORATION profunda, I-EXPLORATION no I-EXPLORATION epidermotrópica I-EXPLORATION y I-EXPLORATION con I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION Grenz. I-EXPLORATION Constituida I-EXPLORATION por I-EXPLORATION células I-EXPLORATION medianas I-EXPLORATION a I-EXPLORATION grandes, I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION epiteloideo I-EXPLORATION y I-EXPLORATION pleomorfismo I-EXPLORATION variable, I-EXPLORATION que I-EXPLORATION incluye I-EXPLORATION formas I-EXPLORATION multinucleadas. I-EXPLORATION Se I-EXPLORATION observó I-EXPLORATION además I-EXPLORATION un I-EXPLORATION componente I-EXPLORATION linfocitario I-EXPLORATION prominente, I-EXPLORATION numerosas I-EXPLORATION mitosis I-EXPLORATION y I-EXPLORATION cuerpos I-EXPLORATION apoptóticos. I-EXPLORATION I-EXPLORATION Inmunohistoquímicamente, I-EXPLORATION las I-EXPLORATION células I-EXPLORATION neoplásicas I-EXPLORATION mostraron I-EXPLORATION reacción I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION CD43, I-EXPLORATION CD45, I-EXPLORATION CD4 I-EXPLORATION (parcial), I-EXPLORATION CD30 I-EXPLORATION (difuso), I-EXPLORATION CD68, I-EXPLORATION CD163, I-EXPLORATION mieloperoxidasa, I-EXPLORATION lizosima I-EXPLORATION y I-EXPLORATION proteína I-EXPLORATION S-100 I-EXPLORATION ; I-EXPLORATION y I-EXPLORATION reacción I-EXPLORATION negativa I-EXPLORATION para I-EXPLORATION TdT, I-EXPLORATION CD34, I-EXPLORATION CD117, I-EXPLORATION CD3, I-EXPLORATION CD20, I-EXPLORATION HMB45 I-EXPLORATION y I-EXPLORATION citoqueratinas I-EXPLORATION totales. I-EXPLORATION I-EXPLORATION Mielograma I-EXPLORATION y I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION mostraron I-EXPLORATION una I-EXPLORATION hipoplasia I-EXPLORATION medular I-EXPLORATION con I-EXPLORATION cambios I-EXPLORATION displásicos I-EXPLORATION leves. I-EXPLORATION Estudio I-EXPLORATION de I-EXPLORATION clonalidad I-EXPLORATION mediante I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION reacción I-EXPLORATION de I-EXPLORATION polimerasa I-EXPLORATION en I-EXPLORATION cadena, I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION reordenamiento I-EXPLORATION policlonal I-EXPLORATION de I-EXPLORATION linfocitos I-EXPLORATION T I-EXPLORATION y I-EXPLORATION B. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS deterioro I-PRESENT_ILLNESS cognitivo I-PRESENT_ILLNESS moderado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Alzheimer I-PRESENT_ILLNESS e B-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nodulo I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY anterior I-PAST_MEDICAL_HISTORY pesquisado I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY ingreso, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY creció I-PAST_MEDICAL_HISTORY rápidamente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY últimas I-PAST_MEDICAL_HISTORY tres I-PAST_MEDICAL_HISTORY semanas, I-PAST_MEDICAL_HISTORY consultando B-PRESENT_ILLNESS por I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS de I-PRESENT_ILLNESS reposo, I-PRESENT_ILLNESS ortopnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disfagia. I-PRESENT_ILLNESS Fue B-PAST_MEDICAL_HISTORY estudiada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otro I-PAST_MEDICAL_HISTORY centro, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY ecografía I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY mostró I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY volumen I-PAST_MEDICAL_HISTORY tiroideo, I-PAST_MEDICAL_HISTORY TSH I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 32, I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY mUI/ml I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY anticuerpos I-PAST_MEDICAL_HISTORY anti I-PAST_MEDICAL_HISTORY TPO I-PAST_MEDICAL_HISTORY (++). I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY realizaron I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY punciones I-PAST_MEDICAL_HISTORY tiroideas, I-PAST_MEDICAL_HISTORY 3 I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ellas I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY muestra I-PAST_MEDICAL_HISTORY insuficiente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY última I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY informada I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY tiroiditis I-PAST_MEDICAL_HISTORY crónica. I-PAST_MEDICAL_HISTORY La I-PAST_MEDICAL_HISTORY tomografía I-PAST_MEDICAL_HISTORY computada I-PAST_MEDICAL_HISTORY (TC) I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY informó I-PAST_MEDICAL_HISTORY gran I-PAST_MEDICAL_HISTORY masa I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY reemplaza I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY tiroides, I-PAST_MEDICAL_HISTORY infiltra I-PAST_MEDICAL_HISTORY musculatura I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY piel I-PAST_MEDICAL_HISTORY adyacente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY rodea I-PAST_MEDICAL_HISTORY paquete I-PAST_MEDICAL_HISTORY vascular I-PAST_MEDICAL_HISTORY cervical I-PAST_MEDICAL_HISTORY derecho. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY octubre I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2004 I-PAST_MEDICAL_HISTORY consultó I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY urgencia I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY nuestro I-PAST_MEDICAL_HISTORY centro I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY disnea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY evolución I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY progresó I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY disnea I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY reposo. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Al B-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION se I-EXPLORATION observaba I-EXPLORATION a I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION ansiosa, I-EXPLORATION lúcida I-EXPLORATION y I-EXPLORATION afebril, I-EXPLORATION taquipneica, I-EXPLORATION con I-EXPLORATION tiraje, I-EXPLORATION estridor I-EXPLORATION laríngeo I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION pétreo I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION cm I-EXPLORATION en I-EXPLORATION región I-EXPLORATION cervical I-EXPLORATION anterior I-EXPLORATION y I-EXPLORATION lateral I-EXPLORATION derecha I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION múltiples I-EXPLORATION adenopatías I-EXPLORATION cervicales. I-EXPLORATION Saturación I-EXPLORATION de I-EXPLORATION oxígeno I-EXPLORATION normal. I-EXPLORATION I-EXPLORATION En I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION velocidad I-EXPLORATION de I-EXPLORATION sedimentación I-EXPLORATION (VHS) I-EXPLORATION de I-EXPLORATION 78 I-EXPLORATION mm/h I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION de I-EXPLORATION 436 I-EXPLORATION U/ I-EXPLORATION L. I-EXPLORATION Hemograma, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION dentro I-EXPLORATION de I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se B-TREATMENT hospitalizó I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT tumor I-TREATMENT cervical I-TREATMENT anterior, I-TREATMENT posiblemente I-TREATMENT cáncer I-TREATMENT tiroideo I-TREATMENT anaplástico I-TREATMENT y I-TREATMENT obstrucción I-TREATMENT secundaria I-TREATMENT de I-TREATMENT la I-TREATMENT vía I-TREATMENT aérea. I-TREATMENT Se I-TREATMENT planteó I-TREATMENT resección I-TREATMENT tumoral I-TREATMENT para I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT urgencia I-TREATMENT obstructiva. I-TREATMENT I-TREATMENT En I-TREATMENT pabellón, I-TREATMENT se I-TREATMENT realizó I-TREATMENT nasofibroscopia I-TREATMENT sin I-TREATMENT hallazgos I-TREATMENT patológicos I-TREATMENT y I-TREATMENT fibrobroncoscopia I-TREATMENT (FBC) I-TREATMENT que I-TREATMENT constató I-TREATMENT a I-TREATMENT nivel I-TREATMENT tiroideo I-TREATMENT una I-TREATMENT estenosis I-TREATMENT traqueal I-TREATMENT severa, I-TREATMENT extrínseca, I-TREATMENT sin I-TREATMENT compromiso I-TREATMENT endoluminal I-TREATMENT ni I-TREATMENT de I-TREATMENT la I-TREATMENT tráquea I-TREATMENT distal, I-TREATMENT procediendo I-TREATMENT a I-TREATMENT la I-TREATMENT intubación I-TREATMENT nasotraqueal I-TREATMENT (N° I-TREATMENT 5.5) I-TREATMENT guiada I-TREATMENT por I-TREATMENT FBC. I-TREATMENT I-TREATMENT En I-TREATMENT el I-TREATMENT acto I-TREATMENT quirúrgico I-TREATMENT se I-TREATMENT observó I-TREATMENT infiltración I-TREATMENT de I-TREATMENT musculatura I-TREATMENT pretlroidea I-TREATMENT secundaria I-TREATMENT a I-TREATMENT tumor I-TREATMENT subyacente, I-TREATMENT el I-TREATMENT cual I-TREATMENT era I-TREATMENT de I-TREATMENT gran I-TREATMENT tamaño, I-TREATMENT aspecto I-TREATMENT encefaloideo, I-TREATMENT muy I-TREATMENT vascularizado I-TREATMENT y I-TREATMENT mal I-TREATMENT definido. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT istmectomía I-TREATMENT tiroidea I-TREATMENT para I-TREATMENT ubicar I-TREATMENT vía I-TREATMENT aérea I-TREATMENT e I-TREATMENT instalar I-TREATMENT traqueostomía. I-TREATMENT La I-TREATMENT tráquea I-TREATMENT estaba I-TREATMENT notoriamente I-TREATMENT desviada I-TREATMENT a I-TREATMENT izquierda I-TREATMENT y I-TREATMENT muy I-TREATMENT profunda, I-TREATMENT 12 I-TREATMENT cm I-TREATMENT bajo I-TREATMENT el I-TREATMENT plano I-TREATMENT cutáneo, I-TREATMENT siendo I-TREATMENT imposible I-TREATMENT instalar I-TREATMENT cánula I-TREATMENT de I-TREATMENT traqueostomía, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT utilizó I-TREATMENT un I-TREATMENT tubo I-TREATMENT orotraqueal I-TREATMENT N° I-TREATMENT 5.5 I-TREATMENT con I-TREATMENT cuff. I-TREATMENT I-TREATMENT El B-EXPLORATION examen I-EXPLORATION anatomopatológico I-EXPLORATION informó I-EXPLORATION "proliferación I-EXPLORATION celular I-EXPLORATION linfoide, I-EXPLORATION dispuesta I-EXPLORATION en I-EXPLORATION sábanas I-EXPLORATION de I-EXPLORATION mediano I-EXPLORATION y I-EXPLORATION gran I-EXPLORATION tamaño, I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION irregulares I-EXPLORATION e I-EXPLORATION hipercromáticos, I-EXPLORATION nucléolo I-EXPLORATION poco I-EXPLORATION prominente I-EXPLORATION y I-EXPLORATION escaso I-EXPLORATION citoplasma I-EXPLORATION eosinófilo I-EXPLORATION pálido, I-EXPLORATION asociado I-EXPLORATION a I-EXPLORATION tejido I-EXPLORATION tiroideo, I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION y I-EXPLORATION tejido I-EXPLORATION adiposo I-EXPLORATION extensamente I-EXPLORATION infiltrado I-EXPLORATION por I-EXPLORATION neoplasia". I-EXPLORATION I-EXPLORATION La I-EXPLORATION inmunohistoquímica I-EXPLORATION señaló I-EXPLORATION antígeno I-EXPLORATION leuco-citario I-EXPLORATION común I-EXPLORATION (+), I-EXPLORATION CD20 I-EXPLORATION (+) I-EXPLORATION focalmente, I-EXPLORATION vimentina I-EXPLORATION (+), I-EXPLORATION queratina I-EXPLORATION (-), I-EXPLORATION BCL2 I-EXPLORATION (-), I-EXPLORATION CD10 I-EXPLORATION (-), I-EXPLORATION CICLINA I-EXPLORATION DI I-EXPLORATION (-), I-EXPLORATION CD30 I-EXPLORATION (-), I-EXPLORATION CD45RO I-EXPLORATION (-) I-EXPLORATION en I-EXPLORATION células I-EXPLORATION neoplásicas. I-EXPLORATION Diagnóstico I-EXPLORATION definitivo: I-EXPLORATION linfoma I-EXPLORATION no I-EXPLORATION Hodgkin I-EXPLORATION tiroideo I-EXPLORATION difuso, I-EXPLORATION estirpe I-EXPLORATION B, I-EXPLORATION de I-EXPLORATION células I-EXPLORATION grandes. I-EXPLORATION I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio, I-EVOLUTION salvo I-EVOLUTION broncorrea I-EVOLUTION purulenta I-EVOLUTION por I-EVOLUTION Pseudomona I-EVOLUTION aeruginosa I-EVOLUTION multisensible I-EVOLUTION que I-EVOLUTION fue I-EVOLUTION tratada I-EVOLUTION con I-EVOLUTION antibióticos. I-EVOLUTION Se B-TREATMENT instaló I-TREATMENT sonda I-TREATMENT nasoye-yunal I-TREATMENT para I-TREATMENT iniciar I-TREATMENT alimentación I-TREATMENT progresiva. I-TREATMENT I-TREATMENT Evaluada B-EXPLORATION por I-EXPLORATION hematología, I-EXPLORATION solicitaron I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION etapificación I-EXPLORATION que I-EXPLORATION descartó I-EXPLORATION otros I-EXPLORATION focos I-EXPLORATION tumora-les, I-EXPLORATION confirmando I-EXPLORATION el I-EXPLORATION origen I-EXPLORATION primario I-EXPLORATION tiroideo I-EXPLORATION del I-EXPLORATION linfoma. I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostró I-EXPLORATION tumor I-EXPLORATION remanente I-EXPLORATION rodeando I-EXPLORATION parcialmente I-EXPLORATION la I-EXPLORATION tráquea I-EXPLORATION y I-EXPLORATION adenopatías I-EXPLORATION paratraqueales I-EXPLORATION derechas I-EXPLORATION de I-EXPLORATION 1-2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro. I-EXPLORATION I-EXPLORATION Comenzó B-TREATMENT tratamiento I-TREATMENT definitivo I-TREATMENT con I-TREATMENT esquema I-TREATMENT CHOP I-TREATMENT (ciclofosfamida, I-TREATMENT adriamicina, I-TREATMENT vincristina I-TREATMENT y I-TREATMENT betametasona) I-TREATMENT al I-TREATMENT vigésimo I-TREATMENT día I-TREATMENT postoperatorio, I-TREATMENT con I-TREATMENT respuesta I-TREATMENT completa I-TREATMENT tras I-TREATMENT primer I-TREATMENT ciclo, I-TREATMENT lo I-TREATMENT que I-TREATMENT permitió I-TREATMENT reemplazar I-TREATMENT tubo I-TREATMENT orotraqueal I-TREATMENT por I-TREATMENT cánula I-TREATMENT de I-TREATMENT traqueostomía I-TREATMENT N° I-TREATMENT 7. I-TREATMENT Se I-TREATMENT otorgó I-TREATMENT el I-TREATMENT alta I-TREATMENT domiciliaria I-TREATMENT al I-TREATMENT finalizar I-TREATMENT el I-TREATMENT segundo I-TREATMENT ciclo. I-TREATMENT I-TREATMENT Luego I-TREATMENT del I-TREATMENT tercer I-TREATMENT ciclo I-TREATMENT de I-TREATMENT quimioterapia, I-TREATMENT abandonó I-TREATMENT tratamiento. I-TREATMENT Familiares B-DERIVED_FROM/TO la I-DERIVED_FROM/TO trasladaron I-DERIVED_FROM/TO a I-DERIVED_FROM/TO una I-DERIVED_FROM/TO clínica I-DERIVED_FROM/TO para I-DERIVED_FROM/TO adultos I-DERIVED_FROM/TO mayores, I-DERIVED_FROM/TO donde I-DERIVED_FROM/TO falleció I-DERIVED_FROM/TO en I-DERIVED_FROM/TO diciembre I-DERIVED_FROM/TO de I-DERIVED_FROM/TO 2004, I-DERIVED_FROM/TO aparentemente I-DERIVED_FROM/TO por I-DERIVED_FROM/TO insuficiencia I-DERIVED_FROM/TO respiratoria I-DERIVED_FROM/TO aguda. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Primigesta B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS gestación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS semanas, I-PRESENT_ILLNESS que I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Obstetricia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS Ginecología I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS Clínico I-PRESENT_ILLNESS San I-PRESENT_ILLNESS Borja I-PRESENT_ILLNESS Arriarán I-PRESENT_ILLNESS el I-PRESENT_ILLNESS día I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS de I-PRESENT_ILLNESS mayo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2008, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS las I-PRESENT_ILLNESS 05: I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS trabajo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS parto I-PRESENT_ILLNESS en I-PRESENT_ILLNESS fase I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dilatación I-PRESENT_ILLNESS rápida I-PRESENT_ILLNESS (5 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dilatación) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS expulsión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS líquido I-PRESENT_ILLNESS amniótico I-PRESENT_ILLNESS (LA) I-PRESENT_ILLNESS con I-PRESENT_ILLNESS tinte I-PRESENT_ILLNESS meconial. I-PRESENT_ILLNESS Tuvo I-PRESENT_ILLNESS una I-PRESENT_ILLNESS rotura I-PRESENT_ILLNESS precoz I-PRESENT_ILLNESS de I-PRESENT_ILLNESS membranas I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS h I-PRESENT_ILLNESS 20 I-PRESENT_ILLNESS min I-PRESENT_ILLNESS antes I-PRESENT_ILLNESS del I-PRESENT_ILLNESS ingreso. I-PRESENT_ILLNESS I-PRESENT_ILLNESS El B-EXPLORATION embarazo I-EXPLORATION fue I-EXPLORATION controlado I-EXPLORATION regularmente I-EXPLORATION en I-EXPLORATION el I-EXPLORATION Consultorio I-EXPLORATION de I-EXPLORATION Maipú I-EXPLORATION y I-EXPLORATION fue I-EXPLORATION considerado I-EXPLORATION como I-EXPLORATION fisiológico. I-EXPLORATION Al I-EXPLORATION ingreso, I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION estaba I-EXPLORATION afebril, I-EXPLORATION normotensa I-EXPLORATION y I-EXPLORATION pulso I-EXPLORATION de I-EXPLORATION 80 I-EXPLORATION por I-EXPLORATION min. I-EXPLORATION En I-EXPLORATION el I-EXPLORATION examen I-EXPLORATION obstétrico I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION 5 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION dilatación, I-EXPLORATION presentación I-EXPLORATION cefálica I-EXPLORATION apoyada, I-EXPLORATION membranas I-EXPLORATION rotas, I-EXPLORATION LA I-EXPLORATION con I-EXPLORATION tinte I-EXPLORATION meconial I-EXPLORATION y I-EXPLORATION latidos I-EXPLORATION cardiofetales I-EXPLORATION (LCF) I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION exámenes I-EXPLORATION hematológicos I-EXPLORATION para I-EXPLORATION pesquisar I-EXPLORATION infección, I-EXPLORATION porque I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION carecía I-EXPLORATION de I-EXPLORATION manifestaciones I-EXPLORATION clínicas I-EXPLORATION compatibles. I-EXPLORATION Se I-EXPLORATION indicó I-EXPLORATION anestesia I-EXPLORATION de I-EXPLORATION conducción I-EXPLORATION con I-EXPLORATION peridural I-EXPLORATION continua I-EXPLORATION y I-EXPLORATION monitorización I-EXPLORATION electrónica I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION una I-EXPLORATION variabilidad I-EXPLORATION menor I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION LCF, I-EXPLORATION una I-EXPLORATION frecuencia I-EXPLORATION cardíaca I-EXPLORATION fetal I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 150 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION min I-EXPLORATION y I-EXPLORATION una I-EXPLORATION desaceleración I-EXPLORATION variable I-EXPLORATION prolongada I-EXPLORATION (hasta I-EXPLORATION 120 I-EXPLORATION LCF I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION durante I-EXPLORATION 3 I-EXPLORATION min). I-EXPLORATION I-EXPLORATION Se I-EXPLORATION reevaluó I-EXPLORATION luego I-EXPLORATION de I-EXPLORATION nueva I-EXPLORATION desaceleración I-EXPLORATION (60 I-EXPLORATION LCF I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION durante I-EXPLORATION 7 I-EXPLORATION min) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION encontró I-EXPLORATION 8 I-EXPLORATION a I-EXPLORATION 9 I-EXPLORATION cms I-EXPLORATION de I-EXPLORATION dilatación, I-EXPLORATION presentación I-EXPLORATION cefálica I-EXPLORATION en I-EXPLORATION II I-EXPLORATION plano I-EXPLORATION y I-EXPLORATION LA I-EXPLORATION con I-EXPLORATION grumos I-EXPLORATION de I-EXPLORATION meconio I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION mal I-EXPLORATION olor. I-EXPLORATION Se B-TREATMENT trasladó I-TREATMENT inmediatamente I-TREATMENT a I-TREATMENT sala I-TREATMENT de I-TREATMENT partos I-TREATMENT con I-TREATMENT dilatación I-TREATMENT completa I-TREATMENT y I-TREATMENT presentación I-TREATMENT cefálica I-TREATMENT en I-TREATMENT tercer I-TREATMENT plano. I-TREATMENT I-TREATMENT El I-TREATMENT parto I-TREATMENT vaginal I-TREATMENT ocurrió I-TREATMENT a I-TREATMENT las I-TREATMENT 7: I-TREATMENT 24 I-TREATMENT h I-TREATMENT del I-TREATMENT 11 I-TREATMENT de I-TREATMENT mayo I-TREATMENT (1 I-TREATMENT h I-TREATMENT 44 I-TREATMENT min I-TREATMENT desde I-TREATMENT el I-TREATMENT ingreso). I-TREATMENT Se I-TREATMENT obtuvo I-TREATMENT un I-TREATMENT recién I-TREATMENT nacido I-TREATMENT (RN) I-TREATMENT de I-TREATMENT 3-440 I-TREATMENT g I-TREATMENT de I-TREATMENT sexo I-TREATMENT masculino, I-TREATMENT con I-TREATMENT muy I-TREATMENT mal I-TREATMENT olor, I-TREATMENT muy I-TREATMENT deprimido I-TREATMENT con I-TREATMENT Apgar I-TREATMENT 1 I-TREATMENT al I-TREATMENT minuto I-TREATMENT y I-TREATMENT 3 I-TREATMENT a I-TREATMENT los I-TREATMENT 5 I-TREATMENT min. I-TREATMENT No I-TREATMENT se I-TREATMENT describió I-TREATMENT presencia I-TREATMENT de I-TREATMENT meconio I-TREATMENT en I-TREATMENT el I-TREATMENT parto, I-TREATMENT ni I-TREATMENT en I-TREATMENT la I-TREATMENT aspiración I-TREATMENT de I-TREATMENT las I-TREATMENT secreciones I-TREATMENT del I-TREATMENT RN. I-TREATMENT En I-TREATMENT la I-TREATMENT sangre I-TREATMENT arterial I-TREATMENT de I-TREATMENT cordón I-TREATMENT se I-TREATMENT encontró I-TREATMENT pH I-TREATMENT 6, I-TREATMENT 9, I-TREATMENT BE I-TREATMENT -25 I-TREATMENT y I-TREATMENT C02 I-TREATMENT 35. I-TREATMENT Ingresó I-TREATMENT intubado I-TREATMENT grave I-TREATMENT a I-TREATMENT la I-TREATMENT UCI I-TREATMENT neonatal, I-TREATMENT con I-TREATMENT los I-TREATMENT diagnósticos: I-TREATMENT RN I-TREATMENT de I-TREATMENT término I-TREATMENT adecuado I-TREATMENT para I-TREATMENT la I-TREATMENT edad I-TREATMENT gestacional, I-TREATMENT de I-TREATMENT 40 I-TREATMENT semanas, I-TREATMENT asfixia I-TREATMENT perinatal I-TREATMENT severa I-TREATMENT (criterios I-TREATMENT de I-TREATMENT la I-TREATMENT Asociación I-TREATMENT Americana I-TREATMENT de I-TREATMENT Pediatría) I-TREATMENT y I-TREATMENT probable I-TREATMENT infección I-TREATMENT connatal. I-TREATMENT I-TREATMENT El B-EVOLUTION RN I-EVOLUTION evolucionó I-EVOLUTION siempre I-EVOLUTION grave, I-EVOLUTION con I-EVOLUTION compromiso I-EVOLUTION del I-EVOLUTION SNC, I-EVOLUTION encefalopatía I-EVOLUTION hipóxica I-EVOLUTION isquémica I-EVOLUTION grado I-EVOLUTION III, I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION shock I-EVOLUTION séptico I-EVOLUTION precoz, I-EVOLUTION con I-EVOLUTION compromiso I-EVOLUTION multiorgánico I-EVOLUTION y I-EVOLUTION necesidad I-EVOLUTION de I-EVOLUTION apoyo I-EVOLUTION ventilatorio I-EVOLUTION y I-EVOLUTION de I-EVOLUTION drogas I-EVOLUTION vasoactivas. I-EVOLUTION I-EVOLUTION A B-TREATMENT las I-TREATMENT 24 I-TREATMENT h I-TREATMENT de I-TREATMENT vida I-TREATMENT los I-TREATMENT hemocultivos I-TREATMENT tomados I-TREATMENT al I-TREATMENT nacer I-TREATMENT fueron I-TREATMENT positivos I-TREATMENT para I-TREATMENT Morganella I-TREATMENT morganii I-TREATMENT cambiándose I-TREATMENT el I-TREATMENT esquema I-TREATMENT antibiótico I-TREATMENT ampicilina-sulbactam I-TREATMENT por I-TREATMENT cefotaxima, I-TREATMENT según I-TREATMENT antibiograma. I-TREATMENT Los B-EXPLORATION exámenes I-EXPLORATION demostraron: I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION leu-copenia, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 129 I-EXPLORATION mg/L, I-EXPLORATION ácido I-EXPLORATION láctico I-EXPLORATION 138 I-EXPLORATION mg/dL. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION reveló I-EXPLORATION infiltrado I-EXPLORATION parenquimatoso I-EXPLORATION bilateral I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION bronconeumonía. I-EXPLORATION El I-EXPLORATION escáner I-EXPLORATION y I-EXPLORATION la I-EXPLORATION ecografía I-EXPLORATION cerebral I-EXPLORATION mostraron I-EXPLORATION edema I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION hemorragia I-EXPLORATION de I-EXPLORATION fosa I-EXPLORATION posterior I-EXPLORATION izquierda I-EXPLORATION concordante I-EXPLORATION con I-EXPLORATION EEG I-EXPLORATION severamente I-EXPLORATION alterado, I-EXPLORATION en I-EXPLORATION status I-EXPLORATION convulsivo. I-EXPLORATION I-EXPLORATION El B-EVOLUTION neonato I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 17 I-EVOLUTION días I-EVOLUTION de I-EVOLUTION vida. I-EVOLUTION La B-EXPLORATION autopsia I-EXPLORATION reveló: I-EXPLORATION RN I-EXPLORATION de I-EXPLORATION término, I-EXPLORATION adecuado I-EXPLORATION para I-EXPLORATION la I-EXPLORATION edad I-EXPLORATION gestacional, I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION morfológicos I-EXPLORATION de I-EXPLORATION shock I-EXPLORATION séptico: I-EXPLORATION coagulación I-EXPLORATION intravascular I-EXPLORATION diseminada, I-EXPLORATION infarto I-EXPLORATION hepático, I-EXPLORATION de I-EXPLORATION glándulas I-EXPLORATION suprarrenales I-EXPLORATION y I-EXPLORATION congestión I-EXPLORATION esplénica. I-EXPLORATION Bronconeumonía I-EXPLORATION bilateral I-EXPLORATION descamativa I-EXPLORATION y I-EXPLORATION hemorrágica. I-EXPLORATION Compromiso I-EXPLORATION cerebral I-EXPLORATION con I-EXPLORATION encefalopatía I-EXPLORATION hipóxica-isquémica. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION placentaria I-EXPLORATION reveló I-EXPLORATION corioamnionitis I-EXPLORATION aguda I-EXPLORATION abscedada, I-EXPLORATION funisitis I-EXPLORATION aguda I-EXPLORATION y I-EXPLORATION perivellositis I-EXPLORATION aguda I-EXPLORATION focal. I-EXPLORATION I-EXPLORATION La B-EVOLUTION madre I-EVOLUTION evolucionó I-EVOLUTION afebril, I-EVOLUTION sin I-EVOLUTION signos I-EVOLUTION clínicos I-EVOLUTION de I-EVOLUTION infección, I-EVOLUTION pero I-EVOLUTION con I-EVOLUTION cultivo I-EVOLUTION de I-EVOLUTION loquios I-EVOLUTION positivos I-EVOLUTION para I-EVOLUTION Morganella I-EVOLUTION morganii, I-EVOLUTION muestra I-EVOLUTION tomada I-EVOLUTION el I-EVOLUTION primer I-EVOLUTION día I-EVOLUTION de I-EVOLUTION puerperio I-EVOLUTION del I-EVOLUTION fondo I-EVOLUTION de I-EVOLUTION saco I-EVOLUTION vaginal. I-EVOLUTION Se B-TREATMENT dio I-TREATMENT de I-TREATMENT alta I-TREATMENT hospitalaria I-TREATMENT a I-TREATMENT los I-TREATMENT tres I-TREATMENT días I-TREATMENT del I-TREATMENT parto I-TREATMENT y I-TREATMENT se I-TREATMENT trató I-TREATMENT durante I-TREATMENT 5 I-TREATMENT días I-TREATMENT con I-TREATMENT gentamicina I-TREATMENT l60 I-TREATMENT mg I-TREATMENT IM I-TREATMENT al I-TREATMENT día. I-TREATMENT Se I-TREATMENT controló I-TREATMENT a I-TREATMENT los I-TREATMENT 11 I-TREATMENT días I-TREATMENT de I-TREATMENT puerperio I-TREATMENT en I-TREATMENT el I-TREATMENT policlínico I-TREATMENT del I-TREATMENT Centro I-TREATMENT Diagnóstico I-TREATMENT Terapéutico I-TREATMENT y I-TREATMENT se I-TREATMENT dio I-TREATMENT de I-TREATMENT alta I-TREATMENT definitiva I-TREATMENT en I-TREATMENT buenas I-TREATMENT condiciones I-TREATMENT físicas. I-TREATMENT I-TREATMENT Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 40 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY medio I-PAST_MEDICAL_HISTORY urbano. I-PAST_MEDICAL_HISTORY Portador B-PRESENT_ILLNESS de I-PRESENT_ILLNESS linfedema I-PRESENT_ILLNESS primario I-PRESENT_ILLNESS tardío I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembro I-PRESENT_ILLNESS inferior I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS de I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS valorado I-PRESENT_ILLNESS con I-PRESENT_ILLNESS linfocen-tellografia I-PRESENT_ILLNESS que I-PRESENT_ILLNESS había I-PRESENT_ILLNESS evidenciado I-PRESENT_ILLNESS ausencia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS drenaje I-PRESENT_ILLNESS linfático I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dicho I-PRESENT_ILLNESS miembro, I-PRESENT_ILLNESS tomografía I-PRESENT_ILLNESS computada I-PRESENT_ILLNESS (TC) I-PRESENT_ILLNESS de I-PRESENT_ILLNESS abdomen, I-PRESENT_ILLNESS pelvis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS muslo I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS alteraciones, I-PRESENT_ILLNESS y I-PRESENT_ILLNESS eco-Doppler I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS y I-PRESENT_ILLNESS venoso I-PRESENT_ILLNESS normales. I-PRESENT_ILLNESS Infecciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS recurrentes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS tórpida I-PRESENT_ILLNESS en I-PRESENT_ILLNESS dicho I-PRESENT_ILLNESS miembro. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 1 I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS y I-PRESENT_ILLNESS medio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS marcada I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS anorexia, I-PRESENT_ILLNESS adelgazamiento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kilos, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS fiebre I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hasta I-PRESENT_ILLNESS 38°C I-PRESENT_ILLNESS axilar. I-PRESENT_ILLNESS En I-PRESENT_ILLNESS la I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS se I-PRESENT_ILLNESS agregó I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS hemoptoica. I-PRESENT_ILLNESS Relataba I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS sobre I-PRESENT_ILLNESS linfedema I-PRESENT_ILLNESS de I-PRESENT_ILLNESS reciente I-PRESENT_ILLNESS aparición. I-PRESENT_ILLNESS Del B-EXPLORATION examen I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION destacaba: I-EXPLORATION severo I-EXPLORATION adelgazamiento, I-EXPLORATION sin I-EXPLORATION palidez I-EXPLORATION ni I-EXPLORATION fiebre. I-EXPLORATION En I-EXPLORATION miembro I-EXPLORATION inferior I-EXPLORATION derecho I-EXPLORATION presentaba I-EXPLORATION linfedema I-EXPLORATION hasta I-EXPLORATION raíz I-EXPLORATION de I-EXPLORATION muslo I-EXPLORATION con I-EXPLORATION múltiples I-EXPLORATION lesiones I-EXPLORATION nodulares I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION firmes, I-EXPLORATION violáceas, I-EXPLORATION algunas I-EXPLORATION descamadas I-EXPLORATION y I-EXPLORATION otras I-EXPLORATION ulceradas I-EXPLORATION con I-EXPLORATION mayor I-EXPLORATION concentración I-EXPLORATION de I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION región I-EXPLORATION poplítea. I-EXPLORATION En I-EXPLORATION muslo I-EXPLORATION proximal I-EXPLORATION presentaba I-EXPLORATION lesión, I-EXPLORATION pediculada I-EXPLORATION y I-EXPLORATION ulcerada. I-EXPLORATION Lesión I-EXPLORATION traumática I-EXPLORATION de I-EXPLORATION pie I-EXPLORATION en I-EXPLORATION vías I-EXPLORATION de I-EXPLORATION cicatrización. I-EXPLORATION Adenomegalias I-EXPLORATION inguinales I-EXPLORATION a I-EXPLORATION derecha, I-EXPLORATION firmes, I-EXPLORATION de I-EXPLORATION 2 I-EXPLORATION cm I-EXPLORATION de I-EXPLORATION diámetro I-EXPLORATION que I-EXPLORATION no I-EXPLORATION formaban I-EXPLORATION conglomerados. I-EXPLORATION A I-EXPLORATION nivel I-EXPLORATION pleuropulmonar I-EXPLORATION destacaba I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION ruidos I-EXPLORATION subcrepitantes I-EXPLORATION bibasales I-EXPLORATION escasos. I-EXPLORATION El I-EXPLORATION resto I-EXPLORATION del I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION era I-EXPLORATION normal. I-EXPLORATION De I-EXPLORATION la I-EXPLORATION analítica I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba I-EXPLORATION hemograma, I-EXPLORATION glicemia, I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION normales, I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 50 I-EXPLORATION mm I-EXPLORATION en I-EXPLORATION la I-EXPLORATION primera I-EXPLORATION hora, I-EXPLORATION y I-EXPLORATION pro I-EXPLORATION teína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION de I-EXPLORATION 30 I-EXPLORATION mg/dL. I-EXPLORATION Serología I-EXPLORATION para I-EXPLORATION VIH I-EXPLORATION negativa. I-EXPLORATION Baciloscopías I-EXPLORATION y I-EXPLORATION prueba I-EXPLORATION de I-EXPLORATION Mantoux I-EXPLORATION negativos. I-EXPLORATION La I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION mostraba I-EXPLORATION imagen I-EXPLORATION nodular I-EXPLORATION paracardíaca I-EXPLORATION izquierda. I-EXPLORATION La I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis I-EXPLORATION mostraba I-EXPLORATION múltiples I-EXPLORATION nodulos I-EXPLORATION pulmonares I-EXPLORATION bilaterales I-EXPLORATION a I-EXPLORATION predominio I-EXPLORATION bibasal, I-EXPLORATION mal I-EXPLORATION delimitados I-EXPLORATION y I-EXPLORATION adenomegalias I-EXPLORATION inguinales I-EXPLORATION e I-EXPLORATION iliacas I-EXPLORATION externas I-EXPLORATION derechas. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION de I-EXPLORATION lesión I-EXPLORATION pediculada I-EXPLORATION del I-EXPLORATION muslo I-EXPLORATION que I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION angiosarcoma, I-EXPLORATION con I-EXPLORATION inmunohistoquímica I-EXPLORATION concordante I-EXPLORATION (positividad I-EXPLORATION para I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION células I-EXPLORATION endoteliales I-EXPLORATION CD31 I-EXPLORATION y I-EXPLORATION CD34, I-EXPLORATION el I-EXPLORATION primero I-EXPLORATION con I-EXPLORATION elevada I-EXPLORATION sensibilidad I-EXPLORATION y I-EXPLORATION especificidad12, I-EXPLORATION 13). I-EXPLORATION Valorado B-TREATMENT por I-TREATMENT servicio I-TREATMENT de I-TREATMENT oncología I-TREATMENT clínica I-TREATMENT se I-TREATMENT inicio I-TREATMENT plan I-TREATMENT de I-TREATMENT poliquimioterapia. I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION a I-EVOLUTION 5 I-EVOLUTION meses I-EVOLUTION del I-EVOLUTION diagnóstico. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS chileno, I-PRESENT_ILLNESS 43 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS ingeniero B-PAST_MEDICAL_HISTORY civil I-PAST_MEDICAL_HISTORY proveniente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Santiago, I-PAST_MEDICAL_HISTORY residente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY Valdivia I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Portador I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemofilia I-PAST_MEDICAL_HISTORY A I-PAST_MEDICAL_HISTORY leve I-PAST_MEDICAL_HISTORY (Factor I-PAST_MEDICAL_HISTORY VIII I-PAST_MEDICAL_HISTORY 10%) I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY epistaxis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hemartrosis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cadera I-PAST_MEDICAL_HISTORY derecha. I-PAST_MEDICAL_HISTORY Hasta I-PAST_MEDICAL_HISTORY 1998 I-PAST_MEDICAL_HISTORY sólo I-PAST_MEDICAL_HISTORY recibió I-PAST_MEDICAL_HISTORY transfusiones I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY plasma I-PAST_MEDICAL_HISTORY fresco I-PAST_MEDICAL_HISTORY congelado I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY crioprecipitados, I-PAST_MEDICAL_HISTORY posteriormente I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY tratado I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY concentrados I-PAST_MEDICAL_HISTORY liofi I-PAST_MEDICAL_HISTORY lizados I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY alta I-PAST_MEDICAL_HISTORY pureza I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY doble I-PAST_MEDICAL_HISTORY inactivación I-PAST_MEDICAL_HISTORY viral I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY antifibrinolíticos I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY procedimientos I-PAST_MEDICAL_HISTORY dentales I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY litotripsia I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY urolitiasis I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY 2000 I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY complicaciones I-PAST_MEDICAL_HISTORY hemorrágicas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En B-PRESENT_ILLNESS agosto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2007 I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS epistaxis I-PRESENT_ILLNESS y I-PRESENT_ILLNESS equimosis I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS traumatismos I-PRESENT_ILLNESS evidentes. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS equimosis I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS de I-PRESENT_ILLNESS predominio I-PRESENT_ILLNESS en I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS En B-EXPLORATION hemograma I-EXPLORATION trombocitopenia I-EXPLORATION de I-EXPLORATION 23.000/mm3. I-EXPLORATION Se I-EXPLORATION tomó I-EXPLORATION mielograma I-EXPLORATION hospitalizado, I-EXPLORATION previa I-EXPLORATION transfusión I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION y I-EXPLORATION concentrado I-EXPLORATION FVIII, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION series I-EXPLORATION hematopoyéticas I-EXPLORATION conservadas. I-EXPLORATION Se B-TREATMENT iniciaron I-TREATMENT pulsos I-TREATMENT de I-TREATMENT solumedrol I-TREATMENT 125 I-TREATMENT mg I-TREATMENT i.v. I-TREATMENT y I-TREATMENT luego I-TREATMENT prednisona I-TREATMENT 60 I-TREATMENT mg/día I-TREATMENT p.o., I-TREATMENT observando I-TREATMENT aumento I-TREATMENT de I-TREATMENT plaquetas I-TREATMENT hasta I-TREATMENT 50.000/mm3 I-TREATMENT el I-TREATMENT cuarto I-TREATMENT día, I-TREATMENT siendo I-TREATMENT dado I-TREATMENT de I-TREATMENT alta. I-TREATMENT I-TREATMENT Dentro B-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaba: I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION transaminasas I-EXPLORATION (GOT I-EXPLORATION 158/GPT I-EXPLORATION 151), I-EXPLORATION TTPA, I-EXPLORATION tiempo I-EXPLORATION de I-EXPLORATION protrombina I-EXPLORATION y I-EXPLORATION albúmina I-EXPLORATION normales, I-EXPLORATION serología I-EXPLORATION VHC I-EXPLORATION positivo, I-EXPLORATION VIH I-EXPLORATION negativo, I-EXPLORATION HBAgS I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION antiplaquetarios I-EXPLORATION circulantes I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION tercer I-EVOLUTION día I-EVOLUTION posterior I-EVOLUTION al I-EVOLUTION alta I-EVOLUTION las I-EVOLUTION plaquetas I-EVOLUTION caen I-EVOLUTION a I-EVOLUTION 27.000/mm3. I-EVOLUTION Se B-TREATMENT mantuvo I-TREATMENT la I-TREATMENT prednisona I-TREATMENT en I-TREATMENT 60 I-TREATMENT mg/día I-TREATMENT con I-TREATMENT persistencia I-TREATMENT de I-TREATMENT la I-TREATMENT trombopenia I-TREATMENT por I-TREATMENT cual I-TREATMENT se I-TREATMENT decidió I-TREATMENT nuevo I-TREATMENT pulso I-TREATMENT de I-TREATMENT solumedrol I-TREATMENT y I-TREATMENT se I-TREATMENT asoció I-TREATMENT azatioprina I-TREATMENT 100 I-TREATMENT mg/día I-TREATMENT con I-TREATMENT buena I-TREATMENT respuesta. I-TREATMENT En I-TREATMENT el I-TREATMENT transcurso I-TREATMENT del I-TREATMENT tratamiento I-TREATMENT esteroidal I-TREATMENT desarrolló I-TREATMENT diabetes I-TREATMENT requiriendo I-TREATMENT uso I-TREATMENT de I-TREATMENT insulina I-TREATMENT y I-TREATMENT luego I-TREATMENT se I-TREATMENT estabilizó I-TREATMENT con I-TREATMENT régimen. I-TREATMENT I-TREATMENT Dada I-TREATMENT la I-TREATMENT dependencia I-TREATMENT a I-TREATMENT corticoides I-TREATMENT e I-TREATMENT inmunosupresor I-TREATMENT en I-TREATMENT noviembre I-TREATMENT de I-TREATMENT 2007 I-TREATMENT se I-TREATMENT realizó I-TREATMENT esplenectomía I-TREATMENT electiva I-TREATMENT y I-TREATMENT biopsia I-TREATMENT hepática I-TREATMENT bajo I-TREATMENT terapia I-TREATMENT de I-TREATMENT reemplazo I-TREATMENT del I-TREATMENT factor I-TREATMENT deficiente I-TREATMENT ajustando I-TREATMENT niveles I-TREATMENT de I-TREATMENT FVIII I-TREATMENT en I-TREATMENT torno I-TREATMENT al I-TREATMENT 40% I-TREATMENT más I-TREATMENT antifibrinolíticos I-TREATMENT por I-TREATMENT diez I-TREATMENT días I-TREATMENT presentando I-TREATMENT dehiscencia I-TREATMENT de I-TREATMENT la I-TREATMENT herida I-TREATMENT operatoria I-TREATMENT en I-TREATMENT el I-TREATMENT día I-TREATMENT 21 I-TREATMENT post I-TREATMENT operatorio I-TREATMENT debiendo I-TREATMENT resuturarse. I-TREATMENT Posterior I-TREATMENT a I-TREATMENT cirugía I-TREATMENT se I-TREATMENT suspendió I-TREATMENT prednisona I-TREATMENT y I-TREATMENT se I-TREATMENT mantuvo I-TREATMENT azatioprina I-TREATMENT 100 I-TREATMENT mg/día I-TREATMENT con B-EXPLORATION lo I-EXPLORATION cual I-EXPLORATION logró I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION alrededor I-EXPLORATION de I-EXPLORATION 50.000/mm3 I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 5 I-EXPLORATION meses. I-EXPLORATION I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION esplénica I-EXPLORATION demostró I-EXPLORATION congestión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pulpa I-EXPLORATION roja I-EXPLORATION y I-EXPLORATION la I-EXPLORATION hepática, I-EXPLORATION hepatitis I-EXPLORATION crónica I-EXPLORATION con I-EXPLORATION moderada I-EXPLORATION actividad, I-EXPLORATION colapso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION trama I-EXPLORATION reticular I-EXPLORATION y I-EXPLORATION formación I-EXPLORATION de I-EXPLORATION puentes I-EXPLORATION porto-portales. I-EXPLORATION Hepatocitos I-EXPLORATION con I-EXPLORATION degeneración I-EXPLORATION balonada, I-EXPLORATION esteatosis I-EXPLORATION microvesicular I-EXPLORATION y I-EXPLORATION colestasia I-EXPLORATION intracelular. I-EXPLORATION I-EXPLORATION Evaluado I-EXPLORATION por I-EXPLORATION gastroenterólogo I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION endoscopia I-EXPLORATION digestiva I-EXPLORATION alta I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION várices I-EXPLORATION esofágicas I-EXPLORATION medianas I-EXPLORATION y I-EXPLORATION gastropatía I-EXPLORATION congestiva, I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION VHC I-EXPLORATION (185.120 I-EXPLORATION UI I-EXPLORATION RNA/ml), I-EXPLORATION genotipo I-EXPLORATION (1b) I-EXPLORATION y I-EXPLORATION se I-EXPLORATION indicó I-EXPLORATION terapia I-EXPLORATION con I-EXPLORATION INF I-EXPLORATION α I-EXPLORATION y I-EXPLORATION ribavirina I-EXPLORATION que I-EXPLORATION no I-EXPLORATION realizó I-EXPLORATION por I-EXPLORATION razones I-EXPLORATION previsionales. I-EXPLORATION I-EXPLORATION Los B-EVOLUTION últimos I-EVOLUTION 2 I-EVOLUTION años I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION diversos I-EVOLUTION episodios I-EVOLUTION hemorragíparos I-EVOLUTION como I-EVOLUTION hemoptisis I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION cuadro I-EVOLUTION bronquial, I-EVOLUTION hematomas I-EVOLUTION musculares I-EVOLUTION (antebrazo I-EVOLUTION y I-EVOLUTION muslo), I-EVOLUTION hemartrosis I-EVOLUTION de I-EVOLUTION rodilla I-EVOLUTION y I-EVOLUTION tobillo I-EVOLUTION derechos, I-EVOLUTION a I-EVOLUTION pesar I-EVOLUTION de I-EVOLUTION mantener I-EVOLUTION recuento I-EVOLUTION plaquetario I-EVOLUTION estable I-EVOLUTION (50.000/mm3). I-EVOLUTION TTPA I-EVOLUTION actual I-EVOLUTION 62, I-EVOLUTION 3 I-EVOLUTION seg I-EVOLUTION y I-EVOLUTION FVIII I-EVOLUTION 7%. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS autovalente, B-PAST_MEDICAL_HISTORY independiente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY actividades I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY vida I-PAST_MEDICAL_HISTORY diaria, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY escolaridad I-PAST_MEDICAL_HISTORY completa, I-PAST_MEDICAL_HISTORY tiene I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial, I-PAST_MEDICAL_HISTORY hipotiroidismo, I-PAST_MEDICAL_HISTORY hipoacusia I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY diabetes I-PAST_MEDICAL_HISTORY mellitus I-PAST_MEDICAL_HISTORY tipo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY (DM I-PAST_MEDICAL_HISTORY 2) I-PAST_MEDICAL_HISTORY manejada I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY glibenclamida I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY metaformina I-PAST_MEDICAL_HISTORY 1.700 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY cual I-PAST_MEDICAL_HISTORY lograba I-PAST_MEDICAL_HISTORY glicemias I-PAST_MEDICAL_HISTORY capilares I-PAST_MEDICAL_HISTORY adecuadas. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Fue B-PRESENT_ILLNESS llevada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS familiares I-PRESENT_ILLNESS al I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia, I-PRESENT_ILLNESS para I-PRESENT_ILLNESS evaluación I-PRESENT_ILLNESS por I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS cualitativo I-PRESENT_ILLNESS de I-PRESENT_ILLNESS conciencia, I-PRESENT_ILLNESS no I-PRESENT_ILLNESS fluctuante, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS más I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 24 I-PRESENT_ILLNESS hrs I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS signos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS focalización I-PRESENT_ILLNESS y I-PRESENT_ILLNESS con I-PRESENT_ILLNESS recuperación I-PRESENT_ILLNESS espontánea I-PRESENT_ILLNESS completa. I-PRESENT_ILLNESS Su I-PRESENT_ILLNESS familia I-PRESENT_ILLNESS señaló I-PRESENT_ILLNESS la I-PRESENT_ILLNESS ocurrencia I-PRESENT_ILLNESS cada I-PRESENT_ILLNESS vez I-PRESENT_ILLNESS más I-PRESENT_ILLNESS frecuente I-PRESENT_ILLNESS de I-PRESENT_ILLNESS episodios I-PRESENT_ILLNESS similares I-PRESENT_ILLNESS en I-PRESENT_ILLNESS los I-PRESENT_ILLNESS últimos I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses, I-PRESENT_ILLNESS indicando I-PRESENT_ILLNESS además, I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS memoria I-PRESENT_ILLNESS reciente, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS conducta I-PRESENT_ILLNESS y I-PRESENT_ILLNESS alteraciones I-PRESENT_ILLNESS autolimitadas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS trastorno I-PRESENT_ILLNESS del I-PRESENT_ILLNESS control I-PRESENT_ILLNESS de I-PRESENT_ILLNESS esfínteres, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS repercusión I-PRESENT_ILLNESS funcional I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS parcial I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS autovalencia. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Ingresó B-EXPLORATION vigil, I-EXPLORATION orientada I-EXPLORATION témporo-espacialmente, I-EXPLORATION atenta, I-EXPLORATION hemodinámicamente I-EXPLORATION estable, I-EXPLORATION afebril, I-EXPLORATION sin I-EXPLORATION apremio I-EXPLORATION respiratorio I-EXPLORATION y I-EXPLORATION con I-EXPLORATION un I-EXPLORATION examen I-EXPLORATION neurológico I-EXPLORATION en I-EXPLORATION el I-EXPLORATION que I-EXPLORATION sólo I-EXPLORATION destacó I-EXPLORATION un I-EXPLORATION rendimiento I-EXPLORATION anormal I-EXPLORATION en I-EXPLORATION el I-EXPLORATION cuestionario I-EXPLORATION Mini I-EXPLORATION Mental, I-EXPLORATION obteniendo I-EXPLORATION 22 I-EXPLORATION puntos, I-EXPLORATION cuyo I-EXPLORATION resultado I-EXPLORATION sugiere I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION deterioro I-EXPLORATION cognitivo I-EXPLORATION (puntaje I-EXPLORATION esperado I-EXPLORATION para I-EXPLORATION nivel I-EXPLORATION de I-EXPLORATION escolaridad I-EXPLORATION > I-EXPLORATION 24 I-EXPLORATION puntos). I-EXPLORATION Entre I-EXPLORATION sus I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION destacaron I-EXPLORATION glicemia, I-EXPLORATION creatininemia, I-EXPLORATION natremia, I-EXPLORATION calcemia, I-EXPLORATION TSH, I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION vitamina I-EXPLORATION B12 I-EXPLORATION y I-EXPLORATION hemograma, I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION presentó I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION parámetrosinflamatorios, I-EXPLORATION ELISA I-EXPLORATION VIH I-EXPLORATION negativo I-EXPLORATION y I-EXPLORATION RPR I-EXPLORATION no I-EXPLORATION reactivo. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION no I-EXPLORATION contrastada, I-EXPLORATION que I-EXPLORATION pesquisó I-EXPLORATION un I-EXPLORATION infarto I-EXPLORATION lacunar I-EXPLORATION hemorrágico I-EXPLORATION putaminal I-EXPLORATION izquierdo, I-EXPLORATION probablemente I-EXPLORATION antiguo. I-EXPLORATION El I-EXPLORATION electroencefalograma I-EXPLORATION mostró I-EXPLORATION lentitud I-EXPLORATION intermitente I-EXPLORATION generalizada. I-EXPLORATION Eco-Doppler I-EXPLORATION carotideo I-EXPLORATION evidenció I-EXPLORATION ateromatosis I-EXPLORATION carotídea I-EXPLORATION derecha I-EXPLORATION sin I-EXPLORATION compromiso I-EXPLORATION hemodinámico. I-EXPLORATION Ninguno I-EXPLORATION de I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION logró I-EXPLORATION explicar I-EXPLORATION el I-EXPLORATION cuadro I-EXPLORATION clínico. I-EXPLORATION I-EXPLORATION Se B-TREATMENT manejó I-TREATMENT con I-TREATMENT régimen I-TREATMENT alimentario I-TREATMENT diabético, I-TREATMENT sin I-TREATMENT hipoglicemiantes I-TREATMENT orales, I-TREATMENT evolucionando B-EVOLUTION en I-EVOLUTION forma I-EVOLUTION asintomática I-EVOLUTION y I-EVOLUTION con I-EVOLUTION glicemias I-EVOLUTION en I-EVOLUTION rango I-EVOLUTION adecuado. I-EVOLUTION La B-EXPLORATION hemoglobina I-EXPLORATION glicosilada I-EXPLORATION A1C I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 2%, I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION hizo I-EXPLORATION sospechar I-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION episodios I-EXPLORATION de I-EXPLORATION hipoglicemia I-EXPLORATION recurrentes. I-EXPLORATION Por B-TREATMENT ello, I-TREATMENT se I-TREATMENT decidió I-TREATMENT suspender I-TREATMENT glibenclamida I-TREATMENT y I-TREATMENT disminuir I-TREATMENT la I-TREATMENT dosis I-TREATMENT de I-TREATMENT metformina I-TREATMENT previo I-TREATMENT al I-TREATMENT alta. I-TREATMENT I-TREATMENT En B-EVOLUTION controles I-EVOLUTION ambulatorios, I-EVOLUTION transcurridos I-EVOLUTION dos I-EVOLUTION y I-EVOLUTION luego I-EVOLUTION seis I-EVOLUTION meses I-EVOLUTION post I-EVOLUTION alta, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encontraba I-EVOLUTION vigil, I-EVOLUTION orientada I-EVOLUTION témporo-espacialmente, I-EVOLUTION bien I-EVOLUTION conectada I-EVOLUTION al I-EVOLUTION medio, I-EVOLUTION logrando I-EVOLUTION 26 I-EVOLUTION puntos I-EVOLUTION en I-EVOLUTION Mini I-EVOLUTION Mental I-EVOLUTION en I-EVOLUTION ambas I-EVOLUTION ocasiones. I-EVOLUTION Su I-EVOLUTION familia I-EVOLUTION no I-EVOLUTION refrió I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION alteración I-EVOLUTION de I-EVOLUTION conciencia, I-EVOLUTION ni I-EVOLUTION conductuales, I-EVOLUTION interpretándose I-EVOLUTION el I-EVOLUTION cuadro I-EVOLUTION original I-EVOLUTION como I-EVOLUTION secundario I-EVOLUTION a I-EVOLUTION hipoglicemias I-EVOLUTION subclínicas I-EVOLUTION frecuentes. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS autovalente B-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY factores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY riesgo I-PAST_MEDICAL_HISTORY coronario I-PAST_MEDICAL_HISTORY conocidos. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS Servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Urgencia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS torácico 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 que I-PRESENT_ILLNESS apareció I-PRESENT_ILLNESS después I-PRESENT_ILLNESS de I-PRESENT_ILLNESS ejercicio I-PRESENT_ILLNESS físico I-PRESENT_ILLNESS moderado, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS estrés I-PRESENT_ILLNESS emocional I-PRESENT_ILLNESS aparente. I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS asoció I-PRESENT_ILLNESS a I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fatigabilidad. I-PRESENT_ILLNESS En B-EXPLORATION la I-EXPLORATION evaluación I-EXPLORATION clínica I-EXPLORATION inicial I-EXPLORATION estaba I-EXPLORATION bien I-EXPLORATION perfundida, I-EXPLORATION con I-EXPLORATION pulso I-EXPLORATION de I-EXPLORATION 105/min, I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION de I-EXPLORATION 98/57 I-EXPLORATION mmHg. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION cardiovascular I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION rutina I-EXPLORATION destacaron I-EXPLORATION un I-EXPLORATION electrocardiograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION supradesnivel I-EXPLORATION del I-EXPLORATION segmento I-EXPLORATION ST I-EXPLORATION en I-EXPLORATION pared I-EXPLORATION anterior I-EXPLORATION (V2-V4) I-EXPLORATION y I-EXPLORATION marcadores I-EXPLORATION de I-EXPLORATION daño I-EXPLORATION miocárdico I-EXPLORATION elevados I-EXPLORATION (troponinas I-EXPLORATION 7, I-EXPLORATION 10 I-EXPLORATION ng/ml, I-EXPLORATION CK-total I-EXPLORATION 368 I-EXPLORATION U/L I-EXPLORATION y I-EXPLORATION CK-MB I-EXPLORATION 57 I-EXPLORATION U/L). I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION coronariografía I-EXPLORATION de I-EXPLORATION urgencia I-EXPLORATION una I-EXPLORATION hora I-EXPLORATION posterior I-EXPLORATION al I-EXPLORATION ingreso, I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION arteria I-EXPLORATION descendente I-EXPLORATION anterior I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION proximal I-EXPLORATION de I-EXPLORATION 30% I-EXPLORATION y I-EXPLORATION flujo I-EXPLORATION lento, I-EXPLORATION no I-EXPLORATION presentando I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION las I-EXPLORATION arterias I-EXPLORATION coronarias I-EXPLORATION lesiones I-EXPLORATION significativas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION ventriculografía I-EXPLORATION izquierda I-EXPLORATION con I-EXPLORATION contraste I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION balonamiento I-EXPLORATION apical. I-EXPLORATION Se B-TREATMENT planteó I-TREATMENT como I-TREATMENT probable I-TREATMENT diagnóstico I-TREATMENT STT I-TREATMENT e I-TREATMENT ingresó I-TREATMENT a I-TREATMENT Unidad I-TREATMENT Coronaria I-TREATMENT para I-TREATMENT tratamiento I-TREATMENT médico I-TREATMENT estándar I-TREATMENT de I-TREATMENT síndrome I-TREATMENT coronario I-TREATMENT agudo I-TREATMENT (SCA). I-TREATMENT I-TREATMENT La B-EXPLORATION ecocardiografía I-EXPLORATION en I-EXPLORATION el I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización I-EXPLORATION mostró: I-EXPLORATION 1) I-EXPLORATION VI I-EXPLORATION de I-EXPLORATION dimensiones I-EXPLORATION básales I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION normales I-EXPLORATION con I-EXPLORATION extensa I-EXPLORATION akinesia I-EXPLORATION anteroseptoapical I-EXPLORATION y I-EXPLORATION de I-EXPLORATION la I-EXPLORATION punta; I-EXPLORATION 2) I-EXPLORATION Función I-EXPLORATION sistólica I-EXPLORATION global I-EXPLORATION moderadamente I-EXPLORATION deprimida I-EXPLORATION con I-EXPLORATION una I-EXPLORATION fracción I-EXPLORATION de I-EXPLORATION eyección I-EXPLORATION del I-EXPLORATION VI I-EXPLORATION estimada I-EXPLORATION en I-EXPLORATION 40%; I-EXPLORATION 3) I-EXPLORATION Insuficiencia I-EXPLORATION tricuspídea I-EXPLORATION severa I-EXPLORATION e I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION moderada; I-EXPLORATION 4) I-EXPLORATION Hipertensión I-EXPLORATION pulmonar I-EXPLORATION severa I-EXPLORATION con I-EXPLORATION presión I-EXPLORATION sistólica I-EXPLORATION de I-EXPLORATION arteria I-EXPLORATION pulmonar I-EXPLORATION de I-EXPLORATION 72 I-EXPLORATION mmHg. I-EXPLORATION I-EXPLORATION Al I-EXPLORATION tercer I-EXPLORATION día, I-EXPLORATION el I-EXPLORATION control I-EXPLORATION electrocardiográfico I-EXPLORATION reveló I-EXPLORATION inversión I-EXPLORATION de I-EXPLORATION onda I-EXPLORATION T I-EXPLORATION de I-EXPLORATION derivaciones I-EXPLORATION V2 I-EXPLORATION a I-EXPLORATION V6. I-EXPLORATION I-EXPLORATION La B-EVOLUTION evolución I-EVOLUTION posterior I-EVOLUTION fue I-EVOLUTION favorable, I-EVOLUTION con I-EVOLUTION desaparición I-EVOLUTION del I-EVOLUTION dolor I-EVOLUTION y I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION los I-EVOLUTION marcadores I-EVOLUTION de I-EVOLUTION daño I-EVOLUTION miocárdico I-EVOLUTION por I-EVOLUTION lo I-EVOLUTION que I-EVOLUTION se I-EVOLUTION decidió I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION noveno I-EVOLUTION día I-EVOLUTION hospitalización. I-EVOLUTION El B-EXPLORATION seguimiento I-EXPLORATION al I-EXPLORATION mes I-EXPLORATION con I-EXPLORATION ecocardiografía I-EXPLORATION 2-D I-EXPLORATION mostró: I-EXPLORATION 1) I-EXPLORATION Función I-EXPLORATION sistólica I-EXPLORATION de I-EXPLORATION VI I-EXPLORATION conservada; I-EXPLORATION 2) I-EXPLORATION Insuficiencia I-EXPLORATION mitral I-EXPLORATION leve I-EXPLORATION con I-EXPLORATION válvula I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION perfusión I-EXPLORATION miocárdica I-EXPLORATION SPECT I-EXPLORATION gatillado I-EXPLORATION para I-EXPLORATION evaluar I-EXPLORATION función I-EXPLORATION ventricular I-EXPLORATION con I-EXPLORATION Tecnecio99m-SESTAMIBI I-EXPLORATION en I-EXPLORATION estrés I-EXPLORATION con I-EXPLORATION protocolo I-EXPLORATION de I-EXPLORATION Bruce I-EXPLORATION y I-EXPLORATION en I-EXPLORATION reposo; I-EXPLORATION concluyó I-EXPLORATION motilidad I-EXPLORATION y I-EXPLORATION engrasamiento I-EXPLORATION global I-EXPLORATION y I-EXPLORATION segmentario I-EXPLORATION del I-EXPLORATION VI I-EXPLORATION conservados, I-EXPLORATION con I-EXPLORATION excelente I-EXPLORATION función I-EXPLORATION sistólica. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertensa, B-PAST_MEDICAL_HISTORY obesa I-PAST_MEDICAL_HISTORY mórbida, I-PAST_MEDICAL_HISTORY planificada B-PRESENT_ILLNESS para I-PRESENT_ILLNESS bypass I-PRESENT_ILLNESS gástrico. I-PRESENT_ILLNESS Durante B-EVOLUTION la I-EVOLUTION inducción I-EVOLUTION anestésica, I-EVOLUTION sin I-EVOLUTION haber I-EVOLUTION modificaciones I-EVOLUTION de I-EVOLUTION PA I-EVOLUTION o I-EVOLUTION FC, I-EVOLUTION presentó I-EVOLUTION alteración I-EVOLUTION del I-EVOLUTION segmento I-EVOLUTION ST I-EVOLUTION sugerente I-EVOLUTION de I-EVOLUTION isquemia. I-EVOLUTION La B-EXPLORATION ETE I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION la I-EXPLORATION motilidad I-EXPLORATION ventricular I-EXPLORATION global I-EXPLORATION ni I-EXPLORATION segmentaria. I-EXPLORATION Se B-TREATMENT decide I-TREATMENT realizar I-TREATMENT la I-TREATMENT cirugía, I-TREATMENT la I-TREATMENT cual I-TREATMENT transcurre I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Post B-EVOLUTION operatorio I-EVOLUTION sin I-EVOLUTION problemas, I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION tercer I-EVOLUTION día. I-EVOLUTION I-EVOLUTION Hombre 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 síndrome I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Down I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY congénita I-PAST_MEDICAL_HISTORY consistente I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY canal I-PAST_MEDICAL_HISTORY aurículo-ventricular I-PAST_MEDICAL_HISTORY completo, I-PAST_MEDICAL_HISTORY reparado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY período I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY lactante, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY reemplazo I-PAST_MEDICAL_HISTORY valvular I-PAST_MEDICAL_HISTORY mitral I-PAST_MEDICAL_HISTORY biológico I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY abril I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 2010, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY otra I-PAST_MEDICAL_HISTORY institución, I-PAST_MEDICAL_HISTORY debido I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY bradicardia, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY implantó I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY marcapaso I-PAST_MEDICAL_HISTORY definitivo I-PAST_MEDICAL_HISTORY unicameral. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY implante I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY realizó I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY bolsillo I-PAST_MEDICAL_HISTORY subcutáneo I-PAST_MEDICAL_HISTORY prepectoral, I-PAST_MEDICAL_HISTORY utilizando I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY electrodo I-PAST_MEDICAL_HISTORY transvenoso I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estimulación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY fijación I-PAST_MEDICAL_HISTORY activa. I-PAST_MEDICAL_HISTORY El I-PAST_MEDICAL_HISTORY dispositivo I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY programado I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY modo I-PAST_MEDICAL_HISTORY AAI I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY frecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY estimulación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY latidos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY minuto, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY frecuencia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY histéresis I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY 40 I-PAST_MEDICAL_HISTORY latidos I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY minuto. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS paciente I-PRESENT_ILLNESS ingresó I-PRESENT_ILLNESS electivamente I-PRESENT_ILLNESS a I-PRESENT_ILLNESS nuestro I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS para I-PRESENT_ILLNESS cirugía I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hernia I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS no I-PRESENT_ILLNESS complicada. I-PRESENT_ILLNESS Por B-EXPLORATION rutina, I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION evaluación I-EXPLORATION pre-operatoria I-EXPLORATION por I-EXPLORATION electro I-EXPLORATION fisiología. I-EXPLORATION En I-EXPLORATION su I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION contracción I-EXPLORATION rítmica I-EXPLORATION de I-EXPLORATION la I-EXPLORATION región I-EXPLORATION pectoral I-EXPLORATION izquierda. I-EXPLORATION Su I-EXPLORATION electrocardiograma I-EXPLORATION mostraba I-EXPLORATION ritmo I-EXPLORATION sinusal I-EXPLORATION a I-EXPLORATION 60 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto I-EXPLORATION con I-EXPLORATION conducción I-EXPLORATION aurículo-ventricular I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION interrogación I-EXPLORATION del I-EXPLORATION dispositivo I-EXPLORATION mostró I-EXPLORATION voltaje I-EXPLORATION de I-EXPLORATION batería I-EXPLORATION normal I-EXPLORATION (2.79 I-EXPLORATION V), I-EXPLORATION con I-EXPLORATION impedancia I-EXPLORATION de I-EXPLORATION estimulación I-EXPLORATION de I-EXPLORATION 833 I-EXPLORATION Ohms I-EXPLORATION y I-EXPLORATION falla I-EXPLORATION de I-EXPLORATION sensado I-EXPLORATION y I-EXPLORATION de I-EXPLORATION captura I-EXPLORATION auricular I-EXPLORATION por I-EXPLORATION el I-EXPLORATION electrodo. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION evidenciando I-EXPLORATION que I-EXPLORATION el I-EXPLORATION electrodo I-EXPLORATION endocavitario I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION retraído I-EXPLORATION fuera I-EXPLORATION de I-EXPLORATION la I-EXPLORATION silueta I-EXPLORATION cardiaca, I-EXPLORATION totalmente I-EXPLORATION enrollado I-EXPLORATION alrededor I-EXPLORATION del I-EXPLORATION generador I-EXPLORATION de I-EXPLORATION pulso I-EXPLORATION en I-EXPLORATION la I-EXPLORATION zona I-EXPLORATION del I-EXPLORATION bolsillo I-EXPLORATION prepectoral. I-EXPLORATION Se B-TREATMENT informó I-TREATMENT a I-TREATMENT sus I-TREATMENT tratantes I-TREATMENT y I-TREATMENT se I-TREATMENT optó I-TREATMENT por I-TREATMENT abandonar I-TREATMENT el I-TREATMENT dispositivo, I-TREATMENT apagando I-TREATMENT el I-TREATMENT marcapaso, I-TREATMENT dado I-TREATMENT que I-TREATMENT el I-TREATMENT paciente I-TREATMENT no I-TREATMENT presentaba I-TREATMENT síntomas I-TREATMENT de I-TREATMENT bradicardia, I-TREATMENT su I-TREATMENT Holter I-TREATMENT ECG I-TREATMENT no I-TREATMENT mostró I-TREATMENT arritmias I-TREATMENT y I-TREATMENT la I-TREATMENT indicación I-TREATMENT original I-TREATMENT era I-TREATMENT cuestionable. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT su I-TREATMENT herniorrafia I-TREATMENT abdominal I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT quirúrgicas I-TREATMENT ni I-TREATMENT cardiovasculares, I-TREATMENT y B-EVOLUTION se I-EVOLUTION mantiene I-EVOLUTION asintomático I-EVOLUTION a I-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 58 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS tabáquico, B-PAST_MEDICAL_HISTORY obeso I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY hipertenso I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY losartán I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY día. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS parestesias I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS pies I-PRESENT_ILLNESS de I-PRESENT_ILLNESS una I-PRESENT_ILLNESS semana I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS debilidad I-PRESENT_ILLNESS progresiva I-PRESENT_ILLNESS de I-PRESENT_ILLNESS las I-PRESENT_ILLNESS cuatro I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS que I-PRESENT_ILLNESS le I-PRESENT_ILLNESS impedían I-PRESENT_ILLNESS la I-PRESENT_ILLNESS marcha. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION estaba I-EXPLORATION consciente I-EXPLORATION y I-EXPLORATION orientado, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION tetraparesia I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION proximal, I-EXPLORATION arreflexia I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION paresia I-EXPLORATION facial I-EXPLORATION derecha. I-EXPLORATION Presión I-EXPLORATION arterial I-EXPLORATION (PA) I-EXPLORATION 177/62 I-EXPLORATION mmHg. I-EXPLORATION Hemograma, I-EXPLORATION creatinina, I-EXPLORATION nitrógeno I-EXPLORATION ureico, I-EXPLORATION electrolitos I-EXPLORATION plasmáticos, I-EXPLORATION gases I-EXPLORATION arteriales I-EXPLORATION y I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION Inmunoglobulinas I-EXPLORATION A, I-EXPLORATION G I-EXPLORATION y I-EXPLORATION M I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION Con B-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT Síndrome I-TREATMENT de I-TREATMENT Guillain-Barré, I-TREATMENT se I-TREATMENT inició I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT inmunoglobulina I-TREATMENT endovenosa I-TREATMENT 0, I-TREATMENT 4 I-TREATMENT g/kg I-TREATMENT de I-TREATMENT peso I-TREATMENT (Inmunoglobulina I-TREATMENT G I-TREATMENT endovenosa I-TREATMENT UNC, I-TREATMENT Argentina). I-TREATMENT Dos B-EVOLUTION horas I-EVOLUTION después I-EVOLUTION de I-EVOLUTION completada I-EVOLUTION la I-EVOLUTION primera I-EVOLUTION infusión, I-EVOLUTION desarrolló I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION conciencia I-EVOLUTION y I-EVOLUTION agitación I-EVOLUTION psicomotora, I-EVOLUTION que I-EVOLUTION obligó I-EVOLUTION a I-EVOLUTION la I-EVOLUTION sedación. I-EVOLUTION Su I-EVOLUTION PA I-EVOLUTION era I-EVOLUTION de I-EVOLUTION 181/90 I-EVOLUTION mmHg I-EVOLUTION y I-EVOLUTION se I-EVOLUTION notó I-EVOLUTION una I-EVOLUTION agravación I-EVOLUTION motora, I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION paresia I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION terceros I-EVOLUTION pares I-EVOLUTION y I-EVOLUTION de I-EVOLUTION pares I-EVOLUTION bulbares, I-EVOLUTION obligando B-TREATMENT a I-TREATMENT la I-TREATMENT intubación I-TREATMENT orotraqueal I-TREATMENT y I-TREATMENT ventilación I-TREATMENT mecánica. I-TREATMENT La B-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION mostró I-EXPLORATION borramiento I-EXPLORATION de I-EXPLORATION surcos I-EXPLORATION y I-EXPLORATION discreto I-EXPLORATION colapso I-EXPLORATION ventricular, I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION edema I-EXPLORATION cerebral. I-EXPLORATION La I-EXPLORATION punción I-EXPLORATION lumbar I-EXPLORATION dio I-EXPLORATION salida I-EXPLORATION a I-EXPLORATION líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION claro. I-EXPLORATION Su I-EXPLORATION estudio I-EXPLORATION reveló I-EXPLORATION 0, I-EXPLORATION 60 I-EXPLORATION g/l I-EXPLORATION de I-EXPLORATION proteínas, I-EXPLORATION glucosa I-EXPLORATION 0, I-EXPLORATION 75 I-EXPLORATION g/l I-EXPLORATION y I-EXPLORATION 1, I-EXPLORATION 6 I-EXPLORATION leucocitos I-EXPLORATION por I-EXPLORATION mm3. I-EXPLORATION La I-EXPLORATION electromiografía I-EXPLORATION definió I-EXPLORATION una I-EXPLORATION polineuropatía I-EXPLORATION desmielinizante I-EXPLORATION aguda. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT la I-TREATMENT Igev I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT plasmaféresis I-TREATMENT ese I-TREATMENT mismo I-TREATMENT día. I-TREATMENT Durante B-EVOLUTION cuatro I-EVOLUTION días I-EVOLUTION permaneció I-EVOLUTION comprometido I-EVOLUTION de I-EVOLUTION conciencia. I-EVOLUTION Al B-TREATMENT quinto I-TREATMENT día I-TREATMENT fue I-TREATMENT extubado I-TREATMENT por I-TREATMENT la I-TREATMENT notable I-TREATMENT recuperación I-TREATMENT motora, I-TREATMENT que I-TREATMENT incluía I-TREATMENT la I-TREATMENT oculomotilidad, I-TREATMENT aunque I-TREATMENT persistía I-TREATMENT leve I-TREATMENT paresia I-TREATMENT de I-TREATMENT la I-TREATMENT aducción I-TREATMENT y I-TREATMENT elevación I-TREATMENT del I-TREATMENT ojo I-TREATMENT izquierdo. I-TREATMENT La B-EXPLORATION TC I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION realizada I-EXPLORATION al I-EXPLORATION séptimo I-EXPLORATION día, I-EXPLORATION mostró I-EXPLORATION regresión I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION cerebral I-EXPLORATION y I-EXPLORATION el I-EXPLORATION EEG I-EXPLORATION realizado I-EXPLORATION ese I-EXPLORATION día I-EXPLORATION fue I-EXPLORATION normal. I-EXPLORATION Completó B-TREATMENT 5 I-TREATMENT sesiones I-TREATMENT de I-TREATMENT plasmaféresis I-TREATMENT logrando B-EVOLUTION bipedestación I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 29 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS procedente B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY Calama. I-PAST_MEDICAL_HISTORY Dentro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sus I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY destaca I-PAST_MEDICAL_HISTORY trombosis I-PAST_MEDICAL_HISTORY retinal I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY ojo I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY 2 I-PAST_MEDICAL_HISTORY meses I-PAST_MEDICAL_HISTORY previo I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY actual I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY madre I-PAST_MEDICAL_HISTORY operada I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY feocromocitoma I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 26 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY edad. I-PAST_MEDICAL_HISTORY Historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 10 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY crisis I-PAST_MEDICAL_HISTORY paroxísticas I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cefalea, I-PAST_MEDICAL_HISTORY naúseas, I-PAST_MEDICAL_HISTORY sudoración, I-PAST_MEDICAL_HISTORY palpitaciones, I-PAST_MEDICAL_HISTORY asociadas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY arterial I-PAST_MEDICAL_HISTORY severa. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY 6 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY beta I-PAST_MEDICAL_HISTORY bloqueadores I-PAST_MEDICAL_HISTORY e I-PAST_MEDICAL_HISTORY inhibidores I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY enzima I-PAST_MEDICAL_HISTORY convertidora I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY angiotensina. I-PAST_MEDICAL_HISTORY Por B-EXPLORATION aumento I-EXPLORATION en I-EXPLORATION la I-EXPLORATION frecuencia I-EXPLORATION de I-EXPLORATION las I-EXPLORATION crisis I-EXPLORATION fue I-EXPLORATION hospitalizada I-EXPLORATION destacando I-EXPLORATION al I-EXPLORATION examen I-EXPLORATION físico: I-EXPLORATION presión I-EXPLORATION arterial I-EXPLORATION 158/111 I-EXPLORATION mmHg, I-EXPLORATION pulso I-EXPLORATION 93 I-EXPLORATION por I-EXPLORATION minuto, I-EXPLORATION examen I-EXPLORATION cardiopulmonar I-EXPLORATION normal, I-EXPLORATION abdomen I-EXPLORATION blando, I-EXPLORATION depresible, I-EXPLORATION sin I-EXPLORATION masas I-EXPLORATION palpables. I-EXPLORATION I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION ingreso; I-EXPLORATION creatinina I-EXPLORATION 0, I-EXPLORATION 75 I-EXPLORATION mg/dL, I-EXPLORATION calcemia I-EXPLORATION 10, I-EXPLORATION 3 I-EXPLORATION mg/dL, I-EXPLORATION fosfemia I-EXPLORATION 3, I-EXPLORATION 5 I-EXPLORATION mg/dL, I-EXPLORATION TSH I-EXPLORATION 0, I-EXPLORATION 45 I-EXPLORATION uUI/mL I-EXPLORATION (0,4-4,0), I-EXPLORATION T4 I-EXPLORATION libre I-EXPLORATION 0, I-EXPLORATION 91 I-EXPLORATION ng/dL I-EXPLORATION (0,81,8), I-EXPLORATION aldosterona I-EXPLORATION plasmática I-EXPLORATION 22, I-EXPLORATION 7 I-EXPLORATION ng/dL I-EXPLORATION (1,0-16), I-EXPLORATION actividad I-EXPLORATION renina I-EXPLORATION plasmática I-EXPLORATION 20 I-EXPLORATION ng/mL/h I-EXPLORATION (1, I-EXPLORATION 6 I-EXPLORATION ± I-EXPLORATION 0, I-EXPLORATION 83), I-EXPLORATION noradrenalina I-EXPLORATION plasmática I-EXPLORATION 7192 I-EXPLORATION pg/mL I-EXPLORATION (41773), I-EXPLORATION adrenalina I-EXPLORATION plasmática I-EXPLORATION < I-EXPLORATION 20 I-EXPLORATION pg/mL I-EXPLORATION (20-82), I-EXPLORATION normetanefrinas I-EXPLORATION urinarias I-EXPLORATION 4816 I-EXPLORATION ug/g I-EXPLORATION creatinina I-EXPLORATION (46-256), I-EXPLORATION metanefrinas I-EXPLORATION urinarias I-EXPLORATION 122 I-EXPLORATION ug/g I-EXPLORATION creatinina I-EXPLORATION (25-155), I-EXPLORATION calcitonina I-EXPLORATION plasmática I-EXPLORATION ultrasensible I-EXPLORATION < I-EXPLORATION 0, I-EXPLORATION 2 I-EXPLORATION pg/mL I-EXPLORATION (< I-EXPLORATION 7, I-EXPLORATION 5), I-EXPLORATION antígeno I-EXPLORATION carcinoembrionario I-EXPLORATION 1, I-EXPLORATION 14 I-EXPLORATION ng/mL I-EXPLORATION (<4,2). I-EXPLORATION Las I-EXPLORATION mediciones I-EXPLORATION de I-EXPLORATION estas I-EXPLORATION hormonas I-EXPLORATION fueron I-EXPLORATION realizadas I-EXPLORATION bajo I-EXPLORATION tratamiento I-EXPLORATION con I-EXPLORATION amlodipino, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION tiene I-EXPLORATION mínima I-EXPLORATION influencia I-EXPLORATION sobre I-EXPLORATION el I-EXPLORATION eje I-EXPLORATION renina-angiotensina-aldosterona I-EXPLORATION y I-EXPLORATION no I-EXPLORATION afecta I-EXPLORATION la I-EXPLORATION medición I-EXPLORATION de I-EXPLORATION las I-EXPLORATION metanefrinas I-EXPLORATION urinarias2, I-EXPLORATION 3. I-EXPLORATION I-EXPLORATION Ecografía I-EXPLORATION tiroidea I-EXPLORATION evidenció I-EXPLORATION nódulos I-EXPLORATION tiroideos I-EXPLORATION bilaterales I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION coloideo, I-EXPLORATION el I-EXPLORATION mayor I-EXPLORATION en I-EXPLORATION lóbulo I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 10 I-EXPLORATION mm. I-EXPLORATION Tomografía I-EXPLORATION computada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION angioTAC I-EXPLORATION renal I-EXPLORATION mostraron I-EXPLORATION 3 I-EXPLORATION masas I-EXPLORATION retroperitoneales: I-EXPLORATION una I-EXPLORATION pararrenal I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION cm, I-EXPLORATION otra I-EXPLORATION en I-EXPLORATION hilio I-EXPLORATION renal I-EXPLORATION izquierdo I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION cm I-EXPLORATION y I-EXPLORATION la I-EXPLORATION tercera I-EXPLORATION paraaórtica I-EXPLORATION de I-EXPLORATION 4 I-EXPLORATION cm, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION cierto I-EXPLORATION grado I-EXPLORATION de I-EXPLORATION compresión I-EXPLORATION de I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION inferior I-EXPLORATION y I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION dos I-EXPLORATION arterias I-EXPLORATION renales I-EXPLORATION izquierda. I-EXPLORATION Fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION y I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM) I-EXPLORATION de I-EXPLORATION cerebro I-EXPLORATION y I-EXPLORATION cuello I-EXPLORATION descartaron I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION hemangiomas I-EXPLORATION retínales I-EXPLORATION y I-EXPLORATION hemangioblastomas I-EXPLORATION cerebrales. I-EXPLORATION En I-EXPLORATION base I-EXPLORATION a I-EXPLORATION la I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION elementos I-EXPLORATION clínicos I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION neurofibromatosis I-EXPLORATION tipo I-EXPLORATION 1 I-EXPLORATION (NF1), I-EXPLORATION neoplasia I-EXPLORATION endocrina I-EXPLORATION múltiple I-EXPLORATION tipo I-EXPLORATION 2 I-EXPLORATION (NEM I-EXPLORATION 2) I-EXPLORATION y I-EXPLORATION de I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION von I-EXPLORATION Hippel-Lindau I-EXPLORATION (VHL), I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION masas I-EXPLORATION extraadrenales I-EXPLORATION y B-FAMILY_HISTORY considerando I-FAMILY_HISTORY el I-FAMILY_HISTORY antecedente I-FAMILY_HISTORY materno I-FAMILY_HISTORY de I-FAMILY_HISTORY feocromocitoma, I-FAMILY_HISTORY se B-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION paraganglioma I-EXPLORATION hereditario. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION genético I-EXPLORATION de I-EXPLORATION la I-EXPLORATION paciente, I-EXPLORATION realizado I-EXPLORATION en I-EXPLORATION el I-EXPLORATION laboratorio I-EXPLORATION del I-EXPLORATION Prof. I-EXPLORATION Hartmut I-EXPLORATION P.H. I-EXPLORATION Neumann I-EXPLORATION (Universidad I-EXPLORATION de I-EXPLORATION Freiburg, I-EXPLORATION Alemania) I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION mutación I-EXPLORATION del I-EXPLORATION gen I-EXPLORATION succinato I-EXPLORATION deshidrogenasa I-EXPLORATION SDHB I-EXPLORATION Exon I-EXPLORATION 2 I-EXPLORATION c.300_304 I-EXPLORATION del I-EXPLORATION CCTCA I-EXPLORATION (p.P56delYfsX5), I-EXPLORATION siendo I-EXPLORATION negativo I-EXPLORATION en I-EXPLORATION su I-EXPLORATION hija. I-EXPLORATION I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT cirugía, I-TREATMENT resecándose I-TREATMENT 3 I-TREATMENT masas I-TREATMENT retro-peritoneales I-TREATMENT que I-TREATMENT se I-TREATMENT correspondían I-TREATMENT en I-TREATMENT ubicación I-TREATMENT y I-TREATMENT tamaño I-TREATMENT con I-TREATMENT la I-TREATMENT TAC I-TREATMENT abdominal. I-TREATMENT El B-EXPLORATION estudio I-EXPLORATION histológico I-EXPLORATION informó I-EXPLORATION paragangliomas. I-EXPLORATION Las I-EXPLORATION normetanefrinas I-EXPLORATION urinarias I-EXPLORATION se I-EXPLORATION normalizaron I-EXPLORATION y I-EXPLORATION las I-EXPLORATION resonancias I-EXPLORATION magnéticas I-EXPLORATION de I-EXPLORATION cabeza, I-EXPLORATION cuello, I-EXPLORATION abdomen I-EXPLORATION y I-EXPLORATION pelvis, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION Tórax I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 71 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY miocardiopatía I-PAST_MEDICAL_HISTORY dilatada I-PAST_MEDICAL_HISTORY idiopática I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY fibrilación I-PAST_MEDICAL_HISTORY auricular I-PAST_MEDICAL_HISTORY permanente I-PAST_MEDICAL_HISTORY desde I-PAST_MEDICAL_HISTORY hace I-PAST_MEDICAL_HISTORY varios I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY Evoluciona B-PRESENT_ILLNESS con I-PRESENT_ILLNESS insuficiencia I-PRESENT_ILLNESS cardiaca I-PRESENT_ILLNESS en I-PRESENT_ILLNESS capacidad I-PRESENT_ILLNESS funcional I-PRESENT_ILLNESS III I-PRESENT_ILLNESS (NYHA) I-PRESENT_ILLNESS a I-PRESENT_ILLNESS pesar I-PRESENT_ILLNESS de I-PRESENT_ILLNESS un I-PRESENT_ILLNESS tratamiento I-PRESENT_ILLNESS médico I-PRESENT_ILLNESS adecuado. I-PRESENT_ILLNESS Su B-EXPLORATION ecocardiograma I-EXPLORATION evidenció I-EXPLORATION dilatación I-EXPLORATION moderada I-EXPLORATION del I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION (DFDVI I-EXPLORATION 64 I-EXPLORATION mm), I-EXPLORATION deterioro I-EXPLORATION severo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION ventricular I-EXPLORATION izquierda I-EXPLORATION (FE I-EXPLORATION 30%) I-EXPLORATION e I-EXPLORATION importante I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION izquierda I-EXPLORATION (diámetro I-EXPLORATION 56 I-EXPLORATION mm). I-EXPLORATION Su B-DERIVED_FROM/TO cardiólogo I-DERIVED_FROM/TO tratante I-DERIVED_FROM/TO la I-DERIVED_FROM/TO derivó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestra I-DERIVED_FROM/TO Institución I-DERIVED_FROM/TO para I-DERIVED_FROM/TO terapia I-DERIVED_FROM/TO de I-DERIVED_FROM/TO resincronización I-DERIVED_FROM/TO biventricular. I-DERIVED_FROM/TO I-DERIVED_FROM/TO Se B-TREATMENT planificó I-TREATMENT el I-TREATMENT implante I-TREATMENT con I-TREATMENT abordaje I-TREATMENT habitual I-TREATMENT por I-TREATMENT el I-TREATMENT lado I-TREATMENT izquierdo. I-TREATMENT Se I-TREATMENT confeccionó I-TREATMENT un I-TREATMENT bolsillo I-TREATMENT subcutáneo I-TREATMENT prepectoral I-TREATMENT izquierdo I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT punción I-TREATMENT de I-TREATMENT la I-TREATMENT vena I-TREATMENT axilar I-TREATMENT izquierda I-TREATMENT con I-TREATMENT técnica I-TREATMENT de I-TREATMENT Seldinger, I-TREATMENT sin I-TREATMENT incidentes. I-TREATMENT Al I-TREATMENT avanzar I-TREATMENT la I-TREATMENT guía, I-TREATMENT se I-TREATMENT observó I-TREATMENT un I-TREATMENT trayecto I-TREATMENT inusual I-TREATMENT desde I-TREATMENT la I-TREATMENT vena I-TREATMENT subclavia I-TREATMENT izquierda I-TREATMENT hacia I-TREATMENT inferior I-TREATMENT por I-TREATMENT la I-TREATMENT región I-TREATMENT paravertebral I-TREATMENT izquierda, I-TREATMENT compatible I-TREATMENT con I-TREATMENT la I-TREATMENT presencia I-TREATMENT de I-TREATMENT una I-TREATMENT VCSIP. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION venograma I-EXPLORATION que I-EXPLORATION confirmó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION VCSIP, I-EXPLORATION con I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION comunicación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION sistema I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vena I-EXPLORATION cava I-EXPLORATION superior I-EXPLORATION derecha. I-EXPLORATION Además I-EXPLORATION el I-EXPLORATION venograma I-EXPLORATION permitió I-EXPLORATION corroborar I-EXPLORATION drenaje I-EXPLORATION de I-EXPLORATION la I-EXPLORATION VCSIP I-EXPLORATION a I-EXPLORATION la I-EXPLORATION aurícula I-EXPLORATION derecha I-EXPLORATION a I-EXPLORATION través I-EXPLORATION del I-EXPLORATION seno I-EXPLORATION coronario, I-EXPLORATION sin I-EXPLORATION cortocircuito I-EXPLORATION intracardiaco. I-EXPLORATION A B-TREATMENT continuación, I-TREATMENT se I-TREATMENT avanzó I-TREATMENT a I-TREATMENT través I-TREATMENT del I-TREATMENT seno I-TREATMENT coronario I-TREATMENT un I-TREATMENT electrodo I-TREATMENT ventricular I-TREATMENT de I-TREATMENT fijación I-TREATMENT activa I-TREATMENT Medtronic® I-TREATMENT modelo I-TREATMENT 4076 I-TREATMENT hasta I-TREATMENT la I-TREATMENT aurícula I-TREATMENT derecha, I-TREATMENT dirigiéndolo I-TREATMENT a I-TREATMENT través I-TREATMENT de I-TREATMENT la I-TREATMENT válvula I-TREATMENT tricúspide I-TREATMENT hasta I-TREATMENT la I-TREATMENT región I-TREATMENT septo I-TREATMENT infundibular I-TREATMENT del I-TREATMENT ventrículo I-TREATMENT derecho. I-TREATMENT Se I-TREATMENT obtuvo I-TREATMENT una I-TREATMENT onda I-TREATMENT R I-TREATMENT sensada I-TREATMENT de I-TREATMENT 12, I-TREATMENT 6 I-TREATMENT mV, I-TREATMENT un I-TREATMENT umbral I-TREATMENT de I-TREATMENT estimulación I-TREATMENT ventricular I-TREATMENT derecho I-TREATMENT de I-TREATMENT 0, I-TREATMENT 4 I-TREATMENT V I-TREATMENT a I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT ms, I-TREATMENT con I-TREATMENT impedancia I-TREATMENT de I-TREATMENT estimulación I-TREATMENT de I-TREATMENT 550 I-TREATMENT Ohms. I-TREATMENT Posteriormente, I-TREATMENT utilizando I-TREATMENT un I-TREATMENT catéter I-TREATMENT Ber-mann I-TREATMENT con I-TREATMENT orificios I-TREATMENT proximales I-TREATMENT al I-TREATMENT balón, I-TREATMENT se I-TREATMENT realizó I-TREATMENT inyección I-TREATMENT de I-TREATMENT medio I-TREATMENT de I-TREATMENT contraste I-TREATMENT desde I-TREATMENT la I-TREATMENT porción I-TREATMENT medial I-TREATMENT del I-TREATMENT seno I-TREATMENT coronario, I-TREATMENT evidenciando I-TREATMENT un I-TREATMENT seno I-TREATMENT coronario I-TREATMENT dilatado, I-TREATMENT sin I-TREATMENT lograr I-TREATMENT contrastar I-TREATMENT ramas I-TREATMENT de I-TREATMENT venas I-TREATMENT coronarias I-TREATMENT laterales. I-TREATMENT Luego, I-TREATMENT utilizando I-TREATMENT una I-TREATMENT vaina I-TREATMENT larga I-TREATMENT y I-TREATMENT un I-TREATMENT catéter I-TREATMENT guía I-TREATMENT Medtronic® I-TREATMENT ángulo I-TREATMENT de I-TREATMENT 130° I-TREATMENT (modelo I-TREATMENT 6248 I-TREATMENT del I-TREATMENT 130) I-TREATMENT se I-TREATMENT canuló I-TREATMENT una I-TREATMENT vena I-TREATMENT coronaria I-TREATMENT póstero-lateral I-TREATMENT izquierda I-TREATMENT y I-TREATMENT se I-TREATMENT avanzó I-TREATMENT un I-TREATMENT electrodo I-TREATMENT de I-TREATMENT estimulación I-TREATMENT bipolar I-TREATMENT Medtronic® I-TREATMENT modelo I-TREATMENT 4196, I-TREATMENT logrando I-TREATMENT una I-TREATMENT ubicación I-TREATMENT satisfactoria I-TREATMENT para I-TREATMENT estimulación I-TREATMENT ventricular I-TREATMENT izquierda, I-TREATMENT donde I-TREATMENT se I-TREATMENT obtuvo I-TREATMENT una I-TREATMENT onda I-TREATMENT R I-TREATMENT sensada I-TREATMENT de I-TREATMENT 19, I-TREATMENT 9 I-TREATMENT mV, I-TREATMENT un I-TREATMENT umbral I-TREATMENT de I-TREATMENT estimulación I-TREATMENT ventricular I-TREATMENT izquierdo I-TREATMENT de I-TREATMENT 2, I-TREATMENT 0 I-TREATMENT V I-TREATMENT a I-TREATMENT 0, I-TREATMENT 5 I-TREATMENT ms, I-TREATMENT con I-TREATMENT impedancia I-TREATMENT de I-TREATMENT estimulación I-TREATMENT de I-TREATMENT 1.200 I-TREATMENT Ohms. I-TREATMENT Se I-TREATMENT fijó I-TREATMENT ambos I-TREATMENT electrodos I-TREATMENT a I-TREATMENT la I-TREATMENT fascia I-TREATMENT prepectoral I-TREATMENT y I-TREATMENT se I-TREATMENT conectaron I-TREATMENT a I-TREATMENT los I-TREATMENT puertos I-TREATMENT respectivos I-TREATMENT del I-TREATMENT generador I-TREATMENT Medtronic® I-TREATMENT Insync I-TREATMENT III I-TREATMENT modelo I-TREATMENT 8042, I-TREATMENT ocluyendo I-TREATMENT el I-TREATMENT puerto I-TREATMENT auricular. I-TREATMENT Finalmente, I-TREATMENT se I-TREATMENT completó I-TREATMENT el I-TREATMENT procedimiento I-TREATMENT realizando I-TREATMENT fulguración I-TREATMENT del I-TREATMENT nodo I-TREATMENT AV I-TREATMENT compacto. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION en I-EVOLUTION forma I-EVOLUTION satisfactoria, I-EVOLUTION con I-EVOLUTION mejoría I-EVOLUTION progresiva I-EVOLUTION de I-EVOLUTION su I-EVOLUTION capacidad I-EVOLUTION funcional. I-EVOLUTION A I-EVOLUTION los I-EVOLUTION 15 I-EVOLUTION días I-EVOLUTION se I-EVOLUTION realizó I-EVOLUTION control I-EVOLUTION del I-EVOLUTION dispositivo I-EVOLUTION que I-EVOLUTION confirmó I-EVOLUTION 99% I-EVOLUTION de I-EVOLUTION estimulación I-EVOLUTION biventricular. I-EVOLUTION Se B-EXPLORATION midió I-EXPLORATION una I-EXPLORATION onda I-EXPLORATION R I-EXPLORATION de I-EXPLORATION 11, I-EXPLORATION 2 I-EXPLORATION -15, I-EXPLORATION 68 I-EXPLORATION mV I-EXPLORATION en I-EXPLORATION ventrículo I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION umbral I-EXPLORATION de I-EXPLORATION estimulación I-EXPLORATION ventricular I-EXPLORATION derecho I-EXPLORATION menor I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 5 I-EXPLORATION V I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION ms I-EXPLORATION con I-EXPLORATION una I-EXPLORATION impedancia I-EXPLORATION de I-EXPLORATION 430 I-EXPLORATION Ohms. I-EXPLORATION La I-EXPLORATION onda I-EXPLORATION R I-EXPLORATION sensada I-EXPLORATION en I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION fue I-EXPLORATION mayor I-EXPLORATION a I-EXPLORATION 22, I-EXPLORATION 4 I-EXPLORATION mV, I-EXPLORATION el I-EXPLORATION umbral I-EXPLORATION de I-EXPLORATION estimulación I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION V I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION ms I-EXPLORATION y I-EXPLORATION la I-EXPLORATION impedancia I-EXPLORATION de I-EXPLORATION 776 I-EXPLORATION Ohms. I-EXPLORATION I-EXPLORATION A B-EVOLUTION 10 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION se I-EVOLUTION ha I-EVOLUTION mantenido I-EVOLUTION en I-EVOLUTION control I-EVOLUTION regular I-EVOLUTION con I-EVOLUTION su I-EVOLUTION cardiólogo I-EVOLUTION y I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION en I-EVOLUTION capacidad I-EVOLUTION funcional I-EVOLUTION I-II I-EVOLUTION (NYHA). I-EVOLUTION El I-EVOLUTION último I-EVOLUTION control I-EVOLUTION de I-EVOLUTION su I-EVOLUTION dispositivo I-EVOLUTION mostró I-EVOLUTION 99% I-EVOLUTION de I-EVOLUTION estimulación I-EVOLUTION biventricular I-EVOLUTION y I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION de I-EVOLUTION sensado I-EVOLUTION y I-EVOLUTION estimulación I-EVOLUTION de I-EVOLUTION ambos I-EVOLUTION electrodos I-EVOLUTION son I-EVOLUTION adecuados. I-EVOLUTION El B-EXPLORATION electrodo I-EXPLORATION ventricular I-EXPLORATION derecho I-EXPLORATION sensa I-EXPLORATION onda I-EXPLORATION R I-EXPLORATION mayor I-EXPLORATION de I-EXPLORATION 8, I-EXPLORATION 0 I-EXPLORATION mV, I-EXPLORATION tiene I-EXPLORATION umbral I-EXPLORATION de I-EXPLORATION estimulación I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 0 I-EXPLORATION V I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION ms, I-EXPLORATION con I-EXPLORATION impedancia I-EXPLORATION de I-EXPLORATION 480 I-EXPLORATION Ohms. I-EXPLORATION El I-EXPLORATION electrodo I-EXPLORATION ventricular I-EXPLORATION izquierdo I-EXPLORATION sensa I-EXPLORATION una I-EXPLORATION onda I-EXPLORATION R I-EXPLORATION de I-EXPLORATION 12, I-EXPLORATION 0 I-EXPLORATION mV, I-EXPLORATION tiene I-EXPLORATION umbral I-EXPLORATION de I-EXPLORATION estimulación I-EXPLORATION de I-EXPLORATION 1, I-EXPLORATION 5 I-EXPLORATION V I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 4 I-EXPLORATION ms, I-EXPLORATION con I-EXPLORATION impedancia I-EXPLORATION de I-EXPLORATION 971 I-EXPLORATION Ohms. I-EXPLORATION Mantiene I-EXPLORATION bloqueo I-EXPLORATION aurículo-ventricular I-EXPLORATION completo I-EXPLORATION con I-EXPLORATION escape I-EXPLORATION nodal I-EXPLORATION a I-EXPLORATION 44 I-EXPLORATION latidos I-EXPLORATION por I-EXPLORATION minuto. I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 38 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS domiciliada I-PRESENT_ILLNESS en I-PRESENT_ILLNESS sector I-PRESENT_ILLNESS rural I-PRESENT_ILLNESS y B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos I-PAST_MEDICAL_HISTORY conocidos. I-PAST_MEDICAL_HISTORY Inició B-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS deterioro I-PRESENT_ILLNESS del I-PRESENT_ILLNESS estado I-PRESENT_ILLNESS general, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS (aproximadamente I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS kg I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tres I-PRESENT_ILLNESS meses) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS edema I-PRESENT_ILLNESS de I-PRESENT_ILLNESS extremidades I-PRESENT_ILLNESS inferiores. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Consultó I-PRESENT_ILLNESS en I-PRESENT_ILLNESS varias I-PRESENT_ILLNESS oportunidades I-PRESENT_ILLNESS en I-PRESENT_ILLNESS el I-PRESENT_ILLNESS centro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS salud I-PRESENT_ILLNESS rural I-PRESENT_ILLNESS de I-PRESENT_ILLNESS su I-PRESENT_ILLNESS sector I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS trató I-PRESENT_ILLNESS en I-PRESENT_ILLNESS forma I-PRESENT_ILLNESS sintomática. I-PRESENT_ILLNESS Presentó I-PRESENT_ILLNESS un I-PRESENT_ILLNESS episodio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS hipoglicemia I-PRESENT_ILLNESS (26 I-PRESENT_ILLNESS mg/dl) I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS trató I-PRESENT_ILLNESS con I-PRESENT_ILLNESS infusión I-PRESENT_ILLNESS de I-PRESENT_ILLNESS solución I-PRESENT_ILLNESS glucosada I-PRESENT_ILLNESS al I-PRESENT_ILLNESS 10%. I-PRESENT_ILLNESS Evolucionó B-DERIVED_FROM/TO con I-DERIVED_FROM/TO normalización I-DERIVED_FROM/TO de I-DERIVED_FROM/TO la I-DERIVED_FROM/TO glicemia I-DERIVED_FROM/TO y I-DERIVED_FROM/TO fue I-DERIVED_FROM/TO trasladada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO nuestro I-DERIVED_FROM/TO hospital. I-DERIVED_FROM/TO I-DERIVED_FROM/TO En B-EXPLORATION la I-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION una I-EXPLORATION ocupación I-EXPLORATION pleural I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION desviación I-EXPLORATION de I-EXPLORATION las I-EXPLORATION estructuras I-EXPLORATION mediastínicas. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION un I-EXPLORATION tumor I-EXPLORATION pleural I-EXPLORATION derecho, I-EXPLORATION con I-EXPLORATION densidad I-EXPLORATION heterogénea, I-EXPLORATION que I-EXPLORATION ocupaba I-EXPLORATION el I-EXPLORATION hemitórax I-EXPLORATION derecho I-EXPLORATION con I-EXPLORATION efecto I-EXPLORATION compresivo, I-EXPLORATION atelectasia I-EXPLORATION pulmonar I-EXPLORATION derecha I-EXPLORATION y I-EXPLORATION desplazamiento I-EXPLORATION del I-EXPLORATION mediastino. I-EXPLORATION En I-EXPLORATION los I-EXPLORATION otros I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION y I-EXPLORATION de I-EXPLORATION imagen I-EXPLORATION no I-EXPLORATION destacaron I-EXPLORATION otros I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION I-EXPLORATION Durante B-EVOLUTION la I-EVOLUTION hospitalización I-EVOLUTION presentó I-EVOLUTION varios I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION hipoglicemia I-EVOLUTION sintomática I-EVOLUTION caracterizada I-EVOLUTION por I-EVOLUTION somnolencia, I-EVOLUTION deterioro I-EVOLUTION de I-EVOLUTION la I-EVOLUTION agudeza I-EVOLUTION visual, I-EVOLUTION debilidad I-EVOLUTION muscular, I-EVOLUTION sudoración, I-EVOLUTION palpitaciones I-EVOLUTION y I-EVOLUTION palidez. I-EVOLUTION Estas I-EVOLUTION hipoglicemias I-EVOLUTION fueron I-EVOLUTION en I-EVOLUTION días I-EVOLUTION diferentes I-EVOLUTION y I-EVOLUTION se I-EVOLUTION registraron I-EVOLUTION al I-EVOLUTION menos I-EVOLUTION 7 I-EVOLUTION mediciones I-EVOLUTION de I-EVOLUTION glicemia I-EVOLUTION entre I-EVOLUTION 27 I-EVOLUTION y I-EVOLUTION 58 I-EVOLUTION mg/dl, I-EVOLUTION en I-EVOLUTION el I-EVOLUTION segundo I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION se I-EVOLUTION registraron I-EVOLUTION dos I-EVOLUTION hipoglicemias. I-EVOLUTION Fue B-TREATMENT tratada I-TREATMENT en I-TREATMENT cada I-TREATMENT episodio I-TREATMENT con I-TREATMENT infusión I-TREATMENT de I-TREATMENT solución I-TREATMENT glucosada I-TREATMENT al I-TREATMENT 10%. I-TREATMENT Debido I-TREATMENT al I-TREATMENT difícil I-TREATMENT control I-TREATMENT metabólico, I-TREATMENT se I-TREATMENT trató I-TREATMENT y I-TREATMENT estudió I-TREATMENT en I-TREATMENT conjunto I-TREATMENT con I-TREATMENT el I-TREATMENT equipo I-TREATMENT de I-TREATMENT endocrinología. I-TREATMENT Las B-EXPLORATION mediciones I-EXPLORATION de I-EXPLORATION insulinemia I-EXPLORATION basal, I-EXPLORATION cortisol, I-EXPLORATION prolactina I-EXPLORATION y I-EXPLORATION hormona I-EXPLORATION tiroestimulante I-EXPLORATION (TSH) I-EXPLORATION estaban I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION de I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION por I-EXPLORATION punción I-EXPLORATION guiada I-EXPLORATION por I-EXPLORATION tomografía I-EXPLORATION computada, I-EXPLORATION el I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION anatomía I-EXPLORATION patológica I-EXPLORATION concluyó I-EXPLORATION que I-EXPLORATION la I-EXPLORATION lesión I-EXPLORATION era I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION un I-EXPLORATION TFSP. I-EXPLORATION I-EXPLORATION Descartada B-TREATMENT otra I-TREATMENT causa I-TREATMENT de I-TREATMENT hipoglicemia I-TREATMENT y I-TREATMENT en I-TREATMENT el I-TREATMENT contexto I-TREATMENT de I-TREATMENT un I-TREATMENT TFSP, I-TREATMENT se I-TREATMENT decidió I-TREATMENT tratamiento I-TREATMENT quirúrgico. I-TREATMENT I-TREATMENT Procedimiento I-TREATMENT quirúrgico I-TREATMENT I-TREATMENT Con I-TREATMENT intubación I-TREATMENT monobronquial I-TREATMENT (tubo I-TREATMENT endotraqueal I-TREATMENT de I-TREATMENT doble I-TREATMENT lumen) I-TREATMENT y I-TREATMENT en I-TREATMENT decúbito I-TREATMENT lateral I-TREATMENT izquierdo. I-TREATMENT Se I-TREATMENT abordó I-TREATMENT por I-TREATMENT amplia I-TREATMENT toracotomía I-TREATMENT posterolateral I-TREATMENT derecha, I-TREATMENT se I-TREATMENT encontró I-TREATMENT un I-TREATMENT tumor I-TREATMENT de I-TREATMENT aspecto I-TREATMENT encapsulado I-TREATMENT que I-TREATMENT ocupaba I-TREATMENT toda I-TREATMENT la I-TREATMENT cavidad I-TREATMENT pleural I-TREATMENT y I-TREATMENT desplazaba I-TREATMENT las I-TREATMENT estructuras I-TREATMENT mediastínicas I-TREATMENT sin I-TREATMENT infiltrarlas. I-TREATMENT Se I-TREATMENT encontraba I-TREATMENT adherido I-TREATMENT a I-TREATMENT la I-TREATMENT pleura I-TREATMENT parietal, I-TREATMENT con I-TREATMENT base I-TREATMENT de I-TREATMENT implantación I-TREATMENT ancha I-TREATMENT y I-TREATMENT sin I-TREATMENT pedículo I-TREATMENT identificable. I-TREATMENT Se I-TREATMENT liberaron I-TREATMENT las I-TREATMENT adherencias I-TREATMENT y I-TREATMENT se I-TREATMENT resecó I-TREATMENT macroscópicamente I-TREATMENT el I-TREATMENT tumor I-TREATMENT en I-TREATMENT forma I-TREATMENT completa. I-TREATMENT Se I-TREATMENT observó I-TREATMENT adecuada I-TREATMENT expansión I-TREATMENT pulmonar I-TREATMENT derecha I-TREATMENT post I-TREATMENT exéresis I-TREATMENT del I-TREATMENT tumor. I-TREATMENT Se I-TREATMENT instalaron I-TREATMENT dos I-TREATMENT tubos I-TREATMENT pleurales I-TREATMENT (28 I-TREATMENT Fr.) I-TREATMENT y I-TREATMENT se I-TREATMENT cerró I-TREATMENT la I-TREATMENT toracotomía I-TREATMENT en I-TREATMENT forma I-TREATMENT habitual. I-TREATMENT I-TREATMENT Evolución B-EVOLUTION postoperatoria I-EVOLUTION I-EVOLUTION La I-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION en I-EVOLUTION el I-EVOLUTION postoperatorio I-EVOLUTION sin I-EVOLUTION incidentes. I-EVOLUTION No I-EVOLUTION presentó I-EVOLUTION nuevos I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION hipoglicemia. I-EVOLUTION Se I-EVOLUTION retiraron I-EVOLUTION los I-EVOLUTION tubos I-EVOLUTION pleurales I-EVOLUTION al I-EVOLUTION séptimo I-EVOLUTION día I-EVOLUTION y I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION el I-EVOLUTION alta I-EVOLUTION hospitalaria I-EVOLUTION al I-EVOLUTION décimo I-EVOLUTION día I-EVOLUTION postoperatorio. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION concluyó: I-EXPLORATION TFSP I-EXPLORATION de I-EXPLORATION 27 I-EXPLORATION x I-EXPLORATION 25 I-EXPLORATION x I-EXPLORATION 11, I-EXPLORATION 5 I-EXPLORATION centímetros I-EXPLORATION y I-EXPLORATION peso I-EXPLORATION de I-EXPLORATION 3.450 I-EXPLORATION gramos, I-EXPLORATION con I-EXPLORATION características I-EXPLORATION histológicas I-EXPLORATION de I-EXPLORATION malignidad. I-EXPLORATION El I-EXPLORATION TFSP I-EXPLORATION tenía I-EXPLORATION necrosis I-EXPLORATION tumoral I-EXPLORATION macro I-EXPLORATION y I-EXPLORATION microscópica I-EXPLORATION extensa, I-EXPLORATION hasta I-EXPLORATION 2 I-EXPLORATION mitosis I-EXPLORATION en I-EXPLORATION 10 I-EXPLORATION campos I-EXPLORATION de I-EXPLORATION aumento I-EXPLORATION mayor I-EXPLORATION y I-EXPLORATION los I-EXPLORATION bordes I-EXPLORATION quirúrgicos I-EXPLORATION estaban I-EXPLORATION libres I-EXPLORATION de I-EXPLORATION lesión. I-EXPLORATION La I-EXPLORATION inmunohistoquímica I-EXPLORATION presentó I-EXPLORATION positividad I-EXPLORATION intensa I-EXPLORATION para I-EXPLORATION Vimentina I-EXPLORATION y I-EXPLORATION CD34. I-EXPLORATION I-EXPLORATION Actualmente, B-EVOLUTION a I-EVOLUTION 15 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION con I-EVOLUTION un I-EVOLUTION control I-EVOLUTION metabólico I-EVOLUTION adecuado, I-EVOLUTION con I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION la I-EVOLUTION glicemia I-EVOLUTION y I-EVOLUTION asintomática I-EVOLUTION desde I-EVOLUTION el I-EVOLUTION punto I-EVOLUTION de I-EVOLUTION vista I-EVOLUTION respiratorio, I-EVOLUTION sin I-EVOLUTION evidencias I-EVOLUTION clínicas I-EVOLUTION ni I-EVOLUTION radiológicas I-EVOLUTION de I-EVOLUTION recidiva I-EVOLUTION del I-EVOLUTION tumor. I-EVOLUTION I-EVOLUTION Escolar B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 13 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 sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos. I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS presentar I-PRESENT_ILLNESS déficit I-PRESENT_ILLNESS motot I-PRESENT_ILLNESS progresivo I-PRESENT_ILLNESS (hemiparesia I-PRESENT_ILLNESS braquiocrural I-PRESENT_ILLNESS izquierda) I-PRESENT_ILLNESS y I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS progresiva. I-PRESENT_ILLNESS La B-EXPLORATION TC I-EXPLORATION cerebral I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION quiste I-EXPLORATION intraxial I-EXPLORATION temporal I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION 60 I-EXPLORATION mm I-EXPLORATION de I-EXPLORATION diámetro, I-EXPLORATION bien I-EXPLORATION delimitado, I-EXPLORATION isodenso I-EXPLORATION respecto I-EXPLORATION al I-EXPLORATION LCR, I-EXPLORATION sin I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION contraste. I-EXPLORATION Significativo I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION con I-EXPLORATION desviación I-EXPLORATION de I-EXPLORATION línea I-EXPLORATION media I-EXPLORATION de I-EXPLORATION 7 I-EXPLORATION mm I-EXPLORATION y I-EXPLORATION herniación I-EXPLORATION uncal. I-EXPLORATION Se B-TREATMENT planteó I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT quiste I-TREATMENT hidatídico I-TREATMENT temporal I-TREATMENT derecho; I-TREATMENT se I-TREATMENT realizó I-TREATMENT la I-TREATMENT exéresis I-TREATMENT intacta I-TREATMENT del I-TREATMENT quiste I-TREATMENT y I-TREATMENT el I-TREATMENT estudio I-TREATMENT anatomopatológico I-TREATMENT confirmó I-TREATMENT la I-TREATMENT etiología I-TREATMENT hidatídica. I-TREATMENT El B-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 I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente, I-EVOLUTION sin I-EVOLUTION complicaciones I-EVOLUTION quirúrgicas I-EVOLUTION ni I-EVOLUTION déficit I-EVOLUTION neurológico. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 57 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS conserje, B-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY tabaquismo I-PAST_MEDICAL_HISTORY activo. I-PAST_MEDICAL_HISTORY Presentaba I-PAST_MEDICAL_HISTORY historia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY múltiples I-PAST_MEDICAL_HISTORY hospitalizaciones I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY distintos I-PAST_MEDICAL_HISTORY centros I-PAST_MEDICAL_HISTORY durante I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2010 I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY estudio I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY hemoptisis I-PAST_MEDICAL_HISTORY autolimitada I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY escasa I-PAST_MEDICAL_HISTORY cuantía I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY relación I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY esfuerzo I-PAST_MEDICAL_HISTORY físico. I-PAST_MEDICAL_HISTORY Al B-PRESENT_ILLNESS preguntar I-PRESENT_ILLNESS dirigidamente, I-PRESENT_ILLNESS refería I-PRESENT_ILLNESS historia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS adinamia, I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS leve I-PRESENT_ILLNESS en I-PRESENT_ILLNESS relación I-PRESENT_ILLNESS a I-PRESENT_ILLNESS esfuerzos I-PRESENT_ILLNESS que I-PRESENT_ILLNESS a I-PRESENT_ILLNESS través I-PRESENT_ILLNESS de I-PRESENT_ILLNESS los I-PRESENT_ILLNESS años I-PRESENT_ILLNESS fue I-PRESENT_ILLNESS empeorando I-PRESENT_ILLNESS apareciendo I-PRESENT_ILLNESS ortopnea I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS ante I-PRESENT_ILLNESS pequeños I-PRESENT_ILLNESS esfuerzos, I-PRESENT_ILLNESS mialgias I-PRESENT_ILLNESS en I-PRESENT_ILLNESS piernas I-PRESENT_ILLNESS y I-PRESENT_ILLNESS rigidez I-PRESENT_ILLNESS matinal I-PRESENT_ILLNESS de I-PRESENT_ILLNESS articulaciones I-PRESENT_ILLNESS de I-PRESENT_ILLNESS manos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 10-15 I-PRESENT_ILLNESS minutos I-PRESENT_ILLNESS de I-PRESENT_ILLNESS duración, I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS artralgias. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Presentaba B-EXPLORATION radiografía I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION ecografía I-EXPLORATION abdominal, I-EXPLORATION endoscopía I-EXPLORATION digestiva I-EXPLORATION alta, I-EXPLORATION ecocardio-grama, I-EXPLORATION perfil I-EXPLORATION bioquímico, I-EXPLORATION creatinina I-EXPLORATION plasmática, I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION y I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION normales. I-EXPLORATION Tuvo I-EXPLORATION un I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION leve I-EXPLORATION anemia I-EXPLORATION (hematocrito I-EXPLORATION 35%) I-EXPLORATION y I-EXPLORATION VHS I-EXPLORATION elevada. I-EXPLORATION En B-EVOLUTION controles I-EVOLUTION posteriores I-EVOLUTION persistió I-EVOLUTION con I-EVOLUTION anemia I-EVOLUTION normocítica-normocrómica I-EVOLUTION de I-EVOLUTION carácter I-EVOLUTION leve, I-EVOLUTION pero I-EVOLUTION VHS I-EVOLUTION se I-EVOLUTION normalizó. I-EVOLUTION I-EVOLUTION Presentó B-EXPLORATION una I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION de I-EXPLORATION tórax, I-EXPLORATION 3 I-EXPLORATION días I-EXPLORATION post I-EXPLORATION hemoptisis, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION múltiples I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION "vidrio I-EXPLORATION esmerilado" I-EXPLORATION difusas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION alveolar I-EXPLORATION y I-EXPLORATION enfisema I-EXPLORATION pulmonar, I-EXPLORATION pero I-EXPLORATION en I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION control I-EXPLORATION mostró I-EXPLORATION sólo I-EXPLORATION enfisema I-EXPLORATION leve. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION fibrobroncoscopía I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION normal, I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION lavado I-EXPLORATION bronco I-EXPLORATION alveolar. I-EXPLORATION Presentaba I-EXPLORATION exámenes I-EXPLORATION inmuno-reumatológicos I-EXPLORATION negativos I-EXPLORATION (ANA, I-EXPLORATION AntiDNAds, I-EXPLORATION ANCA I-EXPLORATION por I-EXPLORATION IFI, I-EXPLORATION Coombs I-EXPLORATION directo I-EXPLORATION e I-EXPLORATION indirecto, I-EXPLORATION FR). I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION manos I-EXPLORATION mostraba I-EXPLORATION leves I-EXPLORATION cambios I-EXPLORATION degenerativos I-EXPLORATION en I-EXPLORATION articulaciones I-EXPLORATION interfalángicas I-EXPLORATION distales. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION físico, I-EXPLORATION se I-EXPLORATION pesquisó I-EXPLORATION distrofia I-EXPLORATION ungueal, I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION de I-EXPLORATION partes I-EXPLORATION blandas I-EXPLORATION de I-EXPLORATION manos I-EXPLORATION sin I-EXPLORATION edema, I-EXPLORATION pigmentación I-EXPLORATION anaranjada I-EXPLORATION de I-EXPLORATION párpados I-EXPLORATION con I-EXPLORATION petequias I-EXPLORATION perioculares I-EXPLORATION y I-EXPLORATION leve I-EXPLORATION macroglosia. I-EXPLORATION Por I-EXPLORATION estos I-EXPLORATION hallazgos I-EXPLORATION se I-EXPLORATION sugirió I-EXPLORATION descartar I-EXPLORATION enfermedad I-EXPLORATION de I-EXPLORATION depósito, I-EXPLORATION postulando I-EXPLORATION como I-EXPLORATION hipótesis I-EXPLORATION diagnóstica I-EXPLORATION amiloidosis I-EXPLORATION sistémica. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION incisional I-EXPLORATION de I-EXPLORATION párpado, I-EXPLORATION mejilla I-EXPLORATION y I-EXPLORATION mano, I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION un I-EXPLORATION infiltrado I-EXPLORATION amorfo I-EXPLORATION intersticial I-EXPLORATION de I-EXPLORATION material I-EXPLORATION hialino I-EXPLORATION eosinofílico I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION amiloideo, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION microhemorragia. I-EXPLORATION Las I-EXPLORATION tinciones I-EXPLORATION de I-EXPLORATION Cresil I-EXPLORATION violeta I-EXPLORATION y I-EXPLORATION rojo I-EXPLORATION Congo I-EXPLORATION fueron I-EXPLORATION positivas I-EXPLORATION con I-EXPLORATION dicroísmo I-EXPLORATION verde I-EXPLORATION manzana I-EXPLORATION positivo I-EXPLORATION bajo I-EXPLORATION luz I-EXPLORATION polarizada I-EXPLORATION y I-EXPLORATION resistencia I-EXPLORATION a I-EXPLORATION permanganato I-EXPLORATION de I-EXPLORATION potasio. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION ecocardiograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION hipertrofia I-EXPLORATION de I-EXPLORATION ventrículo I-EXPLORATION izquierdo, I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION depósito I-EXPLORATION amiloideo. I-EXPLORATION Con I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION tiroides I-EXPLORATION y I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION normales, I-EXPLORATION se I-EXPLORATION planteó I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION una I-EXPLORATION amiloidosis I-EXPLORATION AA. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 64 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS hipertenso B-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY atenolol I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY mantenía I-PAST_MEDICAL_HISTORY cifras I-PAST_MEDICAL_HISTORY tensionales I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY 140/85 I-PAST_MEDICAL_HISTORY mm I-PAST_MEDICAL_HISTORY Hg. I-PAST_MEDICAL_HISTORY El B-EXPLORATION ecocardiograma I-EXPLORATION mostraba I-EXPLORATION una I-EXPLORATION buena I-EXPLORATION función I-EXPLORATION sistólica I-EXPLORATION e I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION izquierda. I-EXPLORATION Se B-TREATMENT realizó I-TREATMENT una I-TREATMENT lobectomía I-TREATMENT hepática I-TREATMENT derecha, I-TREATMENT sin I-TREATMENT incidentes I-TREATMENT de I-TREATMENT importancia I-TREATMENT durante I-TREATMENT el I-TREATMENT intraoperatorio. I-TREATMENT Aproximadamente B-EVOLUTION a I-EVOLUTION las I-EVOLUTION 12 I-EVOLUTION h I-EVOLUTION del I-EVOLUTION post I-EVOLUTION operatorio I-EVOLUTION presentó I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION hasta I-EVOLUTION 80/50 I-EVOLUTION mm I-EVOLUTION Hg I-EVOLUTION y I-EVOLUTION frecuencia I-EVOLUTION cardiaca I-EVOLUTION de I-EVOLUTION 135, I-EVOLUTION sin I-EVOLUTION respuesta I-EVOLUTION a B-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT 500 I-TREATMENT ml I-TREATMENT de I-TREATMENT Voluven®. I-TREATMENT Se I-TREATMENT inició I-TREATMENT infusión I-TREATMENT de I-TREATMENT dobutamina I-TREATMENT que I-TREATMENT se I-TREATMENT aumentó I-TREATMENT hasta I-TREATMENT 7 I-TREATMENT ug/kg/min, I-TREATMENT observándose I-TREATMENT mayor I-TREATMENT deterioro I-TREATMENT de I-TREATMENT las I-TREATMENT condiciones I-TREATMENT hemodinámicas, I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT colocó I-TREATMENT un I-TREATMENT catéter I-TREATMENT de I-TREATMENT arteria I-TREATMENT pulmonar I-TREATMENT que I-TREATMENT mostraba I-TREATMENT una I-TREATMENT presión I-TREATMENT de I-TREATMENT capilar I-TREATMENT pulmonar I-TREATMENT (PCP) I-TREATMENT de I-TREATMENT 18 I-TREATMENT mmHg, I-TREATMENT y I-TREATMENT un I-TREATMENT índice I-TREATMENT cardiaco I-TREATMENT de I-TREATMENT 1, I-TREATMENT 2 I-TREATMENT lt/ I-TREATMENT m2. I-TREATMENT Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION ETE I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION un I-EXPLORATION ventrículo I-EXPLORATION izquierdo I-EXPLORATION hipertrófico, I-EXPLORATION con I-EXPLORATION una I-EXPLORATION cavidad I-EXPLORATION pequeña, I-EXPLORATION con I-EXPLORATION buena I-EXPLORATION función I-EXPLORATION global I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION alteraciones I-EXPLORATION de I-EXPLORATION motilidad I-EXPLORATION segmentaria, I-EXPLORATION y I-EXPLORATION con I-EXPLORATION una I-EXPLORATION válvula I-EXPLORATION aortica I-EXPLORATION de I-EXPLORATION aspecto I-EXPLORATION y I-EXPLORATION movilidad I-EXPLORATION normal. I-EXPLORATION Durante I-EXPLORATION el I-EXPLORATION sístole, I-EXPLORATION la I-EXPLORATION valva I-EXPLORATION anterior I-EXPLORATION de I-EXPLORATION la I-EXPLORATION válvula I-EXPLORATION mitral I-EXPLORATION se I-EXPLORATION desplaza I-EXPLORATION obstruyendo I-EXPLORATION el I-EXPLORATION 70% I-EXPLORATION del I-EXPLORATION TSVI, I-EXPLORATION y I-EXPLORATION produciendo I-EXPLORATION una I-EXPLORATION insuficiencia I-EXPLORATION mitral I-EXPLORATION (IM) I-EXPLORATION moderada. I-EXPLORATION Se B-TREATMENT hizo I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT SAM, I-TREATMENT se I-TREATMENT administraron I-TREATMENT 1.000 I-TREATMENT ml I-TREATMENT de I-TREATMENT Voluven®, I-TREATMENT se I-TREATMENT inició I-TREATMENT infusión I-TREATMENT de I-TREATMENT noradrenalina I-TREATMENT hasta I-TREATMENT 2 I-TREATMENT ug/kg/min, I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT dobutamina, I-TREATMENT y I-TREATMENT se I-TREATMENT administran I-TREATMENT 3 I-TREATMENT mg I-TREATMENT de I-TREATMENT metoprolol. I-TREATMENT Dentro B-EVOLUTION de I-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION 20 I-EVOLUTION min I-EVOLUTION se I-EVOLUTION observa I-EVOLUTION disminución I-EVOLUTION de I-EVOLUTION la I-EVOLUTION obstrucción I-EVOLUTION del I-EVOLUTION TSVI I-EVOLUTION y I-EVOLUTION de I-EVOLUTION la I-EVOLUTION IM, I-EVOLUTION la I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION se I-EVOLUTION estabilizó I-EVOLUTION en I-EVOLUTION 100/60 I-EVOLUTION mm I-EVOLUTION Hg I-EVOLUTION y I-EVOLUTION la I-EVOLUTION frecuencia I-EVOLUTION cardiaca I-EVOLUTION en I-EVOLUTION 100. I-EVOLUTION Doce I-EVOLUTION horas I-EVOLUTION después I-EVOLUTION se I-EVOLUTION presentó I-EVOLUTION nuevo I-EVOLUTION episodio I-EVOLUTION de I-EVOLUTION compromiso I-EVOLUTION hemodinámico I-EVOLUTION de I-EVOLUTION características I-EVOLUTION similares. I-EVOLUTION Por B-EXPLORATION la I-EXPLORATION posibilidad I-EXPLORATION de I-EXPLORATION la I-EXPLORATION existencia I-EXPLORATION de I-EXPLORATION un I-EXPLORATION hemoperitoneo I-EXPLORATION que I-EXPLORATION pudiera I-EXPLORATION perpetuar I-EXPLORATION una I-EXPLORATION condición I-EXPLORATION de I-EXPLORATION hipovolemia I-EXPLORATION que I-EXPLORATION favoreciera I-EXPLORATION el I-EXPLORATION desarrollo I-EXPLORATION de I-EXPLORATION un I-EXPLORATION SAM, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION exploradora, I-EXPLORATION encontrándose I-EXPLORATION 300 I-EXPLORATION ml I-EXPLORATION de I-EXPLORATION sangre I-EXPLORATION antigua, I-EXPLORATION sin I-EXPLORATION identificarse I-EXPLORATION un I-EXPLORATION sitio I-EXPLORATION de I-EXPLORATION sangrado. I-EXPLORATION Se B-TREATMENT aportó I-TREATMENT volumen, I-TREATMENT la I-TREATMENT norepinefrina I-TREATMENT se I-TREATMENT aumentó I-TREATMENT de I-TREATMENT 0, I-TREATMENT 05 I-TREATMENT a I-TREATMENT 1, I-TREATMENT 5 I-TREATMENT ug/kg/min, I-TREATMENT restableciéndose I-TREATMENT PA I-TREATMENT de I-TREATMENT 100/70 I-TREATMENT mm I-TREATMENT Hg, I-TREATMENT PCP I-TREATMENT de I-TREATMENT 22 I-TREATMENT mm I-TREATMENT Hg, I-TREATMENT e I-TREATMENT IC I-TREATMENT 3, I-TREATMENT 2 I-TREATMENT lt/m2. I-TREATMENT No B-EVOLUTION se I-EVOLUTION observaron I-EVOLUTION otros I-EVOLUTION problemas I-EVOLUTION hemodinámicos I-EVOLUTION en I-EVOLUTION el I-EVOLUTION post I-EVOLUTION operatorio. I-EVOLUTION El I-EVOLUTION paciente I-EVOLUTION fue I-EVOLUTION dado I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION día I-EVOLUTION 30 I-EVOLUTION debido I-EVOLUTION a I-EVOLUTION colecciones I-EVOLUTION intra-abdominales I-EVOLUTION que B-TREATMENT requirieron I-TREATMENT drenaje I-TREATMENT percutáneo. I-TREATMENT I-TREATMENT 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 y 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 I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS lesiones I-PRESENT_ILLNESS en I-PRESENT_ILLNESS piel I-PRESENT_ILLNESS del I-PRESENT_ILLNESS tronco I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 15 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS El B-EXPLORATION examen I-EXPLORATION clínico I-EXPLORATION constató I-EXPLORATION múltiples I-EXPLORATION placas I-EXPLORATION y I-EXPLORATION nódulos I-EXPLORATION eritemato-violáceos, I-EXPLORATION no I-EXPLORATION dolorosos I-EXPLORATION ni I-EXPLORATION pruriginosos, I-EXPLORATION que I-EXPLORATION fluctuaban I-EXPLORATION entre I-EXPLORATION 0, I-EXPLORATION 3 I-EXPLORATION y I-EXPLORATION 5 I-EXPLORATION cm, I-EXPLORATION ubicados I-EXPLORATION principalmente I-EXPLORATION en I-EXPLORATION tronco. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION constataron I-EXPLORATION linfoadenopatías I-EXPLORATION ni I-EXPLORATION visceromegalias. I-EXPLORATION El I-EXPLORATION hemograma I-EXPLORATION mostró I-EXPLORATION leucopenia I-EXPLORATION (leucocitos: I-EXPLORATION 3.600/mm3 I-EXPLORATION [basófilos: I-EXPLORATION 1, I-EXPLORATION 1%, I-EXPLORATION eosinófilos: I-EXPLORATION 2, I-EXPLORATION 1%, I-EXPLORATION neutrófilos: I-EXPLORATION 56, I-EXPLORATION 9%, I-EXPLORATION linfocitos: I-EXPLORATION 33, I-EXPLORATION 2%, I-EXPLORATION monocitos: I-EXPLORATION 6, I-EXPLORATION 7%], I-EXPLORATION hematocrito: I-EXPLORATION 46%, I-EXPLORATION hemoglobina: I-EXPLORATION 15, I-EXPLORATION 8 I-EXPLORATION g/dL, I-EXPLORATION plaquetas: I-EXPLORATION 445.000 I-EXPLORATION mm3, I-EXPLORATION VHS: I-EXPLORATION 5 I-EXPLORATION mm/h); I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION y I-EXPLORATION función I-EXPLORATION renal I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION anátomo-patológico I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION demostró I-EXPLORATION fragmento I-EXPLORATION de I-EXPLORATION piel I-EXPLORATION con I-EXPLORATION denso I-EXPLORATION infiltrado I-EXPLORATION nodular I-EXPLORATION dermo-hipodérmico, I-EXPLORATION compuesto I-EXPLORATION por I-EXPLORATION células I-EXPLORATION de I-EXPLORATION tamaño I-EXPLORATION mediano I-EXPLORATION y I-EXPLORATION aspecto I-EXPLORATION inmaduro, I-EXPLORATION con I-EXPLORATION núcleos I-EXPLORATION irregulares, I-EXPLORATION nucléolos I-EXPLORATION inconspicuos, I-EXPLORATION citoplasma I-EXPLORATION escaso I-EXPLORATION y I-EXPLORATION sin I-EXPLORATION gránulos I-EXPLORATION azurófilos. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION observó I-EXPLORATION epidermotropismo, I-EXPLORATION necrosis I-EXPLORATION ni I-EXPLORATION angioinvasión. I-EXPLORATION La I-EXPLORATION inmunohistoquímica I-EXPLORATION resultó I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION CD56, I-EXPLORATION CD4, I-EXPLORATION CD I-EXPLORATION 123, I-EXPLORATION CD45, I-EXPLORATION CD43, I-EXPLORATION y I-EXPLORATION TdT; I-EXPLORATION mientras I-EXPLORATION que I-EXPLORATION CD3, I-EXPLORATION CD45RO, I-EXPLORATION CD20, I-EXPLORATION CD79a, I-EXPLORATION CD5, I-EXPLORATION CD117 I-EXPLORATION y I-EXPLORATION MPO I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION Los I-EXPLORATION hallazgos I-EXPLORATION clínicos I-EXPLORATION e I-EXPLORATION histopatológicos I-EXPLORATION fueron I-EXPLORATION concluyentes I-EXPLORATION con I-EXPLORATION una I-EXPLORATION NBCDP. I-EXPLORATION I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION etapificación I-EXPLORATION con I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION de I-EXPLORATION cuello, I-EXPLORATION tórax I-EXPLORATION y I-EXPLORATION abdomen I-EXPLORATION mostró I-EXPLORATION adenopatías I-EXPLORATION peritraqueales I-EXPLORATION y I-EXPLORATION carinales I-EXPLORATION de I-EXPLORATION hasta I-EXPLORATION 1, I-EXPLORATION 2 I-EXPLORATION cm. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION en I-EXPLORATION la I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION cresta I-EXPLORATION iliaca. I-EXPLORATION I-EXPLORATION En B-TREATMENT la I-TREATMENT actualidad I-TREATMENT luego I-TREATMENT de I-TREATMENT transcurridos I-TREATMENT 5 I-TREATMENT meses, I-TREATMENT el I-TREATMENT paciente I-TREATMENT se I-TREATMENT encuentra I-TREATMENT en I-TREATMENT 4° I-TREATMENT ciclo I-TREATMENT de I-TREATMENT ciclofosfamida-doxorubicina-vincristina-prednisona I-TREATMENT (CHOP) I-TREATMENT con I-TREATMENT regresión I-TREATMENT parcial I-TREATMENT de I-TREATMENT las I-TREATMENT lesiones I-TREATMENT cutáneas. I-TREATMENT I-TREATMENT Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS hipertensa B-PAST_MEDICAL_HISTORY controlada, I-PAST_MEDICAL_HISTORY que B-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS holocránea I-PRESENT_ILLNESS acompañada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS náuseas, I-PRESENT_ILLNESS vómitos I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS cuya I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS llegó I-PRESENT_ILLNESS a I-PRESENT_ILLNESS 10/10 I-PRESENT_ILLNESS al I-PRESENT_ILLNESS tercer I-PRESENT_ILLNESS día I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución. I-PRESENT_ILLNESS La B-DERIVED_FROM/TO aparición I-DERIVED_FROM/TO de I-DERIVED_FROM/TO compromiso I-DERIVED_FROM/TO de I-DERIVED_FROM/TO conciencia I-DERIVED_FROM/TO obligó I-DERIVED_FROM/TO a I-DERIVED_FROM/TO consultar I-DERIVED_FROM/TO en I-DERIVED_FROM/TO Servicio I-DERIVED_FROM/TO de I-DERIVED_FROM/TO Urgencias. I-DERIVED_FROM/TO Ingresó B-EXPLORATION confusa, I-EXPLORATION lenguaje I-EXPLORATION poco I-EXPLORATION fluente, I-EXPLORATION rigidez I-EXPLORATION de I-EXPLORATION nuca, I-EXPLORATION pupilas I-EXPLORATION isocoricas I-EXPLORATION reactivas I-EXPLORATION y I-EXPLORATION fondo I-EXPLORATION de I-EXPLORATION ojo I-EXPLORATION con I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION papila I-EXPLORATION bilateral. I-EXPLORATION Movilizaba I-EXPLORATION las I-EXPLORATION 4 I-EXPLORATION extremidades, I-EXPLORATION tenía I-EXPLORATION reflejos I-EXPLORATION osteotendíneos I-EXPLORATION vivos I-EXPLORATION y I-EXPLORATION Babinski I-EXPLORATION bilateral. I-EXPLORATION Presión I-EXPLORATION arterial I-EXPLORATION 108/64 I-EXPLORATION mmHg, I-EXPLORATION frecuencia I-EXPLORATION cardiaca I-EXPLORATION 56 I-EXPLORATION lmp, I-EXPLORATION subfebril I-EXPLORATION (t° I-EXPLORATION 37, I-EXPLORATION 2°C). I-EXPLORATION Sin I-EXPLORATION lesiones I-EXPLORATION en I-EXPLORATION mucosas I-EXPLORATION o I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION focos I-EXPLORATION dentarios, I-EXPLORATION sinusales, I-EXPLORATION oticos I-EXPLORATION o I-EXPLORATION respiratorio. I-EXPLORATION La I-EXPLORATION tomografía I-EXPLORATION cerebral I-EXPLORATION (TC) I-EXPLORATION mostró I-EXPLORATION hipodensidad I-EXPLORATION frontal I-EXPLORATION izquierda I-EXPLORATION redondeada, I-EXPLORATION con I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION local I-EXPLORATION sobre I-EXPLORATION estructuras I-EXPLORATION adyacentes. I-EXPLORATION Líquido I-EXPLORATION cefalorraquídeo I-EXPLORATION citrino, I-EXPLORATION 760 I-EXPLORATION leucocitos I-EXPLORATION mm3 I-EXPLORATION (97% I-EXPLORATION PMN), I-EXPLORATION proteínas I-EXPLORATION 101, I-EXPLORATION 8 I-EXPLORATION mg/dL, I-EXPLORATION glucosa I-EXPLORATION 69 I-EXPLORATION mg/dL I-EXPLORATION (hemoglucotest I-EXPLORATION de I-EXPLORATION 116 I-EXPLORATION mg/dL), I-EXPLORATION la I-EXPLORATION tinción I-EXPLORATION Gram I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION Hematocrito I-EXPLORATION 29, I-EXPLORATION 9%, I-EXPLORATION hemoglobina I-EXPLORATION 9, I-EXPLORATION 8 I-EXPLORATION g/L, I-EXPLORATION leucocitos I-EXPLORATION 25.800 I-EXPLORATION k/uL, I-EXPLORATION (91, I-EXPLORATION 9% I-EXPLORATION segmentados), I-EXPLORATION plaquetas I-EXPLORATION 286.000 I-EXPLORATION uL, I-EXPLORATION PCR I-EXPLORATION 428 I-EXPLORATION mg/L, I-EXPLORATION protrombina I-EXPLORATION 66%, I-EXPLORATION y I-EXPLORATION electrolitos I-EXPLORATION plasmáticos I-EXPLORATION normales. I-EXPLORATION VHB, I-EXPLORATION VHC, I-EXPLORATION HTLV-1, I-EXPLORATION Chagas I-EXPLORATION y I-EXPLORATION VIH I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT endovenoso I-TREATMENT con I-TREATMENT ceftriaxona I-TREATMENT 2 I-TREATMENT g I-TREATMENT c/12 I-TREATMENT h, I-TREATMENT clindamicina I-TREATMENT 600 I-TREATMENT mg I-TREATMENT c/8 I-TREATMENT h, I-TREATMENT vancomicina I-TREATMENT 1 I-TREATMENT g I-TREATMENT c/12 I-TREATMENT h I-TREATMENT y I-TREATMENT betametasona I-TREATMENT 4 I-TREATMENT mg I-TREATMENT c/8 I-TREATMENT h. I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION persistió I-EVOLUTION comprometida I-EVOLUTION de I-EVOLUTION conciencia I-EVOLUTION (Glasgow I-EVOLUTION 12), I-EVOLUTION con I-EVOLUTION rigidez I-EVOLUTION de I-EVOLUTION nuca I-EVOLUTION y I-EVOLUTION opistótono. I-EVOLUTION Pupilas B-EXPLORATION isocóricas I-EXPLORATION reactivas, I-EXPLORATION reflejos I-EXPLORATION oculocefálicos I-EXPLORATION y I-EXPLORATION corneales I-EXPLORATION conservados, I-EXPLORATION mantenía I-EXPLORATION el I-EXPLORATION edema I-EXPLORATION de I-EXPLORATION papila, I-EXPLORATION la I-EXPLORATION hiperreflexia I-EXPLORATION generalizada I-EXPLORATION y I-EXPLORATION Babinski I-EXPLORATION bilateral. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION magnética I-EXPLORATION (RM), I-EXPLORATION realizada I-EXPLORATION al I-EXPLORATION segundo I-EXPLORATION día I-EXPLORATION de I-EXPLORATION hospitalización, I-EXPLORATION definió I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION bifrontal I-EXPLORATION paramediano I-EXPLORATION anterior, I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION izquierdo, I-EXPLORATION con I-EXPLORATION difusión I-EXPLORATION restringida I-EXPLORATION y I-EXPLORATION edema I-EXPLORATION vasogénico I-EXPLORATION perilesional. I-EXPLORATION Se I-EXPLORATION observó I-EXPLORATION captación I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION leptomeníngeo I-EXPLORATION y I-EXPLORATION se I-EXPLORATION identificó I-EXPLORATION una I-EXPLORATION colección I-EXPLORATION subdural I-EXPLORATION fronto-temporal I-EXPLORATION izquierda I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm. I-EXPLORATION La I-EXPLORATION angioresonancia I-EXPLORATION no I-EXPLORATION agregó I-EXPLORATION elementos I-EXPLORATION significativos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION interpretó I-EXPLORATION como I-EXPLORATION cerebritis I-EXPLORATION bifrontal I-EXPLORATION abscedada, I-EXPLORATION empiema I-EXPLORATION fronto-parietal I-EXPLORATION izquierdo I-EXPLORATION y I-EXPLORATION leptomeningitis. I-EXPLORATION La I-EXPLORATION evaluación I-EXPLORATION neuroquirúrgica I-EXPLORATION realizada I-EXPLORATION en I-EXPLORATION dicho I-EXPLORATION momento I-EXPLORATION sugirió I-EXPLORATION manejo I-EXPLORATION medico I-EXPLORATION del I-EXPLORATION cuadro. I-EXPLORATION El I-EXPLORATION ecocardiograma I-EXPLORATION y I-EXPLORATION ecografía I-EXPLORATION abdomino-pélvica I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION Los I-EXPLORATION hemocultivos, I-EXPLORATION urocultivos, I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION secreción I-EXPLORATION bronquial I-EXPLORATION y I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION LCR I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION I-EXPLORATION Al B-EVOLUTION cuarto I-EVOLUTION día I-EVOLUTION de I-EVOLUTION hospitalización I-EVOLUTION se I-EVOLUTION acentuó I-EVOLUTION el I-EVOLUTION compromiso I-EVOLUTION de I-EVOLUTION conciencia I-EVOLUTION (Glasgow I-EVOLUTION 4). I-EVOLUTION TC B-EXPLORATION cerebral I-EXPLORATION mostró I-EXPLORATION significativo I-EXPLORATION aumento I-EXPLORATION del I-EXPLORATION edema I-EXPLORATION cerebral I-EXPLORATION sin I-EXPLORATION cambios I-EXPLORATION en I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION descritas. I-EXPLORATION La B-TREATMENT reevaluación I-TREATMENT neuroquirúrgica I-TREATMENT decidió I-TREATMENT evacuar I-TREATMENT la I-TREATMENT colección I-TREATMENT subdural I-TREATMENT izquierda, I-TREATMENT dando I-TREATMENT salida I-TREATMENT a I-TREATMENT material I-TREATMENT purulento. I-TREATMENT El B-EVOLUTION procedimiento I-EVOLUTION se I-EVOLUTION desarrolló I-EVOLUTION sin I-EVOLUTION incidencias. I-EVOLUTION En I-EVOLUTION la I-EVOLUTION etapa I-EVOLUTION inmediata I-EVOLUTION post-quirúrgica I-EVOLUTION necesitó I-EVOLUTION apoyo I-EVOLUTION con I-EVOLUTION drogas I-EVOLUTION vasoactivas, I-EVOLUTION no I-EVOLUTION recuperó I-EVOLUTION la I-EVOLUTION conciencia, I-EVOLUTION quedando I-EVOLUTION en I-EVOLUTION coma, I-EVOLUTION con I-EVOLUTION pupilas I-EVOLUTION midriáticas I-EVOLUTION arreflécticas, I-EVOLUTION sin I-EVOLUTION respuestas I-EVOLUTION de I-EVOLUTION tronco. I-EVOLUTION La B-EXPLORATION TC I-EXPLORATION mostró I-EXPLORATION colapso I-EXPLORATION ventricular, I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION surcos I-EXPLORATION y I-EXPLORATION borramiento I-EXPLORATION de I-EXPLORATION las I-EXPLORATION cisternas I-EXPLORATION basales. I-EXPLORATION Conectada I-EXPLORATION a I-EXPLORATION ventilador, I-EXPLORATION el I-EXPLORATION electroencefalograma I-EXPLORATION mostró I-EXPLORATION trazado I-EXPLORATION plano. I-EXPLORATION Se I-EXPLORATION definió I-EXPLORATION muerte I-EXPLORATION cerebral. I-EXPLORATION I-EXPLORATION El I-EXPLORATION cultivo I-EXPLORATION de I-EXPLORATION la I-EXPLORATION colección I-EXPLORATION subdural I-EXPLORATION fue I-EXPLORATION positivo I-EXPLORATION para I-EXPLORATION Streptococcus I-EXPLORATION del I-EXPLORATION grupo I-EXPLORATION anginosus I-EXPLORATION (SAG). I-EXPLORATION I-EXPLORATION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 22 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sana. B-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS por I-PRESENT_ILLNESS aumento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS volumen I-PRESENT_ILLNESS cérvico-parotídeo I-PRESENT_ILLNESS derecho I-PRESENT_ILLNESS sensible, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS y I-PRESENT_ILLNESS refractario I-PRESENT_ILLNESS a I-PRESENT_ILLNESS antiinflamatorios. I-PRESENT_ILLNESS Fue B-TREATMENT interpretado I-TREATMENT como I-TREATMENT síndrome I-TREATMENT de I-TREATMENT mononucleosis I-TREATMENT infecciosa I-TREATMENT y I-TREATMENT por I-TREATMENT su I-TREATMENT persistencia I-TREATMENT se I-TREATMENT le I-TREATMENT indicó I-TREATMENT empíricamente I-TREATMENT amoxicilina-ácido I-TREATMENT clavulánico I-TREATMENT sin I-TREATMENT mejoría I-TREATMENT clínica. I-TREATMENT Finalmente, I-TREATMENT le I-TREATMENT indicaron I-TREATMENT glucocorticoides I-TREATMENT con B-EVOLUTION resolución I-EVOLUTION completa I-EVOLUTION del I-EVOLUTION cuadro. I-EVOLUTION I-EVOLUTION Dos I-EVOLUTION meses I-EVOLUTION después I-EVOLUTION consultó I-EVOLUTION nuevamente I-EVOLUTION por I-EVOLUTION fiebre I-EVOLUTION asociado I-EVOLUTION a I-EVOLUTION múltiples I-EVOLUTION adenopatías I-EVOLUTION submandibulares I-EVOLUTION sensibles I-EVOLUTION e I-EVOLUTION induradas, I-EVOLUTION con I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION parotídeo I-EVOLUTION ipsilateral. I-EVOLUTION Presentaba B-EXPLORATION PCR I-EXPLORATION de I-EXPLORATION 41 I-EXPLORATION mg/L I-EXPLORATION y I-EXPLORATION hemograma I-EXPLORATION con I-EXPLORATION neutro I-EXPLORATION filia I-EXPLORATION relativa. I-EXPLORATION Las I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION estaban I-EXPLORATION en I-EXPLORATION rangos I-EXPLORATION normales. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION TAC I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION parotídeo I-EXPLORATION y I-EXPLORATION de I-EXPLORATION grupos I-EXPLORATION ganglionares I-EXPLORATION cervicales I-EXPLORATION bilaterales, I-EXPLORATION ambos I-EXPLORATION de I-EXPLORATION predominio I-EXPLORATION derecho. I-EXPLORATION Además I-EXPLORATION se I-EXPLORATION informó I-EXPLORATION un I-EXPLORATION probable I-EXPLORATION flegmón I-EXPLORATION cervical. I-EXPLORATION Se I-EXPLORATION reiniciaron I-EXPLORATION los I-EXPLORATION antibióticos I-EXPLORATION (ceftriaxona I-EXPLORATION más I-EXPLORATION clindamicina) I-EXPLORATION sin I-EXPLORATION respuesta. I-EXPLORATION Dada B-TREATMENT la I-TREATMENT persistencia I-TREATMENT del I-TREATMENT cuadro, I-TREATMENT se I-TREATMENT escaló I-TREATMENT a I-TREATMENT esquema I-TREATMENT antibiótico I-TREATMENT de I-TREATMENT segunda I-TREATMENT línea I-TREATMENT (vancomicina I-TREATMENT más I-TREATMENT levofloxacino) I-TREATMENT y B-EXPLORATION se I-EXPLORATION amplió I-EXPLORATION estudio I-EXPLORATION con I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION tórax-abdomen-pelvis I-EXPLORATION que I-EXPLORATION informó I-EXPLORATION linfonodos I-EXPLORATION precarinales I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION mm, I-EXPLORATION sin I-EXPLORATION otros I-EXPLORATION hallazgos. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION inmunológico I-EXPLORATION con I-EXPLORATION ANA I-EXPLORATION e I-EXPLORATION infeccioso I-EXPLORATION para I-EXPLORATION VEB, I-EXPLORATION CMV, I-EXPLORATION VIH, I-EXPLORATION sífilis, I-EXPLORATION Toxoplasma I-EXPLORATION gondii I-EXPLORATION y I-EXPLORATION Bartonella I-EXPLORATION hensenlae I-EXPLORATION fueron I-EXPLORATION negativos. I-EXPLORATION Finalmente, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION de I-EXPLORATION ganglio I-EXPLORATION cervical I-EXPLORATION que I-EXPLORATION reveló I-EXPLORATION hallazgos I-EXPLORATION compatibles I-EXPLORATION con I-EXPLORATION linfadenitis I-EXPLORATION necrotizante I-EXPLORATION histiocitaria. I-EXPLORATION Se B-TREATMENT suspendieron I-TREATMENT los I-TREATMENT antibióticos I-TREATMENT y I-TREATMENT se I-TREATMENT indicó I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT prednisona I-TREATMENT 30 I-TREATMENT mg I-TREATMENT al I-TREATMENT día I-TREATMENT con I-TREATMENT disminución I-TREATMENT progresiva I-TREATMENT de I-TREATMENT las I-TREATMENT dosis I-TREATMENT a I-TREATMENT partir I-TREATMENT de I-TREATMENT la I-TREATMENT segunda I-TREATMENT semana, I-TREATMENT completando I-TREATMENT 1 I-TREATMENT mes I-TREATMENT de I-TREATMENT tratamiento. I-TREATMENT La B-EVOLUTION fiebre I-EVOLUTION cedió I-EVOLUTION a I-EVOLUTION las I-EVOLUTION 24 I-EVOLUTION h I-EVOLUTION tras I-EVOLUTION el I-EVOLUTION inicio I-EVOLUTION de I-EVOLUTION la I-EVOLUTION terapia I-EVOLUTION y I-EVOLUTION no I-EVOLUTION ha I-EVOLUTION presentado I-EVOLUTION recurrencias I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 60 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sin B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY mórbidos, I-PAST_MEDICAL_HISTORY a B-PRESENT_ILLNESS quien I-PRESENT_ILLNESS en I-PRESENT_ILLNESS una I-PRESENT_ILLNESS tomografía I-PRESENT_ILLNESS computada I-PRESENT_ILLNESS de I-PRESENT_ILLNESS abdomen I-PRESENT_ILLNESS efectuada I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS le I-PRESENT_ILLNESS encontró I-PRESENT_ILLNESS un I-PRESENT_ILLNESS carcinoma I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS cm I-PRESENT_ILLNESS localizado I-PRESENT_ILLNESS en I-PRESENT_ILLNESS la I-PRESENT_ILLNESS cabeza I-PRESENT_ILLNESS del I-PRESENT_ILLNESS páncreas. I-PRESENT_ILLNESS Fue B-TREATMENT sometido I-TREATMENT a I-TREATMENT una I-TREATMENT operación I-TREATMENT de I-TREATMENT Whipple. I-TREATMENT Había I-TREATMENT 2 I-TREATMENT adenopatías I-TREATMENT regionales I-TREATMENT con I-TREATMENT metástasis I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT y I-TREATMENT no I-TREATMENT existía I-TREATMENT diseminación I-TREATMENT a I-TREATMENT distancia. I-TREATMENT Tres I-TREATMENT meses I-TREATMENT después I-TREATMENT de I-TREATMENT la I-TREATMENT operación I-TREATMENT se I-TREATMENT inició I-TREATMENT quimioterapia I-TREATMENT con I-TREATMENT GEM. I-TREATMENT Después B-EVOLUTION de I-EVOLUTION recibir I-EVOLUTION 11 I-EVOLUTION dosis I-EVOLUTION de I-EVOLUTION GEM, I-EVOLUTION transcurridos I-EVOLUTION 4 I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION su I-EVOLUTION inicio I-EVOLUTION y I-EVOLUTION habiendo I-EVOLUTION recibido I-EVOLUTION una I-EVOLUTION dosis I-EVOLUTION total I-EVOLUTION acumulada I-EVOLUTION de I-EVOLUTION 16.400 I-EVOLUTION mg I-EVOLUTION (9.318 I-EVOLUTION mg/m2), I-EVOLUTION presentó I-EVOLUTION edema I-EVOLUTION palpebral I-EVOLUTION y I-EVOLUTION de I-EVOLUTION tobillos I-EVOLUTION e I-EVOLUTION hipertensión I-EVOLUTION arterial I-EVOLUTION de I-EVOLUTION hasta I-EVOLUTION 160/110 I-EVOLUTION mmHg. I-EVOLUTION Los B-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION laboratorio I-EXPLORATION mostraron I-EXPLORATION hematuria I-EXPLORATION microscópica I-EXPLORATION (26-50 I-EXPLORATION hematíes I-EXPLORATION por I-EXPLORATION campo), I-EXPLORATION proteinuria I-EXPLORATION (1.740 I-EXPLORATION mg/24 I-EXPLORATION h), I-EXPLORATION cilindruria I-EXPLORATION granulosa, I-EXPLORATION ascenso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION creatinina I-EXPLORATION sérica I-EXPLORATION hasta I-EXPLORATION un I-EXPLORATION máximo I-EXPLORATION de I-EXPLORATION 2, I-EXPLORATION 0 I-EXPLORATION mg/dL I-EXPLORATION con I-EXPLORATION caída I-EXPLORATION del I-EXPLORATION clearance I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION a I-EXPLORATION 52 I-EXPLORATION ml/min/1, I-EXPLORATION 73 I-EXPLORATION m2 I-EXPLORATION (medido) I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 21 I-EXPLORATION días I-EXPLORATION de I-EXPLORATION la I-EXPLORATION última I-EXPLORATION dosis. I-EXPLORATION Previo I-EXPLORATION a I-EXPLORATION ello I-EXPLORATION se I-EXPLORATION había I-EXPLORATION observado I-EXPLORATION anemia I-EXPLORATION progresiva I-EXPLORATION (hemoglobina I-EXPLORATION 6.0 I-EXPLORATION g/dL) I-EXPLORATION y I-EXPLORATION trombocitopenia I-EXPLORATION (20.000 I-EXPLORATION mm3), I-EXPLORATION que I-EXPLORATION se I-EXPLORATION atribuyeron I-EXPLORATION a I-EXPLORATION mielodepresión I-EXPLORATION por I-EXPLORATION GEM. I-EXPLORATION La I-EXPLORATION bilirrubinemia I-EXPLORATION total I-EXPLORATION ascendió I-EXPLORATION a I-EXPLORATION 1, I-EXPLORATION 79 I-EXPLORATION mg/dL, I-EXPLORATION la I-EXPLORATION directa I-EXPLORATION a I-EXPLORATION 0, I-EXPLORATION 93 I-EXPLORATION mg/dL I-EXPLORATION y I-EXPLORATION la I-EXPLORATION LDH I-EXPLORATION a I-EXPLORATION 701 I-EXPLORATION U/L I-EXPLORATION (VN: I-EXPLORATION 125-243), I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION interpretó I-EXPLORATION como I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION toxicidad I-EXPLORATION hepática I-EXPLORATION por I-EXPLORATION GEM. I-EXPLORATION Se B-TREATMENT suspendió I-TREATMENT la I-TREATMENT administración I-TREATMENT de I-TREATMENT nuevas I-TREATMENT dosis I-TREATMENT de I-TREATMENT GEM, I-TREATMENT se I-TREATMENT prescribió I-TREATMENT furosemi-de I-TREATMENT para I-TREATMENT controlar I-TREATMENT el I-TREATMENT edema I-TREATMENT y I-TREATMENT olmesartán I-TREATMENT para I-TREATMENT el I-TREATMENT manejo I-TREATMENT de I-TREATMENT la I-TREATMENT hipertensión I-TREATMENT arterial. I-TREATMENT I-TREATMENT Estando B-EXPLORATION el I-EXPLORATION recuento I-EXPLORATION de I-EXPLORATION plaquetas I-EXPLORATION sobre I-EXPLORATION 100.000 I-EXPLORATION mm3 I-EXPLORATION se I-EXPLORATION efectuó I-EXPLORATION una I-EXPLORATION biopsia I-EXPLORATION renal I-EXPLORATION percutánea I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION hallazgos I-EXPLORATION característicos I-EXPLORATION de I-EXPLORATION una I-EXPLORATION microangiopatía I-EXPLORATION trombótica I-EXPLORATION crónica I-EXPLORATION activa. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION microscopía I-EXPLORATION óptica I-EXPLORATION reveló I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION glomérulos I-EXPLORATION con I-EXPLORATION numerosos I-EXPLORATION dobles I-EXPLORATION contornos I-EXPLORATION en I-EXPLORATION sus I-EXPLORATION asas I-EXPLORATION capilares I-EXPLORATION y I-EXPLORATION arteriolas, I-EXPLORATION con I-EXPLORATION intensa I-EXPLORATION disminución I-EXPLORATION de I-EXPLORATION su I-EXPLORATION lumen, I-EXPLORATION hiperplasia I-EXPLORATION concéntrica I-EXPLORATION de I-EXPLORATION miocélulas I-EXPLORATION y I-EXPLORATION depósito I-EXPLORATION hialino I-EXPLORATION mural I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION material I-EXPLORATION microtrombótico I-EXPLORATION incorporado I-EXPLORATION en I-EXPLORATION su I-EXPLORATION endotelio I-EXPLORATION y I-EXPLORATION pared. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION inmunofluorescencia I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION complejos I-EXPLORATION inmunes I-EXPLORATION en I-EXPLORATION los I-EXPLORATION glomérulos. I-EXPLORATION La I-EXPLORATION microscopía I-EXPLORATION electrónica I-EXPLORATION confirmó I-EXPLORATION las I-EXPLORATION alteraciones I-EXPLORATION glomerulares I-EXPLORATION encontradas I-EXPLORATION en I-EXPLORATION la I-EXPLORATION microscopía I-EXPLORATION óptica; I-EXPLORATION en I-EXPLORATION especial, I-EXPLORATION se I-EXPLORATION demostró I-EXPLORATION la I-EXPLORATION presencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION dobles I-EXPLORATION contornos I-EXPLORATION con I-EXPLORATION interposición I-EXPLORATION celular I-EXPLORATION y I-EXPLORATION expansión I-EXPLORATION acentuada I-EXPLORATION de I-EXPLORATION la I-EXPLORATION lámina I-EXPLORATION rara I-EXPLORATION interna I-EXPLORATION de I-EXPLORATION la I-EXPLORATION membrana I-EXPLORATION basal I-EXPLORATION por I-EXPLORATION material I-EXPLORATION electrón-lúcido I-EXPLORATION y I-EXPLORATION detritus I-EXPLORATION subendotelial. I-EXPLORATION Todas I-EXPLORATION estas I-EXPLORATION alteraciones I-EXPLORATION se I-EXPLORATION encontraron I-EXPLORATION en I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION depósitos I-EXPLORATION densos I-EXPLORATION de I-EXPLORATION tipo I-EXPLORATION complejo I-EXPLORATION inmune. I-EXPLORATION La I-EXPLORATION lesión I-EXPLORATION pedicelar I-EXPLORATION fue I-EXPLORATION moderada. I-EXPLORATION I-EXPLORATION La B-EVOLUTION suspensión I-EVOLUTION de I-EVOLUTION la I-EVOLUTION GEM I-EVOLUTION se I-EVOLUTION acompañó I-EVOLUTION de I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION en I-EVOLUTION la I-EVOLUTION función I-EVOLUTION renal I-EVOLUTION y I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION hematológicos. I-EVOLUTION En B-EXPLORATION el I-EXPLORATION último I-EXPLORATION control, I-EXPLORATION 10 I-EXPLORATION sem I-EXPLORATION después I-EXPLORATION de I-EXPLORATION la I-EXPLORATION última I-EXPLORATION dosis I-EXPLORATION de I-EXPLORATION GEM, I-EXPLORATION la I-EXPLORATION hemoglobina I-EXPLORATION fue I-EXPLORATION 12, I-EXPLORATION 3 I-EXPLORATION g/dL, I-EXPLORATION plaquetas I-EXPLORATION 147.000 I-EXPLORATION mm3, I-EXPLORATION leucocitos I-EXPLORATION 4.700 I-EXPLORATION mm3, I-EXPLORATION creatinina I-EXPLORATION sérica I-EXPLORATION 1, I-EXPLORATION 18 I-EXPLORATION mg/dl, I-EXPLORATION clearance I-EXPLORATION de I-EXPLORATION creatinina I-EXPLORATION 85 I-EXPLORATION ml/min/1, I-EXPLORATION 73 I-EXPLORATION m2 I-EXPLORATION y I-EXPLORATION LDH I-EXPLORATION normal. I-EXPLORATION El B-TREATMENT paciente I-TREATMENT continuó I-TREATMENT recibiendo I-TREATMENT olmesartán I-TREATMENT como I-TREATMENT terapia I-TREATMENT antihipertensiva I-TREATMENT originada I-TREATMENT por I-TREATMENT el I-TREATMENT daño I-TREATMENT renal I-TREATMENT por I-TREATMENT GEM. I-TREATMENT I-TREATMENT . I-TREATMENT I-TREATMENT Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 46 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY infección I-PAST_MEDICAL_HISTORY respiratoria I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY semana I-PAST_MEDICAL_HISTORY previa, I-PAST_MEDICAL_HISTORY luego B-PRESENT_ILLNESS de I-PRESENT_ILLNESS cinco I-PRESENT_ILLNESS días I-PRESENT_ILLNESS comenzó I-PRESENT_ILLNESS con I-PRESENT_ILLNESS disartria, I-PRESENT_ILLNESS diplopía, I-PRESENT_ILLNESS vértigo I-PRESENT_ILLNESS y I-PRESENT_ILLNESS ataxia. I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION se I-EXPLORATION objetivó I-EXPLORATION disartria, I-EXPLORATION midriasis I-EXPLORATION con I-EXPLORATION reflejos I-EXPLORATION fotomotores I-EXPLORATION (RFM) I-EXPLORATION disminuidos, I-EXPLORATION paresia I-EXPLORATION del I-EXPLORATION recto I-EXPLORATION superior I-EXPLORATION izquierdo, I-EXPLORATION nistagmus I-EXPLORATION bihorizontal, I-EXPLORATION ROT I-EXPLORATION abolidos, I-EXPLORATION dismetría I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION Romberg I-EXPLORATION positivo. I-EXPLORATION Se I-EXPLORATION estudió I-EXPLORATION con I-EXPLORATION RM I-EXPLORATION encéfalo I-EXPLORATION normal. I-EXPLORATION La I-EXPLORATION EMG I-EXPLORATION presentó I-EXPLORATION alteración I-EXPLORATION del I-EXPLORATION reflejo I-EXPLORATION de I-EXPLORATION pestañeo. I-EXPLORATION Sin I-EXPLORATION disociación I-EXPLORATION en I-EXPLORATION LCR I-EXPLORATION y I-EXPLORATION anticuerpos I-EXPLORATION anti-GQ1b I-EXPLORATION positivos I-EXPLORATION en I-EXPLORATION suero. I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION sopor, I-EVOLUTION midriasis I-EVOLUTION arrefléctica, I-EVOLUTION biparesia I-EVOLUTION facial I-EVOLUTION y I-EVOLUTION paresia I-EVOLUTION de I-EVOLUTION extremidades I-EVOLUTION superiores. I-EVOLUTION Requirió B-TREATMENT intubación I-TREATMENT para I-TREATMENT manejo I-TREATMENT de I-TREATMENT vía I-TREATMENT aérea I-TREATMENT y I-TREATMENT monitorización I-TREATMENT por I-TREATMENT disautonomía. I-TREATMENT Se I-TREATMENT establecieron I-TREATMENT los I-TREATMENT diagnósticos I-TREATMENT de I-TREATMENT SMF, I-TREATMENT SGB I-TREATMENT y I-TREATMENT EB. I-TREATMENT Recibió I-TREATMENT IgIV I-TREATMENT (0, I-TREATMENT 4 I-TREATMENT gr/kg/día I-TREATMENT por I-TREATMENT 5 I-TREATMENT días I-TREATMENT consecutivos). I-TREATMENT A B-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses I-EVOLUTION tenía I-EVOLUTION examen I-EVOLUTION neurológico I-EVOLUTION normal. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 52 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS no B-PAST_MEDICAL_HISTORY fumadora, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY GPA I-PAST_MEDICAL_HISTORY diagnosticada I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1995. I-PAST_MEDICAL_HISTORY Al B-PRESENT_ILLNESS diagnóstico I-PRESENT_ILLNESS presentó I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS de I-PRESENT_ILLNESS VAS, I-PRESENT_ILLNESS pulmón I-PRESENT_ILLNESS (cuya I-PRESENT_ILLNESS biopsia I-PRESENT_ILLNESS de I-PRESENT_ILLNESS masa I-PRESENT_ILLNESS pulmonar I-PRESENT_ILLNESS por I-PRESENT_ILLNESS videotoracoscopía I-PRESENT_ILLNESS mostró I-PRESENT_ILLNESS infamación I-PRESENT_ILLNESS granulomatosa I-PRESENT_ILLNESS necrotizante), I-PRESENT_ILLNESS y I-PRESENT_ILLNESS micro-hematuria I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS astenia, I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS fiebre, I-PRESENT_ILLNESS por I-PRESENT_ILLNESS lo I-PRESENT_ILLNESS que I-PRESENT_ILLNESS se I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS GPA I-PRESENT_ILLNESS generalizada. I-PRESENT_ILLNESS Al B-EXPLORATION diagnóstico I-EXPLORATION la I-EXPLORATION VSG I-EXPLORATION fue I-EXPLORATION de I-EXPLORATION 113 I-EXPLORATION mm, I-EXPLORATION el I-EXPLORATION ANCA I-EXPLORATION c I-EXPLORATION positivos I-EXPLORATION (no I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION PR3) I-EXPLORATION y I-EXPLORATION la I-EXPLORATION CFV I-EXPLORATION normal. I-EXPLORATION Recibió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT esteroides I-TREATMENT y I-TREATMENT ciclofosfamida I-TREATMENT con I-TREATMENT remisión I-TREATMENT completa I-TREATMENT de I-TREATMENT los I-TREATMENT síntomas, I-TREATMENT analítica I-TREATMENT e I-TREATMENT imágenes. I-TREATMENT Se I-TREATMENT realizó I-TREATMENT mantenimiento I-TREATMENT con I-TREATMENT ciclofosfamida. I-TREATMENT I-TREATMENT A B-EVOLUTION lo I-EVOLUTION largo I-EVOLUTION de I-EVOLUTION la I-EVOLUTION evolución, I-EVOLUTION presentó I-EVOLUTION múltiples I-EVOLUTION recaídas I-EVOLUTION que I-EVOLUTION respondieron I-EVOLUTION a I-EVOLUTION terapéutica I-EVOLUTION específica. I-EVOLUTION Las I-EVOLUTION recaídas I-EVOLUTION siempre I-EVOLUTION fueron I-EVOLUTION en I-EVOLUTION VAS, I-EVOLUTION con I-EVOLUTION otitis, I-EVOLUTION sinusitis I-EVOLUTION y I-EVOLUTION epistaxis I-EVOLUTION recurrentes. I-EVOLUTION Presentó I-EVOLUTION perforación I-EVOLUTION del I-EVOLUTION tabique I-EVOLUTION nasal I-EVOLUTION y I-EVOLUTION mielosupresión I-EVOLUTION por I-EVOLUTION ciclofosfamida, I-EVOLUTION por B-TREATMENT lo I-TREATMENT cual I-TREATMENT se I-TREATMENT rotó I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT micofenolato I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT tres I-TREATMENT gramos I-TREATMENT día. I-TREATMENT I-TREATMENT Al B-EVOLUTION año I-EVOLUTION del I-EVOLUTION diagnóstico I-EVOLUTION comenzó I-EVOLUTION con I-EVOLUTION disnea I-EVOLUTION y I-EVOLUTION estridor I-EVOLUTION laríngeo. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION EFR I-EXPLORATION que I-EXPLORATION evidenció I-EXPLORATION curva I-EXPLORATION cajón I-EXPLORATION y I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION traquea I-EXPLORATION y I-EXPLORATION laringe I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION ESG. I-EXPLORATION Requirió B-TREATMENT tratamiento I-TREATMENT con I-TREATMENT radiofrecuencia I-TREATMENT y I-TREATMENT dilatación. I-TREATMENT Durante I-TREATMENT los I-TREATMENT años I-TREATMENT 2003, I-TREATMENT 2005, I-TREATMENT 2006 I-TREATMENT se I-TREATMENT efectuaron I-TREATMENT dilataciones, I-TREATMENT llegando I-TREATMENT a I-TREATMENT realizar I-TREATMENT traqueostomía I-TREATMENT en I-TREATMENT el I-TREATMENT 2008. I-TREATMENT Falleció B-EVOLUTION en I-EVOLUTION el I-EVOLUTION año I-EVOLUTION 2009 I-EVOLUTION en I-EVOLUTION contexto I-EVOLUTION de I-EVOLUTION una I-EVOLUTION neumonía I-EVOLUTION nosocomial. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 31 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS que I-PRESENT_ILLNESS consultó I-PRESENT_ILLNESS por I-PRESENT_ILLNESS pérdida I-PRESENT_ILLNESS de I-PRESENT_ILLNESS fuerzas I-PRESENT_ILLNESS de I-PRESENT_ILLNESS instalación I-PRESENT_ILLNESS rápida, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS compromiso I-PRESENT_ILLNESS inicial I-PRESENT_ILLNESS de I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS inferiores I-PRESENT_ILLNESS y I-PRESENT_ILLNESS progresión I-PRESENT_ILLNESS a I-PRESENT_ILLNESS miembros I-PRESENT_ILLNESS superiores I-PRESENT_ILLNESS determinando I-PRESENT_ILLNESS cuadriparesia I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cefaloparesia. 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 portador I-PAST_MEDICAL_HISTORY del 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 (VIH) I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY etapa I-PAST_MEDICAL_HISTORY SIDA I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY cumplimiento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY antiretroviral. I-PAST_MEDICAL_HISTORY Presentaba B-PRESENT_ILLNESS diarrea I-PRESENT_ILLNESS con I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS deposiciones I-PRESENT_ILLNESS diarias I-PRESENT_ILLNESS durante I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 10 I-PRESENT_ILLNESS días I-PRESENT_ILLNESS previos I-PRESENT_ILLNESS a I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta. I-PRESENT_ILLNESS Al B-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION vigil, I-EXPLORATION eupneico I-EXPLORATION y I-EXPLORATION apirético. I-EXPLORATION Tenía I-EXPLORATION aceptable I-EXPLORATION estado I-EXPLORATION de I-EXPLORATION hidratación I-EXPLORATION y I-EXPLORATION TA I-EXPLORATION de I-EXPLORATION 110/70 I-EXPLORATION mmHg. I-EXPLORATION En I-EXPLORATION la I-EXPLORATION valoración I-EXPLORATION neuromuscular I-EXPLORATION se I-EXPLORATION objetivaba I-EXPLORATION cuadriparesia I-EXPLORATION con I-EXPLORATION cefaloparesia. I-EXPLORATION El I-EXPLORATION K+pl I-EXPLORATION al I-EXPLORATION momento I-EXPLORATION del I-EXPLORATION ingreso I-EXPLORATION fue I-EXPLORATION informado I-EXPLORATION como I-EXPLORATION indetectable, I-EXPLORATION con I-EXPLORATION un I-EXPLORATION valor I-EXPLORATION de I-EXPLORATION K+ I-EXPLORATION urinario I-EXPLORATION en I-EXPLORATION muestra I-EXPLORATION aislada I-EXPLORATION de I-EXPLORATION 5 I-EXPLORATION mEq/L. I-EXPLORATION Presentaba I-EXPLORATION elevación I-EXPLORATION de I-EXPLORATION la I-EXPLORATION CK. I-EXPLORATION Se B-TREATMENT inició I-TREATMENT reposición I-TREATMENT hidroelectrolítica I-TREATMENT con I-TREATMENT mejoría I-TREATMENT de I-TREATMENT la I-TREATMENT cuadriparesia I-TREATMENT y I-TREATMENT normalización I-TREATMENT de I-TREATMENT los I-TREATMENT valores I-TREATMENT de I-TREATMENT K+pl I-TREATMENT y I-TREATMENT CK. I-TREATMENT Al I-TREATMENT igual I-TREATMENT que I-TREATMENT el I-TREATMENT caso I-TREATMENT 1, I-TREATMENT la I-TREATMENT severa I-TREATMENT disminución I-TREATMENT del I-TREATMENT potasio I-TREATMENT plasmático I-TREATMENT se I-TREATMENT debió I-TREATMENT a I-TREATMENT una I-TREATMENT alteración I-TREATMENT a I-TREATMENT nivel I-TREATMENT del I-TREATMENT balance I-TREATMENT externo I-TREATMENT por I-TREATMENT pérdidas I-TREATMENT de I-TREATMENT origen I-TREATMENT digestivo, I-TREATMENT lo I-TREATMENT que I-TREATMENT concuerda I-TREATMENT con I-TREATMENT el I-TREATMENT valor I-TREATMENT de I-TREATMENT K+ I-TREATMENT en I-TREATMENT orina I-TREATMENT de I-TREATMENT 5 I-TREATMENT mEq/L. I-TREATMENT La B-EVOLUTION reposición I-EVOLUTION hidroelectrolítica I-EVOLUTION revirtió I-EVOLUTION el I-EVOLUTION cuadro I-EVOLUTION en I-EVOLUTION las I-EVOLUTION primeras I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION de I-EVOLUTION tratamiento. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS 78 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino. I-PRESENT_ILLNESS Hipertensión I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS en I-PRESENT_ILLNESS tratamiento, I-PRESENT_ILLNESS enfermedad I-PRESENT_ILLNESS arterial I-PRESENT_ILLNESS oclusiva I-PRESENT_ILLNESS carotídea I-PRESENT_ILLNESS en I-PRESENT_ILLNESS estudio. I-PRESENT_ILLNESS I-PRESENT_ILLNESS Se I-PRESENT_ILLNESS presenta I-PRESENT_ILLNESS con I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS clínico I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS kg, I-PRESENT_ILLNESS disfagia I-PRESENT_ILLNESS y I-PRESENT_ILLNESS saciedad I-PRESENT_ILLNESS precoz. I-PRESENT_ILLNESS Endoscopia B-EXPLORATION digestiva I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION lesión I-EXPLORATION pediculada I-EXPLORATION subcardial I-EXPLORATION en I-EXPLORATION cara I-EXPLORATION posterior. I-EXPLORATION Biopsia I-EXPLORATION endoscópica: I-EXPLORATION "tumor I-EXPLORATION estromal I-EXPLORATION fusocelular I-EXPLORATION con I-EXPLORATION > I-EXPLORATION 10 I-EXPLORATION mitosis I-EXPLORATION atípicas I-EXPLORATION por I-EXPLORATION 50 I-EXPLORATION campos", I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION GIST. I-EXPLORATION I-EXPLORATION Tomografía I-EXPLORATION axial I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION abdomen: I-EXPLORATION lesión I-EXPLORATION subcardial I-EXPLORATION de I-EXPLORATION 6 I-EXPLORATION cm I-EXPLORATION diámetro I-EXPLORATION mayor, I-EXPLORATION sin I-EXPLORATION adenopatías I-EXPLORATION ni I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION diseminación I-EXPLORATION sistémica, I-EXPLORATION que I-EXPLORATION se I-EXPLORATION confirma I-EXPLORATION con I-EXPLORATION un I-EXPLORATION tránsito I-EXPLORATION esófago I-EXPLORATION estómago I-EXPLORATION y I-EXPLORATION duodeno I-EXPLORATION con I-EXPLORATION sulfato I-EXPLORATION de I-EXPLORATION bario: I-EXPLORATION lesión I-EXPLORATION pediculada I-EXPLORATION subcardial. I-EXPLORATION Se B-TREATMENT programa I-TREATMENT resección I-TREATMENT tumoral I-TREATMENT laparoscópica: I-TREATMENT Gastrotomía I-TREATMENT anterior, I-TREATMENT resección I-TREATMENT de I-TREATMENT tumor I-TREATMENT con I-TREATMENT sutura I-TREATMENT mecánica I-TREATMENT a I-TREATMENT pedículo, I-TREATMENT gastrorrafia, I-TREATMENT biopsia I-TREATMENT de I-TREATMENT serosa I-TREATMENT gástrica I-TREATMENT y I-TREATMENT peritoneo. I-TREATMENT Postoperatorio B-EXPLORATION sin I-EXPLORATION complicaciones. I-EXPLORATION I-EXPLORATION Biopsia: I-EXPLORATION Carcinoma I-EXPLORATION escamoso I-EXPLORATION fusocelular I-EXPLORATION sarcomatoide, I-EXPLORATION polipoide I-EXPLORATION y I-EXPLORATION ulcerado I-EXPLORATION 6, I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 5 I-EXPLORATION x I-EXPLORATION 4 I-EXPLORATION cm. I-EXPLORATION Margen I-EXPLORATION positivo I-EXPLORATION de I-EXPLORATION pedículo. I-EXPLORATION Sin I-EXPLORATION permeaciones I-EXPLORATION vasculares, I-EXPLORATION linfáticas I-EXPLORATION ni I-EXPLORATION perineurales. I-EXPLORATION Peritoneo I-EXPLORATION y I-EXPLORATION serosa I-EXPLORATION gástrica: I-EXPLORATION sin I-EXPLORATION neoplasia. I-EXPLORATION I-EXPLORATION Se B-TREATMENT programa I-TREATMENT para I-TREATMENT gastrectomía I-TREATMENT total I-TREATMENT más I-TREATMENT esofagectomía I-TREATMENT distal I-TREATMENT con I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT carcinoma I-TREATMENT escamoso I-TREATMENT de I-TREATMENT la I-TREATMENT unión I-TREATMENT gastroesofágica: I-TREATMENT en I-TREATMENT el I-TREATMENT intraoperatorio I-TREATMENT se I-TREATMENT recibió I-TREATMENT biopsia I-TREATMENT rápida I-TREATMENT de I-TREATMENT límite I-TREATMENT oral I-TREATMENT infiltrado I-TREATMENT por I-TREATMENT carcinoma, I-TREATMENT recorte I-TREATMENT revela I-TREATMENT compromiso I-TREATMENT neoplásico I-TREATMENT proximal I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT no I-TREATMENT reconstituir I-TREATMENT en I-TREATMENT un I-TREATMENT tiempo I-TREATMENT por I-TREATMENT las I-TREATMENT condiciones I-TREATMENT del I-TREATMENT paciente I-TREATMENT en I-TREATMENT el I-TREATMENT intraoperatorio, I-TREATMENT efectuándose I-TREATMENT esofagogastrectomía I-TREATMENT total I-TREATMENT transhiatal, I-TREATMENT esofagostoma I-TREATMENT cervical I-TREATMENT terminal I-TREATMENT transitorio I-TREATMENT y I-TREATMENT yeyunostomía I-TREATMENT de I-TREATMENT Wietzel, I-TREATMENT dejando I-TREATMENT para I-TREATMENT un I-TREATMENT segundo I-TREATMENT tiempo I-TREATMENT la I-TREATMENT reconstitución I-TREATMENT definitiva I-TREATMENT del I-TREATMENT tránsito I-TREATMENT digestivo. I-TREATMENT I-TREATMENT Biopsia B-EXPLORATION definitiva: I-EXPLORATION Carcinoma I-EXPLORATION espinocelular I-EXPLORATION fusocelular I-EXPLORATION sarcomatoide I-EXPLORATION esofágico I-EXPLORATION con I-EXPLORATION extensión I-EXPLORATION hasta I-EXPLORATION submucosa, I-EXPLORATION compromiso I-EXPLORATION de I-EXPLORATION grupo I-EXPLORATION 1 I-EXPLORATION y I-EXPLORATION 5 I-EXPLORATION (4/37), I-EXPLORATION sin I-EXPLORATION adenopatías I-EXPLORATION mediastínicas. I-EXPLORATION Nódulo I-EXPLORATION metastásico I-EXPLORATION en I-EXPLORATION epiplón I-EXPLORATION menor I-EXPLORATION correspondiente I-EXPLORATION a I-EXPLORATION ganglio I-EXPLORATION N° I-EXPLORATION 5. I-EXPLORATION Márgenes I-EXPLORATION quirúrgicos I-EXPLORATION sin I-EXPLORATION neoplasia. I-EXPLORATION I-EXPLORATION Al B-TREATMENT mes I-TREATMENT postoperatorio I-TREATMENT se I-TREATMENT realizó I-TREATMENT reconstrucción I-TREATMENT con I-TREATMENT ascenso I-TREATMENT de I-TREATMENT colon I-TREATMENT derecho I-TREATMENT e I-TREATMENT íleon I-TREATMENT terminal I-TREATMENT vía I-TREATMENT retroesternal: I-TREATMENT esófago-íleo I-TREATMENT anastomosis I-TREATMENT cervical I-TREATMENT terminolateral, I-TREATMENT transverso-duodeno I-TREATMENT anastomosis I-TREATMENT laterolateral, I-TREATMENT íleo-transverso I-TREATMENT anastomosis I-TREATMENT latero-lateral I-TREATMENT y I-TREATMENT yeyunostomía I-TREATMENT de I-TREATMENT Wietzel. I-TREATMENT I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION fístula I-EVOLUTION cervical I-EVOLUTION de I-EVOLUTION bajo I-EVOLUTION débito I-EVOLUTION sin I-EVOLUTION repercusión I-EVOLUTION clínica, I-EVOLUTION alta I-EVOLUTION al I-EVOLUTION día I-EVOLUTION 21 I-EVOLUTION postoperatorio I-EVOLUTION con I-EVOLUTION régimen I-EVOLUTION líquido I-EVOLUTION y I-EVOLUTION aporte I-EVOLUTION por I-EVOLUTION yeyunostomía. I-EVOLUTION I-EVOLUTION Paciente I-EVOLUTION en I-EVOLUTION excelentes I-EVOLUTION condiciones I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 18 I-EVOLUTION meses I-EVOLUTION postoperatorios, I-EVOLUTION autovalente, I-EVOLUTION requirió I-EVOLUTION dilatación I-EVOLUTION endoscópica I-EVOLUTION de I-EVOLUTION anastomosis I-EVOLUTION cervical, I-EVOLUTION sin I-EVOLUTION incidentes. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS fumador. B-PAST_MEDICAL_HISTORY Historia B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS dorsal I-PRESENT_ILLNESS irradiado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS hombro I-PRESENT_ILLNESS izquierdo, I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS 8/10 I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS analgésicos, I-PRESENT_ILLNESS tos I-PRESENT_ILLNESS con I-PRESENT_ILLNESS expectoración I-PRESENT_ILLNESS mucosa, I-PRESENT_ILLNESS baja I-PRESENT_ILLNESS de I-PRESENT_ILLNESS peso I-PRESENT_ILLNESS y I-PRESENT_ILLNESS sudoración I-PRESENT_ILLNESS nocturna. I-PRESENT_ILLNESS Examen B-EXPLORATION físico I-EXPLORATION inicial I-EXPLORATION normal. I-EXPLORATION Presentó I-EXPLORATION anemia I-EXPLORATION leve, I-EXPLORATION VHS: I-EXPLORATION 96 I-EXPLORATION mm/h, I-EXPLORATION examen I-EXPLORATION de I-EXPLORATION orina, I-EXPLORATION función I-EXPLORATION renal, I-EXPLORATION pruebas I-EXPLORATION hepáticas I-EXPLORATION y I-EXPLORATION perfil I-EXPLORATION lipídico I-EXPLORATION normales. I-EXPLORATION Tomografía I-EXPLORATION computada I-EXPLORATION de I-EXPLORATION columna I-EXPLORATION dorsal I-EXPLORATION sin I-EXPLORATION hallazgos I-EXPLORATION significativos. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION nódulos I-EXPLORATION subpleurales I-EXPLORATION en I-EXPLORATION vértices I-EXPLORATION pulmonares I-EXPLORATION y I-EXPLORATION lóbulo I-EXPLORATION superior I-EXPLORATION izquierdo. I-EXPLORATION Hemocultivos I-EXPLORATION negativos. I-EXPLORATION Ecotomografía I-EXPLORATION abdominal I-EXPLORATION normal, I-EXPLORATION aTAC I-EXPLORATION de I-EXPLORATION tórax I-EXPLORATION ateromatosis I-EXPLORATION aórtica I-EXPLORATION segmentaria I-EXPLORATION en I-EXPLORATION aorta I-EXPLORATION descendente, I-EXPLORATION con I-EXPLORATION engrosamiento I-EXPLORATION extraintimal, I-EXPLORATION estenosis I-EXPLORATION significativa I-EXPLORATION de I-EXPLORATION ostium I-EXPLORATION en I-EXPLORATION tronco I-EXPLORATION celíaco. I-EXPLORATION Nodulos I-EXPLORATION pulmonares I-EXPLORATION y I-EXPLORATION condensaciones I-EXPLORATION apicales I-EXPLORATION bilaterales. I-EXPLORATION VDRL: I-EXPLORATION No I-EXPLORATION reactivo, I-EXPLORATION VIH I-EXPLORATION negativo, I-EXPLORATION PPD: I-EXPLORATION 10 I-EXPLORATION mm. I-EXPLORATION Quatiferon I-EXPLORATION (-). I-EXPLORATION El I-EXPLORATION paciente I-EXPLORATION evolucionó I-EXPLORATION con I-EXPLORATION escleritis I-EXPLORATION bilateral I-EXPLORATION y I-EXPLORATION fiebre I-EXPLORATION hasta I-EXPLORATION 37, I-EXPLORATION 8 I-EXPLORATION °C. I-EXPLORATION Se I-EXPLORATION sospecha I-EXPLORATION vasculitis I-EXPLORATION de I-EXPLORATION grandes I-EXPLORATION vasos. I-EXPLORATION Nuevos I-EXPLORATION estudios I-EXPLORATION demostraron I-EXPLORATION ANCA I-EXPLORATION citoplasmático I-EXPLORATION (C): I-EXPLORATION positivo, I-EXPLORATION anti I-EXPLORATION proteinasa I-EXPLORATION 3 I-EXPLORATION (PR3) I-EXPLORATION +6, I-EXPLORATION 5 I-EXPLORATION (VN I-EXPLORATION < I-EXPLORATION 1, I-EXPLORATION 2), I-EXPLORATION C3 I-EXPLORATION y I-EXPLORATION C4 I-EXPLORATION normales, I-EXPLORATION ANA, I-EXPLORATION anticuerpos I-EXPLORATION anti-ADN I-EXPLORATION y I-EXPLORATION ENA I-EXPLORATION negativos. I-EXPLORATION Biopsia I-EXPLORATION pulmonar: I-EXPLORATION Nodulo I-EXPLORATION con I-EXPLORATION centro I-EXPLORATION fibroso, I-EXPLORATION necrosis I-EXPLORATION y I-EXPLORATION reacción I-EXPLORATION histiocitaria, I-EXPLORATION con I-EXPLORATION células I-EXPLORATION gigantes. I-EXPLORATION Se I-EXPLORATION reconoce I-EXPLORATION neumonía I-EXPLORATION organizativa I-EXPLORATION periférica, I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION hemorragia I-EXPLORATION antigua, I-EXPLORATION concordante I-EXPLORATION con I-EXPLORATION PG. I-EXPLORATION Recibió B-TREATMENT corticoterapia I-TREATMENT y I-TREATMENT ciclofosfamida I-TREATMENT oral I-TREATMENT por I-TREATMENT un I-TREATMENT año I-TREATMENT y I-TREATMENT posteriormente I-TREATMENT mantención I-TREATMENT con I-TREATMENT azatioprina. I-TREATMENT Presentó B-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica, I-EVOLUTION normalización I-EVOLUTION de I-EVOLUTION los I-EVOLUTION parámetros I-EVOLUTION inflamatorios, I-EVOLUTION radiografía I-EVOLUTION y I-EVOLUTION aTAC I-EVOLUTION de I-EVOLUTION tórax. I-EVOLUTION Anti I-EVOLUTION PR3 I-EVOLUTION (-) I-EVOLUTION a I-EVOLUTION los I-EVOLUTION 6 I-EVOLUTION meses. I-EVOLUTION I-EVOLUTION Presentamos B-PRESENT_ILLNESS el I-PRESENT_ILLNESS caso 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 75 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 e I-PAST_MEDICAL_HISTORY hipotiroidismo I-PAST_MEDICAL_HISTORY postquirúrgico I-PAST_MEDICAL_HISTORY (por I-PAST_MEDICAL_HISTORY bocio I-PAST_MEDICAL_HISTORY nodular). I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS agosto I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 2008 I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 9 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS fatigabilidad, I-PRESENT_ILLNESS síncopes I-PRESENT_ILLNESS a I-PRESENT_ILLNESS repetición I-PRESENT_ILLNESS y I-PRESENT_ILLNESS disnea I-PRESENT_ILLNESS progresiva. I-PRESENT_ILLNESS Dentro B-EXPLORATION del I-EXPLORATION estudio I-EXPLORATION se I-EXPLORATION pesquisó I-EXPLORATION anemia I-EXPLORATION severa I-EXPLORATION normocítica I-EXPLORATION normocrómica, I-EXPLORATION con I-EXPLORATION hemoglobina I-EXPLORATION de I-EXPLORATION 6, I-EXPLORATION 8 I-EXPLORATION g/dL, I-EXPLORATION leucocitos I-EXPLORATION y I-EXPLORATION plaquetas I-EXPLORATION normales. I-EXPLORATION Además I-EXPLORATION destacó I-EXPLORATION una I-EXPLORATION VHS I-EXPLORATION de I-EXPLORATION 140 I-EXPLORATION mm/h. I-EXPLORATION Por I-EXPLORATION sospecha I-EXPLORATION de I-EXPLORATION MM I-EXPLORATION se I-EXPLORATION continuó I-EXPLORATION estudio I-EXPLORATION destacando I-EXPLORATION proteínas I-EXPLORATION totales I-EXPLORATION 14, I-EXPLORATION 6 I-EXPLORATION g/dL, I-EXPLORATION albúmina I-EXPLORATION 2 I-EXPLORATION g/dL, I-EXPLORATION calcio I-EXPLORATION corregido I-EXPLORATION 10, I-EXPLORATION 8 I-EXPLORATION mg/dL, I-EXPLORATION creatinina: I-EXPLORATION 0, I-EXPLORATION 8 I-EXPLORATION mg/dL, I-EXPLORATION B2 I-EXPLORATION microglobulina I-EXPLORATION 10, I-EXPLORATION 2 I-EXPLORATION mg/L. I-EXPLORATION La I-EXPLORATION electroforesis I-EXPLORATION de I-EXPLORATION proteínas I-EXPLORATION reveló I-EXPLORATION un I-EXPLORATION peak I-EXPLORATION monoclonal I-EXPLORATION en I-EXPLORATION gamma I-EXPLORATION y I-EXPLORATION se I-EXPLORATION vio I-EXPLORATION un I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION inmunoglobulina I-EXPLORATION IgG I-EXPLORATION de I-EXPLORATION 3.450 I-EXPLORATION mg/dl, I-EXPLORATION siendo I-EXPLORATION el I-EXPLORATION resto I-EXPLORATION de I-EXPLORATION las I-EXPLORATION Ig I-EXPLORATION menores I-EXPLORATION al I-EXPLORATION rango I-EXPLORATION normal. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION mielograma I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION 25% I-EXPLORATION de I-EXPLORATION plasmoblastos I-EXPLORATION y I-EXPLORATION plasmocitos, I-EXPLORATION algunos I-EXPLORATION binucleados. I-EXPLORATION La I-EXPLORATION serie I-EXPLORATION radiológica I-EXPLORATION reveló I-EXPLORATION imágenes I-EXPLORATION líticas I-EXPLORATION en I-EXPLORATION calota I-EXPLORATION y I-EXPLORATION en I-EXPLORATION columna I-EXPLORATION lumbar. I-EXPLORATION Por I-EXPLORATION lo I-EXPLORATION tanto, I-EXPLORATION se I-EXPLORATION hizo I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION MM I-EXPLORATION IgG, I-EXPLORATION con I-EXPLORATION índices I-EXPLORATION pronósticos I-EXPLORATION de I-EXPLORATION Durie I-EXPLORATION Salmon I-EXPLORATION IIIA I-EXPLORATION e I-EXPLORATION ISS I-EXPLORATION de I-EXPLORATION 3 I-EXPLORATION puntos. I-EXPLORATION I-EXPLORATION Se B-TREATMENT inició I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT hidratación, I-TREATMENT pamidronato I-TREATMENT y I-TREATMENT melfalán/prednisona, I-TREATMENT recuperándose I-TREATMENT la I-TREATMENT hipercalcemia. I-TREATMENT Recibió I-TREATMENT tratamiento I-TREATMENT con I-TREATMENT melfalán/prednisona I-TREATMENT por I-TREATMENT 6 I-TREATMENT ciclos I-TREATMENT y I-TREATMENT radioterapia I-TREATMENT de I-TREATMENT columna I-TREATMENT lumbar, I-TREATMENT destacando I-TREATMENT en I-TREATMENT los I-TREATMENT controles I-TREATMENT ambulatorios I-TREATMENT mejoría I-TREATMENT en I-TREATMENT albúmina I-TREATMENT y I-TREATMENT calcemia, I-TREATMENT pero I-TREATMENT pancitopenia I-TREATMENT progresiva I-TREATMENT e I-TREATMENT infecciones I-TREATMENT urinarias I-TREATMENT a I-TREATMENT repetición. I-TREATMENT En B-EVOLUTION marzo I-EVOLUTION de I-EVOLUTION 2009 I-EVOLUTION estuvo I-EVOLUTION hospitalizada I-EVOLUTION por I-EVOLUTION neumonía. I-EVOLUTION En I-EVOLUTION noviembre I-EVOLUTION de I-EVOLUTION 2009 I-EVOLUTION evolucionó I-EVOLUTION con I-EVOLUTION mayor I-EVOLUTION dolor I-EVOLUTION óseo I-EVOLUTION y I-EVOLUTION postración. I-EVOLUTION Además, I-EVOLUTION llamó I-EVOLUTION la I-EVOLUTION atención I-EVOLUTION la I-EVOLUTION aparición I-EVOLUTION de I-EVOLUTION lesiones I-EVOLUTION cutáneas I-EVOLUTION nodulares, I-EVOLUTION violáceas, I-EVOLUTION dolorosas I-EVOLUTION de I-EVOLUTION 1, I-EVOLUTION 5 I-EVOLUTION a I-EVOLUTION 2 I-EVOLUTION cm I-EVOLUTION en I-EVOLUTION cuero I-EVOLUTION cabelludo, I-EVOLUTION ángulo I-EVOLUTION mandibular I-EVOLUTION izquierdo, I-EVOLUTION cuello I-EVOLUTION y I-EVOLUTION dorso. I-EVOLUTION Se B-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION de I-EXPLORATION las I-EXPLORATION lesiones I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION una I-EXPLORATION celularidad I-EXPLORATION constituida I-EXPLORATION exclusivamente I-EXPLORATION por I-EXPLORATION células I-EXPLORATION plasmáticas I-EXPLORATION predominando I-EXPLORATION proplasmocitos. I-EXPLORATION La I-EXPLORATION biopsia I-EXPLORATION mostró I-EXPLORATION igualmente I-EXPLORATION infiltración I-EXPLORATION por I-EXPLORATION células I-EXPLORATION plasmáticas. I-EXPLORATION Debido B-TREATMENT a I-TREATMENT progresión I-TREATMENT de I-TREATMENT la I-TREATMENT enfermedad I-TREATMENT se I-TREATMENT cambió I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT a I-TREATMENT talidomida/dexametasona, I-TREATMENT sin I-TREATMENT resultados. I-TREATMENT Se B-EVOLUTION derivó I-EVOLUTION a I-EVOLUTION cuidados I-EVOLUTION paliativos I-EVOLUTION y I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION falleció I-EVOLUTION 2 I-EVOLUTION meses I-EVOLUTION después, I-EVOLUTION por I-EVOLUTION infección I-EVOLUTION en I-EVOLUTION mieloma I-EVOLUTION refractario. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS de 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 transfusión I-PAST_MEDICAL_HISTORY sanguínea I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY 1972, I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY contexto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY sangrado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY úlcera I-PAST_MEDICAL_HISTORY duodenal. I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY testicular I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 15 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY hemicolectomía I-PAST_MEDICAL_HISTORY izquierda I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY cáncer I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY colon I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY 46 I-PAST_MEDICAL_HISTORY años. I-PAST_MEDICAL_HISTORY El B-PRESENT_ILLNESS año I-PRESENT_ILLNESS 1994, I-PRESENT_ILLNESS a I-PRESENT_ILLNESS los I-PRESENT_ILLNESS 51 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS se I-PRESENT_ILLNESS diagnosticó I-PRESENT_ILLNESS cirrosis, I-PRESENT_ILLNESS con I-PRESENT_ILLNESS estudio I-PRESENT_ILLNESS que B-EXPLORATION mostró I-EXPLORATION PCR I-EXPLORATION positiva I-EXPLORATION para I-EXPLORATION VHC. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION biopsia I-EXPLORATION hepática I-EXPLORATION que I-EXPLORATION mostraba I-EXPLORATION hepatitis I-EXPLORATION crónica I-EXPLORATION con I-EXPLORATION fibrosis I-EXPLORATION grado I-EXPLORATION III, I-EXPLORATION sin I-EXPLORATION cirrosis. I-EXPLORATION Recibió B-TREATMENT interferon I-TREATMENT con I-TREATMENT persistencia I-TREATMENT de I-TREATMENT PCR I-TREATMENT + I-TREATMENT de I-TREATMENT VHC. I-TREATMENT Evolucionó B-EVOLUTION con I-EVOLUTION complicaciones I-EVOLUTION de I-EVOLUTION la I-EVOLUTION hipertensión I-EVOLUTION portal, I-EVOLUTION iniciando I-EVOLUTION controles I-EVOLUTION en I-EVOLUTION nuestro I-EVOLUTION centro I-EVOLUTION en I-EVOLUTION el I-EVOLUTION 2007. I-EVOLUTION Ese I-EVOLUTION año I-EVOLUTION se I-EVOLUTION diagnosticó I-EVOLUTION hepatocarcinoma I-EVOLUTION que B-TREATMENT fue I-TREATMENT quimioembolizado. I-TREATMENT Se I-TREATMENT trasplantó I-TREATMENT en I-TREATMENT mayo I-TREATMENT de I-TREATMENT 2008. I-TREATMENT Post I-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 adicionando I-TREATMENT micofenolato I-TREATMENT por I-TREATMENT falla I-TREATMENT renal. I-TREATMENT Se B-EVOLUTION mantuvo I-EVOLUTION con I-EVOLUTION creatinina I-EVOLUTION 1, I-EVOLUTION 4-1, I-EVOLUTION 5 I-EVOLUTION mg/dl, I-EVOLUTION pero I-EVOLUTION 1 I-EVOLUTION año I-EVOLUTION y I-EVOLUTION medio I-EVOLUTION post I-EVOLUTION trasplante I-EVOLUTION tuvo I-EVOLUTION alza I-EVOLUTION hasta I-EVOLUTION 1, I-EVOLUTION 9-2, I-EVOLUTION 0 I-EVOLUTION mg/dl. I-EVOLUTION En B-TREATMENT ese I-TREATMENT momento I-TREATMENT se I-TREATMENT suspendió I-TREATMENT ciclosporina I-TREATMENT y I-TREATMENT se I-TREATMENT agregó I-TREATMENT sirolimus. I-TREATMENT Presentó B-EVOLUTION úlceras I-EVOLUTION orales, I-EVOLUTION suspendiéndose B-TREATMENT micofenolato. I-TREATMENT Por B-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION falla I-EXPLORATION renal I-EXPLORATION se I-EXPLORATION solicitó I-EXPLORATION PCR I-EXPLORATION para I-EXPLORATION VHC, I-EXPLORATION la I-EXPLORATION que I-EXPLORATION resultó I-EXPLORATION negativa. I-EXPLORATION Se I-EXPLORATION solicitó I-EXPLORATION carga I-EXPLORATION viral I-EXPLORATION en I-EXPLORATION 2 I-EXPLORATION oportunidades, I-EXPLORATION ambas I-EXPLORATION negativas. I-EXPLORATION Se I-EXPLORATION interpretó I-EXPLORATION como I-EXPLORATION eliminación I-EXPLORATION espontánea I-EXPLORATION de I-EXPLORATION VHC. I-EXPLORATION I-EXPLORATION Paciente B-PRESENT_ILLNESS femenino I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 41 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY antecedente 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 tratada I-PAST_MEDICAL_HISTORY farmacológicamente. I-PAST_MEDICAL_HISTORY Ingresa B-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS otorrinolaringología I-PRESENT_ILLNESS (ORL) I-PRESENT_ILLNESS del I-PRESENT_ILLNESS Hospital I-PRESENT_ILLNESS San I-PRESENT_ILLNESS Juan I-PRESENT_ILLNESS de I-PRESENT_ILLNESS Dios I-PRESENT_ILLNESS por I-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS de I-PRESENT_ILLNESS otalgia I-PRESENT_ILLNESS derecha I-PRESENT_ILLNESS de I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución, I-PRESENT_ILLNESS de I-PRESENT_ILLNESS inicio I-PRESENT_ILLNESS insidioso, I-PRESENT_ILLNESS el I-PRESENT_ILLNESS cual I-PRESENT_ILLNESS aumenta I-PRESENT_ILLNESS progresivamente I-PRESENT_ILLNESS llegando I-PRESENT_ILLNESS a I-PRESENT_ILLNESS una I-PRESENT_ILLNESS intensidad I-PRESENT_ILLNESS 10/10 I-PRESENT_ILLNESS al I-PRESENT_ILLNESS momento I-PRESENT_ILLNESS de I-PRESENT_ILLNESS la I-PRESENT_ILLNESS consulta, I-PRESENT_ILLNESS según I-PRESENT_ILLNESS la I-PRESENT_ILLNESS Escala I-PRESENT_ILLNESS Visual I-PRESENT_ILLNESS Análoga I-PRESENT_ILLNESS (EVA). I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION la I-EXPLORATION paciente I-EXPLORATION se I-EXPLORATION encontraba I-EXPLORATION afebril, I-EXPLORATION sin I-EXPLORATION embargo I-EXPLORATION se I-EXPLORATION evidencia I-EXPLORATION otorrea I-EXPLORATION purulenta, I-EXPLORATION hipoacusia I-EXPLORATION y I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION preauricular I-EXPLORATION ipsilateral. I-EXPLORATION El I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION cuadro I-EXPLORATION arroja I-EXPLORATION como I-EXPLORATION diagnóstico I-EXPLORATION una I-EXPLORATION otitis I-EXPLORATION externa I-EXPLORATION necrotizante, I-EXPLORATION además I-EXPLORATION de I-EXPLORATION una I-EXPLORATION mastoiditis I-EXPLORATION ebúrnea. I-EXPLORATION El B-TREATMENT manejo I-TREATMENT inicial I-TREATMENT del I-TREATMENT cuadro I-TREATMENT consistió I-TREATMENT en I-TREATMENT la I-TREATMENT hospitalización I-TREATMENT y I-TREATMENT el I-TREATMENT tratamiento I-TREATMENT antibiótico I-TREATMENT con I-TREATMENT un I-TREATMENT esquema I-TREATMENT empírico I-TREATMENT enfocado I-TREATMENT en I-TREATMENT el I-TREATMENT proceso I-TREATMENT ótico I-TREATMENT con I-TREATMENT ceftazidima I-TREATMENT más I-TREATMENT clindamicina I-TREATMENT endovenosa I-TREATMENT y I-TREATMENT ciprofloxacino I-TREATMENT tópico. I-TREATMENT I-TREATMENT El B-EXPLORATION grado I-EXPLORATION de I-EXPLORATION compromiso I-EXPLORATION es I-EXPLORATION objetivado I-EXPLORATION en I-EXPLORATION las I-EXPLORATION imágenes I-EXPLORATION de I-EXPLORATION la I-EXPLORATION tomografía I-EXPLORATION axial I-EXPLORATION computarizada I-EXPLORATION (TAC) I-EXPLORATION que I-EXPLORATION muestra I-EXPLORATION una I-EXPLORATION franca I-EXPLORATION zona I-EXPLORATION de I-EXPLORATION erosión I-EXPLORATION de I-EXPLORATION la I-EXPLORATION superficie I-EXPLORATION ósea I-EXPLORATION condilar I-EXPLORATION mandibular I-EXPLORATION derecha, I-EXPLORATION con I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION capa I-EXPLORATION cortical I-EXPLORATION y I-EXPLORATION destrucción I-EXPLORATION hasta I-EXPLORATION la I-EXPLORATION medular I-EXPLORATION ósea. I-EXPLORATION Por I-EXPLORATION lo I-EXPLORATION anterior I-EXPLORATION se I-EXPLORATION interconsulta I-EXPLORATION a I-EXPLORATION cirugía I-EXPLORATION maxilofacial. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION el I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION volumen I-EXPLORATION preauricular I-EXPLORATION derecho I-EXPLORATION de I-EXPLORATION límites I-EXPLORATION difusos, I-EXPLORATION consistencia I-EXPLORATION firme, I-EXPLORATION con I-EXPLORATION aumento I-EXPLORATION de I-EXPLORATION temperatura I-EXPLORATION local I-EXPLORATION y I-EXPLORATION eritema I-EXPLORATION asociados. I-EXPLORATION El I-EXPLORATION examen I-EXPLORATION funcional I-EXPLORATION revela I-EXPLORATION disminución I-EXPLORATION considerable I-EXPLORATION de I-EXPLORATION la I-EXPLORATION apertura I-EXPLORATION bucal I-EXPLORATION de I-EXPLORATION 20 I-EXPLORATION mm I-EXPLORATION aproximadamente I-EXPLORATION con I-EXPLORATION movimientos I-EXPLORATION de I-EXPLORATION lateralidad I-EXPLORATION conservados, I-EXPLORATION asociándose I-EXPLORATION a I-EXPLORATION artralgia I-EXPLORATION exacerbada I-EXPLORATION por I-EXPLORATION la I-EXPLORATION función. I-EXPLORATION Al I-EXPLORATION examen I-EXPLORATION hay I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION múltiples I-EXPLORATION piezas I-EXPLORATION dentarias I-EXPLORATION posteriores I-EXPLORATION tanto I-EXPLORATION superiores I-EXPLORATION como I-EXPLORATION inferiores. I-EXPLORATION La I-EXPLORATION resonancia I-EXPLORATION nuclear I-EXPLORATION magnética I-EXPLORATION (RNM) I-EXPLORATION muestra I-EXPLORATION cambios I-EXPLORATION degenerativos I-EXPLORATION y I-EXPLORATION erosión I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION cortical I-EXPLORATION de I-EXPLORATION la I-EXPLORATION vertiente I-EXPLORATION anterior I-EXPLORATION del I-EXPLORATION cóndilo I-EXPLORATION mandibular I-EXPLORATION además I-EXPLORATION de I-EXPLORATION un I-EXPLORATION proceso I-EXPLORATION inflamatorio I-EXPLORATION intracapsular I-EXPLORATION diseminado I-EXPLORATION a I-EXPLORATION los I-EXPLORATION músculos I-EXPLORATION masticadores I-EXPLORATION y I-EXPLORATION al I-EXPLORATION espacio I-EXPLORATION temporal I-EXPLORATION del I-EXPLORATION mismo I-EXPLORATION lado. I-EXPLORATION Con I-EXPLORATION los I-EXPLORATION hallazgos I-EXPLORATION clínicos I-EXPLORATION e I-EXPLORATION imagenológicos I-EXPLORATION se I-EXPLORATION plantea I-EXPLORATION la I-EXPLORATION hipótesis I-EXPLORATION diagnóstica I-EXPLORATION de I-EXPLORATION artritis I-EXPLORATION infecciosa I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ATM I-EXPLORATION por I-EXPLORATION continuidad. I-EXPLORATION I-EXPLORATION Luego B-TREATMENT de I-TREATMENT establecido I-TREATMENT el I-TREATMENT diagnóstico I-TREATMENT de I-TREATMENT otitis I-TREATMENT necrotizante I-TREATMENT y I-TREATMENT mastoiditis, I-TREATMENT es I-TREATMENT ingresada I-TREATMENT a I-TREATMENT pabellón I-TREATMENT por I-TREATMENT parte I-TREATMENT del I-TREATMENT equipo I-TREATMENT de I-TREATMENT ORL I-TREATMENT para I-TREATMENT realizar I-TREATMENT una I-TREATMENT mastoidectomía I-TREATMENT radical I-TREATMENT modificada. I-TREATMENT Posteriormente B-EXPLORATION se I-EXPLORATION realiza I-EXPLORATION una I-EXPLORATION punción I-EXPLORATION intraarticular I-EXPLORATION para I-EXPLORATION estudio I-EXPLORATION del I-EXPLORATION contenido, I-EXPLORATION donde I-EXPLORATION se I-EXPLORATION aprecia I-EXPLORATION salida I-EXPLORATION de I-EXPLORATION contenido I-EXPLORATION líquido I-EXPLORATION turbio I-EXPLORATION y I-EXPLORATION seropurulento I-EXPLORATION que I-EXPLORATION se I-EXPLORATION envía I-EXPLORATION a I-EXPLORATION cultivo I-EXPLORATION bacteriológico, I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION resulta I-EXPLORATION negativo I-EXPLORATION a I-EXPLORATION las I-EXPLORATION 72 I-EXPLORATION h I-EXPLORATION de I-EXPLORATION incubación. I-EXPLORATION Se I-EXPLORATION realiza I-EXPLORATION además I-EXPLORATION una I-EXPLORATION artroscentesis I-EXPLORATION con I-EXPLORATION doble I-EXPLORATION aguja I-EXPLORATION de I-EXPLORATION la I-EXPLORATION ATM I-EXPLORATION según I-EXPLORATION la I-EXPLORATION técnica I-EXPLORATION de I-EXPLORATION Nitzan I-EXPLORATION et I-EXPLORATION al13, I-EXPLORATION realizando I-EXPLORATION un I-EXPLORATION lavado I-EXPLORATION profuso I-EXPLORATION de I-EXPLORATION la I-EXPLORATION articulación I-EXPLORATION con I-EXPLORATION solución I-EXPLORATION salina. I-EXPLORATION La B-EVOLUTION paciente I-EVOLUTION posterior I-EVOLUTION a I-EVOLUTION estas I-EVOLUTION intervenciones I-EVOLUTION mejora I-EVOLUTION su I-EVOLUTION condición I-EVOLUTION general, I-EVOLUTION siendo I-EVOLUTION dada I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION con I-EVOLUTION disminución I-EVOLUTION franca I-EVOLUTION de I-EVOLUTION la I-EVOLUTION sintomatología, I-EVOLUTION del I-EVOLUTION aumento I-EVOLUTION de I-EVOLUTION volumen I-EVOLUTION y I-EVOLUTION una I-EVOLUTION mejoría I-EVOLUTION de I-EVOLUTION la I-EVOLUTION apertura I-EVOLUTION bucal I-EVOLUTION llegando I-EVOLUTION hasta I-EVOLUTION los I-EVOLUTION 40 I-EVOLUTION mm. I-EVOLUTION I-EVOLUTION Al I-EVOLUTION control I-EVOLUTION al I-EVOLUTION mes, I-EVOLUTION se I-EVOLUTION presenta I-EVOLUTION asintomática. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION se I-EVOLUTION aprecia I-EVOLUTION la I-EVOLUTION presencia I-EVOLUTION de I-EVOLUTION un I-EVOLUTION ruido I-EVOLUTION articular I-EVOLUTION en I-EVOLUTION apertura I-EVOLUTION y I-EVOLUTION cierre I-EVOLUTION el I-EVOLUTION cual I-EVOLUTION evoluciona I-EVOLUTION a I-EVOLUTION crépito I-EVOLUTION en I-EVOLUTION los I-EVOLUTION siguientes I-EVOLUTION controles. I-EVOLUTION Es B-DERIVED_FROM/TO derivada I-DERIVED_FROM/TO a I-DERIVED_FROM/TO tratamiento I-DERIVED_FROM/TO protésico I-DERIVED_FROM/TO para I-DERIVED_FROM/TO mejorar I-DERIVED_FROM/TO la I-DERIVED_FROM/TO estabilidad I-DERIVED_FROM/TO oclusal I-DERIVED_FROM/TO y I-DERIVED_FROM/TO por I-DERIVED_FROM/TO ende I-DERIVED_FROM/TO disminuir I-DERIVED_FROM/TO la I-DERIVED_FROM/TO sobrecarga I-DERIVED_FROM/TO articular. I-DERIVED_FROM/TO Se B-EXPLORATION pide I-EXPLORATION TAC I-EXPLORATION de I-EXPLORATION control I-EXPLORATION a I-EXPLORATION los I-EXPLORATION 2 I-EXPLORATION meses I-EXPLORATION el I-EXPLORATION cual I-EXPLORATION confirma I-EXPLORATION una I-EXPLORATION regeneración I-EXPLORATION parcial I-EXPLORATION de I-EXPLORATION la I-EXPLORATION cortical I-EXPLORATION ósea I-EXPLORATION condilar. I-EXPLORATION Actualmente, B-EVOLUTION cuatro I-EVOLUTION años I-EVOLUTION después, I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomática, I-EVOLUTION con I-EVOLUTION dinámica I-EVOLUTION mandibular I-EVOLUTION conservada. I-EVOLUTION Sin I-EVOLUTION embargo, I-EVOLUTION como I-EVOLUTION secuela I-EVOLUTION de I-EVOLUTION la I-EVOLUTION otitis I-EVOLUTION media I-EVOLUTION y I-EVOLUTION posterior I-EVOLUTION mastoiditis I-EVOLUTION queda I-EVOLUTION con I-EVOLUTION alteraciones I-EVOLUTION auditivas I-EVOLUTION a I-EVOLUTION la I-EVOLUTION percepción I-EVOLUTION de I-EVOLUTION ruidos I-EVOLUTION graves I-EVOLUTION además I-EVOLUTION de I-EVOLUTION la I-EVOLUTION persistencia I-EVOLUTION de I-EVOLUTION crépito I-EVOLUTION de I-EVOLUTION la I-EVOLUTION ATM I-EVOLUTION derecha I-EVOLUTION debido I-EVOLUTION al I-EVOLUTION daño I-EVOLUTION irreversible I-EVOLUTION de I-EVOLUTION los I-EVOLUTION tejidos I-EVOLUTION intraarticulares. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 45 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS 80 I-PRESENT_ILLNESS kg, I-PRESENT_ILLNESS talla I-PRESENT_ILLNESS 1, I-PRESENT_ILLNESS 72 I-PRESENT_ILLNESS m, I-PRESENT_ILLNESS IMC I-PRESENT_ILLNESS 27, I-PRESENT_ILLNESS 11 I-PRESENT_ILLNESS kg/m2, I-PRESENT_ILLNESS portador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dislipidemia, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY familiares I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY DM. I-PAST_MEDICAL_HISTORY Inicia B-PRESENT_ILLNESS un I-PRESENT_ILLNESS cuadro I-PRESENT_ILLNESS caracterizado I-PRESENT_ILLNESS por I-PRESENT_ILLNESS polidipsia, I-PRESENT_ILLNESS poliuria, I-PRESENT_ILLNESS cansancio I-PRESENT_ILLNESS y I-PRESENT_ILLNESS calambres. I-PRESENT_ILLNESS Al I-PRESENT_ILLNESS mes I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS consulta I-PRESENT_ILLNESS en I-PRESENT_ILLNESS un I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencia. I-PRESENT_ILLNESS En B-EXPLORATION el I-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION destacan I-EXPLORATION piel I-EXPLORATION y I-EXPLORATION mucosas I-EXPLORATION secas, I-EXPLORATION acantosis I-EXPLORATION nigricans I-EXPLORATION en I-EXPLORATION cuello, I-EXPLORATION normotenso I-EXPLORATION y I-EXPLORATION pérdida I-EXPLORATION de I-EXPLORATION 8 I-EXPLORATION kilos I-EXPLORATION de I-EXPLORATION peso. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION realizan I-EXPLORATION exámenes I-EXPLORATION y I-EXPLORATION se I-EXPLORATION hospitaliza I-EXPLORATION con I-EXPLORATION el I-EXPLORATION diagnóstico I-EXPLORATION de I-EXPLORATION cetoacidosis I-EXPLORATION diabética I-EXPLORATION (CAD). I-EXPLORATION Se B-TREATMENT inicia I-TREATMENT solución I-TREATMENT solución I-TREATMENT salina I-TREATMENT 0, I-TREATMENT 9% I-TREATMENT 1.000 I-TREATMENT cc I-TREATMENT con I-TREATMENT cloruro I-TREATMENT de I-TREATMENT potasio I-TREATMENT e I-TREATMENT insulina I-TREATMENT rápida I-TREATMENT (IR) I-TREATMENT 8 I-TREATMENT U I-TREATMENT endovenosa. I-TREATMENT A I-TREATMENT la I-TREATMENT hora, I-TREATMENT se I-TREATMENT continúa I-TREATMENT con I-TREATMENT el I-TREATMENT aporte I-TREATMENT de I-TREATMENT volumen I-TREATMENT (3.000 I-TREATMENT cc) I-TREATMENT e I-TREATMENT IR I-TREATMENT sc I-TREATMENT (subcutánea) I-TREATMENT cada I-TREATMENT 6 I-TREATMENT h, I-TREATMENT según I-TREATMENT glicemias I-TREATMENT capilares. I-TREATMENT Se B-EXPLORATION descarta I-EXPLORATION foco I-EXPLORATION infeccioso. I-EXPLORATION A B-TREATMENT las I-TREATMENT 8 I-TREATMENT h I-TREATMENT de I-TREATMENT tratamiento, I-TREATMENT al I-TREATMENT revertir I-TREATMENT la I-TREATMENT acidosis I-TREATMENT y I-TREATMENT lograr I-TREATMENT glicemias I-TREATMENT < I-TREATMENT 250 I-TREATMENT mg/dl, I-TREATMENT se I-TREATMENT inicia I-TREATMENT terapia I-TREATMENT basal I-TREATMENT bolos I-TREATMENT con I-TREATMENT insulina I-TREATMENT NPH I-TREATMENT (Neutral I-TREATMENT Protamine I-TREATMENT Hagedorn) I-TREATMENT e I-TREATMENT IR I-TREATMENT antes I-TREATMENT del I-TREATMENT desayuno I-TREATMENT (AD) I-TREATMENT y I-TREATMENT cena, I-TREATMENT más I-TREATMENT refuerzos I-TREATMENT de I-TREATMENT IR I-TREATMENT pre-prandiales, I-TREATMENT lográndose B-EVOLUTION una I-EVOLUTION buena I-EVOLUTION respuesta I-EVOLUTION clínica. I-EVOLUTION Al B-TREATMENT alta I-TREATMENT se I-TREATMENT indica I-TREATMENT régimen I-TREATMENT con I-TREATMENT 180 I-TREATMENT g I-TREATMENT de I-TREATMENT hidratos I-TREATMENT de I-TREATMENT carbono, I-TREATMENT insulina I-TREATMENT NPH I-TREATMENT 18 I-TREATMENT U I-TREATMENT AD I-TREATMENT y I-TREATMENT 6 I-TREATMENT U I-TREATMENT a I-TREATMENT las I-TREATMENT 22 I-TREATMENT h, I-TREATMENT con I-TREATMENT automonitoreo I-TREATMENT de I-TREATMENT glicemias I-TREATMENT capilares. I-TREATMENT I-TREATMENT *HCO3 I-TREATMENT Bicarbonato I-TREATMENT de I-TREATMENT sodio. I-TREATMENT **HbA1c I-TREATMENT Hemoglobina I-TREATMENT glicosilada I-TREATMENT A1c. I-TREATMENT I-TREATMENT A B-EVOLUTION las I-EVOLUTION 2 I-EVOLUTION semanas I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION se I-EVOLUTION encuentra I-EVOLUTION asintomático I-EVOLUTION con I-EVOLUTION glicemias I-EVOLUTION capilares I-EVOLUTION de I-EVOLUTION ayunas I-EVOLUTION 70-110 I-EVOLUTION mg/dl, I-EVOLUTION pre-prandiales I-EVOLUTION 100-130 I-EVOLUTION mg/dl I-EVOLUTION y I-EVOLUTION post-prandiales I-EVOLUTION 160-180 I-EVOLUTION mg/dl. I-EVOLUTION Dada B-TREATMENT su I-TREATMENT buena I-TREATMENT evolución I-TREATMENT se I-TREATMENT disminuye I-TREATMENT la I-TREATMENT insulina I-TREATMENT NPH I-TREATMENT a I-TREATMENT 6 I-TREATMENT U I-TREATMENT a I-TREATMENT las I-TREATMENT 22 I-TREATMENT h I-TREATMENT y I-TREATMENT se I-TREATMENT agrega I-TREATMENT metformina I-TREATMENT 850 I-TREATMENT mg I-TREATMENT 2 I-TREATMENT veces I-TREATMENT al I-TREATMENT día. I-TREATMENT Controlado B-EVOLUTION al I-EVOLUTION mes, I-EVOLUTION relata I-EVOLUTION episodios I-EVOLUTION de I-EVOLUTION hipoglicemias I-EVOLUTION de I-EVOLUTION 60 I-EVOLUTION mg/dl I-EVOLUTION durante I-EVOLUTION el I-EVOLUTION día I-EVOLUTION y I-EVOLUTION los I-EVOLUTION exámenes I-EVOLUTION revelan I-EVOLUTION buen I-EVOLUTION control I-EVOLUTION metabólico. I-EVOLUTION I-EVOLUTION *HbA1c I-EVOLUTION Hemoglobina I-EVOLUTION glicosilada I-EVOLUTION A1c. I-EVOLUTION I-EVOLUTION Dado B-EXPLORATION el I-EXPLORATION inicio I-EXPLORATION de I-EXPLORATION una I-EXPLORATION DM I-EXPLORATION en I-EXPLORATION CAD I-EXPLORATION (sospecha I-EXPLORATION de I-EXPLORATION DM1), I-EXPLORATION en I-EXPLORATION un I-EXPLORATION paciente I-EXPLORATION con I-EXPLORATION características I-EXPLORATION fenotípicas I-EXPLORATION de I-EXPLORATION DM2, I-EXPLORATION se I-EXPLORATION solicitaron I-EXPLORATION marcadores I-EXPLORATION inmunológicos I-EXPLORATION para I-EXPLORATION diabetes: I-EXPLORATION anticuerpos I-EXPLORATION anti I-EXPLORATION células I-EXPLORATION beta I-EXPLORATION (ICA), I-EXPLORATION anticuerpos I-EXPLORATION anti I-EXPLORATION insulina I-EXPLORATION (IAA), I-EXPLORATION anticuerpos I-EXPLORATION anti I-EXPLORATION ácido I-EXPLORATION glutámico I-EXPLORATION descarboxilasa I-EXPLORATION (anti-GAD), I-EXPLORATION anticuerpos I-EXPLORATION anti I-EXPLORATION tirosina I-EXPLORATION fosfatasa I-EXPLORATION (IA2), I-EXPLORATION los I-EXPLORATION que I-EXPLORATION resultaron I-EXPLORATION negativos. I-EXPLORATION El I-EXPLORATION péptido I-EXPLORATION C I-EXPLORATION en I-EXPLORATION ayunas I-EXPLORATION fue I-EXPLORATION normal I-EXPLORATION (3, I-EXPLORATION 2 I-EXPLORATION ng/ml). I-EXPLORATION En B-TREATMENT estas I-TREATMENT condiciones I-TREATMENT se I-TREATMENT suspendió I-TREATMENT la I-TREATMENT insulina, I-TREATMENT manteniéndose I-TREATMENT las I-TREATMENT medidas I-TREATMENT no I-TREATMENT farmacológicas I-TREATMENT y I-TREATMENT la I-TREATMENT metformina. I-TREATMENT I-TREATMENT El B-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION en I-EVOLUTION controles I-EVOLUTION periódicos I-EVOLUTION durante I-EVOLUTION 24 I-EVOLUTION meses I-EVOLUTION post I-EVOLUTION alta, I-EVOLUTION lográndose I-EVOLUTION una I-EVOLUTION reducción I-EVOLUTION de I-EVOLUTION 10 I-EVOLUTION kg I-EVOLUTION de I-EVOLUTION peso, I-EVOLUTION glicemias I-EVOLUTION de I-EVOLUTION ayunas I-EVOLUTION inferiores I-EVOLUTION a100 I-EVOLUTION mg/dl, I-EVOLUTION HbA1c I-EVOLUTION 5, I-EVOLUTION 9%, I-EVOLUTION y I-EVOLUTION perfil I-EVOLUTION lipídico I-EVOLUTION y I-EVOLUTION presión I-EVOLUTION arterial I-EVOLUTION normales. I-EVOLUTION I-EVOLUTION Hombre B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 42 I-PRESENT_ILLNESS años I-PRESENT_ILLNESS de I-PRESENT_ILLNESS edad, I-PRESENT_ILLNESS agricultor, B-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY importancia, I-PAST_MEDICAL_HISTORY consulta B-PRESENT_ILLNESS en I-PRESENT_ILLNESS múltiples I-PRESENT_ILLNESS ocasiones I-PRESENT_ILLNESS por I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS meses I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS cefalea I-PRESENT_ILLNESS con I-PRESENT_ILLNESS sensación I-PRESENT_ILLNESS de I-PRESENT_ILLNESS pesadez I-PRESENT_ILLNESS y I-PRESENT_ILLNESS mareos I-PRESENT_ILLNESS sin I-PRESENT_ILLNESS respuesta I-PRESENT_ILLNESS a I-PRESENT_ILLNESS analgésicos I-PRESENT_ILLNESS comunes. I-PRESENT_ILLNESS En B-EVOLUTION su I-EVOLUTION evolución I-EVOLUTION presenta I-EVOLUTION ataxia I-EVOLUTION y I-EVOLUTION lateropulsión I-EVOLUTION derecha. I-EVOLUTION Una I-EVOLUTION semana I-EVOLUTION previo I-EVOLUTION a I-EVOLUTION su I-EVOLUTION ingreso I-EVOLUTION presenta I-EVOLUTION endoforia I-EVOLUTION derecha, I-EVOLUTION diplopia I-EVOLUTION y I-EVOLUTION postración I-EVOLUTION en I-EVOLUTION cama I-EVOLUTION por I-EVOLUTION vértigo I-EVOLUTION intenso. I-EVOLUTION Se B-EXPLORATION realiza I-EXPLORATION TC I-EXPLORATION simple I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION masa I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION posterior I-EXPLORATION y I-EXPLORATION hemorragia I-EXPLORATION subaracnoidea I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION traslada I-EXPLORATION a I-EXPLORATION hospital I-EXPLORATION de I-EXPLORATION nivel I-EXPLORATION terciario. I-EXPLORATION Ingresa B-EVOLUTION al I-EVOLUTION servicio I-EVOLUTION de I-EVOLUTION urgencias, I-EVOLUTION consciente I-EVOLUTION y I-EVOLUTION orientado, I-EVOLUTION con I-EVOLUTION cefalea, I-EVOLUTION diplopia I-EVOLUTION e I-EVOLUTION incapacidad I-EVOLUTION para I-EVOLUTION la I-EVOLUTION marcha I-EVOLUTION por I-EVOLUTION vértigo. I-EVOLUTION Su B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION sólo I-EXPLORATION demostró I-EXPLORATION endoforia I-EXPLORATION derecha, I-EXPLORATION marcha I-EXPLORATION inestable I-EXPLORATION y I-EXPLORATION lateropulsión I-EXPLORATION derecha. I-EXPLORATION Se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION RM I-EXPLORATION simple I-EXPLORATION y I-EXPLORATION contrastada I-EXPLORATION que I-EXPLORATION reportó I-EXPLORATION imagen I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION hemangioblastoma. I-EXPLORATION En I-EXPLORATION exámenes I-EXPLORATION de I-EXPLORATION ingreso I-EXPLORATION se I-EXPLORATION evidenció I-EXPLORATION recuento I-EXPLORATION plaquetario I-EXPLORATION de I-EXPLORATION 10.000/mL, I-EXPLORATION sin I-EXPLORATION otras I-EXPLORATION alteraciones I-EXPLORATION en I-EXPLORATION serie I-EXPLORATION roja I-EXPLORATION ni I-EXPLORATION blanca I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION difirió I-EXPLORATION manejo I-EXPLORATION quirúrgico I-EXPLORATION y I-EXPLORATION se I-EXPLORATION iniciaron I-EXPLORATION estudios I-EXPLORATION complementarios. I-EXPLORATION El I-EXPLORATION perfil I-EXPLORATION de I-EXPLORATION autoinmunidad I-EXPLORATION (ANAS, I-EXPLORATION ENAS, I-EXPLORATION Coombs, I-EXPLORATION inmunoglobulinas, I-EXPLORATION anticoagulante I-EXPLORATION lúpico I-EXPLORATION y I-EXPLORATION anticardiolipinas) I-EXPLORATION infeccioso I-EXPLORATION (VIH, I-EXPLORATION Hepatitis I-EXPLORATION B I-EXPLORATION y I-EXPLORATION C), I-EXPLORATION pruebas I-EXPLORATION de I-EXPLORATION coagulación I-EXPLORATION (PT, I-EXPLORATION PTT) I-EXPLORATION así I-EXPLORATION como I-EXPLORATION los I-EXPLORATION niveles I-EXPLORATION de I-EXPLORATION micronutrientes I-EXPLORATION fueron I-EXPLORATION normales. I-EXPLORATION No I-EXPLORATION se I-EXPLORATION consideró I-EXPLORATION medición I-EXPLORATION de I-EXPLORATION dímero I-EXPLORATION D I-EXPLORATION y I-EXPLORATION fibrinógeno I-EXPLORATION ante I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION síntomas I-EXPLORATION sugerentes I-EXPLORATION de I-EXPLORATION coagulopatía. I-EXPLORATION I-EXPLORATION El B-EVOLUTION paciente I-EVOLUTION presentó I-EVOLUTION deterioro I-EVOLUTION neurológico I-EVOLUTION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT llevar I-TREATMENT a I-TREATMENT cirugía I-TREATMENT urgente I-TREATMENT previo I-TREATMENT soporte I-TREATMENT transfusional I-TREATMENT de I-TREATMENT plaquetas I-TREATMENT para I-TREATMENT resección I-TREATMENT de I-TREATMENT la I-TREATMENT masa I-TREATMENT en I-TREATMENT SNC. I-TREATMENT Por I-TREATMENT trepanación I-TREATMENT occipital I-TREATMENT derecha I-TREATMENT se I-TREATMENT pasa I-TREATMENT catéter I-TREATMENT de I-TREATMENT derivación I-TREATMENT ventricular I-TREATMENT externa I-TREATMENT al I-TREATMENT ventrículo I-TREATMENT lateral I-TREATMENT ipsilateral, I-TREATMENT con I-TREATMENT obtención I-TREATMENT de I-TREATMENT LCR I-TREATMENT a I-TREATMENT presión. I-TREATMENT Se I-TREATMENT identificó I-TREATMENT tumor I-TREATMENT en I-TREATMENT fosa I-TREATMENT posterior, I-TREATMENT realizándose I-TREATMENT drenaje I-TREATMENT de I-TREATMENT quiste I-TREATMENT tumoral I-TREATMENT aspecto I-TREATMENT de I-TREATMENT hemangioblastoma, I-TREATMENT muy I-TREATMENT vascularizado, I-TREATMENT con I-TREATMENT resección I-TREATMENT macroscópica I-TREATMENT total. I-TREATMENT El B-EXPLORATION informe I-EXPLORATION de I-EXPLORATION patología I-EXPLORATION fue I-EXPLORATION compatible I-EXPLORATION con I-EXPLORATION hemangioblastoma. I-EXPLORATION Dada I-EXPLORATION la I-EXPLORATION asociación I-EXPLORATION con I-EXPLORATION el I-EXPLORATION síndrome I-EXPLORATION de I-EXPLORATION Von I-EXPLORATION Hippel I-EXPLORATION Lindau, I-EXPLORATION se I-EXPLORATION consideró I-EXPLORATION adicionalmente I-EXPLORATION búsqueda I-EXPLORATION de I-EXPLORATION otros I-EXPLORATION tumores I-EXPLORATION a I-EXPLORATION nivel I-EXPLORATION abdominal I-EXPLORATION con I-EXPLORATION ecografía I-EXPLORATION la I-EXPLORATION cual I-EXPLORATION fue I-EXPLORATION negativa. I-EXPLORATION I-EXPLORATION Es B-EVOLUTION trasladado I-EVOLUTION a I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION cuidado I-EVOLUTION crítico I-EVOLUTION con I-EVOLUTION excelente I-EVOLUTION respuesta I-EVOLUTION neurológica I-EVOLUTION sin I-EVOLUTION resolución I-EVOLUTION de I-EVOLUTION trombocitopenia I-EVOLUTION –entre I-EVOLUTION 5.000 I-EVOLUTION y I-EVOLUTION 169.000/mL– I-EVOLUTION requiriendo I-EVOLUTION en I-EVOLUTION varias I-EVOLUTION ocasiones I-EVOLUTION soporte I-EVOLUTION transfusional I-EVOLUTION buscando I-EVOLUTION recuentos I-EVOLUTION > I-EVOLUTION 100.000/mL. I-EVOLUTION El B-EXPLORATION seguimiento I-EXPLORATION tomográfico I-EXPLORATION (Día I-EXPLORATION 2 I-EXPLORATION y I-EXPLORATION 7 I-EXPLORATION postoperatorio) I-EXPLORATION demostraban I-EXPLORATION hematoma I-EXPLORATION subdural I-EXPLORATION con I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION herniación I-EXPLORATION en I-EXPLORATION resolución. I-EXPLORATION Es I-EXPLORATION llevado I-EXPLORATION a I-EXPLORATION estudio I-EXPLORATION de I-EXPLORATION médula I-EXPLORATION ósea I-EXPLORATION (mielograma, I-EXPLORATION biopsia, I-EXPLORATION cariotipo) I-EXPLORATION todos I-EXPLORATION normales I-EXPLORATION y B-TREATMENT con I-TREATMENT sospecha I-TREATMENT de I-TREATMENT púrpura I-TREATMENT trombócitopenica I-TREATMENT inmune I-TREATMENT (PTI) I-TREATMENT se I-TREATMENT indicó I-TREATMENT glucocorticoides I-TREATMENT (hidrocortisona I-TREATMENT 50 I-TREATMENT mg I-TREATMENT c/6 I-TREATMENT h I-TREATMENT por I-TREATMENT 2 I-TREATMENT días, I-TREATMENT dexametasona I-TREATMENT 4 I-TREATMENT mg I-TREATMENT c/6 I-TREATMENT h I-TREATMENT por I-TREATMENT 10 I-TREATMENT días) I-TREATMENT sin I-TREATMENT respuesta. I-TREATMENT En I-TREATMENT vista I-TREATMENT de I-TREATMENT riesgo I-TREATMENT de I-TREATMENT sangrado I-TREATMENT intracerebral I-TREATMENT se I-TREATMENT decidió I-TREATMENT aplicar I-TREATMENT inmunoglobulina I-TREATMENT IV I-TREATMENT 1 I-TREATMENT g/kg I-TREATMENT por I-TREATMENT dos I-TREATMENT dosis I-TREATMENT espaciadas I-TREATMENT una I-TREATMENT semana I-TREATMENT más I-TREATMENT prednisona I-TREATMENT a I-TREATMENT 1 I-TREATMENT mg/kg/día I-TREATMENT sin I-TREATMENT mejoría I-TREATMENT clínica I-TREATMENT por I-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT programó I-TREATMENT para I-TREATMENT esplenectomía I-TREATMENT laparoscópica I-TREATMENT 20 I-TREATMENT días I-TREATMENT después I-TREATMENT del I-TREATMENT procedimiento I-TREATMENT neuroquirúrgico. I-TREATMENT El I-TREATMENT procedimiento I-TREATMENT se I-TREATMENT desarrolla I-TREATMENT sin I-TREATMENT complicaciones I-TREATMENT y I-TREATMENT presenta I-TREATMENT recuento I-TREATMENT plaquetario I-TREATMENT de I-TREATMENT 165.000/mL I-TREATMENT en I-TREATMENT el I-TREATMENT postoperatorio I-TREATMENT inmediato, I-TREATMENT con I-TREATMENT bazo I-TREATMENT histológicamente I-TREATMENT normal. I-TREATMENT Cuarenta B-EVOLUTION y I-EVOLUTION ocho I-EVOLUTION horas I-EVOLUTION después, I-EVOLUTION el I-EVOLUTION paciente I-EVOLUTION presenta I-EVOLUTION nuevo I-EVOLUTION deterioro I-EVOLUTION neurológico I-EVOLUTION requiriendo I-EVOLUTION reingreso I-EVOLUTION a I-EVOLUTION UCI. I-EVOLUTION Recuento B-EXPLORATION plaquetario I-EXPLORATION 126.000/mL, I-EXPLORATION tromboelastografía I-EXPLORATION con I-EXPLORATION MA I-EXPLORATION elevado I-EXPLORATION sugerente I-EXPLORATION de I-EXPLORATION hiperagregabilidad I-EXPLORATION plaquetaria I-EXPLORATION y I-EXPLORATION TC I-EXPLORATION de I-EXPLORATION cráneo I-EXPLORATION con I-EXPLORATION hematoma I-EXPLORATION subdural I-EXPLORATION derecho I-EXPLORATION subagudo I-EXPLORATION con I-EXPLORATION efecto I-EXPLORATION de I-EXPLORATION masa I-EXPLORATION y I-EXPLORATION tendencia I-EXPLORATION a I-EXPLORATION herniación I-EXPLORATION con I-EXPLORATION hipodensidad I-EXPLORATION de I-EXPLORATION todo I-EXPLORATION el I-EXPLORATION hemisferio I-EXPLORATION cerebral I-EXPLORATION ipsilateral I-EXPLORATION sugestivo I-EXPLORATION de I-EXPLORATION isquemia I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT lleva I-TREATMENT nuevamente I-TREATMENT a I-TREATMENT cirugía I-TREATMENT de I-TREATMENT emergencia I-TREATMENT –drepanotomía–. I-TREATMENT El B-EXPLORATION TC I-EXPLORATION posterior I-EXPLORATION no I-EXPLORATION demostró I-EXPLORATION cambios I-EXPLORATION significativos. I-EXPLORATION Con B-EVOLUTION estos I-EVOLUTION hallazgos I-EVOLUTION se I-EVOLUTION retira I-EVOLUTION sedación I-EVOLUTION del I-EVOLUTION paciente, I-EVOLUTION 2 I-EVOLUTION días I-EVOLUTION después I-EVOLUTION presenta I-EVOLUTION hipernatremia I-EVOLUTION y I-EVOLUTION fiebre, I-EVOLUTION luego I-EVOLUTION de I-EVOLUTION dos I-EVOLUTION evaluaciones I-EVOLUTION se I-EVOLUTION declara I-EVOLUTION muerte I-EVOLUTION encefálica. I-EVOLUTION I-EVOLUTION Paciente B-PRESENT_ILLNESS sexo I-PRESENT_ILLNESS masculino, I-PRESENT_ILLNESS 81 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS portador B-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY poliartritis I-PAST_MEDICAL_HISTORY simétrica I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY manos, I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY inicio I-PAST_MEDICAL_HISTORY fue I-PAST_MEDICAL_HISTORY catalogado I-PAST_MEDICAL_HISTORY como I-PAST_MEDICAL_HISTORY artritis I-PAST_MEDICAL_HISTORY seronegativa; I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY más I-PAST_MEDICAL_HISTORY tarde I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY agregó I-PAST_MEDICAL_HISTORY cuadro I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY urente I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY parestesias I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY extremidades I-PAST_MEDICAL_HISTORY inferiores. I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY repitió I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY estudio, I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY dado I-PAST_MEDICAL_HISTORY MPO I-PAST_MEDICAL_HISTORY (+) I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY biopsia I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY nervio I-PAST_MEDICAL_HISTORY sural I-PAST_MEDICAL_HISTORY compatible I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY vasculitis I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vaso I-PAST_MEDICAL_HISTORY pequeño, I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY estableció I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vasculitis I-PAST_MEDICAL_HISTORY asociada I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY ANCA I-PAST_MEDICAL_HISTORY (MPO I-PAST_MEDICAL_HISTORY (+)), I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY compromiso I-PAST_MEDICAL_HISTORY pulmonar I-PAST_MEDICAL_HISTORY (Usual I-PAST_MEDICAL_HISTORY Interstitial I-PAST_MEDICAL_HISTORY Pneumonia I-PAST_MEDICAL_HISTORY [UIP], I-PAST_MEDICAL_HISTORY demostrado I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY tomografía I-PAST_MEDICAL_HISTORY axial I-PAST_MEDICAL_HISTORY computada I-PAST_MEDICAL_HISTORY [TAC]), I-PAST_MEDICAL_HISTORY articular I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY neurológico. I-PAST_MEDICAL_HISTORY Además, I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY antecedente I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY cardiopatía I-PAST_MEDICAL_HISTORY coronaria, I-PAST_MEDICAL_HISTORY insuficiencia I-PAST_MEDICAL_HISTORY cardíaca I-PAST_MEDICAL_HISTORY CF I-PAST_MEDICAL_HISTORY I-II I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enfermedad I-PAST_MEDICAL_HISTORY renal I-PAST_MEDICAL_HISTORY crónica I-PAST_MEDICAL_HISTORY (ERC) I-PAST_MEDICAL_HISTORY etapa I-PAST_MEDICAL_HISTORY 3. I-PAST_MEDICAL_HISTORY Desde I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY punto I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vista I-PAST_MEDICAL_HISTORY cardiológico, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY había I-PAST_MEDICAL_HISTORY presentado I-PAST_MEDICAL_HISTORY un I-PAST_MEDICAL_HISTORY síndrome I-PAST_MEDICAL_HISTORY coronario I-PAST_MEDICAL_HISTORY agudo I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY año I-PAST_MEDICAL_HISTORY 2012, I-PAST_MEDICAL_HISTORY cuya I-PAST_MEDICAL_HISTORY coronariografía I-PAST_MEDICAL_HISTORY mostraba I-PAST_MEDICAL_HISTORY oclusión I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ramo I-PAST_MEDICAL_HISTORY marginal I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY estenosis I-PAST_MEDICAL_HISTORY no I-PAST_MEDICAL_HISTORY significativa I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY vasos I-PAST_MEDICAL_HISTORY principales. I-PAST_MEDICAL_HISTORY Ecocardiograma I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY hipertrofia I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY ventrículo I-PAST_MEDICAL_HISTORY izquierdo I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY leve I-PAST_MEDICAL_HISTORY hipertensión I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY arteria I-PAST_MEDICAL_HISTORY pulmonar. I-PAST_MEDICAL_HISTORY Al I-PAST_MEDICAL_HISTORY momento I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY diagnóstico I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY intentó I-PAST_MEDICAL_HISTORY usar I-PAST_MEDICAL_HISTORY ciclofosfamida I-PAST_MEDICAL_HISTORY oral, I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY embargo, I-PAST_MEDICAL_HISTORY el I-PAST_MEDICAL_HISTORY paciente I-PAST_MEDICAL_HISTORY presentó I-PAST_MEDICAL_HISTORY pancitopenia I-PAST_MEDICAL_HISTORY severa, I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY lo I-PAST_MEDICAL_HISTORY que I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY suspendió. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY En I-PAST_MEDICAL_HISTORY tratamiento I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY mantención I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY años I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY prednisona I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg/día I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY azatioprina I-PAST_MEDICAL_HISTORY 50 I-PAST_MEDICAL_HISTORY mg/día. I-PAST_MEDICAL_HISTORY Estable I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY asintomático. I-PAST_MEDICAL_HISTORY Las I-PAST_MEDICAL_HISTORY semanas I-PAST_MEDICAL_HISTORY previas I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY última I-PAST_MEDICAL_HISTORY consulta I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY diagnosticó I-PAST_MEDICAL_HISTORY reactivación I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY vasculitis, I-PAST_MEDICAL_HISTORY caracterizada I-PAST_MEDICAL_HISTORY por I-PAST_MEDICAL_HISTORY reinicio I-PAST_MEDICAL_HISTORY del I-PAST_MEDICAL_HISTORY dolor I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY parestesias I-PAST_MEDICAL_HISTORY en I-PAST_MEDICAL_HISTORY extremidades I-PAST_MEDICAL_HISTORY inferiores, I-PAST_MEDICAL_HISTORY intenso I-PAST_MEDICAL_HISTORY livedo I-PAST_MEDICAL_HISTORY reticularis I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY aumento I-PAST_MEDICAL_HISTORY progresivo I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY VHS I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY PCR, I-PAST_MEDICAL_HISTORY decidiéndose I-PAST_MEDICAL_HISTORY inducción I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY la I-PAST_MEDICAL_HISTORY remisión I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY rituximab I-PAST_MEDICAL_HISTORY (no I-PAST_MEDICAL_HISTORY se I-PAST_MEDICAL_HISTORY tomó I-PAST_MEDICAL_HISTORY nueva I-PAST_MEDICAL_HISTORY biopsia). I-PAST_MEDICAL_HISTORY Exámenes I-PAST_MEDICAL_HISTORY previos I-PAST_MEDICAL_HISTORY al I-PAST_MEDICAL_HISTORY procedimiento: I-PAST_MEDICAL_HISTORY Hemoglobina I-PAST_MEDICAL_HISTORY 13, I-PAST_MEDICAL_HISTORY 9 I-PAST_MEDICAL_HISTORY g/dL, I-PAST_MEDICAL_HISTORY glóbulos I-PAST_MEDICAL_HISTORY blancos I-PAST_MEDICAL_HISTORY 12.300/mm³, I-PAST_MEDICAL_HISTORY VHS I-PAST_MEDICAL_HISTORY 64 I-PAST_MEDICAL_HISTORY mm/h, I-PAST_MEDICAL_HISTORY creatinina I-PAST_MEDICAL_HISTORY 1, I-PAST_MEDICAL_HISTORY 39 I-PAST_MEDICAL_HISTORY mg/dL, I-PAST_MEDICAL_HISTORY nitrógeno I-PAST_MEDICAL_HISTORY ureico I-PAST_MEDICAL_HISTORY 23 I-PAST_MEDICAL_HISTORY mg/dL, I-PAST_MEDICAL_HISTORY glicemia I-PAST_MEDICAL_HISTORY 101 I-PAST_MEDICAL_HISTORY mg/dL, I-PAST_MEDICAL_HISTORY albúmina I-PAST_MEDICAL_HISTORY 4 I-PAST_MEDICAL_HISTORY g/dL, I-PAST_MEDICAL_HISTORY colesterol I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY 145 I-PAST_MEDICAL_HISTORY mg/dl, I-PAST_MEDICAL_HISTORY bilirrubina I-PAST_MEDICAL_HISTORY total I-PAST_MEDICAL_HISTORY 0, I-PAST_MEDICAL_HISTORY 5 I-PAST_MEDICAL_HISTORY mg/dL. I-PAST_MEDICAL_HISTORY I-PAST_MEDICAL_HISTORY Se I-PAST_MEDICAL_HISTORY hospitalizó I-PAST_MEDICAL_HISTORY para I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY administración, I-PAST_MEDICAL_HISTORY premedicándose I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY metilprednisolona I-PAST_MEDICAL_HISTORY (125 I-PAST_MEDICAL_HISTORY mg), I-PAST_MEDICAL_HISTORY transcurriendo I-PAST_MEDICAL_HISTORY sin I-PAST_MEDICAL_HISTORY incidentes I-PAST_MEDICAL_HISTORY y I-PAST_MEDICAL_HISTORY enviado I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY domicilio. I-PAST_MEDICAL_HISTORY Sin I-PAST_MEDICAL_HISTORY embargo, I-PAST_MEDICAL_HISTORY aproximadamente I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY las I-PAST_MEDICAL_HISTORY 24 I-PAST_MEDICAL_HISTORY h I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY su I-PAST_MEDICAL_HISTORY infusión I-PAST_MEDICAL_HISTORY inició I-PAST_MEDICAL_HISTORY fiebre I-PAST_MEDICAL_HISTORY hasta I-PAST_MEDICAL_HISTORY 39, I-PAST_MEDICAL_HISTORY 8 I-PAST_MEDICAL_HISTORY °C, I-PAST_MEDICAL_HISTORY dificultad I-PAST_MEDICAL_HISTORY respiratoria, I-PAST_MEDICAL_HISTORY tos I-PAST_MEDICAL_HISTORY con I-PAST_MEDICAL_HISTORY expectoración I-PAST_MEDICAL_HISTORY mucopurulenta I-PAST_MEDICAL_HISTORY y 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 I-PAST_MEDICAL_HISTORY Consultó B-PRESENT_ILLNESS al I-PRESENT_ILLNESS servicio I-PRESENT_ILLNESS de I-PRESENT_ILLNESS urgencias, I-PRESENT_ILLNESS donde I-PRESENT_ILLNESS se I-PRESENT_ILLNESS evidenció I-PRESENT_ILLNESS febril I-PRESENT_ILLNESS (38, I-PRESENT_ILLNESS 3 I-PRESENT_ILLNESS °C), I-PRESENT_ILLNESS hipotenso I-PRESENT_ILLNESS (PAM I-PRESENT_ILLNESS 49 I-PRESENT_ILLNESS mmHg), I-PRESENT_ILLNESS desaturando I-PRESENT_ILLNESS 89% I-PRESENT_ILLNESS ambiental I-PRESENT_ILLNESS y I-PRESENT_ILLNESS polipneico I-PRESENT_ILLNESS (FR I-PRESENT_ILLNESS 29x’). I-PRESENT_ILLNESS Al B-EXPLORATION examen I-EXPLORATION físico I-EXPLORATION se I-EXPLORATION constató I-EXPLORATION mal I-EXPLORATION perfundido I-EXPLORATION y I-EXPLORATION con I-EXPLORATION uso I-EXPLORATION de I-EXPLORATION musculatura I-EXPLORATION accesoria. I-EXPLORATION Exámenes I-EXPLORATION de I-EXPLORATION laboratorio: I-EXPLORATION Hemoglobina I-EXPLORATION 14, I-EXPLORATION 4 I-EXPLORATION g/dL, I-EXPLORATION leucocitos I-EXPLORATION 5.200/mm³, I-EXPLORATION proteína I-EXPLORATION C I-EXPLORATION reactiva I-EXPLORATION 177 I-EXPLORATION mg/L, I-EXPLORATION gases I-EXPLORATION arteriales: I-EXPLORATION pH I-EXPLORATION 7, I-EXPLORATION 49; I-EXPLORATION pO2 I-EXPLORATION 53 I-EXPLORATION mmHg; I-EXPLORATION HCO3 I-EXPLORATION 19 I-EXPLORATION mEq/L; I-EXPLORATION SatO2 I-EXPLORATION 91%; I-EXPLORATION PaFi I-EXPLORATION 254, I-EXPLORATION lactato I-EXPLORATION arterial I-EXPLORATION 23 I-EXPLORATION mmol, I-EXPLORATION troponina I-EXPLORATION 0, I-EXPLORATION 07 I-EXPLORATION ng/mL, I-EXPLORATION BNP I-EXPLORATION 254 I-EXPLORATION ug/l, I-EXPLORATION creatinina I-EXPLORATION 1, I-EXPLORATION 87 I-EXPLORATION mg/dL, I-EXPLORATION nitrógeno I-EXPLORATION ureico I-EXPLORATION 33 I-EXPLORATION mg/dL. I-EXPLORATION Radiografía I-EXPLORATION de I-EXPLORATION tórax: I-EXPLORATION cardiomegalia, I-EXPLORATION hallazgos I-EXPLORATION secundarios I-EXPLORATION a I-EXPLORATION UIP, I-EXPLORATION sin I-EXPLORATION signos I-EXPLORATION de I-EXPLORATION condensación, I-EXPLORATION congestión I-EXPLORATION ni I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION evidentes. I-EXPLORATION Electrocardiograma: I-EXPLORATION ritmo I-EXPLORATION sinusal, I-EXPLORATION sin I-EXPLORATION alteraciones. I-EXPLORATION I-EXPLORATION Se I-EXPLORATION volemizó I-EXPLORATION vigorosamente, I-EXPLORATION persistiendo I-EXPLORATION hipotenso, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION ingresó I-EXPLORATION a I-EXPLORATION UTI I-EXPLORATION para I-EXPLORATION manejo. I-EXPLORATION Se B-TREATMENT tomaron I-TREATMENT hemocultivos I-TREATMENT y I-TREATMENT se I-TREATMENT inició I-TREATMENT empíricamente I-TREATMENT tratamiento I-TREATMENT antimicrobiano I-TREATMENT con I-TREATMENT moxifloxacino I-TREATMENT (completa I-TREATMENT 10 I-TREATMENT días) I-TREATMENT y I-TREATMENT oseltamivir I-TREATMENT (completa I-TREATMENT 5 I-TREATMENT días). I-TREATMENT Además, I-TREATMENT se I-TREATMENT inició I-TREATMENT uso I-TREATMENT de I-TREATMENT vasoactivos I-TREATMENT y I-TREATMENT corticoides I-TREATMENT en I-TREATMENT dosis I-TREATMENT de I-TREATMENT estrés. I-TREATMENT I-TREATMENT Evolucionó I-TREATMENT con I-TREATMENT requerimientos I-TREATMENT de I-TREATMENT noradrenalina I-TREATMENT hasta I-TREATMENT 0, I-TREATMENT 1 I-TREATMENT mcg/kg/min, I-TREATMENT que I-TREATMENT se I-TREATMENT lograron I-TREATMENT suspender I-TREATMENT a I-TREATMENT las I-TREATMENT 12 I-TREATMENT h. I-TREATMENT Se B-EXPLORATION obtuvo I-EXPLORATION muestra I-EXPLORATION para I-EXPLORATION panel I-EXPLORATION viral I-EXPLORATION y I-EXPLORATION PCR I-EXPLORATION viral I-EXPLORATION (-), I-EXPLORATION hemocultivos I-EXPLORATION (-), I-EXPLORATION urocultivo I-EXPLORATION (-) I-EXPLORATION y I-EXPLORATION ausencia I-EXPLORATION de I-EXPLORATION leucocitosis I-EXPLORATION en I-EXPLORATION mediciones I-EXPLORATION seriadas. I-EXPLORATION TAC I-EXPLORATION tórax I-EXPLORATION no I-EXPLORATION presentaba I-EXPLORATION focos I-EXPLORATION de I-EXPLORATION condensación I-EXPLORATION ni I-EXPLORATION derrame I-EXPLORATION pleural I-EXPLORATION asociado. I-EXPLORATION I-EXPLORATION Evolucionó B-EVOLUTION con I-EVOLUTION rápida I-EVOLUTION remisión I-EVOLUTION de I-EVOLUTION todos I-EVOLUTION los I-EVOLUTION síntomas I-EVOLUTION y I-EVOLUTION en I-EVOLUTION menos I-EVOLUTION de I-EVOLUTION 48 I-EVOLUTION h I-EVOLUTION se I-EVOLUTION trasladó I-EVOLUTION a I-EVOLUTION unidad I-EVOLUTION de I-EVOLUTION menor I-EVOLUTION complejidad. I-EVOLUTION I-EVOLUTION Mujer B-PRESENT_ILLNESS de I-PRESENT_ILLNESS 62 I-PRESENT_ILLNESS años, I-PRESENT_ILLNESS con B-PAST_MEDICAL_HISTORY los I-PAST_MEDICAL_HISTORY antecedentes I-PAST_MEDICAL_HISTORY de I-PAST_MEDICAL_HISTORY HTA, 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 EPOC I-PAST_MEDICAL_HISTORY secundario I-PAST_MEDICAL_HISTORY a I-PAST_MEDICAL_HISTORY tabaquismo, I-PAST_MEDICAL_HISTORY consultó B-PRESENT_ILLNESS en I-PRESENT_ILLNESS su I-PRESENT_ILLNESS hospital I-PRESENT_ILLNESS de I-PRESENT_ILLNESS origen I-PRESENT_ILLNESS por I-PRESENT_ILLNESS dos I-PRESENT_ILLNESS días I-PRESENT_ILLNESS de I-PRESENT_ILLNESS evolución I-PRESENT_ILLNESS de I-PRESENT_ILLNESS dolor I-PRESENT_ILLNESS abdominal I-PRESENT_ILLNESS intenso I-PRESENT_ILLNESS asociado I-PRESENT_ILLNESS a I-PRESENT_ILLNESS vómitos. I-PRESENT_ILLNESS Se B-EXPLORATION realizó I-EXPLORATION un I-EXPLORATION estudio I-EXPLORATION ecográfico I-EXPLORATION y I-EXPLORATION tomografía I-EXPLORATION computada I-EXPLORATION (TC) I-EXPLORATION que I-EXPLORATION visualizó I-EXPLORATION un I-EXPLORATION aneurisma I-EXPLORATION de I-EXPLORATION la I-EXPLORATION aorta I-EXPLORATION abdominal I-EXPLORATION (diámetro I-EXPLORATION de I-EXPLORATION 5, I-EXPLORATION 6 I-EXPLORATION cm) I-EXPLORATION y I-EXPLORATION una I-EXPLORATION UPAA I-EXPLORATION no I-EXPLORATION complicada, I-EXPLORATION por I-EXPLORATION lo I-EXPLORATION que I-EXPLORATION se I-EXPLORATION derivó I-EXPLORATION a I-EXPLORATION nuestro I-EXPLORATION hospital. I-EXPLORATION I-EXPLORATION Ingresó I-EXPLORATION a I-EXPLORATION nuestro I-EXPLORATION centro I-EXPLORATION y I-EXPLORATION se I-EXPLORATION descartó I-EXPLORATION que I-EXPLORATION el I-EXPLORATION dolor I-EXPLORATION fuera I-EXPLORATION secundario I-EXPLORATION a I-EXPLORATION una I-EXPLORATION complicación I-EXPLORATION del I-EXPLORATION aneurisma I-EXPLORATION abdominal, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION ecografía I-EXPLORATION abdominal I-EXPLORATION que I-EXPLORATION sugirió I-EXPLORATION proceso I-EXPLORATION infeccioso I-EXPLORATION en I-EXPLORATION fosa I-EXPLORATION iliaca I-EXPLORATION derecha. I-EXPLORATION Con I-EXPLORATION los I-EXPLORATION antecedentes I-EXPLORATION reunidos, I-EXPLORATION se I-EXPLORATION catalogó I-EXPLORATION como I-EXPLORATION abdomen I-EXPLORATION agudo I-EXPLORATION apendicular I-EXPLORATION y I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION una I-EXPLORATION laparotomía I-EXPLORATION exploradora I-EXPLORATION encontrándose I-EXPLORATION tiflitis I-EXPLORATION y I-EXPLORATION necrosis I-EXPLORATION intestinal, I-EXPLORATION por B-TREATMENT lo I-TREATMENT que I-TREATMENT se I-TREATMENT decidió I-TREATMENT efectuar I-TREATMENT una I-TREATMENT resección I-TREATMENT e I-TREATMENT íleo-ascendo-anastomosis. I-TREATMENT I-TREATMENT Posteriormente, B-EXPLORATION debido I-EXPLORATION al I-EXPLORATION tiempo I-EXPLORATION transcurrido, I-EXPLORATION se I-EXPLORATION realizó I-EXPLORATION nuevo I-EXPLORATION Angio-TC I-EXPLORATION que I-EXPLORATION mostró I-EXPLORATION UPAA, I-EXPLORATION con I-EXPLORATION paso I-EXPLORATION de I-EXPLORATION contraste I-EXPLORATION que I-EXPLORATION se I-EXPLORATION extendía I-EXPLORATION más I-EXPLORATION allá I-EXPLORATION de I-EXPLORATION la I-EXPLORATION pared I-EXPLORATION aórtica, I-EXPLORATION sin I-EXPLORATION clínica I-EXPLORATION de I-EXPLORATION SAA. I-EXPLORATION Se I-EXPLORATION efectuó I-EXPLORATION estudio I-EXPLORATION preoperatorio I-EXPLORATION con I-EXPLORATION coronariografía I-EXPLORATION que I-EXPLORATION no I-EXPLORATION mostró I-EXPLORATION lesiones I-EXPLORATION significativas I-EXPLORATION y I-EXPLORATION ecocardiografía I-EXPLORATION que I-EXPLORATION demostró I-EXPLORATION hipertrofia I-EXPLORATION ventricular I-EXPLORATION izquierda, I-EXPLORATION disfunción I-EXPLORATION diastólica I-EXPLORATION tipo I-EXPLORATION II I-EXPLORATION y I-EXPLORATION dilatación I-EXPLORATION de I-EXPLORATION aurícula I-EXPLORATION izquierda. I-EXPLORATION I-EXPLORATION Debido B-TREATMENT al I-TREATMENT alto I-TREATMENT riesgo I-TREATMENT que I-TREATMENT representaba I-TREATMENT la I-TREATMENT UPAA, I-TREATMENT se I-TREATMENT decidió I-TREATMENT cirugía, I-TREATMENT que I-TREATMENT se I-TREATMENT realizó I-TREATMENT 5 I-TREATMENT semanas I-TREATMENT posterior I-TREATMENT a I-TREATMENT la I-TREATMENT cirugía I-TREATMENT abdominal. I-TREATMENT Se I-TREATMENT abordó I-TREATMENT por I-TREATMENT esternotomía I-TREATMENT y I-TREATMENT se I-TREATMENT realizó I-TREATMENT bajo I-TREATMENT CEC I-TREATMENT reemplazo I-TREATMENT con I-TREATMENT prótesis I-TREATMENT de I-TREATMENT dacron I-TREATMENT Gelware™#26. I-TREATMENT Se I-TREATMENT observó I-TREATMENT en I-TREATMENT el I-TREATMENT intraoperatorio I-TREATMENT una I-TREATMENT lesión I-TREATMENT pulsátil I-TREATMENT de I-TREATMENT alrededor I-TREATMENT de I-TREATMENT dos I-TREATMENT centímetros I-TREATMENT de I-TREATMENT diámetro I-TREATMENT en I-TREATMENT la I-TREATMENT cara I-TREATMENT anterior I-TREATMENT de I-TREATMENT la I-TREATMENT AA I-TREATMENT y, I-TREATMENT al I-TREATMENT diseccionar I-TREATMENT la I-TREATMENT AA, I-TREATMENT se I-TREATMENT encontraron I-TREATMENT tres I-TREATMENT úlceras, I-TREATMENT una I-TREATMENT de I-TREATMENT ellas I-TREATMENT a I-TREATMENT un I-TREATMENT centímetro I-TREATMENT del I-TREATMENT ostium I-TREATMENT coronario I-TREATMENT derecho I-TREATMENT y I-TREATMENT no I-TREATMENT se I-TREATMENT observó I-TREATMENT disección I-TREATMENT aórtica.. I-TREATMENT I-TREATMENT La B-EVOLUTION paciente I-EVOLUTION evolucionó I-EVOLUTION favorablemente I-EVOLUTION y I-EVOLUTION se I-EVOLUTION dio I-EVOLUTION de I-EVOLUTION alta I-EVOLUTION a I-EVOLUTION los I-EVOLUTION siete I-EVOLUTION días I-EVOLUTION postoperada I-EVOLUTION difiriéndose I-EVOLUTION la I-EVOLUTION resolución I-EVOLUTION del I-EVOLUTION aneurisma I-EVOLUTION de I-EVOLUTION la I-EVOLUTION aorta I-EVOLUTION abdominal. I-EVOLUTION I-EVOLUTION El B-EXPLORATION estudio I-EXPLORATION anatomopatológico I-EXPLORATION confirmó I-EXPLORATION UPAA. I-EXPLORATION Actualmente, B-EVOLUTION a I-EVOLUTION un I-EVOLUTION año I-EVOLUTION y I-EVOLUTION diez I-EVOLUTION meses I-EVOLUTION de I-EVOLUTION seguimiento, I-EVOLUTION la I-EVOLUTION paciente I-EVOLUTION continúa I-EVOLUTION sus I-EVOLUTION controles I-EVOLUTION en I-EVOLUTION Cardiología I-EVOLUTION sin I-EVOLUTION presentar I-EVOLUTION sintomatología I-EVOLUTION cardiovascular. I-EVOLUTION I-EVOLUTION